Primary or metastatic malignant melanoma can mimic benign blue nevus in rare cases, making the diagnosis challenging. Herein, we report an exceptionally rare case of blue nevus-like melanoma and its blue nevus-like metastasis which was detected by catheterized urine cytology. The patient presented with blue-colored papuloplaques on his temple which were diagnosed as blue nevus-like melanoma on punch biopsies. While he was admitted for administration of chemotherapy, hematuria was detected. Catheterized urine cytology revealed singly scattered oval to spindle-shaped pigmented cells with a moderate degree of variation in shape and size. Many of them had small nuclei with indiscernible to inconspicuous nucleoli while only a few cells showed nuclear enlargement and nuclear hyperchromasia, which could be diagnostic pitfalls. Most of the cells on the smear were positive for HMB45 immunostaining, which confirmed the diagnosis of metastatic blue nevus-like melanoma. To the best of our knowledge, the present case is the first report describing cytomorphologic findings of blue nevus-like metastasis of melanoma in the urine specimen.
Biopsy ; Catheters* ; Diagnosis ; Drug Therapy ; Hematuria ; Humans ; Melanoma* ; Neoplasm Metastasis ; Nevus, Blue

The causes of sudden death after medullary infarction involve arrhythmia, central respiratory failure, and dysautonomia. Sudden cardiac arrest in a medullary infarction is uncommon. Most of these cases experienced sudden cardiopulmonary arrest within 2 weeks from stroke onset as the extent of lesion increased. Here, we report two cases of medullary infarction presenting as sudden cardiac arrest. These cases indicate that medullary infarction could be one of the causes of sudden cardiac arrest.
Arrhythmias, Cardiac ; Death, Sudden ; Death, Sudden, Cardiac ; Heart Arrest ; Infarction ; Medulla Oblongata ; Primary Dysautonomias ; Respiratory Insufficiency ; Stroke

BACKGROUND: Compared with other chronic diseases, hearing loss is generally overlooked from the perspective of disease burden. However, hearing loss is emerging as an important issue in the current society. The objective of this study was to investigate disease burdens and marginal utilities associated with hearing loss and other chronic diseases. METHODS: This study analyzed the cross-sectional data of 32,986 participants aged 19 years and older who completed the Korea National Health and Nutrition Examination Surveys between 2009 and 2013. Additionally, this study used the pure tone audiometric test, European Quality of Life-Five Dimensions Questionnaire, and chronic disease status. The data were analyzed using a multiple linear regression method. RESULTS: The data of 23,297 people who underwent a pure tone audiogram and completed the European Quality of Life-Five Dimensions Questionnaire were used in this analysis. The marginal utility of hearing loss ranked fifth among nine chronic diseases. The estimated loss of quality-adjusted life years associated with hearing loss was −93.69 years per 100,000 people, which is similar to other chronic diseases. CONCLUSION: This study assessed the marginal utilities and public burdens of hearing loss and eight chronic diseases in a South Korean population. Although the values may vary depending on country and race, this study may provide an indispensable foundation for more detailed studies on hearing loss.
Chronic Disease* ; Continental Population Groups ; Hearing Loss* ; Hearing* ; Humans ; Korea ; Linear Models ; Methods ; Quality-Adjusted Life Years

BACKGROUND: The differential diagnosis of psoriasis and seborrheic dermatitis can be difficult when both conditions are localized to the scalp without the involvement of other skin sites. OBJECTIVE: We aimed to evaluate the histopathological differences between psoriasis and seborrheic dermatitis on the scalp and identify favorable criteria for their differential diagnosis. METHODS: We evaluated 15 cases of psoriasis and 20 cases of seborrheic dermatitis of the scalp that had been clinicopathologically diagnosed. Skin biopsy sections stained with H&E were examined. Additional immunohistochemistry was performed, including Ki-67, keratin 10, caspase-5, and GLUT-1. RESULTS: On histopathological examination, mounds of parakeratosis with neutrophils, spongiform micropustules of Kogoj, and clubbed and evenly elongated rete ridges were significantly more frequently observed in psoriasis. Follicular plugging, shoulder parakeratosis and prominent lymphocytic exocytosis were significantly more common in seborrheic dermatitis. Moreover, significantly higher mitotic figures were observed in psoriatic lesions than in seborrheic dermatitis. Immunohistochemistry did not show any difference between psoriasis and seborrheic dermatitis. CONCLUSION: Histopathological features favoring psoriasis include mounds of parakeratosis with neutrophils, spongiform micropustules of Kogoj, clubbed and evenly elongated rete ridges, and increased mitotic figures (≥6/high-powered field). Features indicating seborrheic dermatitis are follicular plugging, shoulder parakeratosis and prominent lymphocytic exocytosis. Immunohistochemistry was not helpful in differentiating psoriasis from seborrheic dermatitis.
Biopsy ; Dermatitis, Seborrheic* ; Diagnosis, Differential* ; Exocytosis ; Immunohistochemistry ; Keratin-10 ; Neutrophils ; Parakeratosis ; Psoriasis* ; Scalp* ; Shoulder ; Skin

