No abstract available.
Blood Flow Velocity* ; Humans ; Infant, Newborn*

PURPOSE: This study was carried out to identify and re-establish the professional identity in clinical nurses. METHOD: From Dec. 1999, for 4 months, the study had been conducted by narrative analysis method based on hermeneutic principles. Subjects were ten nurses with 3-4 years of nursing experience at a university hospital. The data were collected and transcribed through narrative interviews. RESULT: As a result, the maternal role was identified as the most dominant discourse in which nurses formed their identity. Subjects felt that a maternity is socio-culturally needed in case of nursing. Reconstruction of professional identity consists of 3 stages, Telling, Retelling and Rebuilding. At first, nurses felt confused by skeptism of the profession, interpersonal difficulties, and heavy work loads. However, during the interviews, nurses recognized that nursing is not regarded as significant, effort to make nursing meaningful were small, and there was a lack of understanding others. From this new insight, they re-established a new image of nursing "through better understanding of others, seeking knowledge, and making positive efforts towards qualified nursing". CONCLUSION: The above narrative interviews may help nurses reflect and contextually interpret themselves, so that a new identity could be established. Furthermore researchers can obtain new insight from the subjects, while the subjects form a new nursing image from self-reflection.
Nursing

BACKGROUND: Follicular dendritic cells (FDCs) play key roles during T cell-dependent humoral immune responses by allowing antigen-specific B cells to survive, proliferate, and differentiate within the FDC networks of secondary follicles, i.e., germinal centers (GC). METHODS: A novel monoclonal antibody, 3C8, was generated by immunizing with an FDC line HK, in order to understand the molecular signals involved in the FDC-B cell interactions in the microenvironment of the GC. RESULTS: The 3C8 antibody did not bind to mononuclear cells, including T cells, B cells, and monocytes. Murine L929 and human skin fibroblasts exhibited no or little reactivity to 3C8. However, 3C8 specifically recognized HK cells by flowcytometry. Furthermore, the antigen recognized by 3C8 was restricted to the GC of the human tonsil. Dendritic networks of the GC were intensely stained by 3C8, but cells out side the GC were not. CONCLUSION: Our result s suggest that the antigen 3C8 may play some unique role on FDCs during the GC reactions.
B-Lymphocytes ; Cell Communication ; Dendritic Cells, Follicular* ; Fibroblasts ; Germinal Center ; Humans ; Immunity, Humoral ; Monocytes ; Palatine Tonsil ; Skin ; T-Lymphocytes

Hereditary hemorrhagic telangiectasia(Osler-Rendu-Weber Syndrome) is characterized by telangiectasia of the skin and mucous membranes and intermittent bleeding from vascular abnormalities. About 20% of patients with this is syndrome have pulmonary arteriovenous fistulas. Pulmonary arteriovenous fistula is uncommon malformation which has an abnormal connection between the pulmonary capillary bed, in which venous blind in the pulmonary artery is shunted through the fistula into the pulmonary vein without exposure to alveolar oxygen and result in unoxygenated, desaturated systemic arterial blood, polycythemia, cyanosis and clubbing. Death often results from cerebral abscess and rupture of the malformation with massive hemorrhage. Therapeutic intervention is recommended for all symptomatic patients because of the risk of those serious complications. Treatment options include surgery and transcatheter obliteration with steel coils or detachable balloons. Therapeutic embolization has the advantages that multiple bilateral pulmonary arteriovenous fistulas can be occluded and also that the procedure can be repeated if necessary. Recently we experienced a case of the multiple bilateral pulmonary arteriovenous fistulas associated with telangiectatic change of hepatic artery and multiple angiodysplasia on the gastric mucosa in 41 years old female patient who had mild dyspnea of exertion(NYHA class II), clubbing finger, severe iron deficiency anemia. She was treated with embolization technique using steel coils and iron replacement. After the therapeutic embolization, significant improvement of dyspnea of exertion with disappearance of multiple pulmonary nodule on follow-up simple chest x-ray was noted. During the subsequent six months follow-up period, she bad the improvement of symptoms arid iron deficiency anemia.
Adult ; Anemia, Iron-Deficiency ; Angiodysplasia ; Arteriovenous Fistula* ; Brain Abscess ; Capillaries ; Cyanosis ; Dyspnea ; Embolization, Therapeutic* ; Female ; Fingers ; Fistula ; Follow-Up Studies ; Gastric Mucosa ; Hemorrhage ; Hepatic Artery ; Humans ; Iron ; Mucous Membrane ; Multiple Pulmonary Nodules ; Oxygen ; Polycythemia ; Pulmonary Artery ; Pulmonary Veins ; Rupture ; Skin ; Steel ; Telangiectasia, Hereditary Hemorrhagic ; Telangiectasis ; Thorax

