We report a rare case of carcinosarcoma arising in the stomach. The tumor is presented in the posterior wall of the gastric lower body and antrum of a 56-year-old man. Grossly the tumor has polypoid appearance with diffuse surface ulceration and measures 5.5 cm in diameter. The tumor is accompanied with three separate well differentiated early gastric adenocarcinomas (two EGC type IIc & IIa). Microscopically, the tumor consists of moderately well differentiated adenocarcinoma in the periphery, and lobulated sarcomatous areas in the center, which shows chondroid differentiation. Transitional areas between adenocarcinoma and chondrosarcoma are evident. Immunohistochemical studies show positivity for cytokeratin and carcinoembryonic antigen in the epithelial component, and for vimentin and S-100 in the sarcomatous component. The transitional areas are positive in carcinoembryonic antigen, vimentin, S-100, and cytokeratin. The tumor extended to the subserosa and showed metastasis of only adenocarcinomatous component in six out of 47 dissected perigastric lymph nodes.
Adenocarcinoma ; Carcinoembryonic Antigen ; Carcinosarcoma* ; Chondrosarcoma ; Humans ; Keratins ; Lymph Nodes ; Middle Aged ; Neoplasm Metastasis ; Stomach* ; Ulcer ; Vimentin

No abstract available.
Fetal Blood* ; Humans ; Infant, Newborn* ; Phenotype

BACKGROUND: Physicians rarely take patients' sexual history during routine medical visit, although it would give very helpful information to reach accurate diagnosis and proper management. This survey was conducted to assess the primary physicians' perspectives towards sexual history taking and their actual behaviors on it. METHODS: The survey questionnaire was made through the literature review, in-depth interview and pilot survey. We mailed this questionnaire to 400 primary care physicians who were randomly selected from the lists of internists and family physicians in Seoul and Gyunggi province and 73 of them responded. RESULTS: The mean age of the respondents was 44.3 years. Most of them responded that sexual history is necessary only when the patients' chief complaints are directly related to sexual issues. Among the total, 94% of them answered that he or she took sexual history in less than 25% of the patients who visited his/her own clinic during last one month. The most prevalent barriers to initiate sexual history taking were fear of patients' misunderstanding about sexual harassment or intrusion into patients' personal life (60.3%) and uncertainty to conducting sexual history taking (53.4%). They thought that they were not well educated enough to take sexual history with confidence and more structured education is needed in medical schools and postgraduate residency training. CONCLUSION: Sexual history seemed not to be taken by primary care physicians as a routine medical practice and physicians showed rather passive attitude. Beneficial effects of sexual history taking on patients' management and related communication skills should be emphasized and systematically educated.
Surveys and Questionnaires ; Humans ; Internship and Residency ; Physicians, Family ; Physicians, Primary Care ; Postal Service ; Primary Health Care ; Schools, Medical ; Sexual Harassment ; Uncertainty

No abstract available.
Busan* ; Eclampsia* ; Female ; Pregnancy ; Singing*

Purpose: Despite its well-known clinical importance, physician empathy (PE) has been variably defined and its concepts among cultures are yet to be studied. This study aimed to develop a conceptual framework of PE and explore influencing factors on physicians’ empathetic behavior in the Korean clinical context. Methods: Forty-two faculty members and 67 residents participated in the two-round Delphi survey to arrive at a consensus regarding the conceptual framework of PE in 2019. To explore individual and external factors affecting physicians’ empathetic behavior, a Likert scale questionnaire based on an initial free-text response was administered to the same participants. Results: The conceptual framework of PE among Korean doctors consisted of basic communication skills and attitudes, cognitively understanding of patients’ thoughts and emotions, and communicating the doctors’ understandings to patients. Individual attributes and system- and patient-factors were revealed as influencing factors for PE in real practice. The former included communication ability, self-awareness and management, humanism, clinical competence, and good personality traits. Excessive workload, time constraints, aggressive attitudes, and negative preconceptions towards doctors were perceived as inhibiting or hindering empathy in patient care. Conclusion PE in the Korean clinical context comprised behavioral and cognitive components. Individual attributes, as well as external factors including system- and patient-factors were identified to affect PE in clinical settings. Further studies are needed to enhance the conceptual clarity of PE and identify how to promote doctors’ empathetic practice even in less favorable healthcare environments.

