Malignant melanoma is unique in its propensity to metastasize to the heart with frequencies ranging from 50% to 71%. We report a case of a resection of large intracavitary malignant melanoma causing obstruction of the right ventricular inflow and outflow tract of the heart. A 49-year-old-woman presented clinical symptoms and signs of life-threatening congestive right heart failure. Transthoracic and transesophageal echocardiography revealed a large intracavitary mass occupying the entire right ventricle. Inguinal lymph node biopsy demonstrated metastatic melanoma. The cardiac main mass was palliatively resected and demonstrated to be a metastatic melanoma. The patient improved symptomatically about 60 days after the operation.
Biopsy ; Echocardiography, Transesophageal ; Estrogens, Conjugated (USP) ; Heart ; Heart Failure ; Heart Ventricles ; Humans ; Lymph Nodes ; Melanoma* ; Neoplasm Metastasis*

Korean student nurses may be exposed to stress caused by their future employment (employment stress). The aim of this study was to investigate the effects of a Laughter Program on psychological stress, by assessing salivary cortisol and the subjective happiness of student nurses in order to relieve employment stress.

This study was made to investigate the effect of adenoidectomy on dentofacial skeleton in naso-respiratory dysfunction children. The clinical material compromised the 24 children in a previous study who had naso-respiratory dysfunction and 24 children who were the nasal breathing with normal occlusion. The cephalograms were taken at the initial examination and 1 year later for the control group and experimental group the paired sample statistical analysis was performed. The results were as follows. 1. In cranial base variable, difference between two groups were not statistically significant. 2. In craniofacial variables, experimental group showed brachyfacial pattern but control groups didn't show significant growth pattern. 3. In maxillary variables, experimental group showed flattening the plane. 4. In mandibular variables, experimental group showed the decrease of mandibular plane angle and gonial angle. 5. In facial height variables, experimental group showed horizontal growth rotation.
Adenoidectomy* ; Adenoids ; Child* ; Humans ; Respiration ; Skeleton* ; Skull Base

Together, neonatal hepatitis and biliary atresia make up approximately 70 to 80% of the causes of neonatal cholestasis. Biliary atresia must be differentiated from neonatal hepatitis as soon as possible in order to institute early surgical intervention. We performed this study to examine whether the measurement of the serum alpha-fetoprotein (AFP) and thyroxine-binding globulin(TBG) was useful for differentiating these two conditions. Serum AFP levels were measured using enzyme immunoassay in 76 infants with cholestasis and serum TBG levels were measured using radio immunoassay in 30 infants with cholestasis and 23 infants without cholestasis. Serum AFP and TBG concentrations in patients were compared with the normal ranges in infants and were expressed as standard deviation (SD) scores. 52.7% of the patients with neonatal hepatitis showed SD scores of AFP higher than 4.0. By contrast, 14.3% of the patients with biliary atresia showed SD scores of AFP highter than 4.0(p<0.005). The patients with either neonatal hepatitis or biliary atresia had TBG concentrations above the normal ranges, but there was no difference between neonatal hepatitis and biliary atresia. The patients with neonatal hepatitis who recovered from jaundice after 6 months of age or progressed to chronic liver disease of died of the liver disease showed hight serum levels of AFP and TBG than the patients who recovered from jaundice before 6 months of age. In conclusion. SD scores of AFP could be used to differentiate between neonatal heptatis and biliary atresia, and SD scores of AFP and TBG might be used as an indicator of prognosis of neonatal hepatitis.
alpha-Fetoproteins* ; Biliary Atresia* ; Cholestasis ; Hepatitis A ; Hepatitis* ; Humans ; Immunoassay ; Immunoenzyme Techniques ; Infant ; Jaundice ; Liver Diseases ; Prognosis ; Reference Values ; Thyroxine-Binding Globulin*

BACKGROUND : The proportion and absolute number of older patients admitted through the emergency department (ED) are increasing yearly. As people getting older, they are more likely to suffer from emergency situation of disease, disability, and trauma. Combining with the decrease in physiologic reserve, these added burdens make the elderly more vulnerable to any of the additional situations. Understanding the implications of these facts is crucial to one who is providing optimal triage and emergency care to elderly (aged 65 years or older) and adults (between 15year of age and 64 years of age). METHODS : We conducted an observational survey of emergency patients age 15 or older who admitted to emergency department of Asan Medical Center. A convenience sample of 3,481 were divided into 2 groups by 65 years of age, and final results (admission vs. discharge) after emergency care was compared. The admission rate according to between two groups. We calculated odds ratios of important outcomes by pooling data from individual trials using logistic regression analysis. RESULTS : Admission rate of elderly was higher than adults as 59.2% versus 36.4% (odds ratio=2.32) 95% CI=1.21~3.24). Although vital signs were within normal ranges, admission rate of elderly was significantly higher than adults as follows; normal range of systolic blood pressure (56.0% vs. 35.5%), normal range of respiration rate per minute (55.4% vs. 36.4%), alert status of mentality (34.2% vs. 54.7%). CONCLUSION : We could not define the severity of emergency patients only by using vital signs and/or clinical symptoms, especially to the elderly patients. Even though the vital signs of elderly patients. emergency physician should manage them carefully because of the high severity of clinical condition in elderly then we expected. Emergency Geriatric Assessment tools must be developed differently from general triage tools.
Adult ; Aged* ; Blood Pressure ; Chungcheongnam-do ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Geriatric Assessment ; Humans ; Logistic Models ; Odds Ratio ; Reference Values ; Respiratory Rate ; Triage ; Vital Signs

