Screening and Management of Thyroid Dysfunction During Pregnancy

Thyroid hormone is known to play a crucial role in implantation and embryonic development, as well as in the development of the nervous and musculoskeletal systems of fetus. In particular, thyroid dysfunction is associated with various pregnancy-related complications such as miscarriage, preterm birth, fetal growth restriction, and preeclampsia. Previous studies have primarily focus on the adverse effects of hypothyroidism on fetal neurodevelopment. However, the physiological and metabolic alterations occurring during pregnancy in thyroid physiology make it difficult to diagnose thyroid dysfunction. Therefore, obstetricians should have a comprehensive understanding of physiological changes of the thyroid and be familiar with the latest guidelines regarding the complications and management of thyroid dysfunction during pregnancy.

Usefulness of the procalcitonin test in young febrile infants between 1 and 3 months of age / 소아과

PURPOSE: To study the usefulness of the procalcitonin (PCT) test in young febrile infants between 1 and 3 months of age. METHODS: We evaluated the medical records of 336 febrile infants between 1 and 3 months of age who visited the Emergency Department or outpatient department of Samsung Changwon Hospital from May 2015 to February 2017, and analyzed the clinical characteristics between infants in the serious bacterial infection (SBI) group and non-SBI group. RESULTS: Among the 336 infants, 38 (11.3%) had definitive SBI (bacteremia, n=3; meningitis, n=1; urinary tract infection, n=34). The mean PCT (6.4±11.9 ng/mL) and C-reactive protein (CRP) level (3.8±2.6 mg/dL), and the absolute neutrophil count (ANC) (6,984±4,675) for patients in the SBI group were significantly higher than those for patients in the non-SBI group (PCT, 0.3±1.2 ng/mL; CRP, 1.3±1.6 mg/dL; ANC, 4,888±3,661). PCT had lower sensitivity (43.6%), but higher specificity (92.6%) and accuracy (86.9%) than CRP (92.3%, 25.3%, and 33.0%) for identifying SBI. The area under the receiver operating characteristic curves (AUCs) for definitive SBI were PCT 77.0%, CRP 80.8%, WBC 56.8%, ANC 67.8%, and PLT 48.1%. The AUCs for definitive SBI were PCT+CRP 85.4%, PCT+WBC 77.2%, PCT+ANC 81.3%, CRP+WBC 80.1%, and CRP+ANC 81.6%. CONCLUSION: Our results suggest that the PCT test or a combination of PCT and CRP tests is a more accurate and specific biomarker to detect and rule out SBIs.

Study on Diet-related Quality of Life in Online Self-help Diabetes Mellitus Patients Who Practice Dietary Regimen / 대한지역사회영양학회지

Assessment of quality of life (QOL) is a new method to investigate the effectiveness of dietary regimen. Particularly, diet-related QOL is the most appropriate method to estimate social and psychological problems originated from dietary regimen practice. The purpose of this study was to evaluate the diet-related QOL and the correlation between diet-related QOL and health-related QOL, and dietary regimen practice in online diabetes self-help patients who practice the dietary regimen. Sixty one subjects who intended to practice dietary regimen were recruited from online diabetes self-help community, and instructed to fill-up the self report questionnaires. Contents of questionnaire were comprised of general characteristics, clinical characteristics, dietary compliance, and dietary regimen practice. As a result, the mean score of the 'Dietary impact' among the diet-related QOL sub-scales was the lowest suggesting most of the subjects suffer from burden of dietary regimen practice. The "Dietary impact" was correlated with "Taste", "Convenience" and "Cost" (p < 0.05). "Self-care" and "Satisfaction" were positively associated with well-controlled blood glucose and dietary regimen compliance, but negatively associated with "Dietary impact". Diet-related QOL was significantly correlated with the Health-related QOL, particularly the mental and social component (p < 0.05). Diet-related QOL was negatively associated with BMI, and self monitoring blood glucose was negatively correlated with "Self-care" (p < 0.05). In conclusion, Diet-related QOL might be appropriate to evaluate the effects of dietary regimen or nutrition education. The need for dietary education of cognitive-behavioral strategies and problem-solving ability is required.

