Aberrant left-sided pulmonary artery(pulmonary artery sling) is an uncommon anomaly, which may cause significant respiratory abnormality. We report a case of pulmonary artery sling which is combined with persistent left superior vena cava and dextrocardia. This case was identified by esophagogram and CT and confirmed by MRI and angiography. We consider that MRI is a valuable new method for the diagnosis of aberrant left-sided pulmonary artery.
Angiography ; Arteries ; Dextrocardia ; Diagnosis ; Magnetic Resonance Imaging ; Methods ; Pulmonary Artery* ; Vena Cava, Superior

Purpose: The study was examined to investigate the influence of nurse manager and peer group caring behaviors on organizational socialization and nursing performance Methods: The subjects were 286 clinical nurses from a general hospital in S city. The collected data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation and hierarchical regression analysis with the SPSS 25.0 program. Nurse manager and peer group caring behaviors, organizational socialization, and nursing performance were measured using organizational climate for caring scale, peer group caring interaction scale, organizational socialization and performance measurement scale for hospital nurses. Results There was no significant difference in organizational socialization between nurse manager and peer group caring behaviors. The significant predictors of nursing performance were position (β=-.26), nurse manager caring behaviors (β=.23), and peer group caring behaviors (β=.17). These variables explained 23% of the variance in nursing performance. Conclusion: The results suggest that it is necessary to increase both manager and peer group caring behaviors in order to improve nursing performance.

Between August 1994 and June 1995, seventeen patients diagnosed as having partial or complete ruptures of the anterior cruciate ligament on MRI were managed by non-operative methods. Among them four patients were excluded due to operation during follow-up and the results were evaluated at a one year follow-up. We selected the patients prospectively for non-operative care using the selection criteria of age, degree of instability, activity level and patient compliance. The average age of them was 37.7 years. Initially knee stress test and MRI were checked, and Cybex study and Lysholm knee scoring were done at post-trauma one year follow-up. They were managed conservatively by ROM and muscle strengthening exercises and a brace fitting schedule for three months. Among them, six cases had partial tears and seven had a complete tear initially. At the one year follow-up, five of six cases who had shown partial ruptures, and two of seven cases with complete tears, recovered continuity of the ruptured ACL on MRI. Their Lysholm knee score was 84.4, and the Cybex test showed no difference in muscle power between the injured and uninjuried side. Those patients who had loss of continuity on follow-up MRI showed Lysholm score of 57.4 and decreased muscle power on Cybex study. Although there are still controversies about the adequate management of ACL injuries, our study suggests that conservative management is a viable alternative to surgery as long as the patients are selected prudently. For more concrete results, however, careful analysis based on a longer follow up period is necessary.
Anterior Cruciate Ligament* ; Appointments and Schedules ; Braces ; Exercise ; Exercise Test ; Follow-Up Studies ; Humans ; Knee ; Magnetic Resonance Imaging ; Patient Compliance ; Patient Selection ; Prospective Studies ; Rupture*

OBJECTIVE: Acute appendicitis is one of the most urgent surgical problems. Several factors have been considered as predictors of perforation, but this study focused on the change in pain pattern. The degree of pain and progression of appendicitis were analyzed assuming that the pain intensity would increase until the perforation and the degree of pain would decrease immediately after the perforation occurred. METHODS: In this study, 385 out of 467 patients, who were diagnosed with appendicitis in a single institution and aged between 15 and 65 years, were reviewed retrospectively. The patients' pain scores and the diameters of appendices were analyzed along with the accompanying complications. Correlation analysis and a Student's t-test were performed. RESULTS: In patients with complicated appendicitis, the mean numerical rating scale (NRS) was slightly higher than that of simple appendicitis, but there was no significant difference in the absolute value. Only the size of the appendix showed meaningful differences according to the combined computed tomography findings. The NRS distribution or appendiceal size did not correlate with the time duration from symptom onset. CONCLUSION: The appendiceal size tended to increase with progressing appendicitis. No significant correlation was observed between the patient's pain level and complications. The time duration from symptom onset did not show a relationship with the progression of appendicitis.
Abdominal Pain ; Appendicitis* ; Appendix ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Pain Measurement ; Retrospective Studies

