Experience of the Simulation Based Hospital Disaster Preparation Training Program by the Polls of before and after Training Program

PURPOSE: The objective of this study is to develop an adequate local disaster preparation program that integrates multiple institutes, ultimately saving time, human resources, and expenses. METHODS: The study proceeded in the orders of polls to the medical team before the drill and the lecture which were education on disaster, equipment, how to deal with the various situtuation, and performed the drill, debriefing session, and then reevaluated by polls after the drill. RESULTS: Among the 57 medical staffs, a comparison was made of the polls between before and after the simulation with respect to the treatment ability depending on disaster triage, understanding of disaster data transferring system, test on disaster understanding (p<0.001). However, the difference by work career was not statistically significant (p=0.206, p=0.665). CONCLUSION: We were able to develop a new program with a great response and understanding enabling us to adequately prepare for disasters. We may increase our ability to deal with such situations through unified training, not only within the hospital but also with local institutes through this well-structured program.

A Case of Superior Mesenteric Venous Thrombosis Due to Protein C Deficiency in a Patient with Duodenal Ulcer Bleeding / 대한소화기학회지

Mesenteric venous thrombosis is a clinically very rare disease, and may cause bowel infarction and gangrene. Difficulty in the dignosis the disease due to its non-specific symptoms and low prevalence can cause a clinically fatal situation. Mesenteric venous thrombosis may be caused by both congenital and acquired factors, and protein C deficiency, which is a very rare genetic disorder, is one of many causes of mesenteric thrombosis. The authors experienced a case of mesenteric venous thrombosis caused by protein C deficiency in a patient with duodenal ulcer bleeding, so here we report a case together with literature review.

Cowden's Disease Detected by Gastric Polyposis during Endoscopy in a Routine Check Up: A Case Report / 대한소화기내시경학회지

Cowden's disease, a rare autosomal dominant disorder characterized by benign hamartomatous overgrowth of various tissues, increases the risk of cancer of the thyroid, breast, endometrium, prostate, and possibly other organs. Generally, germline mutations in the coding sequence for PTEN are found in 80% of patients with Cowden's disease. Here we report a rare case of incidentally discovered gastric polyposis during esophagogastroscopy for medical screening in a patient with a history of surgery for breast and thyroid cancer. Identifyng the mutation in the PTEN gene to a diagnosis of Cowden's disease.

A Case of Acute Respiratory Distress Syndrome Induced by Injection of Silicone Fluid for Colpoplasty / 결핵및호흡기질환

Acute respiratory distress syndrome after silicone fluid injection is uncommon. Reasons that organic silicone is inactive in the human body and has low surface tension and is not affected by physical factors such as time or temperature make this material to be widely used as a medical product. However, lately some of its side effects have been noted and also cause respiratory problems in rare occasions. The mechanism is not clear but silicone injection cause one to cough, produce hemoptysis, fever, pleuritic chest pain, and dyspnea, and may even lead to acute respiratory failure. In other countries, these side effects were reported from 1970s and several cases started to appear in Korea from 1990s. We report a 58 years-old female who recovered from acute respiratory distress syndrome after injection of silicone fluid into vaginal wall by a conservative therapy.

A Case of Anticonvulsant Hypersensitivity Syndrome with Subcarinal Lymph node Enlargement and Eosinophilic Pneumonia Induced by Carbamazepine / 결핵및호흡기질환

Anticonvulsant hypersensitivity syndrome (AHS) is an uncommon, but potentially fatal and mutilsystemic disorder that occurs after exposure to the arene oxide-producing anticonvulsants-carbamzepine, phenobarbital and phenytoin. The multisystemic reactions include fever, skin eruptions, lymphadenopathy, hematologic abnormality and hepatitis. The diagnosis of AHS is made by history of drug exposure and clinical course. No specific treatments are proved as benefit except discontinuing the offending drug and trying the steroids in some severe cases. We report a case of carbamazepine induced anticonvulsant hypersensitivity syndrome characterized by skin rash, eosinophilia, subcarinal lymphadenopathy and eosinophilic pneumonia. The patient was resolved completely after only discontinuing carbamazepine.

Stability of obwegeser II method in mandibular prognathic or anterior open bite patients

