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Background and Objectives@#The aim of this study was to compare adherence to positive airway pressure (PAP) therapy in patients with obstructive sleep apnea (OSA) of different severity.Subjects and Method We conducted a retrospective study including 270 adult OSA patients who used a PAP device for at least 3 months. We assessed the percentage of days on which the device was used, the percentage of days on which the device was used for ≥4 h, and the average duration of PAP device usage at 12 weeks of PAP therapy. We also evaluated adequate adherence to PAP therapy using a PAP device for ≥4 h/day and during ≥70% of nights. @*Results@#The percentage of days on which a PAP device used did not differ significantly according to OSA severity (median [Q1-Q3]; mild: 91.40% [81.25%-97.65%], moderate: 94.50% [86.90%-100%], severe: 95.90% [88.10%-100%], p=0.268). We also found that the percentage of days on which a PAP device was used during sleep for ≥4 h was not significantly different in patients with different OSA severity (median [Q1-Q3], mild: 76.20% [69.70%-89.90%], moderate: 89.30% [67.65%-95.70%], severe: 85.70% [75.85%-95.45%], p=0.097). The percentage of patients with adequate PAP adherence did not differ significantly according to OSA severity (mild: 74.2%, moderate: 72.1%, severe: 83.0%, p=0.084). Moreover, the mean duration (minutes) of PAP device usage during sleep did not differ significantly according to OSA severity in the mild, moderate, and severe OSA groups (mean±standard deviation, mild: 348.03± 47.78 min, moderate: 358.58±85.22 min, severe: 363.79±57.21 min, p=0.440). @*Conclusion@#Adherence to PAP therapy did not differ significantly according to OSA severity. Therefore, it is necessary to continuously expand and maintain the insurance for health promotion in OSA patient in South Korea.
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Background@#Conflict in the medical world in 2020 led to the rejection of the national examination for doctors. This study explained the process until the end of the national test refusal situation triggered in 2020 through the signaling game theory. The government has succeeded in requiring medical students to take the national exam. @*Methods@#To explain the rejection of the national examination, we first compose and show an example of two small non-signaling games where medical students know which type the government is of, then combine them to play a signaling game. @*Results@#The behavior of the government and medical students was examined through the signaling game model. In the context of the coronavirus disease 2019 (COVID-19) pandemic, the government makes an ultimatum, whatever the type. And the medical students accept it. They judged that the government could not be expected to abolish the policy. If COVID-19 had not occurred, medical students would have been able to continue the confrontation. @*Conclusion@#The government instilled in the other party the perception that the government would not bend its policies because it was the surly type and would not be afraid of a strong confrontation. Through the image created in this way, the government was forced to accept the ultimatum by medical students. Academically, this study is to deal with the policy-making process through the signaling game theory. In the area of health care policy, this study suggests that various situations such as the type of government or the spread of COVID-19 can become important in addition to the rationality of the policy itself.
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Thyroid tuberculosis with papillary thyroid carcinoma is very rare. The current study shows the case of a 67-year-old female who was admitted to Ansan Hospital of Korea University, with her thyroid nodules showing signs of malignancy under ultrasonography. A histopathological examination proved the coexistence of papillary thyroid carcinoma (PTC) and thyroid tuberculosis (TB). A total thyroidectomy and excision of the enlarged left neck level II lymph node were performed. This report presents a rare case of coexistence of PTC and thyroid TB. Further investigation is needed to evaluate the possible role of PTC in thyroid mycobacterial infection.
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Thyroid tuberculosis with papillary thyroid carcinoma is very rare. The current study shows the case of a 67-year-old female who was admitted to Ansan Hospital of Korea University, with her thyroid nodules showing signs of malignancy under ultrasonography. A histopathological examination proved the coexistence of papillary thyroid carcinoma (PTC) and thyroid tuberculosis (TB). A total thyroidectomy and excision of the enlarged left neck level II lymph node were performed. This report presents a rare case of coexistence of PTC and thyroid TB. Further investigation is needed to evaluate the possible role of PTC in thyroid mycobacterial infection.
