PURPOSE: The aim of this study was to evaluate the clinical manifestations, contact history, and status of tuberculosis contact investigations in school-age children and adolescents with pulmonary tuberculosis (TB) at two centers. METHODS: This study was conducted with 54 patients in the age ranging from 10 to 18 years, who were diagnosed with pulmonary TB at the Pusan National University Hospital and Pusan National University Children's Hospital, January 2008 to December 2012. We retrospectively reviewed the medical records of the patients. RESULTS: The median age of the patients was 16 years old; 11 patients were aged 10 to 14 and 43 patients were aged 15 to 18. Among 54 patients, 19 had history of contact with pulmonary TB, 10 had contact with house members (household), and remaining 9 had contact with classmates (non-household). One out of 10 patients who had household contacts and 6 out of 9 patients who had non-household contacts were evaluated with contact investigation after the exposure to pulmonary TB. Among 7 patients who were evaluated with contact investigation, 3 were diagnosed with active pulmonary TB, 1 had latent tuberculosis infection (LTBI), and 3 had no evidence of TB or LTBI. The median period of diagnosis after the exposure to active pulmonary TB was 2 years in patients with household contacts and 0.23 years in patients with non-household contacts. CONCLUSION: This study suggested that if the contact investigation conducted properly, it would be helpful for early diagnosis and prevention of pulmonary TB.
Adolescent* ; Busan ; Child* ; Diagnosis ; Early Diagnosis ; Family Characteristics ; Humans ; Latent Tuberculosis ; Medical Records ; Retrospective Studies ; Tuberculosis* ; Tuberculosis, Pulmonary*

PURPOSE: To perform and compare differential diagnosis of patients with thyroid-associated myopathy, idiopathic orbital myositis and normal controls based on orbital computed tomography. Orbital fat and extraocular muscle densities were quantified using Hounsfield Unit (HU) and their characteristics were compared and analyzed. METHODS: From February 2005 to January 2013, orbital computed tomography was performed on 90 eyes of 47 thyroid-associated myopathy patients, 18 eyes of 14 idiopathic orbital myositis patients and 280 eyes of 140 normal subjects. The average values of orbital fat and extraocular muscle densities were measured and compared using HU. The density differences between the patients with thyroid-associated myopathy and the normal group were analyzed by age, clinical activity score, ocular protrusion and disease duration. RESULTS: In the thyroid-associated myopathy group, orbital fat and extraocular muscle densities were -87.8 +/- 12.5 HU and 48.7 +/- 7.1 HU, respectively. In the idiopathic orbital myositis group, the orbital fat and extraocular muscle densities were 79.9 +/- 9.9 HU and 49.2 +/- 9.1 HU, respectively. There was a statistically significant lower result of orbital fat in the thyroid-associated myopathy group (p = 0.002), however, the extraocular muscle density did not show a statistically significant difference (p = 0.775). The orbital fat and extraocular muscle densities of the normal group were -79.0 +/- 11.2 HU and 54.3 +/- 6.3 HU, respectively. There were significantly lower results in both orbital fat and extraocular muscle densities in the thyroid-associated myopathy group than normal group (p = 0.000). In active cases and those accompanied by ocular protrusion, there was no significant difference in orbital fat density (p = 0.345 and p = 0.952, respectively), while extraocular muscle density significantly decreased (p = 0.007 and p = 0.003, respectively). CONCLUSIONS: A difference between the orbital fat and extraocular muscle densities in thyroid-associated myopathy and idiopathic orbital myositis could be quantitatively found using HU and orbital computed tomography.
Diagnosis, Differential ; Humans ; Muscles* ; Muscular Diseases* ; Orbit* ; Orbital Myositis*