The purpose of this study was to evaluate the postoperative stability of the severe open bite or mandibular prognathic patients after mandibular set back surgery by Obwegeser II method. There were 19 patients who had been undergone Obwegeser II method. The horizontal and vertical position of the cephalometric points were measured preoperation and immediate postoperation, postoperative 1 month, postoperative 6 months ; were analyzed by linear measurement to evaluate changes in skeletal landmark and the relapse was compared between open bite group and prognathism group. By the operation, horizontal change of B was 6.84+/-4.35mm and vertical change of B was 6.28+/-3.25mm in open bite group and horizontal change of B was 14.20+/-4.81mm and vertical change of B was 1.99+/-2.66mm in prognathism group, horizontal change of Pog was 3.82+/-5.71mm and vertical change of Pog was 5.38+/-2.11mm in open bite group and horizontal change of Pog was 13.24+/- 5.99mm and vertical change of Pog was 1.91+/-0.94mm in prognathism group. Between immediate postoperation and postoperative 1 month, all skeletal landmarks change was no statistical difference (p>0.05) and there were no statistical difference between open bite group and prognathism group except x-Me landmark (p>0.05). Between postoperative 1 month and 6 months, horizontal change of B was 0.12+/-1.35mm and vertical change of B was 1.47+/-1.48mm in open bite group and horizontal change of B was 1.43+/-1.35mm and vertical change of B was 0.82+/-1.99mm in prognathism group, horizontal change of Pog was 0.13+/-1.40mm and vertical change of Pog was 0.88+/-1.71mm in open bite group and horizontal change of Pog was 1.08+/-1.74mm and vertical change of Pog was 0.47+/-1.57mm in prognathism group (p>0.05) and there were no statistical difference between open bite group and prognathism group (p>0.05). Between immediate postoperation and postoperative 6months, horizontal change of B was 0.24+/-1.17mm and vertical change of B was 1.87+/-1.63mm in open bite group and horizontal change of B was 1.54+/-1.55mm and vertical change of B was 1.04+/-1.96mm in prognathism group, horizontal change of Pog was 0.91+/-1.46mm and vertical change of Pog was 1.18+/-2.05mm in open bite group and horizontal change of Pog was 0.96+/-1.62mm and vertical change of Pog was 1.23+/-2.35mm in prognathism group (p>0.05) and there were statistical difference between open bite group and prognathism group in x-B, x-Pog, x-Gn, x-Me (p<0.05). Obwegeser II method is considered as one of the best operation when surgical correction of severe open bite or severe mandibular prognathism is needed.

Clinical analysis of condylar displacement evaluated by 3-D CT under the surgical correction of mandibular prognathism

0.05). In amount of mandibular set back, we found the condylar hange(T2-T1) which had increased tendency from Group 1 to Group 3 and decreased tendency of MM' from Group 1 to 3. but there was no statistical significance (p>0.05). There was some correlation between condylar change and TMJ dysfuction. It seemed that postoperative condylar change had influenced the postoperative TMJ dysfunction, though was no statistical significance (p>0.05). As we have observed the change of condylar axis in the group that complained of TMJ dysfunction after operation in cases of large amount of mandibular set back, do we consider that the more trying to onserve the condylar position will decrease the occurrence rates of the postoperative condylar displacement, TMJ dysfunction and the relapse.

The positional relationship between the mandible and the hyoid bone in mandibular protrusion after orthognathic surgery evaluated with 3-d ct

PURPOSE: This study was intended to evaluate the positional relationship between the hyoid bone and the mandible in patients with mandibular protrusion after mandibular set-back surgery by means of 3D-CT. MATERIALS AND METHODS: Preoperative(3 weeks before) and postoperative (6 weeks after) 3D-CT and cephalogram were taken on 32 patients(12 male, 20 female, mean age of 23.2) treated by bilateral sagittal split osteotomy with rigid fixation. The angular measurement on 3D-CT basilar view were deviation of Me and H, long axis angle of left and right cornu majus. The lineal measurement on 3D-CT basilar view were composed of intercondylar line and coordinates(x,y) of Me and H. The angular and lineal measurement of lateral cephalogram were composed of mandibular plane angle, SNA, SNB, ANB, FH-NA and FH-NB, and coordinates(x,y) of B, Pog, Me and H, PAS, Lpw, MPH and IAS. On the frontal cephalogram, deviation of Me were evaluated. RESULTS: The mean mandibular set-back was 8.0mm horizontally and mandibular plane angle was slightly increased. The hyoid bone was displaced postero-inferiorly, the distance between MP(mandibular plane) and H(hyoid bone) was increased and the posterior airway space values (PAS, Lpw, IAS) were decreased. The coordinates Me(x,y), H(x,y) and deviation angle Me' and H'were revealed the strong positive correlation. CONCLUSION: The results revealed that the horizontal, vertical and transverse relationship of the mandibular and the hyoid bone movements were significantly correlated in patients performed mandibular set-back surgery.

A case of bleeding duodenal varix treated by endoscopic band ligation / 대한내과학회지

The occurrence of duodenal varices is rare. They are often overlooked as a source of upper gastrointestinal bleeding in patients with portal hypertension. Experience in control of bleeding duodenal varices is limited. Endoscopic variceal ligation (EVL) is generally considered a safer alternative than endoscopic injection sclerotherapy for treatment of bleeding esophageal varices. Recently EVL has been described as a successful treatment for ruptured duodenal varices. We present a case of bleeding duodenal varices in a 46-year-old man with liver cirrhosis and cholangiocarcinoma who presented with melena. Emergency endoscopy revealed no esophagogastric varices, but several nodular varices were found in the second portion of the duodenum. A punctate ulcer overlying the varix with intermittent bleeding was observed. The hemorrhagic lesion was successfully treated by endoscopic ligation after failure of hemostasis with ethanolamine injection theapy. Endoscopic ligation may be a therapeutic choice to arrest active duodenal variceal bleeding.