PURPOSE: Intraosseous (IO) is an alternative vascular access method for critically ill patients, especially pediatric arrest patients. This study was aimed to evaluate the effect of the education on pre-hospital IO Access of Level 1 Emergency Medical Technicians (Level-1 EMTs). METHODS: Forty four Level-1 EMTs participated in the IO educational program at Seoul Fire Academy. The IO educational program was consisted of a one-hour lecture followed by a one-hour practical training about the use of the powered device (EZ-IO) to artificial bones. Before and after the program, the knowledge and attitude about IO access were measured with 5 points-scale (1 in lowest and 5 in highest positive response) by the structured questionnaire. After the program, the participants were tested on skill performance (success rate of insertion and procedural time) of IO access. RESULTS: The mean working time and age of participants was 7.6+/-2.4 years and 32.1+/-4.2 years, respectively. Median score (5%~95%) of knowledge about indication of IO access was increased from 2(1-4) to 4(3-5) (p<0.01). Median score (5%~95%) on attitude was improved from 2(1-4) to 4(2-5) (p<0.01). Twelve EMTs (30.7%) showed negative response on IO access in the prehospital area. The success rate of insertion at first time was 84.1% and the mean time to success was 45.5+/-9.4 seconds. CONCLUSION: After 2 hour educational program for Level-1 EMTs, the knowledge and attitude of IO access improved significantly and skill performance was very excellent. We can consider the prehospital IO access of level-1 EMTs in Korea.
Critical Illness ; Emergencies ; Emergency Medical Services ; Emergency Medical Technicians ; Fires ; Humans ; Mandrillus ; Surveys and Questionnaires

The study was conducted to assess school dietitians' preferences for traditional foods, to determine the association with their perception and usage status, and to develop the strategies to increase its utilization of traditional foods in school lunches. The information was obtained by the self-administered questionnaire from the subjects, which were 198 dietitians in schools located in Seoul and Gyeonggi-do. According to the preference for traditional foods, subjects were distributed into three groups (High = 54, Medium = 128, Low = 16). The significances of differences between groups were determined using SPSS 12.0 at p < 0.05. Compared to the dietitians with lower (medium and low) preferences, those with high preferences answered that they had better knowledge (p < 0.001) for traditional foods, and served them more in school lunches (p < 0.01). Also, more dieticians in the high preference group not only felt that they need to train school administrators (p < 0.01) as well as themselves (p < 0.05), but also were currently providing students with the nutrition education on traditional foods (p < 0.05). The results presented the evidence suggesting that having dietitians with higher preference for traditional foods can offer an effective strategy to increase the opportunities for schoolchildren to be exposed to traditional foods. Development of the standard recipes for use in school lunches by the government or the association was answered as the best strategy to increase the use of traditional foods, regardless of the dietitians' preferences.
Administrative Personnel ; Food Preferences ; Humans ; Lunch ; Surveys and Questionnaires

The free TRAM flap has been accepted as an excellent method of autogenous tissue breast reconstruction. In addition, oncologic surgeons and plastic surgeons are trying to perform skin preserved mastectomy to get more esthetically better result in breast reconstruction. Breast tissue and mass would be removed through circumareolar incision, and axillary lymph node dissection could be carried through separate incision on axilla. This paper represents our experiences and results of immediate breast reconstruction with transverse rectus abdominis myocutaneous free flap after skin-sparing mastectomy. From 1999 to 2001, the flaps were utilized in 15 patients to reconstruct the new breast by free TRAM flap after skin sparing mastectomy. The mean age of the patients were a 42-years-old. Location of cancer was on the right breast in 12 cases, left breast in 2 cases and bilateral breasts in 1 case. We chose the thoracodorsal artery and its venae commitantes as recipient vessels, and deep inferior epigastric vessels as donor vessels.All flaps survived completely. There has been no flap necrosis, hematoma, and seroma. The results have been functionally and esthetically satisfactory. There are several advantages in this technique comparing with similar breast reconstruction of routine modified radical mastectomy. This technique leaves less scar and allows better preservation of sensation, aesthetically more natural shape, and better symmetry in reconstructed breast with free TRAM flap afterskin sparing-mastectomy.
Arteries ; Axilla ; Breast* ; Cicatrix ; Female ; Free Tissue Flaps* ; Hematoma ; Humans ; Lymph Node Excision ; Mammaplasty* ; Mastectomy* ; Mastectomy, Modified Radical ; Necrosis ; Rectus Abdominis* ; Sensation ; Seroma ; Skin* ; Tissue Donors

