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Azathioprine is frequently used for the treatment of inflammatory bowel diseases (IBD) such as Crohn's disease and ulcerative colitis. Lymphomas, squamous cell carcinomas, and undifferentiated pleomorphic sarcomas have been reported among patients receiving azathioprine therapy. Herein, we report a case of pleomorphic liposarcoma of chest wall which occurred in a 44-year-old man with Crohn's disease taking azathioprine. He was diagnosed with Crohn's disease 3 years ago after suffering from abdominal pain and hematochezia for 12 years. He had been taking 50 mg of azathioprine per day for 23 months when he visited the thoracic and cardiovascular surgery clinic due to right chest palpable mass that had rapidly grown during the past 2 months. Excisional biopsy was performed and the mass was diagnosed as pleomorphic liposarcoma. Therefore, he underwent radical excision of the right chest wall mass, which measured 11.0 × 6.5 cm in size. He is scheduled to receive radiation therapy and chemotherapy.

Background/aims: Incidentally detected focal 18F-fluorodeoxyglucose (FDG) uptake was compared with colonoscopy. We investigated the characteristics of colon adenomas which were revealed on PET/CT. Then we identified whether additional colonoscopy was necessary in patients with lesions which were revealed on PET/CT but had no matched lesions on colonoscopy., Methods: We retrospectively reviewed 95 patients who underwent colonoscopy within a 6 month interval after they had focal FDG uptake from January 2010 to May 2012 at National Police Hospital in Korea. Also, we analyzed 30 patients who underwent additional colonoscopy within 2 years after they had no matched lesions on primary colonoscopy., Results: PET/CT depicted 54.6% (41/75) of adenomas and adenocarcinomas. The PET visibility of colon adenoma was significantly associated with degree of dysplasia (p=0.027), histologic type (p=0.040), and the size (p=0.038). The positivity rate was increased with higher degree of dysplasia (low-grade dysplasia, 47%; high-grade dysplasia, 78%; adenocarcinoma, 100%) and villous patterns of histologic type (tubular, 46.8%; tubulovillous, 87.5%; villous, 100%). Patients with adenomas larger than 10 mm (87.5%) had higher detection rate compared to those with adenomas smaller than 10 mm (49.0%). Among the 30 patients who underwent additional colonoscopy, only one patient had a 6 mm sized tubular adenoma (low-grade dysplasia)., Conclusions: Incidental focal colonic uptake may indicate advanced adenoma or adenocarcinoma. Thus, it justifies performing colonoscopy for identifying the presence of colon neoplasms. However, in case of unmatched lesions between PET/CT and colonoscopy, there was little evidence that additional colonoscopy would yield benefits.

Purpose: The purpose of this study was to evaluate the effects of a mentoring program to improve the exercise and dietary habits of adolescents., Methods: A non-equivalent control group, pretest-posttest design was used. The independent variable was a mentoring program for improvement of exercise and dietary habits of adolescents, in which the mentors were nursing students and the mentees were female middle school students. The dependent variables were weekly exercise frequency, weekly exercise time, perception of exercise benefit, frequency of vegetable intake, and dietary habits. The intervention was conducted by various methods such as group education, individual approach through the mentor-mentee relationship, and multimedia approaches., Results: At follow-up, the perception of the exercise benefit was significantly greater in the intervention group than in the control group. The weekly exercise frequency and frequency of vegetable intake in the intervention group were significantly greater after the intervention than those before the intervention., Conclusion: This mentoring program is potentially of an effective health promotion program for adolescents and will enable nursing students who participate in the program as mentors to gain confidence in their professional capability.

Purpose: Ego-integrity in older adults is the central concept related to quality of life in later life. Therefore, for effective interventions to enhance the quality of later life, a scale to measure ego-integrity in older adults is necessary. This study was carried out to develop a scale to measure ego-integrity in older adults., Methods: This study utilized cronbach's alpha in analyzing the reliability of the collected data and expert group, and factor analysis and item analysis to analyze validity., Results: Seventeen items were selected from a total of 21 items. Cronbach's alpha coefficient for internal consistency was .88 for the 17 items of ego-integrity in the older adults scale. Three factors evolved by factor analysis, which explained 50.71% of the total variance., Conclusions: The scale for measuring ego-integrity in Korean older adults in this study was evaluated as a tool with a high degree of reliability and validity.