OBJECTIVE: To test if the intake of H2 receptor antagonists (H2-RAs) increases the risk of gastric cancer in the elderly. METHODS: The source population for this study was drawn from the responders to a questionnaire survey administered to the Korea Elderly Pharmacoepidemiological Cohort (KEPEC), who were beneficiaries of the Korean Medical Insurance Corporation, were at least 65 years old, and residing in Busan in 1993. The information on H2-RAs exposure was obtained from a drug prescription database compiled between Jan. 1993 and Dec. 1994. The cases consisted of 76 gastric cancer patients, as confirmed from the KMIC claims data, the National Cancer Registry and the Busan Cancer Registry. The follow-up period was from Jan. 1993 to Dec. 1998. Cancer free controls were randomly selected by 1:4 individual matching, which took in to consideration the year of birth and gender. Information on confounders was collected by a mail questionnaire survey. The odds ratios, and their 95% confidence intervals, were calculated using a conditional logistic regression model. RESULTS: After adjusting for a history of gastric ulcer symptoms, medication history, and body mass index, the adjusted OR (aOR) was 4.6 (95% CI=1.72-12.49). The odds ratio of long term use (more than 7 days) was 2.3 (95% CI=1.07-4.82). The odds ratio of short term use was 4.6 (95% CI=1.26-16.50). The odds ratio of parenteral use was 4.4 (95% CI=1.16-17.05) and combination use between the oral and parenteral routes (aOR, 16.8; 95% CI=1.21-233.24) had the high risk of gastric cancer. The aOR of cimetidine was 1.7 (95% CI=1.04-2.95). The aOR of ranitidine was 2.0 (95% CI=1.21-3.40). The aOR of famotidine was 1.7 (95% CI=0.98-2.80). CONCLUSION: The intake of H2-RAs might increase the risk of gastric cancer through achlorhydria in the elderly.
Achlorhydria ; Aged* ; Body Mass Index ; Busan ; Case-Control Studies* ; Cimetidine ; Cohort Studies ; Drug Prescriptions ; Famotidine ; Follow-Up Studies ; Humans ; Insurance ; Korea ; Logistic Models ; Odds Ratio ; Parturition ; Pharmacoepidemiology ; Postal Service ; Surveys and Questionnaires ; Ranitidine ; Stomach Neoplasms* ; Stomach Ulcer

Cancer metastasis to the skin, especially epidermotropic metastasis, is uncommon. Sometimes it is difficult to find the primary lesion; immunohistochemical (IHC) staining of cutaneous metastasis is used to determine the origin, but diagnosis may occasionally prove difficult. A 77-year-old man visited our hospital with a 1-month diagnostic history of multiple nodules in the right axilla. The patient had undergone surgery for gastric adenocarcinoma (T3N3M0) 21 years ago, and was diagnosed with lung adenocarcinoma 1 year previously; however, no treatment was ongoing. Biopsy of the lesions revealed atypical cells surrounding the papillary projections of the epidermis and tumor nests of the upper dermis. IHC staining was positive for CK7 and CEA and negative for CK5/6, CK20, napsin A, TTF-1, GCDFP 15, and p63. The tissues revealed glandular structures and tested negative for p63 and CK5/6 on IHC staining. The patient was diagnosed with epidermotropic metastasis of lung adenocarcinoma.

PURPOSE: To investigate the clinical characteristics and treatment methods for pediatric thyroid-associated orbitopathy in pediatric patients with thyroid disorders. METHODS: To determine the prevalence and clinical characteristics of pediatric thyroid-associated orbitopathy, we retrospectively analyzed the medical records of 34 patients admitted to the Pediatrics Department of our institution between September 2010 and September 2012. The patients had been diagnosed with autoimmune thyroid disorder and were admitted for treatment of thyroid-associated orbitopathy. RESULTS: In the 24.1 months of follow-up observation, 14 patients were diagnosed with Graves' disease (41.2%) and 20 patients with Hashimoto's thyroiditis (58.8%). Of the 34 patients, 15 (44.1%) developed eye symptoms. Among the eye symptoms, lid swelling was the most prevalent in 41.2% of patients, followed by eyelid retraction in 23.5%, lid lag in 17.6%, conjunctival injection in 14.7%, proptosis in 8.8%, and extraocular muscle hypertrophy in 17.6%. Severe impairment of visual acuity, visual field, and ocular motility were not observed in our study. Although eyelid surgery was performed in 3 cases, most patients were treated conservatively. CONCLUSIONS: Pediatric thyroid-associated orbitopathy was frequently observed in patients with Graves' disease and Hashimoto's thyroiditis. Compared to adults, children showed milder disease manifestation and progression, and the disease could be managed with conservative treatment.
Adult ; Child ; Exophthalmos ; Eye ; Eyelids ; Follow-Up Studies ; Graves Disease ; Humans ; Hypertrophy ; Medical Records ; Muscles ; Pediatrics ; Prevalence ; Retrospective Studies ; Thyroid Gland ; Thyroiditis ; Visual Acuity ; Visual Fields

