Dieulafoy's lesion is a rare condition that may cause intermittent or massive gastrointestinal bleeding. It is characterized by the exteriorization of an arterial vessel into the lumen of the affected organ, generally the upper digestive tract, through an apparently normal mucosa or a small tear or erosion. We report two patients with Dieulafoy's lesions, one in whom the lesion was misdiagnosed as a submucosal tumor and endoscopic biopsy resulted in fatal bleeding.
Autopsy ; Biopsy ; Endoscopy ; Gastrointestinal Hemorrhage* ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Mucous Membrane

Our goal was to examine the effect of area-level deprivation on patient survival time for seven major cancers — stomach, colon, liver, lung, breast, cervix, and thyroid cancer. Data on 10,902 subjects who were diagnosed with major cancers from 2010 and 2011 in Busan were collected regarding the survival time along with several important prognostic factors and an area-level deprivation index was constructed from education, income, unemployment, and welfare assistance, to assess the comprehensive area-level socioeconomic status. A multilevel Cox proportional hazard model was used to investigate the effects of multiple risk factors such as gender, age, tumor stage, diagnosis path, and the area-level deprivation. After adjusting for risk factors the area-level deprivation index was found to be significant in associating with higher hazard rate for several cancers. Estimated hazard ratios (95% CI) were 1.08 (0.99–1.18), 1.23 (1.12–1.36), 1.36 (1.21–1.53) for the second, the third, and the fourth quartile of deprivation index groups, respectively, when compared to the least deprived group. When compared with the least deprived group, the more deprived group showed significant decrease in survival time for major cancers. This novel finding may contribute to the literature regarding the association of area-level socioeconomic status and highlight the importance of careful monitoring of socioeconomic characteristics for cancer prevention and care services.
Breast ; Busan* ; Cervix Uteri ; Colon ; Diagnosis* ; Education ; Female ; Humans ; Liver ; Lung ; Proportional Hazards Models ; Risk Factors ; Social Class* ; Stomach ; Thyroid Neoplasms ; Unemployment

BACKGROUND: Weight overestimation of Korean Americans may be associated with dietary habits and preferences for foods and tastes. METHODS: The subjects were 100 Korean Americans in New York City and LA and 100 Koreans in Seoul, who were 20-29 years old. Self-reported questionnaire consisted of age, height, weight, length of residence in US, preferences for 10 foods and 5 tastes, dietary habits and perception of self body image. Korean Americans were further divided into 3 groups according to length of residence in US. RESULTS: More Korean American women underestimated (27.3% vs. 5.8%), and less overestimated their body weights, than Korean women (31.8% vs. 53.8%, P=0.008). Korean Americans who overestimated their own body weights had significantly higher preference for salty taste and significantly lower dietary habit score regarding regular meals. CONCLUSIONS: Overestimation of self body size, rather than longer residence in US may be associated with the undesirable dietary habit and taste preference of Korean Americans, highlighting the importance of correct body image.
Asian Americans ; Body Image ; Body Size ; Body Weight ; Female ; Food Habits ; Food Preferences ; Humans ; New York City ; Surveys and Questionnaires

Subvalvular aortic aneurysms are rare but can be a cause of sudden death. This case report involves a 36-year-old male who died suddenly from rupture of a subvalvular aortic aneurysm with resultant hemopericardium with tamponade. He had a bicuspid aortic valve with acute infective endocarditis. A review of the literature enlightens the association between bicuspid aortic valve and subvalvular aortic aneurysm. The pathogenesis of the diseases of the aortic root will be discussed.
Adult ; Aortic Aneurysm ; Aortic Valve ; Bicuspid ; Death, Sudden ; Endocarditis ; Heart Valve Diseases ; Humans ; Male ; Pericardial Effusion ; Rupture

PURPOSE: The purpose of this study was to identify the effects of an educational intervention by evaluating neonatal emergency airway management knowledge, critical thinking disposition, problem- solving ability, and confidence in clinical performance after developing and operating a simulation-based neonatal emergency airway management education program for nurses in a neonatal intensive care unit.METHODS: The participants were 30 nurses in a neonatal intensive care unit. Data were collected from June 6 to 15, 2018 and analyzed using IBM SPSS version 22.0.RESULTS: The results of the pretest and posttest for each educational group showed statistically significant improvements in neonatal emergency airway management knowledge, critical thinking, problem- solving ability, and confidence in clinical performance.CONCLUSION: The simulation-based neonatal emergency airway management training program was an effective educational program that enhanced neonatal emergency airway management knowledge, critical thinking disposition, problem-solving ability, and confidence in clinical performance among nurses in a neonatal intensive care unit. Therefore, it is suggested that the program described in this study can contribute to improving nursing quality by enhancing the ability of nurses to cope with emergencies in practice. It can also be used for education for new nurses and contribute to the development of nurses' practices.
Airway Management ; Education ; Emergencies ; Infant, Newborn ; Intensive Care Units, Neonatal ; Intensive Care, Neonatal ; Nursing ; Patient Simulation ; Thinking

