Septic shock is one of the leading cause of death in hospitalized patients and mortality rates of up to 50 % have been reported. Despite all efforts, no regimen today seems to be successful in the treatment of septic shock. The endogenous opioid system (EOS) includes three major families of peptides: dynorphins, endorphins and enkephalins. Several lines of evidence indicate that EOS is implicated in the pathophysiology of anaphylactic and endotoxic shock. An opioid receptor blocker naloxone has been used extensively in studies for the role of EOS or endogenous opiod peptides (EOP). However, there have been few, if any, detailed investigative studies regarding the effect of naloxone on TNF-a production and the lethality in response to endotoxin, and tumorigenesis. ...continue...
Carcinogenesis* ; Cause of Death ; Dynorphins ; Endorphins ; Enkephalins ; Humans ; Melanoma ; Mortality ; Naloxone* ; Nitric Oxide ; Peptides ; Receptors, Opioid* ; Shock, Septic*

Purpose: The purpose of this qualitative study is to explore the changed parenting experiences of mothers of elementary school kids living in the aftermath of the COVID-19 outbreak in Korea. Methods: From July to August in 2020, 10 mothers parenting elementary school students under the COVID-19 were interviewed in depth. For data analysis, a phenomenological research methodology suggested by Colaizzi was used. Results: According to the analysis, the experiences of mothers consisted of four categories: the ‘pain from the uncontrollable COVID-19’, ‘the problem of family relations due to the COVID-19 pandemic situation’, ‘standing firm against the drastic changes’, and ‘accepting the world changed by the COVID-19’. Conclusion The findings in this study vividly represent the parenting experiences of mothers of elementary school students after the outbreak of COVID-19. As the pandemic persists, mothers parenting elementary school students feel complex emotions and experience exhaustion, but in the process, they found family members growing positively and trying to adjust to each other to overcome the crisis. To support positive adaptation to catastrophic situations, an institutional and political foundation is needed to develop a systematic crisis management program customized for mothers and families of elementary school students. The results of this study can be used as basic data when establishing national policies and support systems so that mothers parenting elementary school students can better adapt to and overcome crisis situations.

Thoracic aortic aneurysm (TAA) is the most common pathology of the thoracic aorta. The incidence of TAA is increasing and the true incidence of TAA is likely to be higher than currently reported because of its inherently silent nature. TAAs are an increasingly recognized condition that is diagnosed incidentally on imaging studies performed to evaluate unrelated conditions because most patients with TAA have no symptoms. TAAs normally grow in an indolent manner, but can become rapidly lethal once dissection or rupture occurs. Indeed, aortic aneurysms (both abdominal and thoracic) represent the 15th leading cause of death in individuals older than 55 years, and the 19th leading cause of death in individuals of all ages in the United States. The etiologies underlying TAAs are diverse. Therefore, the evaluation and management of TAAs are complex. The present review summarizes the knowledge of the pathophysiology, natural history and diagnostic modalities, as well as current treatment strategies of TAA on the basis of current literature.
Aorta, Thoracic ; Aortic Aneurysm ; Aortic Aneurysm, Thoracic* ; Cause of Death ; Diagnosis* ; Humans ; Incidence ; Natural History ; Pathology ; Prognosis ; Rupture ; United States

BACKGROUND : A discussion of the chronologic trends of operative indications of breast masses for proper management of breast masses is desirable. METHODS : A retrospective analysis of 882 patients with breast masses who underwent operations at Kangnam General Hospital from January 1986 to December 1997 was done. All the lesions were classified according to for age, size of the mass, and the pathologic result. Concurrently, the distributions of the different masses were retrospectively analyzed for each one-year time period. RESULTS : The most prevalent age group was the third decade (28.6%) followed by the fourth decade (25.3%) and the fifth decade (24.4%). The most common lesion was fibroadenoma (38.7%), followed by mammary dysplasia (22.6%) and malignancy (18.3%). In fibroadenoma, the most common pathologic type was intracanalicular (34.9%), and the juvenile type occurred in significantly younger patients compared to other types (19.2 vs 29.2 years of age). In mammary dysplasia, the most common pathologic type was fibrous (74.4%), and the epithelial hyperplasia and adenosis types were occurred in older patients compared to the other types (39.1 and 41.0 vs 33.5 and 35.4 years of age). As the chronologically changing pattern of the pathologic types, the number of mammary dysplasia had a decreasing tendency and fibroadenoma had a relatively increasing one, and the reason may be the effect of fine-needle aspiration cytology. CONCLUSIONS : The result of this study shows that the distribution of the disease in terms of age and frequency is almost the same as that of other reported results. The trend of the disease types in terms of the time period shows that the operation rate for fibroadenomas is increasing while the rate for mammary dysplasia is decreasing. This tendency might come from the decreasing use of surgical biopsy for mammary dysplasia.
Biopsy* ; Biopsy, Fine-Needle ; Breast* ; Fibroadenoma ; Fibrocystic Breast Disease ; Hospitals, General ; Humans ; Hyperplasia ; Retrospective Studies

