Mechanical obstruction of the common hepatic duct includes the following causes; choledocholithiasis, sclerosis, cholangitis, pancreatic carcinoma, cholangiocarcinoma, postoperative stricture, primary hepatic duct carcinoma, enlarged cystic duct lymph nodes, and metastatic nodal involvement of the porta hepatis. Partial mechanical obstruction of the common hepatic duct caused by impaction of stones and inflammation surrounding the vicinity of the neck of the gallbladder had been reported on the “syndrome del conducto hepatico” in 1948 by Mirizzi. Nowadays, this disease was named by Mirizzi syndrome. Mrizzi syndrome is a rare entity of common hepatic duct obstruction that results from an inflammatory response secondary to a gallstone impacted in the cystic duct or neck of the gallbladder. It results from an almost parallel course and low insertion of the cystic duct into the common hepatic duct. In a variant of Mirizzi's syndrome, the cause of the common hepatic duct obstruction was a primary cystic duct carcinoma rather than gallstone disease. A 71-year-old man was admitted with a four-day history of right upper quadrant abdominal pain. Past medical history was unremarkable. On physical examination, the patient had a temperature of 38℃, icteric sclera and right upper quadrant tenderness. Pertinent laboratory findings included WBC 18,000/cm3; albumin 2.6 g/dl (normal 0-1) with the direct bilirubin, 4.4 mg/dl (normal 0-0.4). Ultrasonography revealed a dilated extrahepatic biliary tree. ERCP showed that the superior margin was angular and more consistent with a calculus causing partial CHD obstruction (Mirizzi syndrome). At surgery a diseased gallbladder containing calculi was found. In addition, there was two calculi partially eroding through the proximal portion of the cystic duct and compressing the common hepatic duct. A cholecystectomy and excision of common bile duct was performed, with Roux-en-Y hepaticojejunostomy. The postoperative course was uneventful.
Abdominal Pain ; Aged ; Biliary Tract ; Bilirubin ; Calculi ; Cholangiocarcinoma ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Cholecystectomy ; Choledocholithiasis ; Common Bile Duct ; Constriction, Pathologic ; Cystic Duct ; Cytochrome P-450 CYP1A1 ; Gallbladder ; Gallstones ; Hepatic Duct, Common ; Humans ; Inflammation ; Jaundice, Obstructive ; Lymph Nodes ; Mirizzi Syndrome* ; Neck ; Physical Examination ; Sclera ; Sclerosis ; Ultrasonography

No abstract available.
Animals ; Rats* ; Reperfusion*

PURPOSE: This study was conducted to evaluate clinical competency of nursing students and to examine the validity and reliability of the scale. METHODS: The Clinical Competency Scale was formed through modification of Lee's Clinical Competency Scale that was originally developed in 1990. The Clinical Competency Scale was applied to 203 nursing students. Construct validity, item convergent and discriminant validity, concurrent validity, and internal consistency reliability of the scale were evaluated. RESULTS: Exploratory factor analysis supported the construct validity with a five factor solution; that explained 63.6% of the total variance. Concurrent validity was demonstrated with the Nursing Competence Scale (r=.78, p < .001). Cronbach's α coefficient for the scale was .96. CONCLUSION: The results of this study suggest that the Clinical Competency Scale has relatively acceptable reliability and validity and can be used in clinical research to assess clinical competency for nursing students.
Clinical Competence ; Humans ; Mental Competency ; Nursing ; Psychometrics ; Reproducibility of Results ; Students, Nursing

