Initial work-up for cervical lymphadenopathy: back to basics

The aim of this study was to evaluate the value of FNA, Tb-PCR, and CBC as an initial work-up protocol for cervical lymphadenopathy to reiterate the importance of CBC in terms of predicting the clinical course. In this consecutive case series, 158 patients with cervical lymphadenopathy were enrolled. All patients underwent FNA and CBC, with or without Tb-PCR. The validity of combined FNA?±?Tb-PCR and CBC in the diagnosis of diseases requiring definitive treatment was evaluated. Final diagnoses were self-limiting disease in 110 (69.6%), malignancy in 19 (12.0%), and tuberculosis in 26 (16.5%). Sensitivity of FNA?±?Tb-PCR was 66.7% and of added CBC profile was 97.9%. Patients with neutropenia or lymphocytosis were found to have a higher chance of spontaneous recovery than patients with a normal WBC profile. FNA and Tb-PCR were found to be important in patients aged more than 20. The results indicate that FNA, Tb-PCR, and CBC are basic and essential in initial work-up for cervical lymphadenopathy. In particular, CBC was found to aid in detecting critical diseases and predicting the likelihood of open biopsy in patients with negative FNA and Tb-PCR. Patient age was also found to be an important determinant of the work-up protocol.     

Ethical Issues Recognized by Critical Care Nurses in the Intensive Care Units of a Tertiary Hospital during Two Separate Periods

This research aimed to investigate the changes in ethical issues in everyday clinical practice recognized by critical care nurses during two observation periods. We conducted a retrospective analysis of data obtained by prospective questionnaire surveys of nurses in the intensive care units (ICU) of a tertiary university-affiliated hospital in Seoul, Korea. Data were collected prospectively during two different periods, February 2002-January 2003 (Period 1) and August 2011-July 2012 (Period 2). Significantly fewer cases with ethical issues were reported in Period 2 than in Period 1 (89 cases [2.1%] of 4,291 ICU admissions vs. 51 [0.5%] of 9,302 ICU admissions, respectively; P < 0.001). The highest incidence of cases with identified ethical issues in both Periods occurred in MICU. The major source of ethical issues in Periods 1 and 2 was behavior-related. Among behaviorrelated issues, inappropriate healthcare professional behavior was predominant in both periods and mainly involved resident physicians. Ethical issue numbers regarding end-oflife (EOL) care significantly decreased in the proportion with respect to ethical issues during Period 2 (P = 0.044). In conclusion, the decreased incidence of cases with identified ethical issues in Period 2 might be associated with ethical enhancement related with EOL and improvements in the ICU care environment of the studied hospital. However, behaviorrelated issues involving resident physicians represent a considerable proportion of ethical issues encountered by critical care nurses. A systemic approach to solve behavior-related issues of resident physicians seems to be required to enhance an ethical environment in the studied ICU.

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General Internists' Perspectives Regarding Primary Care and Currently Related Issues in Korea

Although primary care has been recognized as an essential element of the healthcare system, the primary healthcare of Korea has not been highly valued. Listening to the voices of physicians who are engaged in primary care should be the first step for improving the level of primary care in Korea. In this study, we conducted a questionnaire survey of general internists to investigate their perspectives regarding primary care, and which included the evaluation of current primary care, perception of the five, key attributes of primary care, and their opinions regarding the management system of chronic diseases. A total of 466 general internists'' responses were used in this analysis. The results showed that primary care is considered to have an important role, according to general internists, although their evaluation of the overall status of primary care in Korea indicated that it is poor. The respondents also indicated that the functions of coordination and comprehensiveness in primary care, which can be integral for treating patients with chronic diseases, are most vulnerable. Given the high level of agreement regarding the need for a new medical management system for chronic diseases, based on physicians'' autonomy and provided by clinics, establishing a policy encouraging the participation of general internists should be emphasized.