PURPOSE: The purpose of this study was to investigate the effects of emotional labor, emotional intelligence and social support on job stress in clinical nurses. METHODS: Participants were 123 clinical nurses and data were collected from October to December, 2011 and analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficients and multiple regression with SPSS 18.0. RESULTS: A positive correlation was found between job stress and emotional labor. Emotional labor showed a significant negative correlation with emotional intelligence and social support, whereas a positive correlation was found between emotional intelligence and social support. The strongest predictor of job stress was emotional labor. In addition, institution satisfaction (dissatisfaction) and the reason for selecting the job (opportunities for service) accounted for 21% of variance in job stress. CONCLUSION: The results of this study suggest that it is important to manage emotional labor as well as to improve job satisfaction in order to reduce job stress in clinical nurses.
Emotional Intelligence ; Job Satisfaction

A number of acid-base or electrolyte disorders are associated with decreased or increased HCO3- reabsorption in the renal tubules. There has been a general agreement that potassium depletion induces and maintains metabolic alkalosis in rats. However, many researchers have approached such issue only from functional studies to investigate Na+/H+ exchanger (NHE-3) and Na+/HCO(3-) cotransporter (NBC) activity which closely relates to potassium depletion. In addition the results obtained vary according to their researchers. Thus the present study was employed Western blot analysis and immunohistochemistry together, to examine the alterations of expression and distribution of NHE-3 and NBC-1 with reference to HCO3- reabsorption in the kidneys of rats fed potassium free diets according to the periods. Western blot analysis demonstrated that NHE-3 protein, ~83 kDa at molecular mass, was abundantly expressed in normal group. All potassium-depleted groups showed significantly increased NHE-3 protein compared to normal group. NBC-1 protein, ~110 kDa at molecular mass, was moderately expressed in normal group. All potassium-depleted groups had much higher amounts of the protein than normal group. There was a highly increased amount of NBC-1 protein especially in K-depleted 1 week group. Immunohistochemistry showed positive immunoreactivity of NHE-3 in the apical membranes and brush borders of proximal renal tubule cells. Its reactivity was most prominent in the S3.S1 and S2 had moderate immunoreactivity. Potassium-depleted groups had an identical pattern of cellular labeling of NHE-3 protein compared with that of normal group. However the signal intensity of NHE-3 protein in potassium-depleted groups was much higher than that of normal group. Immunoreactivity of NBC-1 was observed exclusively in the basolateral plasma membranes of proximal tubule cells. There was a strong reactivity in the S1 and S2, whereas S3 did not show any reactivity. Potassium-deprived rats exhibited an identical pattern of cellular labeling of NBC-1 protein compared with that of normal rats. However, the signal intensity of NBC-1 protein was markedly increased in potassium-deprived rats. These results suggest that increased NHE-3 and NBC-1 expression resulted from potassium depletion in the renal proximal tubules, enhances HCO3-reabsorption and consequently maintains metabolic alkalosis.
Alkalosis ; Animals ; Bicarbonates* ; Blotting, Western ; Cell Membrane ; Diet ; Hypokalemia ; Immunohistochemistry ; Kidney Tubules, Proximal ; Kidney* ; Membranes ; Microvilli ; Potassium ; Rats* ; Social Control, Formal*

