The authors report one-case of hyperthyroidism that occurred in a 56-year-old woman with bipolar disorder after 3 years of chronic lithium treatment. The high level in thyroid fuction test returned to normal after discontinuation of lithium. This case is shows that lithium-induced hyperthyroidism can be reversible.
Bipolar Disorder ; Female ; Humans ; Hyperthyroidism* ; Lithium Carbonate* ; Lithium* ; Middle Aged ; Thyroid Gland

Purpose: The Korean Society of Medical Education (KSME) was founded in 1983 and celebrated its 40th anniversary in 2023. This study examines the evolution of topics discussed at KSME conferences from 1971 through 2023, highlighting shifts in the focus of medical education. Methods: We analyzed 90 KSME conferences over 5 decades (1970s, 1980s, 1990s, 2000s, and 2010s), categorizing the topics into three eras based on emerging themes and continuity. Results: Consequently, 37 topics covered at the conference were categorized. Ten topics continuously appeared from the 1970s to the 2010s, including future directions of medical education, teaching methods, faculty development, and curriculum. The topics from the 1970s to the 1990s included 14 areas, such as medical education evaluation, non-undergraduate curriculum, community-related, and research. Thirteen new topics emerged after the 2000s, such as social accountability, student support, professionalism, and quality improvements. The most common topics under innovations in medical education, a case of curriculum innovation at universities that began after 2000, were clinical clerkship, curriculum development, and medical humanities. Conclusion KSME’s selection of conference topics has been strategically aligned with societal needs and the evolving landscape of medical education. Future topics should continue to address relevant societal and educational challenges.

BACKGROUND: The conversion of epidural labor analgesia (ELA) to epidural surgical anesthesia (ESA) for intrapartum cesarean section (CS) often fails, resulting in intraoperative pain. Spinal anesthesia (SA) can provide a denser sensory block than ESA. The purpose of this prospective, non-blinded, parallel-arm, randomized trial was to compare the rate of pain-free surgery between ESA and SA following ELA for intrapartum CS. METHODS: Both groups received continuous epidural infusions for labor pain at a rate of 10 ml/h. In the ESA group (n = 163), ESA was performed with 17 ml of 2% lidocaine mixed with 100 µg fentanyl, 1 : 200,000 epinephrine, and 2 mEq bicarbonate. In the SA group (n = 160), SA was induced with 10 mg of 0.5% hyperbaric bupivacaine and 15 µg fentanyl. We investigated the failure rate of achieving pain-free surgery and the incidence of complications between the two groups. RESULTS: The failure rate of achieving pain-free surgery was higher in the ESA group than the SA group (15.3% vs. 2.5%, P < 0.001). There was no statistical difference between the two groups in the rate of conversion to general anesthesia; however, the rate of analgesic requirement was higher in the ESA group than in the SA group (12.9% vs. 1.3%, P < 0.001). The incidence of high block, nausea, vomiting, hypotension, and shivering and Apgar scores were comparable between the two groups. CONCLUSIONS: SA after ELA can lower the failure rate of pain-free surgery during intrapartum CS compared to ESA after ELA.
Analgesia* ; Anesthesia* ; Anesthesia, Epidural ; Anesthesia, General ; Anesthesia, Spinal* ; Bupivacaine ; Cesarean Section* ; Epinephrine ; Female ; Fentanyl ; Hypotension ; Incidence ; Labor Pain ; Lidocaine ; Nausea ; Pregnancy ; Prospective Studies* ; Shivering ; Vomiting

Objective: There is insufficient data on the etiology of altered mental status (AMS). This study aimed to classify the causes of AMS in patients transported by the 119 emergency medical services (EMS) and analyze the characteristics of vital signs. Methods: We enrolled patients with AMS based on the Glasgow Coma Scale (GCS) score <15, who were transferred to the emergency department by 119 EMS. The causes of AMS were determined through a retrospective review of their medical records. Results: A total of 2,730 patients were enrolled. The major causes for AMS were stroke (19.9%), intoxication (17.7%), traumatic brain injury (9.6%), sepsis (6.4%), and seizures (6.3%). The proportion of non-central nervous system (non-CNS) causes was higher than CNS-related causes (72.4% vs. 27.6%, P<0.001). The proportion of patients with shock was 6.2%. Age >60 years (odds ratio [OR]=2.30; 95% confidence interval [CI], 1.77-3.00), female (OR=0.69; 95% CI, 0.55-0.87), GCS <9 (OR=1.96; 95% CI, 1.57-2.46), systolic blood pressure (SBP) <90 mmHg (OR=2.96; 95% CI, 2.04-4.29), SBP ≥180 mmHg (OR=1.73; 95% CI, 1.29-2.32), respiratory rate >20/min (OR=1.72; 95% CI, 1.34-2.20), saturation <94% (OR, 1.89; 95% CI, 1.46-2.44), body temperature >37.5 Conclusion The etiologies of AMS in patients were varied. Non-CNS causes were more prevalent than CNS-related causes. Approximately 6% of patients met the criteria for shock.

