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: Clinical outcomes and radiologic results after cervical arthroplasty have been reported in many articles, yet relatively few studies after cervical arthroplasty have been conducted in severe degenerative cervical disc disease. MATERIALS AND METHODS: Sixty patients who underwent cervical arthroplasty (Mobi-C(R)) between April 2006 and November 2011 with a minimum follow-up of 18 months were enrolled in this study. Patients were divided into two groups according to Pfirrmann classification on preoperative cervical MR images: group A (Pfirrmann disc grade III, n=38) and group B (Pfirrmann disc grades IV or V, n=22). Visual analogue scale (VAS) scores of neck and arm pain, modified Oswestry Disability Index (mODI) score, and radiological results including cervical range of motion (ROM) were assessed before and after surgery. RESULTS: VAS and mean mODI scores decreased after surgery from 5.1 and 57.6 to 2.7 and 31.5 in group A and from 6.1 and 59.9 to 3.7 and 38.4 in group B, respectively. In both groups, VAS and mODI scores significantly improved postoperatively (p<0.001), although no significant intergroup differences were found. Also, cervical dynamic ROM was preserved or gradually improved up to 18 months after cervical arthroplasty in both groups. Global, segmental and adjacent ROM was similar for both groups during follow-up. No cases of device subsidence or extrusion were recorded. CONCLUSION: Clinical and radiological results following cervical arthroplasty in patients with severe degenerative cervical disc disease were no different from those in patients with mild degenerative cervical disc disease after 18 months of follow-up.
Adult ; Arthroplasty/*methods ; Cervical Vertebrae/pathology/surgery ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc/surgery ; Intervertebral Disc Degeneration/*surgery ; Male ; Middle Aged ; Range of Motion, Articular/physiology ; Retrospective Studies ; Spinal Diseases/surgery ; Treatment Outcome ; Young Adult

Castleman's disease is a distinct lymphoproliferative disorder of unknown origin, which creates both a diagnostic and therapeutic dilemma for most physicians. Here, we present a case of hyaline-vascular and solitary Castleman's disease associated with pure red cell aplasia. A 49-year old woman was admitted suffering from severe anemia. A bone marrow biopsy showed marked erythroid hypoplasia. A solitary retroperitoneal mass was excised and proven to be Castleman's disease with hyaline-vascular type histology. Removal of the mass led to a rapid reversal of anemia. No evidence of recurrence was found 1 year after the excision.
Anemia ; Biopsy ; Bone Marrow ; Female ; Giant Lymph Node Hyperplasia* ; Humans ; Lymphoproliferative Disorders ; Middle Aged ; Recurrence ; Red-Cell Aplasia, Pure*

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