Fitz-Hugh-Curtis syndrome is an extrapelvic manifestation of PID. It is associated with right upper quadrant pain that likely results from the inflammation of liver capsule and diaphragm. The liver capsule becomes involved with inflammatory exudates that later forms violin string adhesion between two liver capsule and adjacent diaphragm or peritoneum. Previously, Neisseria gonorrhea was thought to be the only etiological agent, but recent studies have reported cases of Fitz-Hugh-Curtis syndrome due to Chlamydia trachomatis infection. 15 to 30 percents of women with PID develop symptom of Fitz-Hugh-Curtis syndrome. It is often mistakenly diagnosed as either pneumonia or acute cholecystitis. Laparoscopy may be the definitive method in diagnosis of Fitz-Hugh-Curtis syndrome. However, we have experienced one cases of Fitz-Hugh-Curtis syndrome, which was diagnosed preoperative by pelvic CT imaging and report with the brief review of the literatures.
Chlamydia trachomatis ; Cholecystitis, Acute ; Diagnosis ; Diaphragm ; Exudates and Transudates ; Female ; Gonorrhea ; Humans ; Inflammation ; Laparoscopy* ; Liver ; Neisseria ; Peritoneum ; Pneumonia

PURPOSE: The purpose of this study was to investigate the effects of emotional labor, emotional intelligence and social support on job stress in clinical nurses. METHODS: Participants were 123 clinical nurses and data were collected from October to December, 2011 and analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficients and multiple regression with SPSS 18.0. RESULTS: A positive correlation was found between job stress and emotional labor. Emotional labor showed a significant negative correlation with emotional intelligence and social support, whereas a positive correlation was found between emotional intelligence and social support. The strongest predictor of job stress was emotional labor. In addition, institution satisfaction (dissatisfaction) and the reason for selecting the job (opportunities for service) accounted for 21% of variance in job stress. CONCLUSION: The results of this study suggest that it is important to manage emotional labor as well as to improve job satisfaction in order to reduce job stress in clinical nurses.
Emotional Intelligence ; Job Satisfaction

Nocardiosis is a rare opportunistic bacterial infection. The majority of nocardial infections are acquired through inhalation and smaller numbers of cutaneous nocardiosis are caused by traumatic inoculation of organisms percutaneously. We experienced a patient with lung cancer that developed a primary cutaneous nocardiosis. A 57-year-old man was admitted to the Samsung Medical Center because of a painful swelling lesion of the right foot that developed 3 weeks prior. Three months prior, the patient had been diagnosed with a non-small cell lung cancer, and then underwent palliative bronchial stent insertion, radiation therapy and corticosteroid treatment for an obstructive endobronchial lesion. Incision and drainage was performed as magnetic resonance imaging (MRI) of the foot showed an abscess cavity. Nocardia was isolated from the pus. The antibiotic therapy was changed to oral trimethoprim/ sulfamethoxazole (TMP/SMX) treatment. The skin lesion was improving and the patient was discharged 20 days later. TMP/SMX was continued for a total of three months. The patient has been in good health and the skin lesion had completely healed two months after discharge.
Abscess ; Bacterial Infections ; Carcinoma, Non-Small-Cell Lung ; Drainage ; Foot ; Humans ; Inhalation ; Lung Neoplasms* ; Lung* ; Magnetic Resonance Imaging ; Middle Aged ; Nocardia ; Nocardia Infections* ; Skin ; Stents ; Sulfamethoxazole ; Suppuration

