Broncho-gastric fistula caused by benign gastric ulcer perforation after esophagectomy is very rare. In general anesthesia of a patient with broncho-gastric fistula, in spite of hyperventilation, leakage of the anesthetic gases through fistula may make the patient hypercapneic, and positive pressure ventilation may increase the risk of the pulmanary aspiration by the regurgitation of gastric fluid by stomach distension. For that reason, in this patient, denitrogenation was performed during patient's voluntary respiration with 100% oxygen for 5 minutes, and induction was performed without positive pressure ventilation, and one lung ventilation was carried out. Hypoxemia was followed by one lung ventilation because his pulmonary function was moderate obstructive type and his lung was damaged by aspiration of gastric fluid via broncho-gastric fistula. A low level of continuous positive airway pressure (CPAP) has no significant hemodynamic effect and can maintain the patency of nonventilated lung, so hypoxemia induced by one lung ventilation may be reduced. Thus we carried out one lung ventilation with CPAP (10 cmH2O) in nonventilated lung and blocked broncho-gastric fistula with a bronchial blocker for prevention of both regurgitation of gastric fluid and leakage of anesthetic gases. One lung anesthesia was performed without any problem in this case.
Anesthesia ; Anesthesia, General* ; Anesthetics, Inhalation ; Anoxia ; Continuous Positive Airway Pressure ; Esophagectomy ; Fistula* ; Hemodynamics ; Humans ; Hyperventilation ; Lung ; One-Lung Ventilation ; Oxygen ; Positive-Pressure Respiration ; Respiration ; Stomach ; Stomach Ulcer

PURPOSE: To understand the meaning of death seen by nursing students through art works. METHOD: The qualitative research method and the content analysis were used. The text were essays written by 42 senior nursing students about their impressions on death through art works. RESULT: Statements were classified into six categories and twenty six themes. The six categories include definitions of death, feelings about the death of a main character, responses to the death of the main character, feelings of significant others about the death of the main character, feelings of participants in this study, and oaths of the participants in this study. CONCLUSION: It is shown that participants recognize their position as nursing students, although they may not escape the fear of death, will learn to cope with death, and the dying in a suitably professional manner. In this respect, the study is considered to be helpful for the students in learning the knowledge and information which are needed for hospice nursing care more effectively.
Hospice and Palliative Care Nursing ; Humans ; Learning ; Nursing* ; Qualitative Research ; Students, Nursing* ; United Nations

Osteoporosis is one of the major causes of insufficiency fractures, and since plain radiographic findings are either unhelpful or misleading, insufficiency fracture in the sacrum is particularly difficult to diagnosis and to differentiate from other disease processes such as metastasis. We report the MR findings of two cases of insufficiency fracture of the sacrum. These were not demonstrable on conventional radiographs, but bone scintigraphy revealed unilateral sacral alar uptake, suggesting an active sacral lesion. Both T1 and T2-weighted MR images demonstrated fractures of the sacrum as bands of low signal intensity, with areas of surrounding increased signal intensity seen on the latter suggesting marrow edema.
Bone Marrow ; Diagnosis ; Edema ; Fractures, Stress* ; Humans ; Neoplasm Metastasis ; Osteoporosis ; Radionuclide Imaging ; Sacrum

PURPOSE: The purpose of this study was to analyze the subjectivity of contents related to death as a nursing curriculum subject for nurses and students. METHOD: The Q-methodology which provides a method for analyzing the subjectivity of each items was used. The 34 selected Q-statements sorted by each of the 36 participants were classified into a normal distribution by using a 9 point scale. The collected data were analyzed using the QUANL PC program. RESULTS: Four types of content related to death nursing curriculum were identified. Type I is the psychologically sympathetic type, Type II is the clinical based experience type, Type III is the physically comfort seeking type, and Type IV is the human-understanding oriented type. CONCLUSION: The results of this study show that different approaches to education are needed to address the four types of content related to death as a nursing curriculum subject. Both contents and characteristics need to be considered.
Curriculum* ; Education ; Humans ; Nursing*

PURPOSE: The purpose of this study was to understand and analyze the experience of restoration among Korean elders with suicide ideation. METHODS: A phenomenological research method guided data collection and analysis. A total of five elders having had suicide ideation participated. Data were collected through individual in-depth interviews. All interviews were audio taped and transcribed verbatim. Coding was used to establish different concepts and categories. RESULTS: As the results of analysis, the following three constituents have been found as a retrospective focus based on the primary suicide ideation: expanding their view and facing reality, reconstructing their view about life and death as well as self. CONCLUSION: The results of this study may contribute to health professionals working at various crisis settings to understand Korean elders with suicide ideation.
*Adaptation, Psychological ; Aged ; Attitude to Death ; Female ; Humans ; Interviews as Topic ; Korea ; Male ; Self Psychology ; Social Support ; Suicide/*psychology ; Suicide, Attempted/psychology

PURPOSE: The purpose of this study was to develop a multidimensional suicide prevention program for Korean elders by utilizing a community network and to evaluate its effect. METHODS: A non-equivalent control group pretest-posttest design was used. The subjects were recruited from two different elderly institutions located in D city and K province, Korea. Nineteen subjects in the control group received no intervention and 20 subjects in the experimental group received a multidimensional suicide prevention program. RESULTS: There were more significant decreases in depression, suicide ideation, and increases in life satisfaction in the experimental group compared to the control group. CONCLUSION: According to the above results, the multidimensional suicide prevention program for Korean elders decreased stressful events like depression, and suicide ideation and increased life satisfaction through the community network. These findings suggest that this program can be used as an efficient intervention for elders in a critical situation.
Aged ; Aged, 80 and over ; Community Networks ; Data Interpretation, Statistical ; Depression ; Female ; Humans ; Korea ; Male ; Middle Aged ; Personal Satisfaction ; Program Development ; *Program Evaluation ; Questionnaires ; Suicide/*prevention & control ; Suicide, Attempted/*prevention & control