Purpose: This article was to collect data on the safety of coronavirus disease 2019 (COVID-19) vaccines in children with underlying medical conditions. Methods: We constructed a prospective cohort of children and adolescents aged 5 to 19 years who had received at least one dose of COVID-19 vaccine. Patients diagnosed with and treated for chronic kidney disease, autoimmune disease, or other chronic conditions at the Seoul National University Children’s Hospital were recruited from June to December 2022. A mobile survey questionnaire was sent to their guardians. The presence of adverse events on the day (day 0), 3 weeks (day 21), and 6 months (day 180) after the 1st dose of COVID-19 vaccine was recorded by the guardians. Results: A total of 73 children participated. The median age was 14 years, and 64.4% of the patients were male. On the day of immunization, 65.8% of the patients reported at least one adverse event. Pain at the injection site, fatigue, headache, arthralgia, and myalgia were the most common symptoms. The prevalence of adverse events decreased over time (65.8% on day 0, 27.4% between days 0 and 21, and 24.6% between days 21 and 180). Severe acute respiratory syndrome coronavirus 2 infection after the 1st dose occurred in 17 patients (23.3%) and one of the patients (5.88%) was hospitalized due to infection. Conclusions Adverse events after COVID-19 vaccination were generally mild in children and adolescents with underlying medical conditions. Our findings provide evidence for the safety of COVID-19 vaccination in the vulnerable pediatric population.

PURPOSE: Ursodeoxycholic acid (UDCA) is known to decrease hepatic injury by promoting the biliary secretion of retained toxic endogenous bile acids in hepatobiliary diseases complicated by total parenteral nutrition (TPN). However, most studies have focused on treatment for complications after TPN. We investigated the preventive role of early administration of UDCA in TPN-induced hepatobiliary complications by a randomized, double-blind, placebo-controlled trial. METHODS: Between May 2000 and May 2002, thirteen patients, who were given TPN more than 10 days in the hospital, were assigned randomly to two groups. One was the case group (7 patients) who were given UDCA simultaneously with TPN regimen, and the other, the control group (6 patients) who were given placebo. Their age ranged from 1 day to 13 years. They were affected with diseases impossible for enteral nutrition, such as prematurity, cerebral palsy, chronic diarrhea, anorexia nervosa, pancreatitis, and cyclic vomiting. The duration of TPN ranged from 10 to 70 days. Hematologic parameters including liver function test were measured at regular intervals, and the duration, composition, administration rate, total calorie of TPN were recorded. The serum levels of total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase were compared between groups after cessation of the study. RESULTS: The autoregressive coefficient of the control group was 0.4419 (p=0.0651) in bilirubin, -0.0431 (p=0.7923) in AST, 0.2398 (p=0.2416) in ALT, and 0.2459 (p=0.1922) in alkaline phosphatase by mixed procedure model when the parameters were referred to the case group. CONCLUSION: The serum level of total bilirubin did not increase in comparison with that of the control group, but statistically insignificant, when both TPN and UDCA were administered simultaneously from the beginning.
Alanine Transaminase ; Alkaline Phosphatase ; Anorexia Nervosa ; Aspartate Aminotransferases ; Bile Acids and Salts ; Bilirubin ; Cerebral Palsy ; Diarrhea ; Enteral Nutrition ; Humans ; Liver Function Tests ; Pancreatitis ; Parenteral Nutrition, Total ; Ursodeoxycholic Acid* ; Vomiting

A rare case of spinal epidural granulocytic sarcoma (GS) preceding acute myelogenous leukemia is described. A 10-year-old boy presented with lower leg weakness. The initial diagnosis was a histiocytic lymphoma, and he was treated accordingly. No evidence of bone marrow involvement was found at that time. The correct diagnosis of epidural GS was made possible in retrospect by using immunoperoxidase staining for lysozyme fourteen months later when the patient showed the full-blown features of leukemia. This rare tumor should be considered in the differential diagnosis of an epidural mass with cord compression in patients with or even without acute leukemia, because early diagnosis followed by appropriate combined chemotherapy and radiation may obviate surgical intervention and eventually prevent leukemic transformation.
Child ; Epidural Neoplasms/*complications/pathology ; Humans ; Immunoenzyme Techniques ; Leukemia, Myeloid/*complications/pathology ; Leukemia, Myeloid, Acute/*complications/pathology ; Male ; Neoplasms, Second Primary