Clinical Analysis of Breast Cancer Patients Treated with Surgery / 한국유방암학회지

purpose: In Korea, the incidence of breast cancer is continuously increasing. Since 2001, breast cancer is the most common cancer in females.(1) Methods: We analyzed the clinical data of 323 breast cancer patients who were treated in department of surgery at Pusan National University Hospital between January 2001 and December 2002. Results: A total of 323 patients, 322 patients are female and 1 patient is male. The most common prevalent age was the fifth decades. The most common sign and symptom was a painless palpable mass. The most common tumor location was the left upper outer quadrant. The main preoperative histologic diagnostic methods were core needle biopsy (48.3%) and Fine Needle Aspiration (35.6%). Breast conservation surgeries were performed in 259 cases (80.2%), a modified radical mastectomy in 35 cases (10.9%), a radical mastectomy in 3 cases (0.9%), a simple mastectomy in 3 cases (0.9%) and other procedures in 23 cases (7.1%). According to the TNM staging system, the most common stage was stage IIA (121 cases, 37.4%). The most common pathologic type was invasive ductal carcinoma (273 cases, 84.6%). Axillary lymph node metastasis was present in 109 cases (33.7%). The most common distant metastasis site was the bone (12 cases, 3.7%). The average follow-up period was 22.3 months. 19 cases (5.9%) were recurred between 15 to 28 months after surgery. Their mean disease- free interval was 21.2months. During the follow-up, 4 patients died. Conclusion: In spite of the short follow-up period, this study shows that breast conservation surgery is a recommendable modality in breast cancer, in terms of recurrence rate, disease free survival, patient's satisfaction and cosmetics.

A Case of Sirenomelia Diagnosed at 14 Gestational Weeks / 대한주산의학회잡지

Sirenomelia, characterised by a complete or incomplete fusion of the lower extremities, is a severe form of caudal defect affecting 1 in 60,000 births. Most cases of sirenomelia die within 5days after birth and are associated with abnormalities such as renal agenesis, urinary tract agenesis, single umbilical artery, etc. Thirdtrimester ultrasonographic diagnosis is usually impaired by severe oligohydramnios whereas the amount of amniotic fluid may be efficient to allow diagnosis in the late first trimester. We report of a case of sirenomelia at 14 weeks of gestation using prenatal transvaginal and transabdominal ultrasonography.

A case of allgrove syndrome / 대한내과학회지

Allgrove syndrome, also known as Tripple A syndrome is characterized by ACTH-resistant adrenal insufficiency, achalasia of esophagus and alacrima. Since its first description by Allgrove et al. (1978), more than 60 cases from all over the world have been reported. In Korea, however, there was no report of this Allgrove syndrome. We report studies on a 18-year old male patient with this rare triad. The patient had alacrima from birth; isolated glucocorticoids deficiency had been diagnosed at 6 years of age and achalasia at age 18. We report the case with the review of literature.

4 Cases of Pelvic Actinomycoses / 대한산부인과학회잡지

Actinomycoces is a gram positive, anaerobic, branching and non-acid fast bacterium which is a normal habitant of the skin, oral cavity, tonsil and gastrointestinal tract and its human infection is rare. Pelvic actinomycoses is frequently caused by Actinomycoces israel-ii. It is chronic, progressive, and more suppurative than granulomatous disease, and the symptoms are usually persistent and gradual, therefore the misdiagnosis and improper trea-tment are not uncommon. Actinomycoses is generally classified as cervicofacial, abdominal and thoracic type ac- cording to the site of the primary infection. Many actinomycotic pelvic infections in women used intrauterine device with long du- ration were reported, in contrast, others suggest that actinomycoces developed opportunistic infection irrespective of intrauterine device presence. We have experienced 4 cases of pelvic actinomycoses, one case with IUD(Lippes' loop) in a 47 year old woman, the other case with abdominal wall ctinomycoses in a 34 year old woman, the third case without IUD in a 41 year old woman, the fourth case with IUD(Cu-7) in a 37 year old woman and reported them with a review of literature.

