BACKGROUND: In order to improve the quality of life of dying patients so that they may die with dignity, they need to receive not only the physical, psychological, social, and spiritual care, but also systematic and continuous care. However, their is no adequate medical service at present. We studied terminal cancer patients'behavior patterns of health care utilization, the problems of caring for the patient, and medical services that bereaved families suggested for terminal cancer patients and their families. METHODS: From 271 patients'families who participated in our hospice program from March 1991 to February 1996, 108 bereaved families whom we able to had been contact were interviewed by three student nurses with a structured questionnaire. RESULTS: The terminal cancer patients received their medical care through admission to hospital(45.4%), outpatient clinic(22.2%), emergency room(16.7%), and oriental medicine(12.0%). But during their terminal phase of the illness, 32.4% of patients never received medical care including oriental medicine, and 28.7% received alternative medicine care such as intake of mushroom and elm tree. 26 bereaved families(24.1%) pointed out the indifference of the medical team as a problem receiving proper hospital care, and 22 bereaved families(20.4%) emphasized emotional strain of their helplessness with the patient's suffering as a problem of caring for the patient at home. Over 90% of bereaved families from their experience suggested needs of continuous care, hospice care, home care, and 24hr telephone service. CONCLUSIONS: There were inappropriate behavior patterns of health care utilization which resulted in large proportion of terminal cancer patients received alternative medicine never receiving proper medical care. Therefore, there is a need to develop the continuous and comprehensive care for terminal cancer patients and their family, such as hospice.)
Agaricales ; Complementary Therapies ; Delivery of Health Care* ; Emergencies ; Home Care Services ; Hospice Care ; Hospices ; Humans ; Medicine, East Asian Traditional ; Outpatients ; Quality of Life ; Telephone ; Ulmus ; Surveys and Questionnaires

No abstract available.
Radiation Oncology*

Infectious mononucleosis(IM) is a benign self-limiting disease and result from a polyclonal B cell proliferation secondary to Epstein-Barr virus (EBV) infections. The infection is controlled by cytotoxic T cells triggered by EBV infected B cells. However, rare cases develop severe or fatal IM accompanied by hemophagocytic syndrome. We report a case of a 4-year-old girl who presented with high fever, hepatosplenomegaly, hepatic failure, pancytopenia and coagulopathy. Despite intensive treatment, the patient's condition deteriorated rapidly and died 3 days after admission. At autopsy, there was prominent infiltration of atypical lymphocytes with hemophagocytosis in multiple organs, especially liver, spleen and lymph nodes. Atypical lymphocytes were immunopositive for T cell markers and showed positive signal in EBV in situ hybridization.
Autopsy ; B-Lymphocytes ; Cell Proliferation ; Child, Preschool ; Female ; Fever ; Herpesvirus 4, Human ; Humans ; In Situ Hybridization ; Infectious Mononucleosis* ; Liver ; Liver Failure ; Lymph Nodes ; Lymphocytes ; Lymphohistiocytosis, Hemophagocytic ; Pancytopenia ; Spleen ; T-Lymphocytes

Keratosis follicularis squamosa (Dohi) is a keratinizing disorder which is a separate clinical entity from keratosis follicularis (Darier's disease). It occurs predominantly in Japanese and appears clinically as scaly patches of 3~10 mm in diameter with brownish follicular plugs in the center, which are symmetrically scattered on the trunks and thighs. Scales on the margin, slightly detached from the underlying epidermis, look like 'lotus leaves on the water'. The efficacy of minocycline has already been confirmed in many cases. In this report, we describe a case of using 1% of pimecrolimus cream for keratosis follicularis squamosa (Dohi) instead of minocycline.
Asian Continental Ancestry Group ; Darier Disease ; Epidermis ; Humans ; Keratins ; Keratosis ; Minocycline ; Tacrolimus ; Thigh ; Weights and Measures