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Background@#In this study, we compared the incidents of humidifier disinfectants and incidents of mild hepatitis in Japan to highlight the differences in government response in the health care field in terms of “chain of responsibility”. @*Methods@#We examined whether the three mechanisms of action and the chain of responsibility hypothesis were applied to compare the cases of Korea and Japan. The incident of Japan occurred in 1987 in Misawa city, Aomori prefecture. In the 1990s, the safety of blood products increased dramatically. However, relief for infected victims was neglected. Green Cross did not notify the parties. In Korea, in the spring of 2011, a number of lung disease patients were accidentally admitted to a hospital in Seoul, and a female patient with respiratory failure symptoms expired. The Korea Centers for Disease Control and Prevention conducted animal tests and the Ministry of Health and Welfare issued an order for forced collection of humidifier disinfectants. @*Results@#In the case of Japan, the Ministry of Health and Welfare had to take responsibility for follow-up measures such as the investigation of the cause, so it was tied to a “chain of responsibility”. However, in the case of Korea, the Ministry of Health and Welfare was free from the chain. @*Conclusion@#Through the comparison between the cases of Japan and Korea, we confirmed that whether or not a government organization chooses to conceal responsibility depends on its past behavior, which is whether it is free from the chain of responsibility or not. Therefore, it was reaffirmed that an organization (ministry or department) free from the chain of responsibility must exist within the government.
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Background@#In this study, we compared the incidents of humidifier disinfectants and incidents of mild hepatitis in Japan to highlight the differences in government response in the health care field in terms of “chain of responsibility”. @*Methods@#We examined whether the three mechanisms of action and the chain of responsibility hypothesis were applied to compare the cases of Korea and Japan. The incident of Japan occurred in 1987 in Misawa city, Aomori prefecture. In the 1990s, the safety of blood products increased dramatically. However, relief for infected victims was neglected. Green Cross did not notify the parties. In Korea, in the spring of 2011, a number of lung disease patients were accidentally admitted to a hospital in Seoul, and a female patient with respiratory failure symptoms expired. The Korea Centers for Disease Control and Prevention conducted animal tests and the Ministry of Health and Welfare issued an order for forced collection of humidifier disinfectants. @*Results@#In the case of Japan, the Ministry of Health and Welfare had to take responsibility for follow-up measures such as the investigation of the cause, so it was tied to a “chain of responsibility”. However, in the case of Korea, the Ministry of Health and Welfare was free from the chain. @*Conclusion@#Through the comparison between the cases of Japan and Korea, we confirmed that whether or not a government organization chooses to conceal responsibility depends on its past behavior, which is whether it is free from the chain of responsibility or not. Therefore, it was reaffirmed that an organization (ministry or department) free from the chain of responsibility must exist within the government.
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Since the government is fully aware of the specificity and importance of the healthcare field, it operates bureaucracy and affiliated organizations composed of many government ministries and experts and is also handling the related bureaus. However, recent incidents of humidifier disinfectant not only make these government activities unreliable but also cause disappointment to many people. Why did not the government take active measures to ensure product safety? But why was the Korea Centers for Disease Control and Prevention (KCDC) able to speed up the identification of the cause and the recovery of the product? The purpose of this study is to clarify the behavioral mechanisms of government intervention by comparing the behaviors of the Ministry of Trade, Industry and Energy and the KCDC. Then, we will discuss the desirable government structure.