PURPOSE: Bacteremia is one of the major concerns in the treatment of pediatric cancer patients. This study was to determine the etiologic agents and the pattern of antibiotic susceptibilities in a single tertiary medical center. METHODS: We retrospectively reviewed the medical records of the cases of bacteremia in pediatric cancer patients from 1998 to 2005 in Keimyung University Dongsan Medical Center. RESULTS: There were 62 cases of bacteremia from 44 patients. Gram-positive organisms(48.3%) were more common than gram-negative organisms(38.7%) or fungi(13%). Among gram-positive organisms, Staphylococcus epidermidis was the most common etiologic agent(63.3%), followed by Staphylococcus aureus(16.7%), alpha-hemolytic Streptococcus(16.7%), and Streptococcus mitis(3.3%). Among gram-negative organisms, Alcaligenes xylosoxidans was the most common agent(41.7%) and the other organisms were Klebsiella pneumoniae(20.8%), Stenotrophomonas maltophilia(12.5%), Acinetobacter baumanii(8.2%), etc. In febrile neutropenic patients, however, K. pneumoniae was the most common cause of gram-negative bacteremia. All of the isolated K. pneumoniae in our center produced extended-spectrum beta-lactamase and were related with high mortality. S. aureus, S. epidermidis, and Streptococcus species were all susceptible to vancomycin and teicoplanin. Most staphylococci were resistant to penicillin and oxacillin. Most of the gram-negative organisms were susceptible to imipenem. CONCLUSION: Gram-positive organisms were more commonly isolated than gram-negative organisms in pediatric cancer patients like other studies. We could obtained valuable information on the choice of proper antibiotics in our institution. Further studies will be needed to explain the prevalence of A. xylosoxidans in our center.
Acinetobacter ; Alcaligenes ; Anti-Bacterial Agents ; Bacteremia* ; beta-Lactamases ; Child ; Humans ; Imipenem ; Klebsiella ; Medical Records ; Mortality ; Oxacillin ; Penicillins ; Pneumonia ; Prevalence ; Retrospective Studies ; Staphylococcus ; Staphylococcus epidermidis ; Stenotrophomonas ; Streptococcus ; Teicoplanin ; Vancomycin

Pseudomonas aeruginosa pneumonia is characteristically found as a hospital-acquired infection in patients with underlying medical disorders. Few cases of community acquired P. aeruginosa pneumonia have been reported in individuals without underlying diseases. We report a case of P. aeruginosa pneumonia in a healthy 33-year-old man. He visited our hospital because of fever, non-productive cough, and pleuritic chest pain. On physical examination, the breathing sounds were decreased on the right lower lung field. The chest radiograph showed lobar consolidations with a cavity on the right upper lung field. Blood cultures and a pleural fluid culture yielded P. aeruginosa. Despite aggressive management including antibiotics and mechanical ventilation, he died 26 hours after the onset of symptoms. P. aeruginosa should be included in the differential diagnosis of severe community-acquired pneumonia.
Adult* ; Anti-Bacterial Agents ; Chest Pain ; Cough ; Diagnosis, Differential ; Fever ; Humans ; Lung ; Physical Examination ; Pneumonia* ; Pseudomonas aeruginosa* ; Pseudomonas* ; Radiography, Thoracic ; Respiration, Artificial ; Respiratory Sounds ; Sepsis

BACKGROUND: Human Immunodeficiency Virus (HIV) primarily infects CD4 lymphocyte, resulting in quantitative and qualitative defect of CD4 lymphocyte and eventually AIDS. This study was designed to determine the epidemiologic, cellular, and immunologic markers as possible indicator, of progression to AIDS. METHODS: A total of 115 HIV infected patients enrolled between September 1987 and July 1996 was analyzed. AIDS was defined according to criteria presented by Centers for Disease Control in 1993. The variables considered in the analysis were age, sex, route of transmission, delayed hypersensitivity skin test, WBC counts, hemoglobin, ESR, lymphocyte counts, platelet counts, CD4 lymphocyte counts, CD8 lymphocyte counts, and serum beta2-microglobulin. Predictors of AIDS were determined by multiple logistic regression analysis. RESULTS: Median follow-up duration of study was 12.05 months. Thirty-one subjects were diagnosed as AIDS during the study period. AIDS-defining illness included tuberculosis (23 cases), Pneumocystis carinii pneumonia (6 cases), esophageal candidiasis (6 cases), cytomegalovirus disease (6 cases), cryptococcal meningitis (2 cases), cryptosporidiosis (2 cases), isosporiosis (2 cases), primary central nervous system lymphoma (1 case). On univariate analysis, low hemoglobin, low lymphocyte counts, high platelet counts, high ESR, low CD4 lymphocyte counts, low CD8 lymphocyte counts, and high serum beta2-microglobulin level are associated with progression to AIDS. On multivariate analysis, only the low CD4 lymphocyte counts is associated with increased AIDS hazard. In a group treated with zidovudine, any changes of celluar and immunologic markers during four months following treatment are not associated with progression to AIDS. CONCLUSION: In HIV infected persons, several laboratory markers might predict AIDS when analyzed individually. However, in multivariate analysis, only low CD4 lymphocyte count is an independent predictor of progression to AIDS
Animals ; Biological Markers ; Candidiasis ; CD4 Lymphocyte Count ; Centers for Disease Control and Prevention (U.S.) ; Central Nervous System ; Cryptosporidiosis ; Cytomegalovirus ; Follow-Up Studies ; HIV Infections ; HIV* ; Humans* ; Hypersensitivity, Delayed ; Logistic Models ; Lymphocyte Count ; Lymphocytes ; Lymphoma ; Meningitis, Cryptococcal ; Multivariate Analysis ; Platelet Count ; Pneumonia, Pneumocystis ; Prognosis ; Skin Tests ; Tuberculosis ; Zidovudine