The treatment for full thickness skin defect with the full or split-thickness autograft was often associated with aesthetically poor result, hypertrophic scar or extensive injury on donor site. Because of this donor morbidity, the use of artificial dermis was considered, which was the substrate of collagen or collagen cross-linked with polyglactin or polylactin. Unfortunately this substrate was void of advantages for the artificial dermis but was of easy biodegradability, antigenicity, or cytotoxic property. Currently chitosan is given attention by many investigators for its biochemical properties in wound healing process. Chitosan is the deacetylated derivative of chitin, which is a polymer of 2-amino-2-deoxy glucose with chemically active free amino group. Chitosan facilitates wound healing process, and then stimulates migration of polymorphonuclear cell(PMN) and macrophage, release of IL-8 and accelerates collagen synthesis surely with vascularization. Indeed chitosan supplies the resistance against bacterial infection of the wound. In this study, we have investigated the clinical applicability of the artificial dermal substrate which is cross-linked of collagen and GAG with chitosan, which we have applied on the full thickness skin defect in Fisher rat. The conclusions are as the follows: 1. There was sufficient vascularization in the grafted dermal substrate for STSG after 2 weeks of artificial dermis grafting. 2. Four 4 weeks after artificial dermis grafting, the architecture of the dermal substrate was maintained in about half amounts and the half of dermal skeleton was replaced with the newly formed dermis(neodermis). In conclusion, the dermal substrate used in this study is available enough for wound of full thickness skin defect.
Animals ; Autografts ; Bacterial Infections ; Chitin ; Chitosan ; Cicatrix, Hypertrophic ; Collagen ; Dermis ; Equipment and Supplies ; Glucose ; Humans ; Interleukin-8 ; Macrophages ; Polyglactin 910 ; Polymers ; Rats ; Research Personnel ; Skeleton ; Skin ; Tissue Donors ; Transplants ; Wound Healing ; Wounds and Injuries

BACKGROUND: Pilomatricoma is a benign appendageal tumor characterized by basaloid and shadow cells. Differentiation towards normal hair follicles is often observed in this condition. OBJECTIVE: The purpose of this study was to analyze the clinical and histopathological features of pilomatricoma and to confirm diverse types of differentiation towards normal hair follicles, and its origin. METHODS: We retrospectively reviewed medical records and histopathological findings of 64 patients who had visited our hospital in the last 7 years. The evolutional stages of tumor and differentiation were analyzed through histopathological findings. RESULTS: The majority of the tumors occurred in the first two decades (69.8%). Unlike previous reports, the male to female ratio was 1.1:1. The mean duration was 11.8 months. The predilection sites were the upper extremities (40.8%), face (33.8%), neck (15.5%), back (2.8%), scalp (2.8%), and thigh (2.8%) in that order. Histopathologically, most of the tumors were located in the lower dermis (76%) and enclosed by pseudocapsules. The evolution of tumor was divided into four groups- early, fully developed, early regressive, and late regressive stage, as previously reported. Our 71 cases were classified as: 2 early, 16 fully developed, 34 early regressive, and 19 late regressive stage. Calcification (60.5%) and ossification (8.4%) were observed, and the ratio increased as the tumor aged. Inflammatory cell infiltration and multinucleated giant cells were observed disorderly. Differentiation to normal hair follicles was observed: 14 cases to infundibulum, 10 isthmus, 17 outer root sheath, and 11 inner root sheath. CONCLUSION: Pilomatricoma is a benign tumor that differentiates toward the hair cortex. Basaloid and shadow cells correspond to hair matrix cells and immature hair cortex cells, respectively. Basaloid cell can also differentiate to normal hair follicles.
Aged ; Dermis ; Female ; Giant Cells ; Hair ; Hair Follicle ; Humans ; Male ; Medical Records ; Neck ; Pilomatrixoma ; Retrospective Studies ; Scalp ; Thigh ; Upper Extremity

Vitiligo universalis is an uncommon variant that is rarely seen. Interestingly, vitiligo universalis often accompanies systemic diseases such as endocrinopathies. A 43-year-old man presented with whole body depigmentation and poliosis affecting most of his scalp and body hair. He had undergone a liver transplant 2 years ago due to liver cirrhosis from a chronic hepatitis B infection and has been treated for diabetes mellitus for several years. Histopathology showed no melanocytes and an absence of epidermal pigmentation on the skin. We herein report a rare case of vitiligo universalis associated with chronic viral hepatitis B.
Adult ; Diabetes Mellitus ; Hair ; Hepatitis B ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Humans ; Liver ; Liver Cirrhosis ; Melanocytes ; Pigmentation ; Scalp ; Skin ; Transplants ; Vitiligo