No abstract available.
Abscess* ; Thyroid Gland*

PURPOSE: The aims of this study were to explore the terms that patients preferred to be called during medical encounters and to provide a guideline about the proper use of appellations about patients in teaching medical students. METHODS: Patients were asked to select items from given examples to indicate how they wanted to be addressed by their doctors and how their doctors tended to address them. These terms were categorized into 3 groups; 1) terms that includes name, 2) "patient+honorific suffix, boon (hwanja- boon)", and 3) other general terms. The survey also included questions on patient's perception of the importance of terms of address in building a good doctor-patient relationship. The questionnaire was distributed to 440 out-patients of the three university affiliated hospitals in Seoul and Gyeonggi province from August to September 2007. RESULTS: Three hundred ninety-two respondents were analyzed after excluding 58 respondents who did not meet the study criteria. The ages of the respondents ranged from 18 to 80 years, and 56% of them were male. Most patients preferred to be called by the terms that includes their name (284, 72.4%) and the most preferred term was "family name (FN)+given name (GN)+honorific suffix, nim" (156, 39.8%), while doctors used the terms "patient+honorific suffix, boon" (188, 48.0%) most frequently. About 59% of respondents were addressed as they preferred. Patients in their 30s and 40s showed significantly higher perceptions of the importance of terms of address than other age groups (p= 0.0007). CONCLUSION: Patients preferred to be called by their full name with an honorific suffix; however, patients' preferences and doctors' usage were not in agreement in many cases. The results of this study suggest that doctors should pay more attention to the proper use of appellation during medical encounters. Furthermore, these results can be used to teach undergraduate medical students and guide physicians on how to address patients in practice.
Aniline Compounds ; Surveys and Questionnaires ; Humans ; Male ; Outpatients ; Physician-Patient Relations ; Students, Medical

PURPOSE: The purpose of this study was to describe the essential structure of the lived experience of working mothers' parenting burden in Korea. METHODS: Eight working mothers with young children were interviewed. The Colaizzi analysis of phenomenological research was applied. RESULTS: Seven theme clusters were extracted: a life with constant conflict, sense of guilt, feeling anxious because of lack of information about education for their children, social stigma as a deficient mother, family relationship becoming distant, a life being exhausted, day to day struggle. CONCLUSION: These results provide an opportunity to have a better understanding of the experiences of working mothers related to parenting their young children. It would also serve as a medium for the formulation of appropriate nursing intervention relevant to burdens of parenthood.
Child ; Family Relations ; Guilt ; Humans ; Korea ; Mothers ; Parenting ; Parents ; Social Stigma

Actinobacillus actinomycetemcomitans, a gram-negative, capnophiTic bacterium, is associated with several human diseases including periodontal disease. Products of A. actinomycetemcomitans exert immunomodulatory effects on various lymphoid populations, some of which may be implicated in the pathogenesis of periodontitis. It has been recently suggested that some of periodontopathic bacterial products might possess superantigenic (SAg) activities. In order to examine SAg activity of A. actinomycetemcomitans, we tried to purify immunomodulating factor (IMF) which can induce proliferation of mouse splenocytes and human PBMC. IMF fraction was obtained from the culture supernatant of A. actinomycetemcomitans by alcohol precipitation, ultrafiltration, size exclusion chromatography, and dye ligand affinity chromatography which has been widely used for the puri5cation of known SAgs. SDS-PAGE analysis showed that the factor migrated to a molecular mass of 40 kDa. The concentration of IMF which elicited maximal proliferative response of mouse splenocytes was ranged 1-10 ug/ml of protein on day 3 in culture. Human PBMC gave a similar response profile to IMF, but their maximal response was obtained by lower concentraion of IMF on day 2 in culture. This activity of IMF was heat and proteinase K sensitive and was not blocked by co-incubation with polymyxin B, a ligand for the lipid A region of lipopolysaccharide. T cell-enriched fraction of mouse splenocytes obtained by nylon wool column lost the response to IMF. Even though mitomycin C-treated antigen presenting cells were added to T cell-enriched fraction, the response to IMF was feeble as compared to unfractionated cells. Splenocytes depleted of T cells by anti-Thy 1.2 and complement also did not respond to IMF. These findings demonstrated that T cells are responsible for a minor proportion of the observed proliferation induced by IMF and the help of these cells are essential to the most of the proliferating cells which may be B cells. This observation was confirmed by flow cytometric analysis of responding lymphocyte subpopulations. These results indicate that IMF of A. actinomycetemcomitans does not act in a manner consistent with known SAgs but is more relevant to the explanation of pathologic findings of periodontal lesions.
Actinobacillus* ; Aggregatibacter actinomycetemcomitans* ; Animals ; Antigen-Presenting Cells ; B-Lymphocytes ; Chromatography, Affinity ; Chromatography, Gel ; Complement System Proteins ; Electrophoresis, Polyacrylamide Gel ; Endopeptidase K ; Hot Temperature ; Humans ; Interleukin-2* ; Lipid A ; Lymphocyte Subsets ; Lymphocytes* ; Mice ; Mitomycin ; Nylons ; Periodontal Diseases ; Periodontitis ; Polymyxin B ; T-Lymphocytes ; Ultrafiltration ; Wool

No abstract available.
Actinobacillus* ; Aggregatibacter actinomycetemcomitans* ; Apoptosis* ; Humans ; Jurkat Cells*