BACKGROUND: There is experimental evidence that overexpression of cyclin D1 accelerates the entry of cells into the S-phase, but that p16 inhibits the CDK4 and CDK6 by binding in competition with the cyclin D1. Previous attempts to correlate cyclin D1 amplification with prognoses have frequently drawn associations with adverse outcome or a more aggressive phenotype. Recently, overexpression of cyclin D1 has been associated with improved relapse-free survival and overall survival rates. To elucidate whether the expressions of the cyclin D1 and the p16 protein might be of clinical value as prognostic factors, we used the chi-square test to compare the immunoreactivities of the cyclin D1 and the p16 proteins with the histopathologic findings and with such known prognostic factors as the estrogen receptor, progesteron receptor, c-erbB-2, p53 and Ki-67. METHODS: The expressions of the cyclin D1 and the p16 proteins were analysed using immunohistochemical methods in formalin-fixed and paraffin-embedded tissue samples of 340 invasive breast carcinomas accumulated between 1990 to 1997 at Yeungnam University Hospital. Disease-free survival and overall survival were compared to cyclin D1 and p16 status by using the Kaplan-Meier method. RESULTS: Nuclear immunoreactivities of the cyclin D1 and the p16 proteins were detected in 75.6% (257/340) and 70.5% (208/295) cases, respectively. Cyclin D1 was found to have a strong correlation with lower histologic grade, lower nuclear grade, lower mitotic index, and lower Scarff-Bloom-Richardson (SBR) and Modified-Scarff-Bloom-Richardson (MSBR) grade (p<0.05). Cyclin D1 was more common in non-ductal carcinomas than ductal carcinomas, though this difference did not reach statistical significance. Cyclin D1 was also correlated with positive estrogen receptor, negative c-erbB-2, and positive p16 protein. P16 protein expression was found to have a correlation with positive estrogen receptor and progesterone receptor. The expressions of the cyclin D1 and the p16 proteins were not significantly correlated with overall survival and disease-free survival. CONCLUSIONS: These results show that the expressions of the cyclin D1 and the p16 proteins can not be used as prognostic indicators in primary breast carcinomas.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Cyclin D1* ; Cyclins* ; Disease-Free Survival ; Estrogens ; Mitotic Index ; Phenotype ; Prognosis ; Receptors, Progesterone ; Survival Rate

Many patients regard tonsillectomy as a minor operation because it is performed frequently. Although tonsillectomy is considered a relatively safe surgical procedure, numerous complications have been described. The common complications are hemorrhage, infection, and following anesthesia, aspiration, cardiac arrhythmia, and laryngeal trauma. Cervicofacial emphysema and pneumomediastinum are rarely observed sequelae of surgical intervention in the upper aerodigestive tract. Although these complications resolve spontaneously in most cases, a few cases result in tension pneumothorax and other life-threatening conditions. Symptoms include chest pain, neck pain, dyspnea and odynophagia. Treatment involves frequent assessment of the airway and extent of the emphysema. The authors of the present study report of a patient who developed pneumomediastinum shortly after an adenotonsillectomy as well as a review of the related literature.
Anesthesia ; Arrhythmias, Cardiac ; Chest Pain ; Dyspnea ; Emphysema ; Hemorrhage ; Humans ; Mediastinal Emphysema ; Neck Pain ; Pneumothorax ; Subcutaneous Emphysema ; Tonsillectomy

No abstract available.
Hemorrhoids*

The infantile convulsions and choreoathetosis (ICCA) syndrome is defined when two overlapping clinical features of benign familial infantile epilepsy (BFIE) and paroxysmal kinesigenic dyskinesia (PKD) are present in an individual or a family. Since the gene encoding proline-rich transmembrane protein 2 (PRRT2) was first identified in Han Chinese families with PKD, mutations of PRRT2 have additionally been reported in patients with BFIE and ICCA. We attempted to identify the genetic etiology in an ICCA family where the proband, her elder sister, and a maternal male cousin had BFIE, and her mother had PKD. Whole-exome sequencing performed in the proband and her sister and mother identified a novel pathogenic mutation of PRRT2 (c.640delinsCC; p.Ala214ProfsTer11), which was verified by Sanger sequencing. This frameshift PRRT2 mutation located near the genetic hot spot of base 649_650 results in the premature termination of the protein, as do most previously reported mutations in BFIE, ICCA, and PKD.
Asian Continental Ancestry Group ; Dyskinesias ; Epilepsy ; Frameshift Mutation ; Humans ; Male ; Mothers ; Seizures ; Siblings