The free TRAM flap has been accepted as an excellent method of autogenous tissue breast reconstruction. In addition, oncologic surgeons and plastic surgeons are trying to perform skin preserved mastectomy to get more esthetically better result in breast reconstruction. Breast tissue and mass would be removed through circumareolar incision, and axillary lymph node dissection could be carried through separate incision on axilla. This paper represents our experiences and results of immediate breast reconstruction with transverse rectus abdominis myocutaneous free flap after skin-sparing mastectomy. From 1999 to 2001, the flaps were utilized in 15 patients to reconstruct the new breast by free TRAM flap after skin sparing mastectomy. The mean age of the patients were a 42-years-old. Location of cancer was on the right breast in 12 cases, left breast in 2 cases and bilateral breasts in 1 case. We chose the thoracodorsal artery and its venae commitantes as recipient vessels, and deep inferior epigastric vessels as donor vessels.All flaps survived completely. There has been no flap necrosis, hematoma, and seroma. The results have been functionally and esthetically satisfactory. There are several advantages in this technique comparing with similar breast reconstruction of routine modified radical mastectomy. This technique leaves less scar and allows better preservation of sensation, aesthetically more natural shape, and better symmetry in reconstructed breast with free TRAM flap afterskin sparing-mastectomy.
Arteries ; Axilla ; Breast* ; Cicatrix ; Female ; Free Tissue Flaps* ; Hematoma ; Humans ; Lymph Node Excision ; Mammaplasty* ; Mastectomy* ; Mastectomy, Modified Radical ; Necrosis ; Rectus Abdominis* ; Sensation ; Seroma ; Skin* ; Tissue Donors

Even for experienced surgeons, it is possible that the complex and variable anatomy and the proximity of important structures make endoscopic sinus surgery a tough job. The main cause of surgical complications is that the image of two dimensional computed tomography scan is not correlated with the endoscopic view during operation. Recently developed computer aided endoscopic sinus surgery(CAESS) may be an important step in reducing the incidence of complications. Authors used the CAESS in 3 cases. The first was the case of huge multiple polyps and needed the revision of surgery. The second was the case of multiple polyps and cleft palate which was operated previously. The last was the case of pituitary cyst. Surgery of the extensive sinus disease or the causes with surgically-congenitally altered anatomical landmarks was safe and easy when CAESS was utilized.
Cleft Palate ; Incidence ; Polyps

Current trends in restorative dentistry focus on improving the esthetics and keeping the sound dental tissues as long as possible. The aims of this case report were to describe the successful outcome of cubic-phase zirconia laminate veneers for a patient with isolated microdontia by using a digital workflow, and to describe their clinical implications. A 15-year-old female who had isolated microdontia in combination with spacing visited Ajou University Dental Hospital for esthetic treatment. In this case, 6 maxillary anterior teeth were restored with cubic-phase zirconia laminate veneers without tooth structure removal by using a digital impression, computer-aided design (CAD) software, and computer-aided manufacturing (CAM) procedures. At 6-month follow-up, no distinct mechanical and biological complications were detected and the prostheses exhibited satisfactory esthetics and functions. Due to its favorable tissue responses and enhanced translucency, cubic-phase zirconia can be a suitable strategy for a noninvasive esthetic approach.
Adolescent ; Computer-Aided Design ; Dentistry ; Esthetics ; Female ; Follow-Up Studies ; Humans ; Prostheses and Implants ; Tooth

PURPOSE: There is no concensus on the type of therapy useful for elderly cancer patients. Since 2000, Korea has become an elderly society. This study aims to assess clinical characteristics of elderly breast cancer women, and to evaluate determinants and effects of treatment choice for breast cancer prognosis among elderly patients. METHODS: We reviewed the clinical reports of 123 breast cancer patients aged > or =70 yr recorded at the Asan Medical Center Breast Cancer Registry between 1992 and 2002. Patient and tumor chariteristics, comorbidity, surgical method, adjuvant therapy and cause of death were taken into consideration. Survival analysis was determined according to the treatment method. RESULTS: The median time to diagnosis was 33.6 months. Only 9 patients (5.1%) were diagnosed in the screening program. A modified radical mastectomy was performed for 74 patients (60.1%), Breast conserving surgery was performed for 26 patients (24.7%), and there was no further curative therapy for 12 patients (9.7%). 32 patients (38.1%) had axillary lymph node metastasis. The median follow-up duration was 43.1 months; the overall survival rate was 71.8%, and the disease free survival rate was 65.4%. Breast cancer related mortality was 62.8%. CONCLUSION: Delayed diagnosis and infrequent screening were frequent among elderly patients. Cancer related morbidity was less than general breast cancer patients. Treatment needs to be adapted to the general health status of the patient and comorbid conditions, but has to offer the best chance of cure, regardless of age.
Aged ; Breast Neoplasms* ; Breast* ; Cause of Death ; Chungcheongnam-do ; Comorbidity ; Delayed Diagnosis ; Diagnosis ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Korea ; Lymph Nodes ; Mass Screening ; Mastectomy, Modified Radical ; Mastectomy, Segmental ; Mortality ; Neoplasm Metastasis ; Prognosis ; Survival Rate