BACKGROUND: Ureteral stone(UTS) and acute pyelonephritis are the most common causes of nontraumatic acute flank pain in adults. Urography(IVU) is known as the most ideal diagnostic modality of obstructive uropathy to date. However, it has many practical limitations in overcrowding Korean emergency department to perform IVU as the diagnostic test of UTS. So we have performed prospective analytic study to compare IVU with its alternative diagnostic modalities. METHOD AND RESULTS: Our study was performed at Asan Medical Center from March, 1998 to July, 1999. We performed urinalysis, KUB, grayscale ultrasonography, and IVU in 243 patients, suspected to have UTS, based on histories, physical examination. After excluding patients with undetermined results(n=7) or spontaneous passage of stone before IVU(n=24), 212 patients were enrolled in our study. All of the other diagnostic tests were performed within one hour after emergency room presentation except IVU (53+/-24 hours). Diagnostic agreement among tests are as follows: Urinalysis shows good agreements with KUB(0.53) and IVU(0.62). KUB shows good agreement with IVU(0.48). Ultrasonography shows good agreement with IVU(0.58). Sensitivity(%), specificity(%), positive predicitive value(%), negative predicitive value(%), accuracy(%), and odds ratio of each diagnostic methods are as follows: Urinalysis is 91, 19, 78, 42, 74, 3.88; KUB is 55, 33, 72, 19, 50, 2.49; ultrasonography is 58, 92, 96, 41, 66, 45.61, and IVU is 81, 96, 98, 62, 84, 107.72. CONCLUSION: Although IVU seems to be the most ideal diagnostic modality for the UTS to date, it takes too long time for emergency physicians to confirm the diagnostic using IVU. We can performed other diagnostic modalities within one hour. However, emergency physicians suffer from poor diagnostic accuracy. Therefore, it is concluded that we are in need of more accurate alternative diagnostic modalities for UTS.
Adult ; Chungcheongnam-do ; Diagnosis* ; Diagnostic Tests, Routine ; Emergencies* ; Emergency Service, Hospital* ; Flank Pain ; Humans ; Odds Ratio ; Physical Examination ; Prospective Studies ; Pyelonephritis ; Ultrasonography* ; Ureter* ; Urinalysis

No abstract available.
Tuberculosis*

BACKGROUND: This study was conducted to provide a fundamental data and improve health-related quality of life (HRQoL) in increasing population of middle-aged male patients with benign prostatic hyperplasia (BPH) by investigating and analyzing the factors affecting the HRQoL. METHODS: The survey was performed with 124 middle-aged male BPH patients of Fatima hospital located in Daegu city. The data were collected by questionnaires and were analyzed by using SPSS WIN ver. 18.0 (IBM Corp., New York, NY, USA). RESULTS: Severity of BPH in participants was classified into moderate (54%), severe (31.5%), and mild (14.5%). The mean HRQoL score was 3.78 points. The scores in each section were 4.18 points for ‘disability of daily living activity’, 3.95 points for ‘discomfort due to BPH’, 3.69 points for ‘psychological state’, 3.65 points for ‘anxiety’ and 2.93 points for ‘sex life’. Perceived health state presented positive correlation with HRQoL and negative correlation with BPH symptoms. The BPH symptoms showed negative correlation with HRQoL. The level of BPH symptoms, perceived health status and prostate volume were revealed to influence the HRQoL in the order of the degree of influence. The factors' determination value was 63.0%. CONCLUSIONS: It was confirmed that the lower the patient's level of BPH symptoms is, the better the perceived health status is and that the smaller the prostate volume is, the higher the HRQoL is. Therefore, administration of medicine that relieves BPH symptoms and reduces a volume of the prostate should be encouraged and sustainable education, customized treatment and nursing care should be provided.
Daegu ; Education ; Humans ; Male* ; Middle Aged ; Nursing Care ; Prostate ; Prostatic Hyperplasia* ; Quality of Life*

No abstract available.
Thymus Hyperplasia*

We describe a case of eosinophilic pustular folliculitis in a 1-month-old Korean male infant. The patient was suffering from erythematous papules and pustules affecting the scalp, trunk, and extremities, detected at birth. The flare was accompanied by leukocytosis and eosinophila. Histopathology revealed folliculitis with a predominant eosinophilic infiltrate. Lesions showed partial response to topical steroid and disappeared in four weeks. Three months after the resolution of the lesions, he presented a similar clinical picture as the previous episode.
Eosinophils* ; Extremities ; Folliculitis* ; Humans ; Infant ; Infant, Newborn* ; Leukocytosis ; Male ; Parturition ; Scalp