Neuronal ceroid lipofuscinoses (NCLs) are inherited neurodegenerative disorders, which are caused by the accumulation of lipopigment in lysosomes. Variant forms of late infantile NCLs (vLINCLs) characterized by a later onset of seizures and visual impairment (3–8 years) than in the classic form (2–4 years) are caused by mutations of the gene encoding ceroid lipofuscinosis neuronal protein 6 (CLN6). In a girl with progressive myoclonus epilepsy, we found heterozygous variants of CLN6 (NM_017882.2; NP_060352.1): c.296A>G (p.Lys99Arg) and c.307C>T (p.Arg103Trp). They were identified with whole-exome sequencing and verified with Sanger sequencing. At 7 years and 9 months, our patient had developed multiple types of seizures, prominent myoclonus with photosensitivity, regression in motor and language skills, pyramidal and extrapyramidal signs, and brain atrophy in brain images, all of which were progressive and were compatible with vLINCLs. However, this first Korean report shows no visual impairment, which resembles the previously reported Japanese case.
Asian Continental Ancestry Group ; Atrophy ; Brain ; Ceroid ; Child ; Female ; Humans ; Lysosomes ; Myoclonic Epilepsies, Progressive* ; Myoclonus ; Neurodegenerative Diseases ; Neuronal Ceroid-Lipofuscinoses ; Neurons ; Seizures ; Vision Disorders

Left-sided gallbladder (LSGB) is a rare anomaly, but it is often associated with multiple combined variations of the liver anatomy. We present the case of a patient with LSGB who underwent successful resection of perihilar cholangiocarcinoma. The patient was a 67-year-old male who presented with upper abdominal pain and obstructive jaundice. Initial imaging studies led to the diagnosis of Bismuth-Corlette type IIIB perihilar cholangiocarcinoma. Due to the unique location of the gallbladder and combined multiple hepatic anomalies, LSGB was highly suspected. During surgery after hilar dissection, we recognized that the tumor was located at the imaginary hilar bile duct bifurcation, but its actual location was corresponding to the biliary confluence of the left median and lateral sections. The extent of resection included extended left lateral sectionectomy, caudate lobe resection, and bile duct resection. Since some of the umbilical portion of the portal vein was invaded, it was resected and repaired with a portal vein branch patch. Due to anatomical variation of the biliary system, only one right-sided duct was reconstructed. The patient recovered uneventfully without any complication. LSGB should be recognized as a constellation of multiple hepatic anomalies, and therefore, thorough investigations are necessary to enable the performance of safe hepatic and biliary resections.
Abdominal Pain ; Aged ; Bile Ducts* ; Biliary Tract ; Cholangiocarcinoma* ; Diagnosis ; Gallbladder* ; Hepatectomy* ; Humans ; Jaundice, Obstructive ; Liver ; Male ; Portal Vein

Objective: Religious behaviors are considered as complex brain-based phenomena that may be associated with structural brain change. To identify the pattern of regional brain volume change in nuns, we investigated structural alterations in the brains of nuns using a fast processing automated segmentation method based on deep learning algorithms. Methods: We retrospectively reviewed the medical records of the catholic sisters between the ages of 31 and 80 who are members of the charity of St. Vincent de Paul of Korea. A total of 193 asymptomatic subjects (86 nuns and 107 control subjects) received comprehensive health screening and underwent brain MRI scans. We compared cortical and sub-cortical volume between groups across multiple locations using our in-house U-Net++ deep learning-based automatic segmentation tool. Results: Compared to the control group, the nun group displayed increased gray matter volume in the right lingual cortex, left isthmus-cingulate, posterior-cingulate, rostral-middle-frontal, superior-frontal, supramarginal, temporal-pole cortices, and bilateral pars-triangularis cortices after correction for multiple comparisons. On the other hand, the nun group showed reduced gray matter volume in the temporal and parietal regions relative to healthy controls. Conclusion Our study suggests that spiritual practice may affect brain structure, especially in several frontal regions involved in a higher level of insight function.