A 4-month-old intact male Sapsaree dog was referred due to a history of postprandial regurgitation following consumption of solid food. Thoracic radiography revealed focal leftward displacement of the thoracic trachea at T1 to T4 vertebrae levels. Barium contrast radiography revealed focal dilation of the cranial thoracic esophagus at the heart base level. Persistent right aortic arch (PRAA) with an aberrant left subclavian artery branching from the patent ductus arteriosus was diagnosed by computed tomography angiography (CTA). Although barium contrast radiography can presumptive diagnose PRAA, CTA should be considered for identifying additional vascular anomalies, specific types, and surgical planning.

A 3-year-old spayed female Russian blue cat was presented for dyspnea, nasal discharge, and stertorous breathing. Plain thoracic radiography revealed no specific findings. Computed tomography (CT) was performed to differentiate upper airway tract disorders. It revealed the presence of an iso-attenuating mass measuring 10.0 × 7.9 × 15.6 mm, with mild homogeneous contrast enhancement occupying the rostral nasopharynx. The mass was surgically debulked via a longitudinal incision in the soft palate. Histopathological and immunohistochemistry analysis of the surgically excised mass revealed CD3–/ CD79a+ B cell lymphoma with an incomplete margin. The patient underwent hypofractionated radiation therapy, receiving a total of 36 Gray (Gy) in 6 Gy fractions over a six-week period. A follow-up CT examination was performed after 27 months of irradiation and the patient was confirmed to have achieved a complete response. There were no complications related to irradiation. The patient was alive for 40 months without recurrence. This study suggests that hypofractionated radiation therapy combined with surgical debulking could be considered as a treatment option for feline nasopharyngeal lymphoma.

A 13-year-old male neutered Miniature Pinscher presented with coughing and dyspnea. The dog had been coughing for the past 4 weeks. The patient had mild dehydration on physical examination, and muffled heart sounds were detected. Thoracic radiographs revealed pleural effusion, which was consistent with chylous effusion based on cytological and biochemical evaluations. Computed tomography (CT) lymphangiography, which was performed via intrametatarsal pad injection, revealed no evidence of thoracic duct rupture or obvious leakage. On CT angiography (CTA), an intraluminal filling defect was identified in the cranial vena cava (CrVC). CrVC thrombosis with secondary chylothorax was diagnosed based on CT lymphangiography and CTA. Clopidogrel, rivaroxaban, and recombinant tissue-plasminogen activator were prescribed. The follow-up CTA, 4 months after diagnosis, revealed a decrease in the thrombus, and no pleural effusion was identified. Although CrVC thrombosis is an uncommon presentation in veterinary patients, thrombus in the CrVC should be considered as a differential diagnosis of chylothorax in dogs. CT lymphangiography and CTA could be helpful in identifying and differentiating the underlying etiologies of chylothorax.

Background and Objectives: Sialendoscopy is useful for the diagnosis and treatment of obstructive salivary gland diseases, but not yet universally employed because it requires dedicate, expensive, and fragile endoscopic equipment; moreover, the surgical technique is also delicate. Here, we describe our initial experience of sialendoscopy, as well as the learning curve, precautions, and drawbacks that beginners must overcome in employing sialendoscopy.Subjects and Method The medical records of 98 patients who underwent sialendoscopic procedures at Eunpyeong St. Mary’s Hospital from May 2019 to March 2022 were retrospectively reviewed. The type of procedure, success rate, operation time, and complications were analyzed. Results: We have performed a total of 85 sialendoscopic procedures, including 79 to treat submandibular sialolithiasis, two to treat submandibular ductal stenosis, two to treat parotid sialolithiasis, and two to treat parotid ductal stenosis. Of the total of 81 patients with sialolithiasis, 82.4% were treated by sialendoscopy only, 15.3% by hybrid procedure, and 2.3% opted to preserve the salivary gland and convert to external submandibular gland excision. Four patients with ductal stenosis were treated via endoscopic bougination; stents were placed for 4 weeks without any restenosis. The operation time was significantly shorter for the second half than for the first half of the patients (58.6 min vs. 39.8 min). Longer operation time was associated with the parotid gland diseases, larger stones (>5 mm in diameter), more proximal stones (from the salivary gland), and multiple stones. We encountered no major surgical complications. Conclusion Sialendoscopy is useful and safe; even beginners can evaluate and manage obstructive salivary gland diseases.

Purpose: This study aimed to identify the influence of consecutive night-shift work and working time on insomnia among hospital nurses. Methods: A descriptive correlational research designutilizing secondary data analysis was adopted. Data on consecutive night-shift work, working time, and insomnia were collected from 64 hospital nurses using a Fitbit activity tracker and questionnaires, and analyzed using hierarchical logistic regression. Results: Consecutive night-shift work for more than three days had a significant influence on insomnia among hospital nurses. Weekly working hours also accounted significantly for the variance in insomnia, exceeding the influence of consecutive night-shift work. Conclusion Development and implementation of proper schedules to control consecutive night-shift work and working time is important to alleviate insomnia among hospital nurses.

Primary care physicians who can deliver high quality primary care services are essential for strengthening the primary health care system. In Korea, primary care was regarded as substandard services practiced by any medical doctor without postgraduate education in primary care. The current and future health care systems are challenged by increasing complexity and co-morbidity and healthcare costs in medical care. The developed countries are preparing for the future by increasing support for basic, postgraduate, and continuing medical education in primary care. To strengthen the primary care in Korea, basic medical education programs should require experience in primary care clinics with a teaching and education function. Postgraduate primary care medical education must be enhanced to be qualified to practice in the community. The recognition of the importance of primary care and the need for changes in the current education and healthcare system among medical professionals and other stakeholders and support systems such as legislation and finance for primary care medical education.
Delivery of Health Care ; Developed Countries ; Education, Medical ; Education, Medical, Continuing ; Health Care Costs ; Humans ; Korea ; Physicians, Primary Care ; Primary Health Care ; Residence Characteristics

PURPOSE: We aimed to evaluate objective ultrasonography (US) findings for diagnosis of liver cirrhosis and to correlate the utility between the use of the low frequency and high frequency probes for images analyzed on the picture archiving and communications system (PACS). MATERIALS AND METHODS: A total of 87 patients participated in the study; 19 patients that had a clinically proven normal liver and 68 patients that had biopsy-proven chronic liver disease were evaluated with the use of US for the status of the liver. Multiple variables such as a 'smooth surface,' 'irregular nodular surface,' 'homogeneous echotexture,' 'heterogeneous appearance mixed with hypoechoic and hyperechoic echotexture' and 'hypoechoic honeycomb like echotexture' were evaluated based on images obtained with the use of both low frequency and high frequency probes by two observers. The diagnoses obtained after US were correlated with the histological results using assess agreement as statistical method. The concordance rate was calculated to correlate the utility between the use of the low frequency and high frequency probes. RESULTS: An 'irregular nodular surface' showed high interobserver agreement for the diagnosis of liver cirrhosis on images obtained with the low frequency probe (kappa= 0.61). In addition, 'hypoechoic honeycomb' showed high interobserver agreement on images obtained with the high frequency probe (kappa= 0.60). The use of the low frequency probe was associated with more accuracy for the diagnosis of liver cirrhosis (73%). CONCLUSION: Objective US findings for the diagnosis of liver cirrhosis are an 'irregular nodular surface' on images obtained with use of a low frequency probe and a 'hypoechoic honeycomb' on images with use of a high frequency probe.
Humans ; Liver ; Liver Cirrhosis ; Liver Diseases