Thoracic fracture-dislocations reportedly lead to an 80% incidence of complete paraplegia. Thus, thoracic fracture-dislocations without cord injury are uncommon. There are a few cases of thoracic fracture-dislocations in which the neural sparing status was associated with separation of the posterior spinal structures, such as the pedicles and laminae. The authors experienced two cases of thoracic fracture-dislocations without spinal cord injury: one was a 50-year-old man who fell from the fourth floor of a building and sustained a T6-7 fracture-dislocation; and the other was a 43-year-old man who was involved in motorcycle accident and sustained a T12 fracture-dislocation. Segmental spinal instrumentation and fusion without open reduction was performed in each of the two cases and there has not been any abnormality detected on neurological examination at a minimum follow-up period of 2 years.
Adult ; Follow-Up Studies ; Humans ; Incidence ; Middle Aged ; Motorcycles ; Neurologic Examination ; Paraplegia ; Spinal Cord Injuries* ; Spinal Cord*

Umbilical vein varix has diverse clinical features and an unpredictable course during the pregnancy and/or perinatal period. We report a rare case of isolated fetal varix of the intra-abdominal umbilical vein, which was associated with fetal cardiomegaly. After birth, the umbilical vein varix remained with continuous blood flow through the patent ductus venosus. In addition, persistent cardiomegaly was complicated with an atrial septal defect.
Cardiomegaly ; Heart Septal Defects, Atrial* ; Parturition ; Pregnancy ; Prenatal Diagnosis ; Umbilical Veins* ; Varicose Veins*

Regional hub neonatal intensive care centers are opening supported by Ministry of Health and Welfare, with the need for more neonatal intensive care unit (NICU) beds response to increasing number of prematurity. Besides beds expansion, functional role of NICU is important and the evaluation tool of functional analysis of NICU is necessary. In this review, admission of preterm infant born before 32 gestational weeks was considered as a functional component and the annual number of those babies was used as an activity marker. The activity of NICU was higher with increased bed number, but also increased equipment, NICU personnel, obstetric personnel were independent factors for the higher NICU activity. Levels of NICU can be defined according to the activity, and reference bed size, equipment, personnel can be defined according to each level. In reverse, functional analysis of NICU can be performed with known bed size or equipment predicting activity level. Meanwhile, the evaluation of 13 regional hub NICU revealed that they partially contributed to the regionalization of NICU, and the activity was increased in all regional hub NICUs. Three regional hub NICUs showed markedly increased activity after opening, and those centers showed increased NICU personnel and obstetric personnel compared to other centers. In terms of regional hub government support, multilateral plan should be operated, besides simple bed size, considering distribution of different functional level of regional NICUs and leaking patient in the region.
Hospital Bed Capacity ; Humans ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal

PURPOSE: Staphylococcus aureus is a major cause of skin and soft tissue infections (SSTIs). This study aimed to determine the temporal trends in antibiotic susceptibility of S. aureus in SSTI patients aged <19 years.METHODS: This retrospective observational study was conducted in pediatric patients with SSTI caused by community-associated S. aureus. Microbiologic and demographic data were collected, and the trends of antibiotic susceptibility results were evaluated.RESULTS: From January 2010 to December 2018, a total of 807 S. aureus isolates were included. An overall increase in susceptibility of isolates to oxacillin was noted (P<0.001), with 75.0% of isolates being oxacillin-susceptible in 2018. S. aureus remained highly susceptible to trimethoprim/sulfamethoxazole and tetracycline, with 97.6% and 95.2% isolate susceptibility in 2018, respectively. Isolates from younger children aged 1 to 5 years had a significantly lower rate of susceptibility to oxacillin than older children aged 6 to 18 years (53.4% vs. 75.0%, P<0.001).CONCLUSIONS: The proportion of methicillin-resistant S. aureus isolates appears to decrease in pediatric patients with community-associated SSTI caused by S. aureus. Clinicians should be aware of regional susceptibility patterns when choosing empirical regimens.
Child ; Humans ; Methicillin Resistance ; Observational Study ; Oxacillin ; Retrospective Studies ; Skin ; Soft Tissue Infections ; Staphylococcal Skin Infections ; Staphylococcus aureus ; Staphylococcus ; Tetracycline

