PURPOSE: The purpose of this study is to verify the factors that determines burnout of nurses in emergency department. METHODS: The survey was given to 170 ED nurses which are located in Busan from July 1st to August 31st of 2012. The results were analyzed by descriptive statistics, t-test, ANOVA, pearson correlation coefficients and stepwise multiple regression using SAS 9.2 program. RESULTS: There were statistically significant differences in burnout depending on gender, position, workplace satisfaction, job satisfaction. Significant positive correlation between compassion fatigue and burnout was found. Also significant negative correlation was found between self-esteem, compassion satisfaction and burnout. Factors influencing burnout were self-esteem, compassion satisfaction and compassion fatigue with R2 value 58.0%. CONCLUSION: Considering these results, it seems that great efforts will be needed for reducing burnout by mitigating the emergency nurses' compassion fatigue and introducing programs to increase the self-esteem and compassion satisfaction.
Busan ; Emergencies ; Emergency Service, Hospital* ; Empathy* ; Fatigue* ; Job Satisfaction

It is important to maintain normal calcium concentration especially ionized calcium concentration in chronic renal failure patients on hemodialysis. The direct measurement of ionized calcium is less commonly used due to a lack of automated equipment as well as the cost of laboratory equipment. Numerous formulas for adjusted total calcium and calculated ionized calcium are used in clinical practice. We examined the relationship between direct measured ionized calcium and total calcium, corrected total calcium, calculated ionized calcium (formula of Nordin et al) in 53 chronic renal failure patients on hemodialysis. The results were as follows; 1) In predialysis group, plasma total and ionized calcium levels were 2.36+/-0.26, 1.04+/-0.21mmol/L respectively, and higher than normal controls. The correlations between plasma ionized calcium and total calcium, calculated ionized calcium, corrected total calcium were r=0.72 (P=0.0001), r=0.81 (P=0.0001), r=0.65 (P=0.0001) respectively. The plasma ionized calcium level was not correlated with the level of albumin, pH, phosphate, parathyroid hormone. 2) The plasma total and ionized calcium levels were significantly increased with hemodialysis and values were 2.49+/-0.14mmol, 1.14+/-0.14mmol/L respectively. The correlation between ionized and total calcium was r=0.41 (P=0.0021). These results suggested that the calculated ionized calcium (formula of Nordin et al) and total calcium can be used to predict the plasma ionized calcium level in chronic renal patients on hemodialysis.
Calcium* ; Humans ; Hydrogen-Ion Concentration ; Kidney Failure, Chronic ; Parathyroid Hormone ; Plasma ; Renal Dialysis*

In cholangiographic techniques, the close relationship between choledochal cyst and anomalous union of pancreaticobiliary duct has attracted medical attention. There have been rare cases in which the papilla of Vater was found in a position other than its normal position, and such cases have been reported sporadically. However, such cases are interesting in the anatomical context. In this review, we present our experience of choledochal cyst in a 30-month-old boy in whom the papilla of Vater was positioned in the third portion of the duodenum.
Cholangiography ; Choledochal Cyst ; Duodenum ; Preschool Child

No abstract available.
Transplants* ; Urinary Incontinence*

PURPOSE: To report a case of corneal edema caused by an iatrogenic lidocaine injection into the corneal stroma created while performing a local anesthetic (lidocaine) injection into the eyelid for a blepharoplasty procedure. CASE SUMMARY: A 15-year-old female visited our clinic after the onset of severe pain and decreased visual acuity while receiving a local anesthetic injection in the upper blepharon for a blepharoplasty procedure. At the first clinical visit, visual acuity was hand motion and an accurate anterior chamber examination was difficult because of corneal edema. The Seidel test was negative. On corneal optical coherence tomography, the corneal thickness was 1,580 µm without any sign of Descemet's membrane detachment. We prescribed 5% NaCl four times a day and prednisolone acetate eight times a day. On the next day after injury, the corneal edema was significantly improved (central corneal thickness: 660 µm), and Descemet's membrane detachment was still not observed. One week after injury, the naïve visual acuity was 20/20, the central corneal thickness was 560 µm, and the endothelial cell count was 3,260 cells/cm². Three weeks after injury, the corneal edema was fully resolved and only slight temporal corneal haziness remained. After 2 months, the cornea was clear without any subjective discomfort. CONCLUSIONS: Corneal edema without Descemet's membrane detachment can be resolved spontaneously without aggressive treatment such as gas or air injection. However, endothelial cell count and corneal opacity need to be monitored on follow up exam. This clinical experience suggests that severe corneal edema in anterior stromal layer could be spontaneously resolved without severe complication.
Adolescent ; Anesthesia, Local ; Anterior Chamber ; Blepharoplasty ; Cornea ; Corneal Edema ; Corneal Opacity ; Corneal Stroma ; Descemet Membrane ; Edema ; Endothelial Cells ; Eyelids ; Female ; Follow-Up Studies ; Hand ; Humans ; Lidocaine ; Prednisolone ; Tomography, Optical Coherence ; Visual Acuity