Adjustment of North Korean Defectors in South Korea / 신경정신의학

The authors interviewed with 21 North Korean defectors who detected from North Korea in 1990-1995 and investigated their adjustment to South Korean society. The main categories of their problems in adjustment were a poor social network, financial difficulties, problems in social competency, problems resulting from their indoctrinated way of thinking, some psychological problems such as excessive self-consciousness and guilty feelings, and some social-structural problems such as poor education system in the government shelter. But, generally speaking, inspite of their problems, they have adjusted to South Korea society rather successfully In the view of short term adjustment, the reasons for their success were thought to be the characteristics and merits of a capitalistic economy ; their compliant personalities resulting from an educational system that emphasized obedience to authority and Kim Il Sung, and the dualism of North Korean lifts. Four points were discussed to assist a successful adjustment in the long term ; Fostering of the ability to make individual choices with internal principles, overcoming a judgemental, moralizing attitude, overcoming of overfull thought centered attitude and rebounding thought-lacking attitude, overcoming the effect of negative collectivism. Three things have been suggested to foster their healthy adjustment ; development and running of resocialization program for the each period of settlement ; building up a network of accessible support organizations who work for the adjustment of defectors ; systemic studies of North Korean people and defecters for the successful adjustment to unified Korean society. It is said that the division of Korean people has been the most tragic thing happen to Korea. But there can be a greater tragedy and that would be the unification of land but not the unification of people. failure to understand the real problems of the North Korean population can potentially produce conflicts and confusion which can only lead to funker re-division and greater tragedy. It is very important to study the adjustment to problems of North Korean defectors to help prepare far the unification of the Korean people.

A New Direction for Teaching Medical Ethics / 한국의학교육

Drawing on our observation that many medical professionals have considerable difficulty in using what they know about ethics, we have developed a course for teaching the fifth year medical students a systematic approach to ethical reasoning and problem-solving, rather than teaching bioethical theories or prominent current ethical issues in developed countries. This course consisted of a series of guided group discussions and debates in classroom using over 50 cases classified under seven major headings. Responses and reactions from students and participating clinicians are encouraging. Several ideas for improving medical ethics curricula are discussed, including emphases on the thorough understanding of various aspects of human relations in medical practice, enhancing the ability of articulate the students own values, provoking the student to get involved in the ethical situation when studying the cases, and the need to introduce social science concepts in analyzing the ethical issues in the health care system.

A Preliminary Epidemiologic Study on Korean Veterans Exposed to Herbicides in Vietnam War / 예방의학회지