OBJECTIVE: The incidence of idiopathic thrombocytopenic purpura (ITP) is greatest in female during their childbearing years, so the concurrence of pregnancy and ITP is not unusual. Numerous studies have examined the outcomes of newborns, whereas fewer studies have been conducted with regard to the morbidity of obstetric patients with ITP. This study was aimed to find the outcome of pregnancy combined with ITP and the influence of the pregnancy on the severity of this disease. METHODS: From January 1996 to December 2005, a total of 62 pregnant women with ITP and their 73 deliveries were recruited for the study. Among them, 38 were diagnosed with ITP during pregnancy and the other 24 had pre-existing ITP before pregnancy. RESULTS: The severity of thrombocytopenia was exacerbated during pregnancy, but recovered to a level of non-pregnant period after delivery in most cases. The outcome of pregnancy of all the patients was uneventful except each one case of fetal demise at 35 gestational weeks and preterm delivery at 30 gestational weeks. One patient suffered from multiple subdural hemorrhage during pregnancy, which was spontaneouly recovered. Twenty newborns (27.8%) had transient congenital thrombocytopenia and 18 of them required treatment for hemostatic impairment. CONCLUSION: For women with ITP, Pregnancy can affect the severity of ITP, but life-threatening complication was almost lacking. Although, in not a few cases, there may need to treat both mothers and infants to raise their platelet counts, most mothers with ITP can proceed with their pregnancies and delivery healthy infant without complication.
Female ; Hematoma, Subdural ; Humans ; Incidence ; Infant ; Infant, Newborn ; Mothers ; Platelet Count ; Pregnancy* ; Pregnant Women ; Purpura* ; Purpura, Thrombocytopenic, Idiopathic ; Thrombocytopenia* ; Thrombocytopenia, Neonatal Alloimmune

BACKGROUND: Biomedical products such as viral vaccines can be contaminated with hazardous viruses during manufacturing processes and storage, thus causing harmful side effects. To assure the safety of biomedical products, highly effective and sensitive methods should be available to detect contaminating viruses. In this study, we performed recovery tests to determine the limit of detection of HIV-1. METHODS: An HIV-1 plasmid preparation was serially diluted and spiked into various culture media (DMEM, RPMI-1640, IMDM, GICM, and SDM) containing 10% fetal bovine serum (FBS). The HIV-1 plasmid was detected by PCR alone or a combination of PCR and ELISA (PCR/ELISA). RESULTS: When spiked into DMEM, RPMI, and IMDM, less than 4x10(-2) ng of HIV-1 plasmid was not detectable as HIV-1 PCR products in agarose gel. Intra- and inter-assays (n=6) showed that the PCR-ELISA system could detect PCR products diluted as much as 1, 875 times from HIV-1 plasmid serially spiked in various media. CONCLUSIONS: The PCR/ELISA system can be useful for the detection of trace amounts of hazardous viruses which may be present as contaminants in biological products.
Biological Products ; Culture Media ; Enzyme-Linked Immunosorbent Assay ; HIV-1* ; Limit of Detection ; Plasmids ; Polymerase Chain Reaction ; Sepharose ; Viral Vaccines

Among chemotherapeutic regimens used for advanced ovarian cancer, platinum-based combination chemotherapy remains a mainstay of the treatment of advanced ovarian cancer, providing significant response rates and survival benefits. However, with widespread use of long-term chemotherapy in treating ovarian cancer, emergence of secondary leukemia has become medical concern as one of the most unfavorable late complications. Depending upon the type, duration, and dosage of previous chemotherapy, the risk of developing acute myeloid leukemia has been estimated to be between 2% and 10%. Moreover, the frequency of this complication might increase as the survival in patients with ovarian cancer undergoing chemotherapy continues to increase with developing therapeutic options. Recently, we experienced a case of secondary acute myeloid leukemia developing 3.5 years after platinum-based chemotherapy. In this report, clinical course of the patient and contributing factors for the secondary leukemia were presented.
Drug Therapy* ; Drug Therapy, Combination ; Humans ; Leukemia ; Leukemia, Myeloid, Acute* ; Ovarian Neoplasms* ; Platinum*