Objective: The purpose of the present study was to screen the prevalence of aneurysms in migraineurs; to differentiate presenting features in migraineurs with and without aneurysm; and also to correlate the locations of aneurysm to the clinical features of migraine. Methods: A total of 4,416 subjects were interviewed and completed self-reported questionnaires on headache. Of these, 1,773 subjects diagnosed to have migraines based on the International Classification of Headache Disorders II (ICHD-II) criteria were screened for aneurysm by magnetic resonance angiography (MRA). When aneurysm was suspected, further investigation with trans femoral cerebral angiography (TFCA) or three dimensional computerized tomography (CT) angiography was performed. Based upon MRA findings, subjects were grouped into unruptured aneurysm migraine patients (UAMP) and no aneurysm migraine patients (NAMP). Results: The prevalence of aneurysm was 3.6% (63 of 1,773) with the mean age of 56.0 years, which were not different from those of general population. There was no difference in migraine subtypes between UAMP and NAMP. Aggravation of headache by estrogen replacement therapy during menopause (p=.039), history of migraine in young age (p= .021), diplopia (p=.026), and retroauricular pain (p=.025) were significantly associated with presence of aneurysm. Although aneurysms were detected more in anterior circulation, there was no correlation between aneurysm site and headache location. The average size of aneurysm was 3.5 ± 2.1 mm and none were ruptured. Interventional therapy of aneurysm did not alter the feature of migraine. Conclusions: The incidence of aneurysm was not different in migraine patients as compared to the general population. Some features which significantly differentiate whether migrainuers have aneurysm or not warrant further study to have a predictive and localizing value.

Purpose: : How a doctor communicates with a patient is very critical not only to the delivery of an accurate information but also to the relationship management between them. This study aims at investigating doctors’ relationship management strategies to develop rapport in diagnosis communication with their patients by analyzing dialogues collected from currently aired Korean drama and previous studies. Methods: : By using Brown & Levinson’s politeness and Spensor-Oatey’s rapport management as theoretical frameworks, it categorized doctors’ relationship management strategies suggested by Korean medical education and analyzed rapport management components utilized in the strategies. It also investigated the components and the domains affecting rapport between doctors and patients in the collected dialogues. Results: : Relationship management strategies recommended to doctors in Korean medical education were related with all of Spensor-Oatey’s rapport management components: face, interactional goals and social rights/obligations management. In the dialogues collected from the drama, face management and stylistic domains were utilized more frequently to enhance the relationship compared to those from actual situation and simulation. Conclusion : Considering diagnosis communication is a face-threatening act to a patient, a doctor needs to utilize various relationship management strategies carefully and effectively. These results will help doctors to review their dialogues with patients and to improve their relationship with patients.

OBJECTIVE: To investigate the stem cell-like characteristics of human periodontal ligament (PDL) stromal cells outgrown from orthodontically extracted premolars and to evaluate the potential for myogenic differentiation. METHODS: PDL stromal cells were obtained from extracted premolars by using the outgrowth method. Cell morphological features, self-replication capability, and the presence of cell-surface markers, along with osteogenic, adipogenic, and chondrogenic differentiation, were confirmed. In addition, myogenic differentiation was induced by the use of 5-aza-2'-deoxycytidine (5-Aza) for DNA demethylation. RESULTS: PDL stromal cells showed growth patterns and morphological features similar to those of fibroblasts. In contrast, the proliferation rates of premolar PDL stromal cells were similar to those of bone marrow and adipogenic stem cells. PDL stromal cells expressed surface markers of human mesenchymal stem cells (i.e., CD90 and CD105), but not those of hematopoietic stem cells (i.e., CD31 and CD34). PDL stromal cells were differentiated into osteogenic, adipogenic, and chondrogenic lineages. Myotube structures were induced in PDL stromal cells after 5-Aza pretreatment, but not in the absence of 5-Aza pretreatment. CONCLUSIONS: PDL stromal cells isolated from extracted premolars can potentially be a good source of postnatal stem cells for oromaxillofacial regeneration in bone and muscle.
Azacitidine ; Bicuspid ; Bone Marrow ; DNA ; Durapatite ; Fibroblasts ; Hematopoietic Stem Cells ; Humans ; Mesenchymal Stromal Cells ; Molecular Biology ; Muscle Fibers, Skeletal ; Muscles ; Periodontal Ligament ; Regeneration ; Stem Cells ; Stromal Cells

Because of the inherent complex anatomy and functional arrangement of the cranial nerves (CNs), neuroimaging of cranial neuropathy is challenging. With recent advances in magnetic resonance imaging (MRI) techniques, the cause of cranial neuropathy can now be detected in many cases. As an active multidisciplinary team member of cranial neuropathy, it is essential for the neuroradiologist to be familiar with the detailed anatomy of the CNs on MRI. This review contains the basic MRI anatomy of CNs III–XII according to a segmental classification from the brain stem to the extracranial region. The optimal imaging options to best evaluate the specific segment of the CNs will also be discussed briefly.

C-arm fluoroscopy is a useful tool for interventional pain management. However, with the increasing use of C-arm fluoroscopy, the risk of accumulated radiation exposure is a significant concern for pain physicians. Therefore, efforts are needed to reduce radiation exposure. There are three types of radiation exposure sources: (1) the primary X-ray beam, (2) scattered radiation, and (3) leakage from the X-ray tube.The major radiation exposure risk for most medical staff members is scattered radiation, the amount of which is affected by many factors. Pain physicians can reduce their radiation exposure by use of several effective methods, which utilize the following main principles: reducing the exposure time, increasing the distance from the radiation source, and radiation shielding. Some methods reduce not only the pain physician’s but also the patient’s radiation exposure. Taking images with collimation and minimal use of magnification are ways to reduce the intensity of the primary X-ray beam and the amount of scattered radiation. It is also important to carefully select the C-arm fluoroscopy mode, such as pulsed mode or low-dose mode, for ensuring the physician’s and patient’s radiation safety. Pain physicians should practice these principles and also be aware of the annual permissible radiation dose as well as checking their radiation exposure. This article aimed to review the literature on radiation safety in relation to C-arm fluoroscopy and provide recommendations to pain physicians during C-arm fluoroscopy-guided interventional pain management.