Medico-legal investigations in Korea depend mostly on postmortem inspection without autopsy. Both untrained physicians and experienced forensic pathologists may not be able to determine the cause and manner of death only by postmortem inspection. The aim of our study was to show the limitations of postmortem inspection by evaluating the discrepancy between the results of postmortem inspection and autopsy after natural death. The manner of death by postmortem inspection changed to unnatural death in 9.4% of the cases (12 cases/127 cases) after autopsy. The cause of death in most cases was consumption of alcohol, agricultural chemicals, and antipsychotic intoxication. The cause of death by postmortem inspection changed in 24.3% of the cases (26 cases/107 cases) among cases of confirmed natural death after autopsy. The positive predictive value of cause of death by postmortem inspection was higher for cardiovascular disease (79.0%) and lower for chronic alcoholism and/or chronic liver disease (28.6%). This study shows that forensic pathologists could make considerable errors in determining the cause and manner of death without autopsy and emphasizes the necessity to refine medico-legal investigations in Korea by introducing the limited autopsy with toxicologic study and supportive postmortem imaging.
Agrochemicals ; Alcoholism ; Autopsy ; Cardiovascular Diseases ; Cause of Death ; Korea ; Liver Diseases

Dermatofibroma with granular cells is composed mainly of spindle shaped cells mixed with in-conspicuous foamy cells that contain granular cytoplasm. We present a case of dermatofibroma with granular cells in a 36-year-old male who visited our clinic to evaluate a slow-growing nodule on the medial side of the left lawer leg. He have had the nodule for five years and sometimes felt an itching sensation. Biopsy of the nodule identified a dermal nodular tumor showing cellular spindle cell proliferation admixed with peripheral foamy histiocytes. With the immunohistochemical staining, the granular cell was positive for alpha-1-antitrypsin and CD68, and negative for S-100. A few electron-dense granules were seen in the cytoplasm on the electronmicroscopic study. These results suggested that the granular cells originated from histiocytes.
Adult ; Biopsy ; Cell Proliferation ; Cytoplasm ; Histiocytes ; Histiocytoma, Benign Fibrous* ; Humans ; Leg ; Male ; Pruritus ; Sensation

OBJECTIVE: The involvement of IGF system in hyperandrogenism and abnormal follicular development is controversial. This study is to assess whether IGF system contribute to it in the women with polycystic ovary(PCO). METHODS: Baseline serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol (E2), testosterone (T), androstenedione (ADD), prolactin, thyroid stimulating hormone (TSH), free insulin-like growth factor(IGF)-I, free IGF-II, insulin-like growth factor binding protein(IGFBP)-1, and IGFBP-3 were measured in twelve healthy regularly cycling volunteers and forty-two women with PCO then, the changes of baseline serum levels were evaluated after laparoscopic ovarian electrocauterization in nine PCO patients. In addition, the expression pattern of IGF-I and IGF-II was examined in the ovary of control and PCO group. RESULTS: Baseline levels of LH, ADD, free IGF-II, and IGFBP-3 were significantly higher in PCO group. However, there were no significant differences in the levels of free IGF-I and IGFBP-1, although free IGF-I showed decreasing tendency in PCO group. And there was a significant positive correlation between the LH and free IGF-II level in the PCO(P=0.011, r2=0.3899), but not in the control. After ovarian electrocauterization, LH, T, and ADD levels decreased, and free IGF-I and IGFBP-3 level increased. While free IGF-II and IGFBP-1 level showed no significant changes. In the ovary, expression of both IGFs showed similar pattern in normal and PCO ovaries. CONCLUSIONS: The elevated IGFBP-3 level may alter the bioavailability of IGF(s) in the PCO. The change in IGF-I level and resumption of ovulation after electrocauterization, suggest a possible role of IGF system in the impairment of follicular development in the PCO.
Androstenedione ; Biological Availability ; Carrier Proteins* ; Estradiol ; Female ; Follicle Stimulating Hormone ; Humans ; Hyperandrogenism ; Insulin-Like Growth Factor Binding Protein 1 ; Insulin-Like Growth Factor Binding Protein 3 ; Insulin-Like Growth Factor I ; Insulin-Like Growth Factor II ; Luteinizing Hormone ; Ovary* ; Ovulation ; Prolactin ; Somatomedins* ; Testosterone ; Thyrotropin ; Volunteers

Colorectal cancer during pregnancy is rare but the trend for women to delay pregnancy until later in life may result in increased incidence of colorectal cancer during pregnancy. The most common symptoms are rectal bleeding, abdominal discomfort, abdominal distension, anorexia, nausea, vomiting, constipation, anemia and weight loss. Rectal bleeding, if it is occurred, is often attributed to hemorrhoids, a common finding of pregnancy and many of these symptoms are commonplace in normal pregnancy. This delays diagnosis of colorectal cancer during pregnancy and leads to more advanced stage and poor prognosis compared to the general population. We experienced a woman at 27 weeks gestation who complained of low abdominal distention and was diagnosed of sigmoid colon cancer and underwent cesarean section and hemicolectomy at 30 weeks gestation, so we present it with brief review of literature."
Anemia ; Anorexia ; Cesarean Section ; Colorectal Neoplasms* ; Constipation ; Diagnosis ; Female ; Hemorrhage ; Hemorrhoids ; Humans ; Incidence ; Nausea ; Pregnancy* ; Prognosis ; Sigmoid Neoplasms ; Vomiting ; Weight Loss