Primary sclerosing cholangitis is a chronic disease of unknown cause, characterized by inflammation and fibrosis of the biliary tree with diffuse multifocal stricture formation. With increasing knowledge of primary sclerosing cholangitis, it is now recognized that in the setting of inflammatory bowel disease, cholangiocarcinoma is a complication of primary sclerosing cholangitis. We recently experienced a case of 41 year old female patient who had Crohns disease associated with primary sclerosing cholangitis and cholangioearcinoma. We report a case of primary sclerosing cholangitis with cholangiocarcinoma with literature review.
Adult ; Biliary Tract* ; Cholangiocarcinoma* ; Cholangitis, Sclerosing* ; Chronic Disease ; Constriction, Pathologic ; Crohn Disease ; Female ; Fibrosis ; Humans ; Inflammation ; Inflammatory Bowel Diseases ; Pancreas*

We present a case of this distinctive variety of malignant lymphoma, which was diagnosed in the axillary lymph nodes of a 66-year-old woman. The patient was admitted to the GS department due to palpable mass on the right axillary area for two months. A 2 x 1 cm sized mass was also palpated on the cervical area. The laboratory and radiologic findings were unremarkable. Axillary dissection was done under the impression of metastatic carcinoma from breast. Received lymph nodes were multiple and variable in size, ranging from 0.5 cm to 5.0 cm in diameter. Histologically, the lymph nodes were partly effaced and involved by nodular and diffuse infiltrations of large lymphoid cells in the subcapsular and medullary sinuses. In diffuse areas, typical starry-sky pattern was seen. Immunohistochemically, the tumor cells were negative for broad-spectrum keratin, but positive for leukocyte antigen, ML, and B cell markers, L26, and 4KB5. T cell marker. UCHL1 was negative. On staining with histiocytic marker, Mac387 antibody, the tingible-body macrophages were only positive. Interstitial plasma cells and some of the tumor cells were positive for lambda light chain. Electron microscopic study, which was done on paraffin embedded tissue showed lymphoid-type of nuclei without cellular junction suggestive for carcinoma.
Female ; Humans ; Neoplasm Metastasis

Improving mental health and reducing the burden of mental illness are complementary strategies which, along with the treatment and rehabilitation of people with mental disorders, significantly improve population health and well-being. A Institute of Medicine report describes a range of interventions for mental disorders that included treatment and maintenance, reserving the term "prevention" for efforts that occur before onset of a diagnosable disorder. Mental health problems affect 10-20% of children and adolescents worldwide. Despite their relevance as a leading cause of health-related disability and their long lasting consequences, the mental health needs of children and adolescents are neglected. Early intervention can help reduce the significant impacts that children and adolescents with serious mental health problems may experience. Screening is the first step in early intervention, recognizing emotional and behavioral problems and providing help at an early stage. It is essential to implement early intervention in a sensitive and ethical manner to avoid any of the negative outcomes.
Adolescent* ; Child* ; Early Intervention (Education) ; Humans ; Institute of Medicine (U.S.) ; Mass Screening ; Mental Disorders ; Mental Health* ; Primary Prevention ; Rehabilitation ; Resin Cements

PURPOSE: The purpose of this study was to identify an influence of self-esteem and family- support on powerlessness of hospitalized elderly patients with chronic disease. METHOD: The subjects were 151 hospitalized elderly patients, age over 60, with chronic disease and admitted for at least 1 week. The data were collected by individual interview using a tructured questionnaire during the period from July 10th to August l0th, 2003 from three general hospitals in Busan. The data were analyzed by descriptive statistics, t-test, ANOVA, Pearson's correlation, hierarchical multiple regression. RESULT: The level of self-esteem, family support, and powerlessness was 38.00, 38.26, and 38.38, respectively. There was a significant positive correlation between self-esteem and family support and a negative correlation between self-esteem and powerlessness and between family support and powerlessness. Self-esteem and family support were each significant predictor of powerlessness. CONCLUSION: This study showed the hospitalized elderly patients need greater family-support and higher self-esteem to relieve the level of powerlessness. I suggest to study for replication in a larger sample size and considering the lengths of hospitalization for generalization of this study and to develop individual intervention programs for increasing family support and self esteem and testify their effects on the relief of powerlessness of the elderly.
Aged* ; Busan ; Chronic Disease* ; Generalization (Psychology) ; Hospitalization ; Hospitals, General ; Humans ; Sample Size ; Self Concept ; Surveys and Questionnaires

