The irritable bowel syndrome(IBS) is a chronic functional gastrointestinal disorder, characterized by abdominal pain, bloating and bowel disturbance. The pathophysiology of IBS is very complicated. Recent studies indicate that the most important mechanisms include visceral hypersensitivity, abnormal gut motility, autonomic nervous system(ANS) dysfunction and disorder of regulation of the brain-gut axis. Patients with IBS frequently present impaired autonomic regulation. Heart rate variability(HRV) is an acknowledged tool for estimating autonomic function. We experienced two cases of increased parasympathetic nervous system by HRV in irritable bowel syndrome with diarrhea as a predominant symptom.
Abdominal Pain ; Autonomic Nervous System ; Axis, Cervical Vertebra ; Diarrhea ; Gastrointestinal Diseases ; Heart Rate ; Humans ; Hypersensitivity ; Irritable Bowel Syndrome ; Parasympathetic Nervous System

BACKGROUND: Burnout is a common problem for interns and residents. It may be related to medical error, but little is known about this relationship. The purpose of this study was to determine the association between burnout and perceived medical errors among interns and residents. METHODS: The study group consisted of interns and residents working in a university hospital in Busan. Data were provided by 86 (58.5%) of 147 interns and residents. They completed a questionnaire including self-assessment of medical errors, a linear analog self-assessment of overall quality of life (QOL), fatigue, the Epworth Sleepiness Scale (ESS) score, the Maslach Burnout Inventory, and a validated depression screening tool. RESULTS: According to univariate logistic regression analyses, there was an association between perceived medical errors and fatigue (odds ratio [OR], 1.37 per unit increase; 95% confidence interval [CI], 1.12 to 1.69; P < 0.003) and ESS scores (OR, 1.13 per unit increase; 95% CI, 1.03 to 1.23; P < 0.009). Perceived medical errors were also associated with burnout (ORs per 1-unit change; emotional exhaustion OR, 1.07; 95% CI, 1.02 to 1.13; P < 0.005; depersonalization OR, 1.11; 95% CI, 1.02 to 1.21; P < 0.013), a negative depression screen (OR, 0.29; 95% CI, 0.11 to 0.76; P < 0.013), and overall QOL (OR, 0.80; 95% CI, 0.70 to 0.98; P < 0.033). In multivariate logistic regression analyses, an association was identified between perceived medical errors and emotional exhaustion (OR, 1.06; 95% CI, 1.00 to 1.11; P < 0.046) when adjusted for ESS, and depersonalization (OR, 1.01; 95% CI, 1.01 to 1.19; P < 0.04) when adjusted for fatigue. CONCLUSION: Higher levels of burnout among interns and residents were associated with perceived medical errors.
Depersonalization ; Depression ; Fatigue ; Logistic Models ; Mass Screening ; Medical Errors ; Quality of Life ; Self-Assessment

Primary carcinoma of the female urethra is relatively rare neoplasm. Urethral cancers account for less than 0.02 per cent of all neoplasms occurring In women and 0.01 per cent of all urologic malignancies. The rarity of the disease as well as the changes and improvements in the various treatment modalities have prevented unanimity of opinion with regard to its proper treatment. We report one case of transitional cell carcinoma in female urethra with brief review of the literature.
Carcinoma, Transitional Cell* ; Female* ; Humans ; Urethra* ; Urethral Neoplasms

BACKGROUND: Respiratory viruses (RV) are important pathogen in both children and immunocompromised hosts. Rapid diagnosis of RV is important to manage patients and to implement infection control measures. To investigate the testing situation in Korea, we performed surveillance for the 95 medical institutions. Due to the paucity of long-term, multi-center data on RV epidemiology in Korea, we analyzed data from 5 university hospitals. METHODS: Surveillance questionnaires were sent to 95 members of the Korean Society for Clinical Microbiology. The RV data from 5 university hospitals, 2001 through 2005, were collected retrospectively and analyzed for the isolation rate of each virus. RESULTS: Among the 63 institutions, who replied, 49% performed RV testing and 84% of the testing institutes were university hospitals. A hundred percent institutes tested for respiratory syncytial virus (RSV), whereas 81% tested for influenza virus (Flu), 74% for parainfluenza virus (PIV) and adenovirus each, 32% for rhinovirus, 23% for coronavirus, and 36% for metapneumovirus. PCR and/or culture were employed in 42% of the institutes, immunochromatography 29%, immunofluorescent assay 23%, and enzyme immunoassay 7%. Among the total 11,131 specimens received, virus was detected in 22%, ranging from 12% to 28% by hospital. The most frequently detected virus was RSV (54%) and followed by PIV (18%), Flu (15%), and adenovirus (13%). But species distributions of these viruses were quite different by hospital or by year. CONCLUSION: It is necessary for more active implementation of the RV testing because only 55% of university hospitals and 17% of general hospitals performed this test.
Academies and Institutes ; Adenoviridae ; Child ; Coronavirus ; Diagnosis ; Epidemiology* ; Hospitals, General ; Hospitals, University* ; Humans ; Immunochromatography ; Immunocompromised Host ; Immunoenzyme Techniques ; Infection Control ; Korea* ; Metapneumovirus ; Orthomyxoviridae ; Paramyxoviridae Infections ; Polymerase Chain Reaction ; Republic of Korea ; Respiratory Syncytial Viruses ; Retrospective Studies ; Rhinovirus ; Surveys and Questionnaires