No abstract available.
Female ; Pregnancy ; Pregnancy, Ectopic*

Background: This study aimed to investigate perceptions of Clostridioides difficile infection (CDI) diagnostic tests among physicians who prescribe CDI diagnostic tests as part of providing direct patient care. Methods: In August 2018, we provided a 12-question survey of gastroenterologists (the most common referral source for CDI testing) to 35 medical institutions in Korea, asking them about their perceptions of CDI diagnosis and testing. Results: A comparison of the perceptions of physicians and clinical pathologists (CPs) found that physicians had a lower perceived sensitivity of the toxin AB enzyme immunoassay test. For nucleic acid amplification tests, physicians exhibited a perception of higher assay sensitivity and specificity than CPs. The specificity of culture tests was generally perceived as high by physicians, whereas CPs regarding expressed mixed opinions. All but one physician and one CPs found the algorithmic test useful. Concerning the CDI isolation criteria, physicians commenced patient isolation by concurrently assessing both test results and clinical symptoms, rather than exclusively relying upon test results. Among CPs, 84.6% said they could rely on symptoms to determine when to release a patient from isolation, while 46.2% of physicians said they would rely on test results. Conclusion This study provides useful information on the status of laboratory diagnosis of CDI in Korea and what needs to be improved, which will help to standardize and improve laboratory diagnosis of CDI in Korea.

Nearly 80% of patients with Crohn's disease (CD) require surgical treatment for complications or failure of medical management. We managed a 31-year-old man with CD who presented with a post-operative fistula. The patient had undergone surgery due to multiple strictures and a fistula. However, a new fistula developed that connected to the intraperitoneal abscess. Intravenous antibiotics were started and multiple percutaneous drainage tubes were inserted to treat the abdominal abscess. However, the amount of drainage was consistently high, even one month after the operation. To treat the postoperative fistula, 5 mg/kg of infliximab was started, and the amount of drainage decreased dramatically to less than 10 cc a day. Some studies have reported that infliximab decreases the recurrence of CD after surgery. The effect of infliximab on post-operative fistulas in patients with CD has not been sufficiently studied. Our results indicated that the use of infliximab to treat post-operative fistula should be explored further in future clinical studies.
Abdominal Abscess ; Abscess ; Adult ; Anti-Bacterial Agents ; Constriction, Pathologic ; Crohn Disease* ; Drainage ; Fistula* ; Humans ; Infliximab ; Recurrence

Central serous chorioretinopathy (CSCR) is an idiopathic disorder characterized by serous detachment of the macula and retinal pigment epithelial (RPE) detachment. Its etiology and pathophysiology are still unknown. However, CSCR can arise secondary to chronic treatment with steroids. We present two cases in which CSCR developed in patients on oral steroid therapy and resolved after treatment was stopped. We also offer a review of the literature.
Central Serous Chorioretinopathy ; Glomerulonephritis ; Humans ; Retinaldehyde ; Steroids

BACKGROUND/AIMS: Endoscopic mucosal resection (EMR) has been known as a method of local treatment for early gastric cancer (EGC) or gastric adenoma. The purpose of this study was to identify the factors affecting complete resection rate (CRR) of EMR and to identify histological discrepancy between endoscopic biopsy and the resected specimen obtained by EMR. METHODS: Forty four gastric adenomas and twenty seven EGCs in 63 patients were treated by EMR from January, 1999 until August, 2002. We analysed the factors affecting CRR on the basis of location, macroscopic type, size, piecemeal resection, and EMR methods. RESULTS: The CRR in antrum was 72%. The CRR of the method using endoscopic resection with hypertonic saline-epinephrine solution, injection, precutting and snaring (ER-HSE) was 78%. The CRR according to en bloc resection was 77%. Sixty six percents of histological coincidence was noted between the endoscopic biopsy and the resected specimen of gastric adenoma. CONCLUSIONS: In this study, the CRR of the ER-HSE method and the lesion located in antrum is higher than that other groups. Gastric adenoma should be removed by EMR because of histologic discrepancy between the endoscopic biopsy and the resected specimen.
Adenoma* ; Biopsy* ; Humans ; SNARE Proteins ; Stomach Neoplasms*

Protothecosis is an unusual human infection caused by the achlorophyllic algae Prototheca, and most commonly by Prototheca wickerhamii. A 65-year-old man presented with a 2-month history of a painful, erythematous, non-healing, ulcerative plaque on the extensor surface of his left forearm. He was previously diagnosed with diabetes and iatrogenic Cushing syndrome. A skin biopsy specimen revealed characteristic morula-like sporangia in the dermis by PAS positive staining. Prototheca wickerhamii was identified by culture and biochemical studies. Initially, itraconazole was administered for 8 weeks, followed by fluconazole, and the patient's condition was greatly improved.
Aged ; Biopsy ; Cushing Syndrome ; Dermis ; Fluconazole ; Forearm ; Humans ; Itraconazole ; Prototheca ; Skin ; Sporangia ; Ulcer