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Background@#Appropriate blood component transfusion might differ between intraoperative massive bleeding and traumatic massive bleeding in the emergency department because trauma patients initially bleed undiluted blood and replacement typically lags behind blood loss. We compared these two blood loss scenarios, intraoperative and traumatic, using a computer simulation. @*Methods@#We modified the multi-compartment dynamic model developed by Hirshberg and implemented it using STELLA 9.0. In this model, blood pressure changes as blood volume fluctuates as bleeding rate and transcapillary refill rate are controlled by blood pressure. Using this simulation, we compared the intraoperative bleeding scenario with the traumatic bleeding scenario. In both scenarios, patients started to bleed at a rate of 50 ml/min. In the intraoperative bleeding scenario, fluid was administered to maintain isovolemic status; however, in the traumatic bleeding scenario, no fluid was supplied for up to 30 min and no blood was supplied for up to 50 min. Each unit of packed red blood cells (PRBC) was given when the hematocrit decreased to 27%, fresh frozen plasma (FFP) was transfused when plasma was diluted to 30%, and platelet concentrate (PC) was transfused when platelet count became 50,000/ml. @*Results@#In both scenarios, the appropriate ratio of PRBC:FFP was 1:0.47 before PC transfusion, and the ratio of PRBC:FFP:platelets was 1:0.35:0.39 after initiation of PC transfusion. @*Conclusion@#The ratio of transfused blood component did not differ between the intraoperative bleeding and traumatic bleeding scenarios.
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Percutaneous epidural neuroplasty may lead to complications such as hematoma, infection, epidural abscess, meningitis, hypotension, respiratory depression, urinary and fecal dysfunction, sexual dysfunction and paresthesia. Other technical complications may include shearing or tearing, misplacement, blockage and migration of the catheter. We report a case of a 41-year-old female patient, who underwent surgical removal of a sheared catheter, which was retained for 30 months after cervical Racz neuroplasty.
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Adulto , Feminino , Humanos , Catéteres , Abscesso Epidural , Espaço Epidural , Hematoma , Hipotensão , Meningite , Pescoço , Parestesia , Insuficiência RespiratóriaRESUMO
Pudendal neuralgia is characterized by severe sharp pain along the innervation area of pudendal nerve, which may be worsened when sitting position. Successful pudendal nerve block is crucial to the diagnosis of pudendal neuralgia. Although fluoroscopy-guided pudendal nerve blocks have traditionally been performed, recently ultrasound-guided pudendal nerve blocks were reported. For the long term effect of nerve block, pulsed radiofrequency was performed under fluoroscopic guidance in some reports. We report our successful experiences of three cases using ultrasound-guided pulsed radiofrequency.
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Humanos , Diagnóstico , Bloqueio Nervoso , Nervo Pudendo , Neuralgia do PudendoRESUMO
PURPOSE: To evaluate the accuracy of Pentacam(R) built-in 5 intraocular pressure (IOP) correction programs used to measure the IOP of patients who received corneal refractive surgery. METHODS: IOP of 124 eyes from 62 patients who underwent epipolis laser in situ keratomileusis was measured with Goldmann applanation tonometry (GAT) at 6 months pre- and post-operatively. The collected data was input into Pentacam(R), calculated by 5 correction programs, Ehlers, Shah, Dresden, Orssengo / Pye, Kohlhaas, and compared. RESULTS: The GAT-based pre- and post-operative IOP was 15.75 +/- 2.24 mm Hg, and 10.72 +/- 2.31 mm Hg, respectively, revealing the post-operative IOP to be significantly lower than the pre-operative IOP (p < 0.001). Among the 5 correction programs within Pentacam(R), Ehlers program showed little difference between pre- and post-operative IOP values (p = 0.228) and the post-operative correction value showed no significant difference with the pre-operative GAT value (p = 0.413). CONCLUSIONS: The Ehlers program is the most accurate among the 5 Pentacam(R) correction programs evaluated in the present study, and can be a useful tool for correcting the true IOP of patients which tends to be higher after corneal refractive surgery.
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Humanos , Pressão Intraocular , Ceratomileuse Assistida por Excimer Laser In Situ , Manometria , Procedimentos Cirúrgicos RefrativosRESUMO
PURPOSE: To investigate the error tendency between preoperative target diopter and postoperative manifest refraction in cataract surgery cases and the effect of axial length and vitrectomy on refractive error (RE). METHODS: We retrospectively studied 90 eyes of 90 patients who underwent cataract surgery. The power of intraocular lens (IOL) was calculated by SRK/T formula. Patients were devided into four groups based on axial length (AXL) and the past history of vitrectomy. RESULTS: The mean of RE showed no significant difference between groups. But an increasing AXL was associated with increased myopic shift with normal range AXL (24.4 mm) (r = 0.718, p < 0.001). In vitrectomized eyes, it showed no significant refractive shift with both normal range and long AXL. CONCLUSIONS: When determining IOL power using SRK/T formula in nonvitrectomized eyes, postoperative refractive shift based on axial length should be considered.
