In air leak syndrome, a significant portion of the volume delivered during a positive pressure breath can be lost through the leak. HFOV can achieve adequate ventilation at lower peak and/or mean intrapulmonary pressure than conventional mechanical ventilation (CMV) and has been an effective treatment of already established air leak syndrome. We report a 1-day-old male infant with severe respiratory failure from pneumothorax and pneumomediastinum, who was refractory to CMV with chest tube drainage. HFOV was applied to this patient for 114 hours, and improvement of oxygenation and ventilation as well as significant reduction of pneumothorax followed.
Chest Tubes ; Drainage ; Humans ; Infant ; Male ; Mediastinal Emphysema ; Oxygen ; Pneumothorax ; Respiration, Artificial ; Respiratory Insufficiency ; Ventilation*

Neuroleptic malignant syndrome is a rare, but potentially life-threatening adverse event associated with the use of neuroleptic agents. We describe the case of a 47-year-old schizophrenic woman who was treated with clozapine for years. The patient developed acute renal failure with pulmonary edema, and underwent mechanical ventilation and hemodialysis.
Acute Kidney Injury ; Antipsychotic Agents ; Clozapine* ; Female ; Humans ; Middle Aged ; Neuroleptic Malignant Syndrome* ; Pulmonary Edema ; Renal Dialysis ; Respiration, Artificial ; Rhabdomyolysis

Gynecomastia is a proliferation of the glandular component of the male breast. Gynecomastia is the most common variant condition of the male breast and results from the effect of an altered estrogen-androgen balance on breast tissue or from the increased sensitivity of breast tissue to a normal estrogen level. We experienced a case of macrogynecomastia in a 16-year-old boy who had a normal male phenotype and was treated by reduction mammoplasty with breast tissue removal, which was effective and produced good cosmetic and psychologic results.
Adolescent ; Breast ; Estrogens ; Female ; Gynecomastia ; Humans ; Male ; Mammaplasty* ; Phenotype

Coexistence of cranial and spinal subdural hematomas is rare and only a few cases have been reported in the literature. Herein, we report a case of cranial and spinal subdural hematomas after previous head trauma. As the pathogenesis of simultaneous intracranial and spinal subdural hematoma yet remains unclear, we developed an alternative theory to those proposed in the literature for their coexistence, the migration of blood through the subdural space.
Craniocerebral Trauma ; Hematoma, Subdural* ; Hematoma, Subdural, Spinal* ; Subdural Space

PURPOSE: The purposes of this study were to compare confidence in practice of intermittent gavage tube feeding and participants' satisfaction by three types of feedback; professor verbal feedback, professor feedback with smartphone video, and peer feedback with smartphone video. In addition, frequently failed items in the intermittent gavage tube feeding procedure were analyzed. METHODS: Data were collected from a convenience sample of 78 nursing college students in November 2014. Students were randomly assigned to the control group, experimental group I (smartphone video with professor feedback) or group II (smartphone video with peer feedback). Data were analyzed using descriptive statistics including chi-square test, ANOVA, and Scheffe test with SPSS 21.0. RESULTS: Confidence in practice of intermittent gavage tube feeding and satisfaction with feedback were highest in experimental group I that had professor feedback with smartphone video. For the procedure, the most frequently failed item was giving an explanation to patients about the purpose and the procedure of tube feeding. CONCLUSION: The results indicate that professor verbal feedback with smartphone video is the most benefit to the nursing students in acquiring core nursing practice skills.
Enteral Nutrition* ; Humans ; Nursing* ; Students, Nursing*

Purpose: This study develops a chatbot for school violence prevention (C-SVP) among elementary school students. Methods: Among the analysis, design, development, implementation, and evaluation (ADDIE) models, ADD phases were applied to develop a C-SVP. Students’ learning needs were identified by constructing content with a design that attracted their attention. Subsequently, a formative evaluation was conducted on the developed C-SVP to test its applicability by ten elementary school students targeting the 5th and 6th grades. Results: The chatbot was designed using KakaoTalk and named “School Guardian Angel.” The formative evaluation revealed that the developed C-SVP was easily accessible and useful for elementary school students. Conclusion The developed C-SVP is expected to be effective in preventing violence among elementary school students. However, further research involving children of various age groups is required.

