No abstract available.
Adult* ; Humans ; Liver* ; Rhabdoid Tumor*

Purpose: This descriptive study investigated the effects of nurses’ knowledge of withdrawalof life-sustaining treatment, death anxiety, and perceptions of hospice care on their attitudes toward withdrawal of life-sustaining treatment. Methods: Data were collected from 262 nurses at tertiary hospitals, general hospitals, or primary hospitals in Busan, Korea, and statistically analyzed using the t-test, analysis of variance, the Scheffé test, Pearson correlation coefficients, and hierarchical regression analysis. Results: The participants’ scores were 3.68±0.45 (out of 5) for attitudes toward withdrawal of life-sustaining treatment, 0.65± 0.15 (out of 1) for knowledge of withdrawal of life-sustaining treatment, 2.61±0.26 (out of 4) for death anxiety, and 4.06±0.43 (out of 5) for perceptions of hospice care. Furthermore, knowledge of withdrawal of life-sustaining treatment and perceptions of hospice care showed positive correlations with attitudes toward withdrawal of life-sustaining treatment, while death anxiety showed a negative correlation. The most significant factors influencing attitudes toward withdrawal of life-sustaining treatment were perceptions of hospice care, followed by having experienced caring for patients who withdrew life-sustaining treatment, death anxiety, having a spouse, and ethical values, and the overall explanatory power was 43.0%. Conclusion This study showed that perceptions of hospice were an important fac-tor influencing nurses’ attitudes toward withdrawal of life-sustaining treatment. Therefore,it is necessary to develop and validate educational intervention programs that can improve perceptions of hospice care.

OBJECTIVES: Catecholamine metabolism has been thought to be related to the pathophysiology of panic disorder. There are two human COMT alleles, coding for a low activity enzyme, COMT L(L), and a high activity enzyme, COMT H(H), respectively. We examined the distribution of COMT genotypes and the relationship between COMT genetic polymorphism and some clinical characteristics in patients with panic disorder. METHOD: We recruited 51 patients who met the DSM-IV criteria for panic disorder, and 45 normal control subjects who had neither medical nor psychiatric illnesses. Genetic polymorphism of COMT was identified in all subjects using PCR-based restriction fragment length polymorphism(RFLP) analysis. We assessed some clinical variables including treatment responses in panic patients and measured anxiety and depression levels in normal control subjects using Spielberger State-Trait Anxiety Inventory (STAI) and Beck Depression Inventory (BDI). RESULT: The frequency of the homozygous LL genotype was higher in panic patients than that in control subjects (19.6% vs. 2.2%). We found that panic disorder was significantly associated with L allele (x2=8.66, p=0.003) and LL genotype(x2=8.45, p=0.015). Panic patients with LL genotype showed poorer treatment response than those with other genotypes (F=4.98, p=0.011). CONCLUSION: These results suggest that LL genotype of the COMT gene may be related to the pathophysiology and clinical courses in some patients with panic disorder.
Alleles ; Anxiety ; Catechol O-Methyltransferase* ; Clinical Coding ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Genotype ; Humans ; Metabolism ; Panic Disorder* ; Panic* ; Pilot Projects* ; Polymorphism, Genetic*

Sacroiliac (SI) joint pain can result from degeneration, infection, malignancy, and trauma. Patients with metastatic bone pain who do not respond to conventional treatment may need more aggressive neuroinvasive approaches. Recently, pulsed radiofrequency (PRF) neuromodulation has emerged as a promising treatment alternative for refractory cases of SI joint pain. Nevertheless, there is no report on the treatment of pain arising from SI joint metastases with PRF. We are reporting about a 63-year-old woman suffering from buttock pain due to breast cancer metastases in the SI joint. We treated this patient with PRF neuromodulation of the L4-S3 primary dorsal rami and lateral branches using a rotating curved needle technique. The patient tolerated the procedures well, without any complications. She experienced about 70% reduction in pain, and pain relief was sustained for 10 months. This result suggests that PRF neuromodulation is a safe, effective treatment for pain from SI joint metastases.
Arthralgia ; Breast Neoplasms ; Buttocks ; Female ; Humans ; Joints ; Middle Aged ; Needles ; Neoplasm Metastasis* ; Sacroiliac Joint*

Primary sternal osteomyelitis (PSO) is a rare condition that may develop without any contiguous focus of infection. Due to the rarity of the disease, early diagnosis and appropriate treatment are often delayed. Herein, we describe a patient with PSO caused by Staphylococcus aureus that presented with chest pain and fever. The patient had no predisposing factors for sternal osteomyelitis. The chest pain was thought to be non-cardiogenic, as electrocardiography and cardiac enzyme did not reveal ischemic changes when he visited the emergency room. After blood culture revealed the presence of S. aureus, every effort was made to identify the primary focus of infection. Bone scan and magnetic resonance imaging revealed osteomyelitis with soft tissue inflammation around the sternum. After 8 weeks of antibiotics treatment, the patient recovered without any complications.
Adult* ; Anti-Bacterial Agents ; Causality ; Chest Pain ; Early Diagnosis ; Electrocardiography ; Emergency Service, Hospital ; Fever ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Osteomyelitis* ; Staphylococcus aureus* ; Staphylococcus* ; Sternum