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Humanos , Catarata , Olho , Lentes Intraoculares , Valores de Referência , Erros de Refração , Estudos Retrospectivos , VitrectomiaRESUMO
Klinefelter's syndrome which is characterized by hypogonadism with karyotype abnormality (47 XXY or 46 XY/47 XXY) in males has been reported to be associated with autoimmune diseases including rheumatoid arthritis and systemic lupus erythematosus. However, Klinefelter's syndrome accompanying with polymyositis has rarely been reported. We report a case of KFS with polymyosits in a 38-year old man for the first time in Korea.
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Humanos , Masculino , Artrite Reumatoide , Doenças Autoimunes , Hipogonadismo , Cariótipo , Síndrome de Klinefelter , Coreia (Geográfico) , Lúpus Eritematoso Sistêmico , PolimiositeRESUMO
A chronic intestinal pseudo-obstruction is a rare disorder and a severe digestive syndrome. It is characterized by deranged gut propulsive motility that resembles a mechanical obstruction, but no obstructive process is present. An intestinal pseudo-obstruction may be classified as acute or chronic; the chronic form may also be classified as idiopathic or secondary to a variety of diseases. Treatment of intestinal pseudo-obstruction involves nutritional, pharmacological, and surgical therapies. Surgery should be limited to patients who are refractory to medical therapy and show a deteriorating course. Despite available medical and surgical interventions, the outcome remains poor. Here, we describe a case of a 54-year-old female with chronic constipation and abdominal distension, who was subsequently found to have segmental aganglionosis. The patient was treated with a subtotal colectomy and ileosigmoidostomy without sequelae.
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Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Colectomia , Pseudo-Obstrução do Colo , Constipação Intestinal , Fluconazol , Doença de Hirschsprung , Pseudo-Obstrução IntestinalRESUMO
Infliximab, a chimeric monoclonal immunoglobulin antibody to tumor necrosis factor (TNF)-alpha is widely used in the treatment of rheumatoid arthritis (RA). The commonly reported cardiac side effects of infliximab include exacerbation of congestive heart failure, hypotension, and syncope. Cardiac arrhythmia and conduction disturbances have been reported only rarely in a few case reports and to the best of our knowledge, there are no previous reports on the occurrence of atrial fibrillation secondary to infliximab use in RA patients. Here, we report a case of acute atrial fibrillation with rapid ventricular response that occurred 24 hr after first dose of infliximab in a 55-year-old female patient with RA, who recovered to sinus rhythm after pharmacologic management.
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Feminino , Humanos , Pessoa de Meia-Idade , Anticorpos Monoclonais , Arritmias Cardíacas , Artrite Reumatoide , Fibrilação Atrial , Insuficiência Cardíaca , Hipotensão , Imunoglobulinas , Síncope , Fator de Necrose Tumoral alfa , InfliximabRESUMO
Chronic lymphocytic leukemia (CLL) is the most common type of leukemia occurring in Western nations. In CLL it is well known that the risk of a secondary malignancy is higher than in the normal population. But in Korea, CLL is a rare type of leukemia, so there have been only a few reported cases with a secondary malignancy. CLL is characterized by progressive defects in both cell-mediated and humoral immunity. It is known that defects in the immune system of patients with CLL contribute to the development of a secondary malignancy. We experienced a case of a 71-year-old man who suffered from a chronic cough and was diagnosed with small cell lung cancer coexisting with CLL. Until this case, there was no reported case in Korea of small cell lung cancer coexisting with CLL. We now report a case of small cell lung cancer coexisting with CLL and present a literature review.