OBJECTIVE: Computed tomography (CT)-based method of three dimensional (3D) analysis (MIMICS®, Materialise, Leuven, Belgium) is reported as very useful software for evaluation of OPLL, but its reliability and reproducibility are obscure. This study was conducted to evaluate the accuracy of MIMICS® system, and inter- and intra-observer reliability in the measurement of OPLL. METHODS: Three neurosurgeons independently analyzed the randomly selected 10 OPLL cases with medical image processing software (MIMICS®) which create 3D model with Digital Imaging and Communication in Medicine (DICOM) data from CT images after brief explanation was given to examiners before the image construction steps. To assess the reliability of inter- and intra-examiner intraclass correlation coefficient (ICC), 3 examiners measured 4 parameters (volume, length, width, and length) in 10 cases 2 times with 1-week interval. RESULTS: The inter-examiner ICCs among 3 examiners were 0.996 (95% confidence interval [CI], 0.987–0.999) for volume measurement, 0.973 (95% CI, 0.907–0.978) for thickness, 0.969 (95% CI, 0.895–0.993) for width, and 0.995 (95% CI, 0.983–0.999) for length. The intra-examiner ICCs were 0.994 (range, 0.991–0.996) for volume, 0.996 (range, 0.944–0.998) for length, 0.930 (range, 0.873–0.947) for width, and 0.987 (range, 0.985–0.995) for length. CONCLUSION: The medical image processing software (MIMICS®) provided detailed quantification OPLL volume with minimal error of inter- and intra-observer reliability in the measurement of OPLL.
Longitudinal Ligaments* ; Methods ; Neurosurgeons ; Observer Variation*

Isolated ACTH deficiency is a rare cause of secondary adrenocortical insufficiency. The clinical presentation can be similar to that of primary adrenal insufficiency, but most of them may be nonspecific. A female patient of 25 months of age, complainig short stature, showed hypocortisolemia without ACTH & cortisol stimulation by insulin-induced hypoglycemia test. All the other hormone state was normal. Left hand AP view revealed delayed bone age(3 month) compared with chronological age. No radiologic abnormality was found in sella MRI and adrenal CT. Here we report a case of isolated ACTH deficiency presented by short stature.
Addison Disease ; Adrenocorticotropic Hormone ; Female ; Hand ; Humans ; Hydrocortisone ; Hypoglycemia ; Magnetic Resonance Imaging

PURPOSE: Brain-based learning has become increasingly important in nursing education. The purpose of this study is to (a) synthesize the literature on brain-based learning in nursing education using Whittemore and Knafl's integrative review method, and (b) discuss teaching strategies for nursing educators. METHOD: Searches were made through the CINAHL, OVID, PubMED, and SCOPUS databases using the terms nurs* AND (brain based OR neuroscience) AND (educa* OR learn* OR teach*). Included were original articles in the domain of undergraduate nursing education written in English in peer-reviewed journals between January 1984 and December 2013. Twenty-four papers met the criteria. RESULTS: Three themes were retrieved: (a) activate whole-brain functions, (b) establish supportive educational environments, and (c) encourage learners to be more active. CONCLUSION: Brain-based learning enhances the learning capabilities of undergraduate nursing students.
Brain ; Education ; Education, Nursing ; Humans ; Learning ; Nursing ; Students, Nursing

There are few reports in the literature of complete obstruction of the vertebral artery (VA) due to an electric screw driver bit penetration through the neural foramen into the spinal canal with Brown-Sequard syndrome (BSS). A 25-year-old man was admitted to the emergency department with a penetrated neck injury by an electric screw driver bit after a struggle. The patient presented the clinical features of BSS. Computed tomography scan revealed that the electric screw driver bit penetrated through the right neural foramen at the level of C3-4, and it caused an injury to the right half of the spinal cord. Emergent angiography revealed VA dissection, which was managed by immediate coil embolization at both proximal and distal ends of the injury site. After occlusion of the VA, the electric screw driver bit was extracted under general anesthesia. Bleeding was minimal and controlled without difficulties. No postoperative complications, such as wound dehiscence, CSF leakage, or infection, were noted. Endovascular approaches for occlusion of vertebral artery lesions are safe and effective methods of treatment.
Adult ; Anesthesia, General ; Angiography ; Brown-Sequard Syndrome* ; Cervical Vertebrae ; Embolization, Therapeutic ; Emergencies ; Female ; Hemorrhage ; Humans ; Methods ; Neck Injuries ; Postoperative Complications ; Spinal Canal ; Spinal Cord ; Vertebral Artery Dissection ; Vertebral Artery* ; Wounds and Injuries ; Wounds, Penetrating