BACKGROUND: Many patients received transfusion in emergency department because of blood loss. There are few studies on massive transfusion for non-traumatic patients. This study investigated mortality and risk factor for non-traumatic bleeding patients who received transfusion. METHODS: Non-trauma patients who received transfusion at the emergency department for 3 years from March 2009 to February 2011 were enrolled. The patients who are younger than 15 years, trauma patients, and transfused FFP or platelet alone are excluded. Medical records was investigated retrospectively. We investigated predictive factors for MT on non-trauma patients and predictive factors for mortality on MT patients. RESULTS: Among 1655 non-trauma patients, 150 patients (9.24%) received MT. The age of MT group was younger than that of non-MT group and systolic bloor pressure, diastolic blood pressure, mean arterial pressure were significantly lower. Base excess, pH, lactate levels were significantly different between MT and non-MT group. Intensive care unit length of stay was longer, mortality of 24 hours was higher and survival discharge was lower than non-MT group. Mortality rate of MT group was 20.7% which was significantly higher than non-MT group's 9.3%. FFP:RBC ratio was higher in MT group than non-MT group. Among the MT group, non-survival group used higher FFP:RBC ratio product than survival group. On multivariate analysis, sBP, MAP, lactate, pH, BE were significant as predictors of MT. CONCLUSION: For non-trauma patients in emergency department, if sBP, MAP, lactate, pH, BE are abnormal, massive transfusion could be expected. Like trauma patients, basic scoring system that can predict MT would be necessary and useful.
Arterial Pressure ; Blood Platelets ; Blood Pressure ; Blood Transfusion* ; Emergencies* ; Hemorrhage ; Humans ; Hydrogen-Ion Concentration ; Intensive Care Units ; Lactic Acid ; Length of Stay ; Medical Records ; Mortality ; Multivariate Analysis ; Retrospective Studies ; Risk Factors

OBJECTIVE: To investigate whether transcranial direct current stimulation (tDCS) can improve dysarthria in stroke patients. METHOD: Twelve patients who developed dysarthria after acute middle cerebral artery (MCA) infarction were included in this study. In a prospective, double blinded, randomized case control study performed between January 2007 and December 2008, six patients were randomized to anodal tDCS application and conventional speech therapy, and six patients were randomized to the sham group which received only conventional speech therapy. tDCS was delivered for 30 minutes at 2 mA with 25cm2, five times/week, for a total two weeks. The effects were assessed in maximal phonation time (MPT), alternative motion rates (AMR)-Pa, AMR-Ta, AMR-Ka, and sequential motion rates (SMR)-PaTaKa using the Multi-Media Dimension Voice Program. RESULTS: Pre-treatment patient evaluation showed no significant difference between the two groups for all parameters. The MPT, AMR-Pa, AMR-Ta, AMR-Ka, and SMR-PaTaKa were improved pre- and post-treatment in the stimulation group, while MPT, SMR-PaTaKa were improved in the sham group (p<0.05). The AMR-Pa significantly improved in the stimulation group compared to the sham group (p<0.05). CONCLUSION: As these results demonstrated the beneficial effects of anodal tDCS on dysarthria, tDCS can successfully be used as a treatment modality for patients suffering from dysarthria after stroke.
Case-Control Studies ; Dysarthria ; Humans ; Infarction ; Middle Cerebral Artery ; Phonation ; Prospective Studies ; Salicylamides ; Speech Therapy ; Stress, Psychological ; Stroke ; Voice

Nipple size varies from person to person, but having a large nipple, or macrothelia, can be a concern for some women; therefore, some surgical methods have been developed for the reduction of nipple size. Conventional surgical methods for nipple reduction are classified into two types according to their purpose: reduction of length and reduction of diameter. For reduction of length, soft tissue is resected (except the central supplying vessel) and shortened by circumferential repair. The disadvantage of this method is possible necrosis of the nipple and impairment of the lactiferous duct. For reduction of diameter, a wedge-shaped resection is done from side to center and the defect is covered by a local advancement flap. The disadvantage of this method is the locally focused tension line, which is associated with unfavorable aesthetic outcomes. In this article, we present a case involving a novel method of nipple reduction surgery, referred to as the tripod wedge resection technique, which has three benefits compared to conventional nipple reduction surgery: simultaneous reduction of both length and diameter, relative safety for the vasculature and lactiferous duct, and an evenly tensioned incision line.