This study was conducted to estimate the prevalence of antimicrobial prescribing for acute upper respiratory tract infections (URI) among pediatric outpatients and to identify the national patterns of its use from 2009 to 2011 in Korea. Using National Patients Sample database from 2009 to 2011, we estimated the frequency of antibiotics prescribing for URI in pediatric outpatients with diagnoses of acute nasopharyngitis (common cold), acute sinusitis, acute pharyngitis, acute tonsillitis, acute laryngitis/tracheitis, acute obstructive laryngitis/epiglottitis, and acute upper respiratory infections of multiple and unspecified sites. The proportions of each antibiotic class were calculated by year and absolute and relative differences were estimated. Also, we investigated daily amount of prescribed antibiotics per defined population according to the type of medical care institution, physician specialty, and geographic region. The overall antibiotic prescribing proportion was 58.7% and its annual proportion slightly decreased (55.4% in 2011 vs. 60.5% in 2009; adjusted odds ratio, 0.82; 95% confidence interval, 0.82-0.83). Variations by the type of medical care institution were observed. Tertiary hospitals (45.0%) were less likely to prescribe antibiotics than primary care clinics (59.4%), hospitals (59.0%), and general hospitals (61.2%); they showed different tendencies in choosing antibiotics. Variations by physician specialty and region were also observed. Prevalence of antimicrobial prescribing for pediatric URI is still considered higher than that of western countries and varies by the type of medical care institution, physician specialty, and geographic region.
Acute Disease ; Anti-Bacterial Agents/*therapeutic use ; Databases, Factual ; Drug Prescriptions/*statistics & numerical data ; Hospitals ; Humans ; Odds Ratio ; Physicians/trends ; Practice Patterns, Physicians' ; Republic of Korea ; Respiratory Tract Infections/*drug therapy

Children with chronic illness are known to have an increased risk of emotional and behavioral problems. Many studies have been conducted to identify risk and resistance factors associated with differences in adjustment among these children. It is a major theoretical framework of the Wallander and Varni model that modifiable risk and resistance factors can be identified empirically. Risk factors in the original model include disease/ disability parameters, functional dependence in the activities of daily living, and psychosocial stressors. Resistance factors in the original model are delineated in three categories: intrapersonal factors such as competence, temperament; socialecological factors such as family psychological environment, social support; and stressprocessing factors such as cognitive appraisal and coping strategies. In addition, it is proposed that the factors such as age of onset, certainty of diagnosis and prognosis of illness affect adjustment. Children with chronic illness are known to have an increased risk of emotional, behavioral, academic problems. Research findings show that children with chronic illnesses are at a higher risk for developing emotional problems such as anxiety, depression, social withdrawal and low self-esteem. The parents of children with Type 1 diabetes and asthma reported emotional and behavioral problems more. Also children with chronic illness tend to more behavior problems than healthy peers. Especially, increased risk of children with neurological conditions is explained by the lower level of cognitive functioning. The association of poor school performance with type I diabetes and sickle cell anemia is proposed.
Activities of Daily Living ; Affective Symptoms ; Age of Onset ; Anemia, Sickle Cell ; Anxiety ; Asthma ; Behavioral Symptoms ; Child ; Chronic Disease ; Depression ; Humans ; Mental Competency ; Parents ; Prognosis ; R Factors ; Risk Factors ; Social Environment

Congenital coronary arteriovenous fistula is a rare condition which is an abnormal communication of the coronary artery with the right ventricle, right atrium, left atrium or left ventricle. Coronary artery aneurysm is an uncommon disease which is defined as coronary dilatation which exceeds the diameter of normal adjacent segments or the diameter of the patient's largest coronary vessel by 1.5 times. In young ages, symptoms are unusual, but significant symptoms and complications such as congestive heart failure, subacute bacterial endocarditis, coronary steal syndrome, aneurysm formation, rupture, and pulmonary hypertension may appear among the older age group. We report a case of giant aneurysm of a congenital coronary arteriovenous fistula between left co-ronary artery and right ventricular outflow tract with significant left to right shunt confirmed in a 84-year old female with a brief review of literature.
Aged, 80 and over ; Aneurysm* ; Arteries ; Arteriovenous Fistula* ; Coronary Aneurysm ; Coronary Vessels* ; Dilatation ; Endocarditis, Subacute Bacterial ; Female ; Heart Atria ; Heart Failure ; Heart Ventricles ; Humans ; Hypertension, Pulmonary ; Rupture