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Idoso , Humanos , Tosse , Sistema Imunitário , Imunidade Humoral , Coreia (Geográfico) , Leucemia , Leucemia Linfocítica Crônica de Células B , Carcinoma de Pequenas Células do PulmãoRESUMO
The use of pulmonary artery catheters has increased considerably since the Swan-Ganz catheter was first introduced in 1970. It is extremely helpful in the management of critically ill patients and in pulmonary hypertension. However, its manipulation carries potential risks, including subclavian or carotid artery laceration, pneumothorax, thoracic duct laceration, phrenic nerve injury, air embolism, arrhythmias, infection, valvular damage, thrombosis, pulmonary infarction, and pulmonary artery rupture. Pulmonary artery rupture, albeit rare, remains a severe complication. Here, we present a patient who developed pulmonary artery rupture and total atelectasis of the left lung after placement of a pulmonary artery catheter.
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Humanos , Arritmias Cardíacas , Artérias Carótidas , Cateterismo , Catéteres , Estado Terminal , Embolia Aérea , Hipertensão Pulmonar , Lacerações , Pulmão , Nervo Frênico , Pneumotórax , Artéria Pulmonar , Atelectasia Pulmonar , Infarto Pulmonar , Ruptura , Ducto Torácico , TromboseRESUMO
The use of pulmonary artery catheters has increased considerably since the Swan-Ganz catheter was first introduced in 1970. It is extremely helpful in the management of critically ill patients and in pulmonary hypertension. However, its manipulation carries potential risks, including subclavian or carotid artery laceration, pneumothorax, thoracic duct laceration, phrenic nerve injury, air embolism, arrhythmias, infection, valvular damage, thrombosis, pulmonary infarction, and pulmonary artery rupture. Pulmonary artery rupture, albeit rare, remains a severe complication. Here, we present a patient who developed pulmonary artery rupture and total atelectasis of the left lung after placement of a pulmonary artery catheter.
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Humanos , Arritmias Cardíacas , Artérias Carótidas , Cateterismo , Catéteres , Estado Terminal , Embolia Aérea , Hipertensão Pulmonar , Lacerações , Pulmão , Nervo Frênico , Pneumotórax , Artéria Pulmonar , Atelectasia Pulmonar , Infarto Pulmonar , Ruptura , Ducto Torácico , TromboseRESUMO
Breathlessness is a frequent and distressing symptom in terminal cancer patients. Refractory breathlessness is defined as a state that does not respond to conventional disease-specific therapy with an exclusion of reversible underlying causes, and the main classes of symptomatic drug treatments include opioids and benzodiazepines. Korean Family Medicine Palliative Medicine Research Group discussed two terminal cancer patients in whom severe breathlessness with different causes were treated with inhalation of nebulized furosemide, which is an emerging option of palliative treatment. It still remains unclear how it becomes effective or how much it is effective, therefore, its routine use seems to be somewhat early. Nevertherless, if a patient with intractable breathlessness does not have a marked obstructive airway lesion, its use should be considered. Based on the discussion in the seminar, we want to share our experience of the application of inhaled furosemide with other palliative care practitioners and strongly recommend further research on this topic in the future.
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Humanos , Analgésicos Opioides , Benzodiazepinas , Dispneia , Furosemida , Inalação , Cuidados PaliativosRESUMO
Kimura's disease is a rare chronic inflammatory disease of unknown etiology which appears primarily in young Asian males as non-tender subcutaneous swellings in the head and neck region. Histologic characteristics are the presence of lymphoid follicles, vascular proliferation and infiltration of eosinophils. Peripheral eosinophilia and elevated serum IgE are frequently combined. Systemic steroid therapy with surgical excision is the mainstay of treatment, though recurrence after surgery or discontinued steroid treatment is common. It has been known that about 16% of the cases are associated with renal diseases, particularly nephrotic syndrome. We present an 8-year-old boy with a past history of steroid-responsive, infrequently relapsing nephrotic syndrome who developed right buccal swelling and peripheral eosinophilia during the remission state. He has been managed with surgical resection, steroid and cyclosporine due to multiple recurrences.