The purpose of this study was to define a one portion size of food frequently consumed by Korean children aged 6-11 for convenient use in food selection, diet planning, nutritional evaluation, and nutrition education. We analyzed using the original data on 889 persons (9.96%) aged 6-11 years among 8,930 persons to whom NHANES 2005 and selected food items consumed by the intake frequency of 10 or higher among the 500 most frequently consumed food items. A total of 172 varieties of food items of regular use were selected. Also the portion size of food items was set on the basis of the median (50 percentile) of the portion size for a single intake by a single person was analyzed. The portion size of cereals was 5 g for prosomillet to 120 g for hamburger. As for vegetables, it posted 1 g for red pepper to 50 g for nabakkimchi. The portion size of meats and products was 15 g for luncheon meat to 120 g for beef feet soup. In comparison of children's portion size with adults', the children's portion sizes of every food groups, with the exception of meats and eggs, were lower than those of adults. The portion size of the regular food items of children in this study will be conveniently and effectively used by children, children's diet planners and researchers in selecting food items for a nutritionally balanced diet and in assessing the children's diet intake.
Adult ; Aged ; Capsicum ; Edible Grain ; Child ; Diet ; Eggs ; Food Preferences ; Foot ; Humans ; Korea ; Meat ; Nutrition Surveys ; Ovum ; Single Person ; Vegetables

Poland syndrome, also known as pectoral aplasia-dysdactylia syndrome, is a rare anomaly, characterized by aplasia of the pectoralis major muscle with ipsilateral upper extremity anomalies. The cause of Poland syndrome is still unknown. Several twin patients were reported to propose a genetic or nongenetic hypothesis. We experienced a female baby showing absence of the pectoralis major muscle in a pair of mixed twin. The patient was referred to our hospital for evaluation of an asymmetric chest wall. She showed depression of the left chest wall, ipsilateral nipple hypoplasia, and axillary webbing. A chest CT scan showed aplasia of the left large pectoral muscle. Our patient had no abnormalities such as symbrachydactyly in an ipsilateral upper extremity. In comparison, a physical examination showed that the fraternal twin boy was completely normal.
Depression ; Female ; Humans ; Male ; Nipples ; Physical Examination ; Poland Syndrome* ; Poland* ; Thoracic Wall ; Tomography, X-Ray Computed ; Twins ; Twins, Dizygotic* ; Upper Extremity

Leiomyoma and adenomyosis of the uterus are the most common gynecologic disorders in an enlarged uterus. The characteristic US and MR findings in differentiation between both lesions were prospectively evaluated in 30 patients. Of 30 patients, 15 were leiomyomas, 6 were adenomyosises, 8 were leiomyomas and adenomyosises, and 1 was a normal pregnancy, histologically. The total number of leiomyom nodules were 49 while adenomyosises were 14 (9 diffuse and 5 focal). Among 49 myomas nodules, 36 were correctly diagnosed by sonography. The characteristic US findings of uterine leiomyoma were well defined nodules (36), hypoechoic peripheral rim (16), and whorl-like internal echoes (13). Forty four of the 49 myoma nodules were correctly diagnosed by MRI. The characteristic MR findings of myoma were well defined nodules (43), peripheral low signal intensity rim on T1WI (13) and T2WI (9), and peripheral high signal intensity rim on T2WI (5). Among 14 adenomyosises, 9 were correctly diagnosed by sonography. The characteristic US findings of adenomyosis were diffuse uterine hypertrophy more than 5.5cm in AP diameter with endometrial displacement and no significant echo change in myometrium All 14 adenomyosis as were correctly diagnosed from MRI. On T2WI, adenomyosis appeared as ill defined localized or diffuse thickening of the junctional zone more than 1cm in thickness. It was our conclusion that to differentiate between leiomyoma and adenomyosis focused on should be the detection of existence of nodule in leiomyoma, the primary sign, not on the secondary indirect sign.
Adenomyosis* ; Animals ; Female ; Humans ; Hypertrophy ; Leiomyoma* ; Magnetic Resonance Imaging ; Mice ; Myoma ; Myometrium ; Pregnancy ; Prospective Studies ; Uterus