Among chemical agents in herbicides, dioxin(2,3,7,8-tetrachloro dibenzo-rho-dioxin: a chemical contaminant in herbicides sprayed during the vietnam war has been known to be the major agent causing toxic effects. Approximately 320,000 korean soldiers participated the vietnam war from 1964 to 1974. Although the potential hazards of the herbicides among Korean veterans exposed were implicated, the problem had not been a public issue until 1991 when Korean veterans were informed U. S. companies, the herbicides manufacturer payed fund, from which a trust fund for New Zealand and Australian Class members were established in 1985. After a series of appeals and demonstration by the korean veterans demanding medical care and compensation for their serious health damages, a bill of medical care and compensation for herbicides victims was promulgated in March 1993 and become effective from May 1993. This study was carried out with two major objectives: the first to understand the health problems caused from the herbicides by reviewing literatures published, and the second to examine the nature and extent of health impacts among Korean veterans exposed and to develop valid study methods for the major study by interviewing and reviewing records on a part of veterans (638 persons) registered and completed medical examination in Seoul Veterans Administration Hospital from June to october 1993. The results obtained are as follows: 1. The literature review of 107 papers revealed that: l) Dioxin is teratogenic, carcinogenic and affects almost all organs including nertous, endocrine, and reproductive systems in animal experiments. 2) The diseases showing evidence of causal association were Hodgkin's disease, non-Hodgkin's disease, lung cancer, lymphoma, soft tissue sarcoma, chloroacne and polyneuropathy when judged on the basis of consistency in study results and biological plausibility. 2. Interview and medical record review study on 638 veterans, though limited validity owing to lack of control group, crude estimates of dioxin exposure levels (no biomarkers measurable), and uncertainty of diagnosis, showed that: 1) Most of the study subject's were in their 40's of age and had been dispatched to vietnam during the period from 1965-1970 around one year. 2) Most frequently complained symptoms in medical examination were motor weakness(32%), sensory abnormalities in extremities(23%), skin diseases(22%), and pain in extremities(20%) whereas in interview they were more frequent in order of skin problem(44%), motor weakness (38%), sensory abnormalities and pain in extremities(l7% and 19% each). Kappa indices on the same category of complaints between two sources of information were variable and relatively low. 3) On medical examination, only a part of the 638 subjects had initial impression (442 pts) and final diagnosis (218 pts) suggesting decision making on diagnosis appeared to be difficult even with all available modern medical technologies; in initial impression disorders from peripheral and central neuropathy were predominant whereas in final diagnosis various types of skin disorder were most frequent. 4) when dose-response relationship between several conditions (from questionnaire) and arbitrary exposure scores were examined by CMH linear trend test, spontaneous abortion, sexual problems and health problem of offsprings showed statistically significant linear trends. However, pregnancy, accident and suicidal attempts did not show any relationship in this study capacity. 5) Among complaints, psychosis and neurosis(anxiety, phobia) in interview study, and memory disorder and psychosis in medical record study revealed linear trend. 6) Skin disorder was the only condition showing linear trend in initial impression and none in final diagnosis on medical examination. Even though objective to select out dioxin-related disease or group of diseases from this study was not achieved the research experiences provided firm basis for developing various methodological approaches. 3. From this preliminary study we concluded that a larger scale major epidemiologic study on health impacts of herbicides among Korean veterans exposed is not only indispensible but also well designed study with more valid exposure information and diagnosis may be able to establish causal relationship between certain groups of diseases and exposure to the herbicides among Korean veterans.

Current issues in the U.S. mental health service system: a community health perspective

No abstract available.

Effects of General Anesthesia in Patients with Abnormal Liver Function / 대한마취과학회지

Recently, halothane has been commonly used as an inhalation anesthetic agent, but it is generally accepted that it can cause postoperative hepatic dysfunction. Therefore, other anesthetic agents which have relatively less hepatotoxic effects have been recommended. This study was undertaken to evaluate the postoperative hepatic changes in patients with abnormal liver function or hepatobiliary diseases. Patients were divided into three subgroups hepatobiliary, other hepatobiliary and jaundice, or HBsAG(+) for the two anesthetic agents, enflurane and Thalamonal. Liver function tests were performed before surgery, and on the 3rd, 5th and 9th postoperative days. The results were as follows: 1) SGOT and SGPT showed a more statistically significant decrease in Thalamonal anesthesia than in enflurane anesthesia in hepatobiliary and jaundice or HBsAg(+) groups. However, in the other hepatobiliary groups, there were no significant differences between the anesthetics. 2) Total protein, albumin, total bilirubin, direct bilirubin and alkaline phosphatase levels were not shown to be significantly different between the use of the two anesthetics in all groups. It is suggested that postoperative hepatic changes may have improved more significantly in Thalamonal anesthesia than in enflurane anesthesia in hepatobiliary patients with abnormal liver function and jaundice or HBsAg(+) patients.