No abstract available.
Pneumothorax*

Pleomorphic (undifferentated) carcinoma is a rare histologic type of carcinomas of the gallbladder and an atypical carcinoid is thought to be an intermediated type between carcinoid tumor and small cell carcinoma. Dense core "neurosecretory" granules can be found in the above mentioned tumors. We experienced a case of a double tumor of the gallbladder in a 51-year old male patient. Grossly, a large solid mass, about 5.0 cm in diameter, was found in the fundic portion and the neck portion also had a small 1.5 cm-sized polypoid mass. Microscopically, these lesions had features of pleomorphic carcinoma and atypical carcinoid, respectively. Immunohistochemically, they manifested reactivity for neuron specific enolase. Ultrastructural study revealed neurosecretory granules in the cytoplasms of tumor cells of the fundic and neck masses. Although light microscopic features of these tumor masses are quite different, we consider that these tumors represent a spectrum of neuroendocrine differentiation.
Male ; Humans

No abstract available.

Magnetic Resonance image(MRI) is used as the diagnostic modality for evaluation of suspected intramedullary tumors and differential diagnosis of these tumors at the spinal cord. We experienced intramedullary astrocytoma of cerviced cord with large syrinx and multiple peritumoral cysts consisted of subacute and chronic hemorrhage at the margin and within the syrinx and cysts on MRI.
Astrocytoma* ; Diagnosis, Differential ; Hemorrhage* ; Magnetic Resonance Imaging ; Spinal Cord*

No abstract available.
Paragonimiasis*

Thrombosis in valve or left atrium after mechanical mitral valve replacement causes prosthetic valve dysfunction or thromboembolism. Early and adequate therapy is very important but clinically not easy. Thrombolysis can avoid reoperation-related risks and act as an optimal therapy for prosthetic valve thrombosis. This report describes three patients who were treated by using low molecular weight heparin (LMWH) and wafarin. Two patients, including one pregnant woman, had prosthetic valve thrombosis and immobility of valve leaflets, and one patient with recent cerebral infarction due to thromboembolism had thrombus in left atrium. Fraxiparine 0.3 cc (7,500 ICU AXa) was administrated subcutaneously twice or triple daily. At discharge, thrombosis in valve and left atrium were completely or near totally lysed and valve leaflets were normally mobile. During the period of thrombolysis and follow up, there were no complications in all patients.
Cerebral Infarction ; Female ; Follow-Up Studies ; Heart Atria ; Heparin ; Heparin, Low-Molecular-Weight ; Humans ; Mitral Valve* ; Nadroparin ; Pregnant Women ; Thromboembolism ; Thrombolytic Therapy ; Thrombosis*

Degenerative and regnerative changes are occurred in the dorsal root ganglion (DRG) cells after the peripheral nerve injury. This experiment aimed to study the changes of neurotrophic factors and their receptors mRNA expressions in the regenerating sensory neurons after nerve crush injury. To study the regenration process of DRG neurons, the peripheral nerve was crushed rather than transection. mRNA expression was examined by in situ hybridization with oligonucleotide probes to nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin 3 (NT-3), nerve growth factor receptor (NGFR), trkA, trkB and trkC. The results are as following: 1. After the peripheral nerve crush injury, the number of NGF and BDNF mRNA containing neurons are increased for 5 weeks with peak at 1 day and 3 days, respectively. NGFR mRNA containing neurons are transiently decreased during several days after the lesion but return to normal within 1 week. 2. The number of trkA and trkB mRNA containing neurons are not altered by nerve crush. 3. NT-3 and trkC mRNA containing neurons are not observed in the control and lesioned DRG. This study provides the morphological evidences of neurotrophins and their receptors mRNAs changes in the DRG neurons in response to crush nerve injury.
Animals ; Brain-Derived Neurotrophic Factor ; Diagnosis-Related Groups ; Ganglia, Spinal* ; In Situ Hybridization ; Nerve Crush ; Nerve Growth Factor ; Nerve Growth Factors* ; Neurons ; Neurotrophin 3 ; Oligonucleotide Probes ; Peripheral Nerve Injuries* ; Peripheral Nerves* ; Rats* ; RNA, Messenger* ; Sensory Receptor Cells ; Spinal Nerve Roots*

Purpose: To identify the effect of a new leadership type by confirming the effect of clinical nurses' grit and nursing work environment on nursing performance and retention intention with the mediating effect of compassionate rationalism leadership in the process. Methods: A proportional stratified sampling method was used with 45 tertiary general hospitals nationwide as the sampling unit. An online survey targeting nurses who have been working continuously for more than one year was conducted from October 14 to November 9, 2022. The final analysis included 1,256 questionnaires. The correlation between the participants' variables was analyzed using Pearson's correlation coefficients. The mediating effect was confirmed using a regression analysis, and bootstrapping. Results: The compassionate rationalism leadership had a mediating effect on the relationship between grit and nursing performance (F=203.21, p<.001), nursing work environment and nursing performance (F=109.48, p<.001), grit and retention intention (F=149.90, p<.001), and nursing work environment and retention intention (F=25.14, p<.001). Conclusion The compassionate rationalism leadership of nursing managers had a positive effect on nursing performance and retention intention.Therefore, with the development and application of educational programs of compassionate rationalism leadership, it can be used to improve nursing performance and operate an efficient nursing organization.