Background: : Radiation therapy, one of the strongest anti-cancer treatments, is already performed totreat primary glioblastoma; however, the effect of repeated radiation therapy for recurrent tumors has notbeen fully explored. The aim of this study was to determine the efficacy of re-irradiation in treating recurrentglioblastoma. Methods: : The study included 36 patients with recurrent glioblastoma treated with repeated radiationtherapy between 2002 and 2016. Stereotactic radiosurgery (SRS) and hypo-fractionated stereotacticradiotherapy (HSRT) were performed in these patients. Results: : Fourteen patients received SRS with a median dose of 25 Gy (range, 20-32 Gy) in1-5 fractions. Twenty-two patients received HSRT with a median dose of 40 Gy (range, 31.5-52 Gy) in6-20 fractions. There were six treatment-related grade 3 adverse events. Survival analysis showed thatre-irradiation significantly prolonged overall survival (OS) and progression-free survival (PFS). The medianOS and one-year OS rate after re-irradiation were 17.2 months and 60.4%, respectively. The medianPFS and 6-month PFS rate after re-irradiation were 4.4 months and 41.9%, respectively. Of the 36 patients,three survived without any progression in their condition. Conclusion : Re-irradiation for recurrent glioblastoma showed favorable outcomes. Radiation doseand fractionation should be carefully considered to minimize radiation necrosis.

PURPOSE: This study compared the performance for the prediction of three-level versus five level triage tool (Emergency Severity Index version 4, ESI) on the hospital outcome of emergency patients. METHODS: This was an observational study that included all patients >15-year-of-age visiting an urban tertiary hospital emergency department (ED) in Korea from July 2007 to December 2008. We collected data from the electronic medical records, which included demographic factors, hospital outcome including admission to intensive care unit (ICU) and hospital mortality, and result of triage at arrival to ED. A three-level triage tool was used in the first year (July 2007 to June 2008), divided in four 3-month periods (threelevel phase). For 5 weeks, the three-level tool and ESI were used simultaneously (test phase). For the last 4 months, ESI was used for triage (five-level phase). We described the demographic findings of each study phase and compared the performance for the prediction of admission to ICU as well as hospital mortality, using the area under the receiver operating characteristic curve (AUC). RESULTS: A total of 34,342 patients during three-level phase, 3,371 during the test phase, and 11,048 during five-level phase were involved. Demographic findings about gender, age, week and time of visiting to ED, use of ambulance service, injury or illness, and results after ED management were similar without significant difference. Proportion of admission to ICU and hospital mortality at ED and on the ward was 6.1% in period 1, 6.1% in period 2, and 5.6% in period 3 of the three-level phase, 5.8% in the test phase, and 5.8% in the five-level phase. The calculated AUC of the three periods in the three-level phase was 0.747 (95% Confidence Interval, CI, 0.729~0.765), 0.786 (95% CI, 0.769~0.804), and 0.786 (95% CI, 0.769~0.804). During the test phase, the AUC of the three-level was 0.820 (95% CI, 0.786~0.854) and that of the five-level was 0.842 (95% CI, 0.809~0.874). During five-level phase using ESI, AUC of ESI was 0.826 (95% CI, 0.809~0.844). CONCLUSION: ESI showed greater ability to predict hospital mortality than the three-level triage tool of emergency patients in a Korean ED, where the emergency care system and insurance coverage differs from North America.
Ambulances ; Area Under Curve ; Demography ; Electronic Health Records ; Emergencies ; Emergency Medical Services ; Hospital Mortality ; Humans ; Insurance Coverage ; Intensive Care Units ; Korea ; North America ; ROC Curve ; Tertiary Care Centers ; Triage