Lynch syndrome is the most common inherited colon cancer syndrome. Patients with Lynch syndrome develop a range of cancers including colorectal cancer (CRC) and carry a mutation on one of the mismatched repair (MMR) genes. Although CRC usually occurs after the fourth decade in patients with Lynch syndrome harboring a heterozygous MMR gene mutation, it can occur in children with Lynch syndrome who have a compound heterozygous or homozygous MMR gene mutation. We report a case of CRC in a 13-year-old patient with Lynch syndrome and congenital heart disease. This patient had a heterozygous mutation in MLH1 (an MMR gene), but no compound MMR gene defects, and a K-RAS somatic mutation in the cancer cells.
Adolescent* ; Child ; Colonic Neoplasms ; Colorectal Neoplasms* ; Colorectal Neoplasms, Hereditary Nonpolyposis* ; Female* ; Heart Defects, Congenital ; Humans

Background/Aims: The multidisciplinary team (MDT) approach is a cornerstone of clinical oncology. This study investigated the current state of MDT care, including patient satisfaction, in Korea. Methods: We obtained the annual number of cancer patients who have received MDT care since 2014 from the registry of the Health Insurance Review and Assessment Service (HIRA). In addition, patients who received MDT care from August 2014 to May 2017 at four university hospitals were further characterized, and patient satisfaction was measured prospectively using a patient-reported questionnaire. Results: The total number of patients who received MDT care increased from 2014 to 2016 (2,113 to 9,998 patients, respectively) in the HIRA Cohort. The type of cancer that most often required MDT was breast cancer (23.8%), followed by colorectal cancer (19.1%). In the Representative Cohort (n = 1,032), MDT was requested by the surgeon more than half the time (55.7%). The main focus of MDT was decision making for further treatment planning (99.0%). The number of doctors participating in the MDT was usually five (70.0%). After initiating an MDT approach, the treatment plan changed for 17.4% of patients. Among these patients, 359 completed a prospective satisfaction survey regarding their MDT care. The overall satisfaction with the MDT approach was very high, with an average score of 9.6 out of 10 points. Conclusions The application of MDT care is a rapidly growing trend in clinical oncology, and shows high patient satisfaction. Further research is needed to determine which types of cancer patients could benefit most from MDT, and to enable MDT care to operate more efficiently so that it may expand successfully throughout Korea.

PURPOSE: The aim of this study was to investigate the prognosis, patterns of failure, and prognostic factors for breast cancer patients with pathologically proven synchronous ipsilateral supraclavicular lymph node (ISCLN) metastases. METHODS: We reviewed the records of breast cancer patients with pathologically proven ISCLN metastases. Local aggressive treatment was defined as treatment including surgery, axillary lymph node dissection (ALND), ISCLN excision, radiotherapy (RT), and chemotherapy. RESULTS: A total of 111 patients were included. The 5-year overall survival (OS) and disease-free survival (DFS) rates were 64.2% and 56.2%, respectively. On univariate analysis, RT, ALND, trastuzumab treatment, hormone receptor (HR) status, and local aggressive treatment were identified as significant factors for OS. The 5-year OS for 73 patients who received local aggressive treatment was superior to that of 38 patients who received nonaggressive treatment (70.9% vs. 49.3%, p=0.036). Multivariate analysis showed that RT, HR status, and trastuzumab were significant variables for the 5-year OS and DFS. CONCLUSION: Multimodality treatment with surgery, taxane-based chemotherapy, hormone therapy, and RT is strongly recommended for breast cancer patients with synchronous ISCLN metastases.
Breast Neoplasms* ; Disease-Free Survival ; Drug Therapy ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Multivariate Analysis ; Neoplasm Metastasis* ; Prognosis ; Radiotherapy ; Treatment Outcome* ; Trastuzumab