BACKGROUND: Portable cardiopulmonary bypass (CPB) technique has been used increasingly as a potent and effective option for emergency cardiopulmonary resuscitation (CPR) because it can maintain more stable hemodynamics and provide better survival than conventional CPR techniques. This study was designed to develop a prototype of Korean portable CPB system and, by applying it to CPR, to discriminate whether it would be superior to standard open-chest CPR. MATERIAL AND METHOD: By using adult mongrel dogs, open-chest CPR (OCPR group, n=4) and portable-CPB CPR (CPB group, n=4) were compared with respects to restoration of spontaneous circulation (ROSC), hemodynamics, effects on blood cells, blood gas patterns, biochemical markers, and survivals. Ventricular fibrillation-cardiac arrest (VF-CA) of arrest (VF-CA) of 4 minutes followed by basic life support (BLS) of 15 minutes was applied in either group, which was standardized by the protocol of American Heart Association. Then, advanced life support (ALS) was applied to either group under the support of internal cardiac massage or CPB. ALS was maintained until ROSC was achieved but not longer than 30 minutes regardless of the presence of ROSC. All of the measured values were expressed as means+/-SD percent change from baseline. RESULT: During the early ALS, higher mean arterial pressure was maintained in CPB group than in OCPR group (90+/-19 vs. 71+/-32 %; p<.05) and lower mean pulmonary arterial pressure was also maintained in CPB group than in OCPR group (105+/-24 vs. 146+/-6%; p<.05). ROSC was achieved in all dogs. Post-ROSC levels of hematocrit, RBC, and platelet were decreased and plasma free hemoglobin was increased significantly in CPB group compared to OCPR group (p<.05). Changes in blood gas patterns, lactate, and CK-MB levels were not different between groups. Early mortality was seen in 3 dogs in OCPR group (survival time 31+/-36 hours) and 2 in CPB group (228+/-153 hours, p=ns). The remainders in both groups showed prolonged survival. CONCLUSION: These findings indicate that portable CPB can be effective to maintain stable hemodynamics during cardiac arrest, to achieve ROSC and to prolong survival. Further study is needed to refine the portable CPB system and to meet clinical challenges.
Adult ; American Heart Association ; Animals ; Arterial Pressure ; Biomarkers ; Blood Cells ; Blood Platelets ; Cardiopulmonary Bypass* ; Cardiopulmonary Resuscitation* ; Dogs* ; Emergencies* ; Heart Arrest* ; Heart Massage ; Hematocrit ; Hemodynamics ; Humans ; Lactic Acid ; Mortality ; Plasma

BACKGROUND: Effective cardiopulmonary resuscitation (CPR) should provide acceptable hemodynamics for the vital organs during cardiac arrest and early restoration of spontaneous circulation that guarantees long-term, neurologically intact survival. CPR using heart-lung bypass has been suggested as an option for that use. This study was designed to determine the effectiveness of standard CPR techniques, closed-vs. open-chest CPR, which could be used in the future study verifying the role of heart-lung bypass CPR. MATERIAL AND METHOD: By using adult mongrel dogs, closed-chest CPR (CCCPR, n=4) and open-chest CPR (OCCPR, n=5) were compared with respects to hemodynamics, restoration of spontaneous circulation (ROSC), and survival. Ventricular fibrillation-cardiac arrest (VF-CA) was induced by electrical shock in all animals. After 4 minutes of cardiac arrest, basic life support (BLS) was applied for 15 minutes and followed by advanced life support (ALS). ALS was maintained until achi ving ROSC but not longer than 30 minutes regardless of the recovery. Resuscitation procedures in either group were standardized by adopting the protocol of American Heart Association. RESULT: Prearrest baseline hemodynamic data was not different between two groups. During resuscitation, substantially higher systolic pressure was maintained in OCCPR group than in CCCPR group (45+/-15 vs. 33+/-11 mmHg during BLS, 83+/-36 vs. 44+/-15 mmHg during ALS; p=NS). Mean pulmonary arterial pressure went up to the level of mean systemic arterial pressures in CCCPR group and to half of that in OCCPR group, and had kept higher in CCCPR group throughout CPR (32+/-10 vs. 22+/-4 mmHg during BLS and 32+/-15 vs. 24+/-10 mmHg during ALS; p=NS). ROSC was obtained in 4 of 5 dogs receiving open-chest CPR and 2 of 4 closed-chest CPR. Prolonged survival was noted in all dogs in OCCPR group (6 to 1440 hours) but not in CCPR group (p<.05). CONCLUSION: These findings indicate that open-chest CPR can be more effective t maintain hemodynamics during cardiac arrest and to obtain restoration of spontaneous circulation and survival. Further experiment will be designed to compare heart-lung bypass CPR with open-chest CPR.
Adult ; American Heart Association ; Animals ; Arterial Pressure ; Blood Pressure ; Cardiopulmonary Bypass* ; Cardiopulmonary Resuscitation ; Dogs ; Heart Arrest ; Hemodynamics ; Humans ; Resuscitation ; Shock ; Ventricular Fibrillation