Purpose: Ego-integrity in Erikson's stage theory is used frequently among health team members related to the care of the elderly and has specific meanings within the context of quality of life in later life. However, the concept of ego-integrity in the elderly has not been well articulated in the literature. This study was conducted clarify and conceptualize the phenomena of ego-integrity in the elderly., Method: A Hybrid Model of concept development was applied to develop a concept of ego-integrity, which included a field study carried out in Seoul, South Korea using in-depth interviews with old adults who were admitted as a right person for research subject according to attributes of ego-integrity analysed in the theoretical phase., Results: The concept of ego-integrity emerged as a complex phenomenon having meanings in several different dimensions which encompassed several attributes., Conclusions: Ego-integrity is a concept having needs that should be treated in a specific way and it is possible to enrich the meaning and methods to manage ego-integrity in nursing interventions for promoting quality of life so that its application may have effects that have positive impacts on the elderly's well being.

Purpose: The purpose of this study was to evaluate the effects on health information education for the deaf., Method: One group pre-test and post-test research design was applied to 46 deaf people. The instrument developed by research team was used for data collection. The questionnaire consisted of 91 items including demographics and 5 diseases, such as hypertension, cancer, diabetes, pulmonary tuberculosis, and hepatitis., Result: The degrees of knowledge on 4 diseases, such as, hypertension, diabetes, pulmonary tuberculosis, and hepatitis were significantly improved. There was no educational effect on cancer even though the degree of knowledge during the pre-test was the highest. There were educational effects on 5 diseases by gender, but no effects by age and hearing/deaf status of parent., Conclusion: This study was the first for the deaf in nursing. Further studies are needed for the deaf who have low education. Also, good educational materials using video and CD need to be developed.

Background/aims: Long-term efficacy and the rate of viral breakthrough in patients with HBeAg- negative chronic hepatitis B receiving lamivudine therapy is uncertain. This study was conducted to determine the rate of viral breakthrough according to the HBeAg status and the relation of viral breakthrough with YMDD mutants., Methods: Two hundred and five patients with HBeAg-positive and 49 patients with HBeAg-negative chronic hepatitis B, who had received lamivudine for at least 9 months, were included. The mean durations of the lamivudine treatment were 176 months and 155 months in HBeAg-positive and negative patients, respectively. Analysis of HBV genome for YMDD mutations was performed by restriction-fragment-length polymorphism assay and direct sequencing., Results: While the cumulative rates of viral breakthrough at 12th and 24th months of the lamivudine therapy were 0% and 7% in the HBeAg-negative group, they were 12% and 39% in the HBeAg-positive group. The cumulative rate of viral breakthrough in the HBeAg-negative group was significantly lower than in the HBeAg-positive group (p<0.01). In multivariate analysis, the only significant factor related to viral breakthrough was the HBeAg status (p<0.05). The YMDD mutants were detected in all patients with viral breakthrough irrespective of HBeAg status. However, in patients without viral breakthrough, the rate of YMDD mutants was significantly higher in the HBeAg-negative group than in the HBeAg-positive group (13.3% vs 5.1%; p<0.01)., Conclusions: Lamivudine is expected to be more persistently effective in HBeAg-negative chronic hepatitis B because of a lower viral breakthrough rate than in HBeAg-positive chronic hepatitis B in spite of the emergence of YMDD mutants.

Background/aims: Long-term lamivudine therapy can induce the emergence of lamivudine resistant hepatitis B virus (HBV) mutants. Clinically emergence of the mutant is expressed by the reappearance of disappeared HBV DNA in serum. Continued lamivudine treatment has been usually recommended in cases of viral breakthrough. However, the clinical outcome in patients with viral breakthrough is not clear. The aim of this study was to investigate the clinical course of chronic hepatitis B patients after viral breakthrough during lamivudine therapy., Methods: A total of 74 patients with chronic hepatitis B who showed viral breakthrough after at least 6 months of lamivudine treatment were included in this study. They had positive HBeAg and HBV DNA before treatment. The median follow-up duration after breakthrough was 13 months., Results: After viral breakthrough, only 8 patients (11%) maintained normal ALT levels and 66 patients (89%) showed elevation of ALT. 30 patients (41%) showed acute exacerbation of hepatitis (ALT increase over five-times upper normal limit). These acute exacerbations occurred within three months after breakthrough in 19 patients (63%). In the cases of acute exacerbation, 6 patients showed decompensated progression such as elevation of serum total bilirubin. One of them died of hepatic failure. A predictive factor for acute exacerbation was not found. HBeAg seroconversion occurred in 8 patients after viral breakthrough but their clinical course was highly variable., Conclusions: Chronic hepatitis B patients who had viral breakthrough during lamivudine therapy should be followed carefully and regularly in mind of potential clinical deterioration. New strategies are needed to manage the cases of acute exacerbation after viral breakthrough.