BACKGROUND: There have been few studies about pain using a big data. The purpose of this study was to identify the prevalence of pain, and trends of pain associated with chronic diseases and personal out-of-pocket medical expenditures over time. METHODS: Subjects were 58,151 individuals, using the Korea Health Panel from 2009 to 2013. Chi-square and multinomial logistic regression were conducted to identify the prevalence and odds ratios (ORs) of pain. Repeated measures ANOVA was used to find the trend over these 5 years. RESULTS: Prevalence of mild and severe pain was 28.1% and 1.7% respectively. The ORs of mild and severe pain were 1.6 and 1.4 in females compared with males. From 2009 to 2013, numbers of chronic diseases producing mild pain were 2.1, 2.4, 2.8, 2.9, and 3.1 and those producing severe pain were 3.0, 3.4, 3.9, 4.2, and 4.4, respectively. After applying the average South Korean inflation rate by year over 5 years, the annual, personal out-of-pocket medical expenditures (unit: ￦1,000) for mild pain were 322, 349, 379, 420, and 461, and those for severe pain were 331, 399, 504, 546, and 569, respectively (P < 0.0001). CONCLUSIONS: The pain prevalence was 29.8%. The numbers of chronic diseases and the personal out-of-pocket medical expenditures revealed increasing trends annually, especially in those with pain. Therefore, to eliminate and alleviate the pain, there needs to be further study for developing a systemic approach.
Chronic Disease* ; Female ; Financing, Personal ; Health Expenditures* ; Humans ; Inflation, Economic ; Korea* ; Logistic Models ; Male ; Odds Ratio ; Prevalence*

PURPOSE: The purpose of this study was to identify accidental mortality during school activities of students in elementary, middle or high school in Seoul and consequent compensation payment. METHODS: Fifty-eight students died due to accidents during the period 1988 through 2007. Data were obtained from the Seoul School Safety and Insurance Association, and Seoul Metropolitan Office of Education. Chi-square, t test, and ANCOVA were used in the data analysis. RESULTS: Among students, 75.9% were male and 37.9% were high school students. Accidental mortality was 1.61 per one million students (2.33 for male, and 0.82 for female students, and 0.93, 2.13 and 2.31 for elementary, middle and high school students, respectively). Mortality caused by drowning and falls per one million student was 0.85 and 0.74 for male, and 0.23 and 0.35 for female students. After age, year and cause were adjusted using ANCOVA, the mean compensation payment was 40,615 thousand won for male, and 62,000 thousands for female students. Highest compensation payment was 127,137 thousand for cerebral concussion after age, gender, year and cause were adjusted. CONCLUSION: To decrease student accidental mortality, especially drowning and falls, development of efficient safety-enforcing education is essential to prevent injuries and avoid preventable compensation costs.
Accidents/history/*mortality ; Adolescent ; Age Factors ; Child ; *Compensation and Redress ; Female ; History, 20th Century ; History, 21st Century ; Humans ; Male ; Republic of Korea ; Schools ; Sex Factors ; Students/*statistics & numerical data

We reviewed eight solitary fibrous tumors occurring at sites other than pleura (three orbit, two retroperitoneum, one each hard palate, thyroid, and tongue) which shared the histologic and immunohistochemical features of solitary fibrous tumors of pleura. Six patients were women, and two were men, aged from 26 to 74 years. The tumors ranging from 1.5 to 19 cm in diameter presented as well-circumscribed, unencapsulated, soft to rubbery tissue masses. Histologically they were characterized by a proliferation of spindle or ovoid cells intervened by a dense bundles of collagen. A variety of growth patterns was identified but the so-called patternless pattern was the predominant one. One tumor exhibited highly cellular sarcomatous areas with extensive necrosis, which was diagnosed as malignant solitary fibrous tumor. Immunohistochemical studies showed that all of the tumors were strongly positive for both CD34 and vimentin, but negative for cytokeratin, S-100 protein, EMA, and desmin. One case examined ultrastructurally showed features of fibroblast. All but one showed no evidence of recurrence or metastasis over follow-up period of 14 to 32 months. We conclude that extrapleural solitary fibrous tumors represent a distinct mesenchymal tumor with variable histologic features and should be differentiated from other spindle cell mesenchymal tumors.
Collagen ; Desmin ; Female ; Fibroblasts ; Follow-Up Studies ; Humans ; Keratins ; Male ; Necrosis ; Neoplasm Metastasis ; Orbit ; Palate, Hard ; Pleura ; Recurrence ; S100 Proteins ; Solitary Fibrous Tumors* ; Thyroid Gland ; Vimentin