Objective: There is insufficient data on the etiology of altered mental status (AMS). This study aimed to classify the causes of AMS in patients transported by the 119 emergency medical services (EMS) and analyze the characteristics of vital signs. Methods: We enrolled patients with AMS based on the Glasgow Coma Scale (GCS) score <15, who were transferred to the emergency department by 119 EMS. The causes of AMS were determined through a retrospective review of their medical records. Results: A total of 2,730 patients were enrolled. The major causes for AMS were stroke (19.9%), intoxication (17.7%), traumatic brain injury (9.6%), sepsis (6.4%), and seizures (6.3%). The proportion of non-central nervous system (non-CNS) causes was higher than CNS-related causes (72.4% vs. 27.6%, P<0.001). The proportion of patients with shock was 6.2%. Age >60 years (odds ratio [OR]=2.30; 95% confidence interval [CI], 1.77-3.00), female (OR=0.69; 95% CI, 0.55-0.87), GCS <9 (OR=1.96; 95% CI, 1.57-2.46), systolic blood pressure (SBP) <90 mmHg (OR=2.96; 95% CI, 2.04-4.29), SBP ≥180 mmHg (OR=1.73; 95% CI, 1.29-2.32), respiratory rate >20/min (OR=1.72; 95% CI, 1.34-2.20), saturation <94% (OR, 1.89; 95% CI, 1.46-2.44), body temperature >37.5 Conclusion The etiologies of AMS in patients were varied. Non-CNS causes were more prevalent than CNS-related causes. Approximately 6% of patients met the criteria for shock.

Objective: There is insufficient data on the etiology of altered mental status (AMS). This study aimed to classify the causes of AMS in patients transported by the 119 emergency medical services (EMS) and analyze the characteristics of vital signs. Methods: We enrolled patients with AMS based on the Glasgow Coma Scale (GCS) score <15, who were transferred to the emergency department by 119 EMS. The causes of AMS were determined through a retrospective review of their medical records. Results: A total of 2,730 patients were enrolled. The major causes for AMS were stroke (19.9%), intoxication (17.7%), traumatic brain injury (9.6%), sepsis (6.4%), and seizures (6.3%). The proportion of non-central nervous system (non-CNS) causes was higher than CNS-related causes (72.4% vs. 27.6%, P<0.001). The proportion of patients with shock was 6.2%. Age >60 years (odds ratio [OR]=2.30; 95% confidence interval [CI], 1.77-3.00), female (OR=0.69; 95% CI, 0.55-0.87), GCS <9 (OR=1.96; 95% CI, 1.57-2.46), systolic blood pressure (SBP) <90 mmHg (OR=2.96; 95% CI, 2.04-4.29), SBP ≥180 mmHg (OR=1.73; 95% CI, 1.29-2.32), respiratory rate >20/min (OR=1.72; 95% CI, 1.34-2.20), saturation <94% (OR, 1.89; 95% CI, 1.46-2.44), body temperature >37.5 Conclusion The etiologies of AMS in patients were varied. Non-CNS causes were more prevalent than CNS-related causes. Approximately 6% of patients met the criteria for shock.

Objective: There is insufficient data on the etiology of altered mental status (AMS). This study aimed to classify the causes of AMS in patients transported by the 119 emergency medical services (EMS) and analyze the characteristics of vital signs. Methods: We enrolled patients with AMS based on the Glasgow Coma Scale (GCS) score <15, who were transferred to the emergency department by 119 EMS. The causes of AMS were determined through a retrospective review of their medical records. Results: A total of 2,730 patients were enrolled. The major causes for AMS were stroke (19.9%), intoxication (17.7%), traumatic brain injury (9.6%), sepsis (6.4%), and seizures (6.3%). The proportion of non-central nervous system (non-CNS) causes was higher than CNS-related causes (72.4% vs. 27.6%, P<0.001). The proportion of patients with shock was 6.2%. Age >60 years (odds ratio [OR]=2.30; 95% confidence interval [CI], 1.77-3.00), female (OR=0.69; 95% CI, 0.55-0.87), GCS <9 (OR=1.96; 95% CI, 1.57-2.46), systolic blood pressure (SBP) <90 mmHg (OR=2.96; 95% CI, 2.04-4.29), SBP ≥180 mmHg (OR=1.73; 95% CI, 1.29-2.32), respiratory rate >20/min (OR=1.72; 95% CI, 1.34-2.20), saturation <94% (OR, 1.89; 95% CI, 1.46-2.44), body temperature >37.5 Conclusion The etiologies of AMS in patients were varied. Non-CNS causes were more prevalent than CNS-related causes. Approximately 6% of patients met the criteria for shock.