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Standards for Endovascular Neurosurgical Training and Certification of the Society of Korean Endovascular Neurosurgeons 2013

The need for standard endovascular neurosurgical (ENS) training programs and certification in Korea cannot be overlooked due to the increasing number of ENS specialists and the expanding ENS field. The Society of Korean Endovascular Neurosurgeons (SKEN) Certification Committee has prepared training programs and certification since 2010, and the first certificates were issued in 2013. A task force team (TFT) was organized in August 2010 to develop training programs and certification. TFT members researched programs and systems in other countries to develop a program that best suited Korea. After 2 years, a rough draft of the ENS training and certification regulations were prepared, and the standard training program title was decided. The SKEN Certification Committee made an official announcement about the certification program in March 2013. The final certification regulations comprised three major parts: certified endovascular neurosurgeons (EN), certified ENS institutions, and certified ENS training institutions. Applications have been evaluated and the results were announced in June 2013 as follows: 126 members received EN certification and 55 hospitals became ENS-certified institutions. The SKEN has established standard ENS training programs together with a certification system, and it is expected that they will advance the field of ENS to enhance public health and safety in Korea.     

Polymyositis with cytochrome C oxidase negative fibers—a pathological and clinical challenge

Polymyositis (PM) with cytochrome C oxidase negative fibers also referred to as PM with mitochondrial pathology (PM-Mito) is characterized by the symptoms of inclusion body myositis (IBM) and by the myopathological findings of PM except for an increase of muscle fibers with insufficient mitochondrial cytochrome C oxidase activity. Few PM-Mito cases are published; mitochondrial ultrastructure has not been studied in these patients. We report 2 PM-Mito patients with later onset than usually seen in IBM and poor responsiveness to glucocorticoids. Electron microscopy of muscle fibers showed irregular mitochondrial ultrastructure. Sjögren syndrome related antinuclear antibodies (Anti-Ro and Anti-La) were found in one of the two patients but the typical clinical symptoms of Sjögren syndrome such as xerostomia and keratoconjunctivitis were absent in this patient. Taken together, our observations, viewed in conjunction with the current literature, suggest that PM-Mito is an underdiagnosed disease with a multifactorial pathogenesis that should be elucidated in further studies. We want to encourage clinicians and pathologists to consider the possibility of PM-Mito in patients with atypical PM or sIBM.     

Tc-99m RBC perfusion and blood-pool scintigraphy in the evaluation of vascular leiomyoma of the hand

A 62-year-old man with a soft, non-tender, movable mass 2.5 x 2.5-cm in diameter in the volar surface of the right index finger over the proximal phalanx underwent Tc-99m RBC perfusion and blood-pool scintigraphy to evaluate the vascular nature and extent of the mass. Highly increased activity on early and delayed blood-pool images with increased perfusion was demonstrated in the mass. The lesion with high flow rates and large blood pool spaces was considered highly suggestive of one of the various types of peripheral hemangioma. Angiography revealed a vascular neoplasm with tumor vessels. Microscopic examination of the resected tumor revealed vascular leiomyoma containing numerous dilated vascular channels. These scintigraphic abnormalities were regarded as resulting from hypervascularity demonstrated angiographically and blood pooling within the dilated vascular channels demonstrated histologically. It is concluded that Tc-99m RBC perfusion and blood pool scintigraphy may be an important non-invasive approach to demonstrate vascular leiomyoma prior to surgical biopsy or resection.     

Validation of the Korean version of the McMaster Quality of Life Scale in terminal cancer patients

The purpose of this study was to develop and validate a Korean version of McMaster Quality of Life Scale (K-MQLS) suitable for evaluating clinical hospice and palliative care. The McMaster Quality of Life Scale (MQLS) is a brief and comprehensive scale that is used to assess cancer patients receiving palliative care due to poor physical condition. To further develop the K-MQLS, we followed rigorous international translation steps and performed validity, reliability, and sensitivity analyses. The results of our study show that the K-MQLS is an efficient tool in terms of its validity, reliability, and sensitivity for the measurement of the health-related quality of life during the palliative phase. This developed tool could be used in research or clinical settings to assess health-related quality of life in Korean palliative care patients.