The treatment of choice for Cushing's disease is surgical removal of tumor, the source of ACTH overproduction. In occasional patients in whom a surgical approach including total adrenalectomy is not feasible or surgical removal of tumor is not complete, medical treatment may be necessary because pituitary irradiation requires a long 1ag time to remission. Although ketoconazole, an imidazole derivative with inhibitory activity on adrenal steroidogenesis has been reported to be effective in the treatment of Cushing's disease, the limited effectiveness in lowering very high level of cortisol and occasional hepatotoxicity restrains its wide use. In this report, we describe a woman with Cushing's disease due to pituitary microadenoma. Transsphenoidal pituitary adenomeetomy followed by ketoconzole treatment had been unsuccessful in achieving remission of the disease, but combined treatment with ketoconazole and octreotide accomplished successful reduction in cortisol production.
Adrenalectomy ; Adrenocorticotropic Hormone ; Female ; Humans ; Hydrocortisone ; Ketoconazole* ; Octreotide* ; Pituitary Irradiation

STUDY DESIGN: We report two cases of symptomatic spinal epidural lipomatosis (SEL) associated with long-term use of steroid medication OBJECTIVES: The purpose of this study was to assess the clinical characteristics, diagnosis and treatment of symptomatic spinal epidural lipomatosis. SUMMARY OF LITERATURE REVIEW: Spinal epidural lipomatosis is a condition in which excess adipose tissue is deposited circumferentially about the spinal cord in the epidural space. It can present neurologic symptoms including back pain, radiculopathy or cauda equina. Magnetic resonance imaging is the most helpful dignostic means and should be used initially if suspected. Treatment is decompressive laminectomy and debulking of fat. MATERIALS AND METHODS: Two cases of lumbar epidural lipomatosis with neurologic symptoms were discussed and evaluated by physical examination, postmyelography CT and MRI. RESULTS: Two cases were treated with decompressive laminectomy and debulking of fat. Increased accumulation of the fatty tissue was seen predominently in posterior and posterolateral epidural space of the spinal canal, displacing and compressing the lumbar spinal cord anteriorly. Both gross and histologic evaluation revealed overgrowth of unencapsulated normal appearing fat consistent with spinal epidural lipomatosis. One case was demonstrated gradual improvement in symtoms after operation but the other was died due to medical problems. CONCLUSION: The authors reviewed the literature and reported the results of operative treatment of patients with lumbago, radicular pain and intermitent claudication caused by epidural lipomatosis of lumbar spine and degenerative spinal stenosis.
Adipose Tissue ; Back Pain ; Cauda Equina ; Diagnosis ; Epidural Space ; Humans ; Laminectomy ; Lipomatosis* ; Low Back Pain ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Physical Examination ; Radiculopathy ; Spinal Canal ; Spinal Cord ; Spinal Stenosis ; Spine

A 5-month-old male infantshowed greasy sealy papules on the scalp, dirty scaly papules on the trunk and scaly petechial papules on both the palms and soles since birth. When admitted to the hospital, the patient exhibited lymphadenopathy, hepatomegaly, abdominal distension, mild fever and skin eruption. The biopsy specimens from the skin and lymph node showed an infiltrate composed almost entirely of histiocytic cells with irregularly shaped nuclei and abundant, well demarcated cytoplasm. The histiocytic cells of the infiltrate were proved as Langerhans cells by electron microscopic examination and S-100 protein study. He was treated with methotrexate 30mg/m twice a week and prednisolone 40mg/m daily. Initially skin lesions and general condition were improved, but the patient expired. due to septicemia after 3 months.
Biopsy ; Cytoplasm ; Fever ; Hepatomegaly ; Humans ; Infant ; Langerhans Cells ; Lymph Nodes ; Lymphatic Diseases ; Male ; Methotrexate ; Parturition ; Prednisolone ; S100 Proteins ; Scalp ; Sepsis ; Skin

We investigated the relationship between the circumferential extent of peripheral anterior synechiae (PAS) and the severity of visual field defects in primary angle-closure glaucoma (PACG). Correlations between visual field defects and the extent of PAS were analyzed in 73 eyes; 28 with and 45 without acute attacks. Spearman's correlation coefficient between the severity of visual field defects and the extent of PAS was 0.348 (P = 0.003) in all subjects (n = 73), 0.377 (P = 0.012) in the PACG eyes without acute attacks (n = 45), and 0.338 (P = 0.079) in the eyes with acute attacks (n = 28). Our results showed a statistically significant correlation between the extent of PAS and the severity of visual field damage in PACGoverall, and especially in PACG patients without a history of acute attacks.
Aged ; Comparative Study ; Female ; Glaucoma, Angle-Closure/*etiology/physiopathology ; Humans ; Intraocular Pressure ; Iris Diseases/*complications/physiopathology ; Male ; Middle Aged ; Perimetry ; Scotoma/*etiology/physiopathology ; *Visual Fields

Heterotopic pregnancy is the coexistency of intrauterine and extrauterine pregnancy. The incidence of heterotopic pregnancy is about 1 to 30,000 pregnancy in a natural cycle. However, the frequency of heterotopic pregnancy has steadily increased because of rising incidence of pelvic inflammatory disease, pelvic surgery and the development of ovulation induction and assisted reproduction. Because heterotopic pregnancy is difficult to diagnose and it has high morbidity and mortality rate, one should always take this into consideration and should conduct careful and thorough gynecologic evaluation. We have experienced a case of heterotopic pregnancy in a 29-year old woman who presented with acute abdominal pain in a natural cycle and report this case with a brief review of literature.
Abdominal Pain ; Adult ; Female ; Humans ; Incidence ; Mortality ; Ovulation Induction ; Pelvic Inflammatory Disease ; Pregnancy ; Pregnancy, Heterotopic* ; Reproduction