PURPOSE: This study was designed to evaluate the characteristics of exertional heat stroke between the non-survival and the survival groups. METHODS: From January 1996 to December 2002, patients with exertional heat stroke who came to the emergency department of a military hospital were enrolled. Data on individual factors, atmospheric conditions, pre-hospital management, initial vital signs, laboratory findings, presence of seizure attack, and performance of intubation were reviewed retrospectively and compared between the nonsurvival and the survival groups. RESULTS: During the study period, 22 patients were diagnosed as suffering from exertional heat stroke and 5 patients died. Most of the episodes occurred during the summer days with high ambient temperature (mean 30.6+/-3.0 degrees C) and humidity (mean 75.6+/-7.7%), and 13 patients were unacclimatized recruits. The non-survival group showed a lower initial systolic blood pressure, platelet count, arterial pH, and HCO3 - level, and a higher serum creatinine, ALT, and amylase level than did the survival group (p<0.05). However there were no significant differences in individual factors, atmospheric conditions, pre-hospital management, initial pulse rate, temperature, white blood cell count, hemoglobin count, and the sodium, potassium, BUN and AST levels between the two groups. CONCLUSION: Initial systolic blood pressure, platelet count, and arterial pH, as well as HCO3 -, serum creatinine, ALT, and amylase levels seem to be important factors for the prognosis of exertional heat stroke.
Amylases ; Blood Pressure ; Creatinine ; Emergency Service, Hospital ; Heart Rate ; Heat Stroke* ; Hospitals, Military ; Hot Temperature* ; Humans ; Humidity ; Hydrogen-Ion Concentration ; Intubation ; Leukocyte Count ; Military Personnel* ; Platelet Count ; Potassium ; Prognosis ; Retrospective Studies ; Seizures ; Sodium ; Vital Signs

Diabetic muscle infarction (DMI) is a rare complication that usually occurs in diabetic patients with advanced microvascular complication. DMI presents with abrupt or subacute onset of pain, tenderness and swelling of a localized muscle group in the lower extremities in most instances. It is usually improved by conservative management such as avoiding weight bearing or pain control, but recurs frequently in 50% of the patients. The diagnosis is based on magnetic resonance imaging (MRI), which is not specific but highly indicative. A forty-nine-years-old female on hemodialysis was admitted presenting with severe pain and swelling of right thigh. To evaluate the causes of leg swelling, angiography and MRI in both legs and muscle biopsy at right thigh were performed. There was no deep vein thrombosis and arteriosclerosis in the lower extremities on angiography. The patient was diagnosed to DMI by MRI. After conservative treatment such as administration of analgesics, anti-platelet agent and physical therapy, pain and swelling of thigh was diminished, but frequently recurred. We describe a case of recurrent diabetic muscle infarction in a patient with maintenance hemodialysis therapy.
Analgesics ; Angiography ; Arteriosclerosis ; Biopsy ; Diabetes Mellitus ; Diagnosis ; Dialysis ; Female ; Humans ; Infarction* ; Leg ; Lower Extremity ; Magnetic Resonance Imaging ; Renal Dialysis* ; Thigh ; Venous Thrombosis ; Weight-Bearing

PURPOSE: To evaluate the contralateral breast dose using a virtual wedge compared with that using a physical wedge and an open beam in a Siemens linear accelerator. MATERIALS AND METHODS: The contralateral breast dose was measured using diodes placed on a humanoid phantom. Diodes were placed at 5.5 cm (position 1), 9.5 cm (position 2), and 14 cm (position 3) along the medial-lateral line from the medial edge of the treatment field. A 6-MV photon beam was used with tangential irradiation technique at 50 and 230 degrees of gantry angle. Asymmetrically collimated 17 x 10 cm field was used. For the first set of experiment, four treatment set-ups were used, which were an open medial beam with a 30-degree wedged lateral beam (physical and virtual wedges, respectively) and a 15-degree wedged medial beam with a 15-degree wedged lateral beam (physical and virtual wedges, respectively). The second set of experiment consists of setting with medial beam without wedge, a 15-degree wedge, and a 60-degree wedge (physical and virtual wedges, respectively). Identical monitor units were delivered. Each set of experiment was repeated for three times. RESULTS: In the first set of experiment, the contralateral breast dose was the highest at the position 1 and decreased in order of the position 2 and 3. The contralateral breast dose was reduced with open beam on the medial side (2.70+/-1.46%) compared to medial beam with a wedge (both physical and virtual) (3.25+/-1.59%). The differences were larger with a physical wedge (0.99+/-0.18%) than a virtual wedge (0.10+/-0.01%) at all positions. The use of a virtual wedge reduced the contralateral breast dose by 0.12% to 1.20% of the prescribed dose compared to a physical wedge with same technique. In the second experiment, the contralateral breast dose decreased in order of the open beam, the virtual wedge, and the physical wedge at the position 1, and it decreased in order of a physical wedge, an open beam, and a virtual wedge at the position 2 and 3. CONCLUSION: The virtual wedge equipped in a Siemens linear accelerator was found to be useful in reducing dose to the contralateral breast. Our additional finding was that the surface dose distribution from the Siemens accelerator was different from a Varian accelerator.
Breast* ; Particle Accelerators