Lymphangioma of the esophagus is a rare submucosal benign tumor. A 49-year-old man was referred because of a foreign body sensation in the esophagus. In endoscopy, a 10.0×1.0-cm longitudinal, translucent, whitish yellow mass covered with normal esophageal mucosa was found in the lower esophagus. Endoscopic ultrasonography revealed a heterogeneous, mainly hypoechoic, well-circumscribed lesion located in the third layer. Incisional biopsy was performed, and histologic findings showed multiple dilated lymphatic vessels, consistent with lymphangioma. After 3 months of proton pump inhibitor treatment, the symptom was relieved and the patient is currently asymptomatic and under surveillance.
Biopsy ; Endoscopy ; Endosonography ; Esophagus ; Foreign Bodies ; Humans ; Lymphangioma ; Lymphatic Vessels ; Middle Aged ; Mucous Membrane ; Proton Pumps ; Sensation

Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease characterized by progressive fibrosis and destruction of intra- and extrahepatic bile ducts resulting in hepatic failure and death. Only the liver transplantation is the possible treatment for patients to survive. There has been a few reports that steroid is an effective treatment in autoimmune variant sclerosing cholangitis, which is thought to be a familial diseases with different etiology, and steroid responsive biliary strictures be named as immunoglobulin G4 (IgG4)-associated cholangitis (IAC). There is no reliable data regarding effective steroid treatment in autoimmue variant sclerosing cholangitis in Korea. We report a case of 32-year-old male with sclerosing cholangitis, who was diagnosed by endoscopic retrograde cholangiopancreatography (ERCP) and liver biopsy, showing favorable response to prednisolone therapy.
Adult ; Anti-Inflammatory Agents/*therapeutic use ; Cholangiopancreatography, Endoscopic Retrograde/methods ; Cholangitis, Sclerosing/*diagnosis/pathology ; Humans ; Male ; Prednisolone/*therapeutic use ; Treatment Outcome

BACKGROUND/AIMS: Inflammatory pseudotumor rarely occurs in the liver. However, it is important to discriminate it from malignant hepatic tumor in order to avoid unnecessary surgery. We aimed to elucidate the characteristic features of this disease entity by analyzing our experiences and by reviewing the related literatures. METHODS: Fifteen patients were enrolled during a recent three-year period. The patients were pathologically diagnosed with inflammatory pseudotumor of the liver, and their clinical and imaging findings were analyzed retrospectively. RESULTS: Our study population was composed of ten men and five women, and their mean age was 60.3+/-9.2 years. Their initial diagnoses were inflammatory pseudotumor (n=8), malignant tumors (n=3) and abscess (n=4). Twelve of 15 patients were associated with biliary diseases such as biliary stone, gallbladder cancer, empyema or cholangiocarcinoma. The most common symptom was abdominal pain. The most common CT and MR findings could be summarized as a delayed hyperattenuating mass with an internal hypoattenuating component. The tumors were solitary in 13 patients and multiple in two patients. The lesions regressed spontaneously in seven patients. Four patients were treated by antibiotics and 3 patients by surgical resection. CONCLUSIONS: Inflammatory pseudotumor of the liver seems to have relatively common clinical and imaging features, as described above. However, these features are not disease-specific; thus, preoperative histologic confirmation is necessary to avoid unnecessary surgery.
Adult ; Aged ; Female ; Granuloma, Plasma Cell/*diagnosis/radiography ; Humans ; Liver Diseases/*diagnosis/radiography ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Plasma Cells ; Tomography, X-Ray Computed

BACKGROUND/AIMS: In spite of increasing interests about nonalcoholic steatohepatitis (NASH), there are few reports about the ultrastructure of hepatocyte in this disease. The aim of this study was to clarify abnormal electron microscopic (EM) findings and related factors in NASH. METHODS: Total of fourteen patients who underwent liver biopsy due to steatohepatitis were included. Precise personal history was taken and variable blood tests such as liver function test, lipid profile, and serum iron study were done. Pathologic examination with light and electron microscopy was done by single pathologist. RESULTS: Eleven men and three women were included and mean age was 33.7+/-12.8 years. Nine patients drinking less than 40 g/week was grouped as "NASH group" and other 5 patients drinking more than 40 g/week and body mass index less than 25 was grouped as "ASH (Alcoholic Steatohepatitis) group". Polymorphism of mitochondria such as megamitochondria or loss of cristae was major abnormal EM findings and was more common in "NASH group" than "ASH group" (p=0.027). There was no significant clinical or pathological factors related with the presence of these abnormal EM findings. CONCLUSIONS: Polymorphism of mitochondria is major abnormal EM finding of steatohepatitis and is more common in NASH than ASH. And there is no significant clinical or pathological factors which could predict the presence of these abnormal EM findings.
Adolescent ; Adult ; Fatty Liver/*pathology ; Female ; Hepatocytes/*ultrastructure ; Humans ; Liver Diseases, Alcoholic/*pathology ; Male ; Microscopy, Electron, Transmission ; Middle Aged ; Mitochondria, Liver/ultrastructure

Noonan syndrome is an autosomal dominant disorder characterized by dysmorphic facial features, congenital heart defects and short stature. To date, renal artery stenosis has not been associated with Noonan syndrome. We report the case of a 27-year old male who presented with malignant hypertension associated with renal artery stenosis, dysmorphic facial features, pectus excavatum, pulmonary stenosis and hypertrophic cardiomyopathy who was diagnosed with Noonan syndrome.
Adult* ; Balloon Valvuloplasty ; Cardiomyopathy, Hypertrophic ; Funnel Chest ; Heart Defects, Congenital ; Humans ; Hypertension, Malignant* ; Male ; Noonan Syndrome* ; Pulmonary Valve Stenosis ; Renal Artery Obstruction