BACKGROUND: Estrogen deficiency after menopause is a major reason of bone loss in postmenopausal women. YSM (years since menopause) is negatively related with BMD in postmenopausal women. Bone loss after menopause is accelerated in early stage of menopause, and then decreases. There are some evidence that body weight can prevent bone loss in menopausal women. Therefore, we evaluated associations of the general characteristics and lumbar BMD of postmenopausal Korean women, and determined the rate of bone loss after menopause at 5-year interval. METHODS: BMD was measured by DEXA system and physical, anthropometric data including body fat were obtained in 1006 peri - and postmenopausal women. Pearsons correlation coefficient were made among pesical, anthropometric data and lumbar BMD. To determine the contributable factors for lumbar BMD, multiple regression analysis was done. RESULTS: 1) In Pearsons correlation analysis among body composition YSM and spinal BMD, YSM was strongly associated negatively with spinal BMD. 2) On the other hand, weight and BMI was associated positively with spinal BMD. 3) The percent difference in spinal BMD between perimenopause and 5-years after menopause was 15.3% 4) Years since menopause, body weight was revealed as an important factor that predicted spinal BMD by multiple stepwise regression analysis. CONCLUSIONS: We conclude that YSM and body weight were revealed as important factors that can predict spinal BMD in postmenopausal women.
Adipose Tissue ; Body Composition ; Body Weight ; Bone Density* ; Estrogens ; Female ; Hand ; Humans ; Menopause ; Perimenopause ; Reproductive History

Inflammatory linear verrucous epidermal nevus(ILVEN) is a relatively rare skin disorder, characterized by chronic inflammatory psoriasiform pattern. This chronic skin disorder is generally believed to be resistant to various treatments, although some authors have reported success with 13-cis-retinoic acid and 585 nm pulsed laser therapy. We experienced a 15-month aged female ILVEN patient who has been suffered from linear erythematous verrucous pathes mainly located on left inguinal area, hand, and foot with persistent itching sense. This skin lesion have been developed at birth, and more spread out toward right extremity after 1 year old age . We initially treated this skin lesion with topical corticosteroids and oral anti-histamines, but this treatment was not successful. So we retreated this patient with etretinate(oral retinoid) and topical 13-cis-retinoic acids, we found that therapeutic responses to these applications were more remarkable. Now, we closely observe this patient's clinical course further more.
Adrenal Cortex Hormones ; Etretinate ; Extremities ; Female ; Foot ; Hand ; Humans ; Isotretinoin ; Laser Therapy ; Nevus, Sebaceous of Jadassohn* ; Parturition ; Pruritus ; Skin

Injury of the femoral artery with a femoral intertrochanteric fracture is rare, and usually occurs on the deep femoral artery during surgery. We experienced a case of preoperative injury of the superficial femoral artery by a lesser trochanteric fragment. We repaired the femoral artery through an anterior approach before internal fixation.
Femoral Artery ; Femur

PURPOSE: Total body irradiation (TBI) or whole body irradiation is used to acquire immune suppression, to treat malignant lymphoma and leukemia, and as an conditioning regimen for bone marrow transplantation. For these purposes, many methods were developed to obtain homogenous dose distribution. The objective of this study was to analyze and confirm the accuracy and the homogeneity of the treatment setup, the parallel opposed lateral technique, currently used in Seoul National University Hospital. MATERIALS AND METHODS: Surface dose data, measured with a thermoluminescent dosimeter, of 8 patients among 10 patients, who were given total body irradiation with the parallel opposed lateral technique between September 1996 to August 1998, at Seoul National University Hospital were analyzed. Surface doses were measured at the head, neck, axilla, thigh, and ankle level. Surface and midline doses were measured with similar set-up and technique in the Humanoid phantom. RESULTS: Measured surface doses relative to prescribed dose for the head, neck, axilla, thigh, and ankle level were 91.3+/-7.8, 98.3+/-7.5, 95.1+/-6.3, 98.3+/-5.5, and 95.3+/-6.3%, respectively. The midline doses of the head, neck, axilla, thigh, and ankle level estimated from the surface-to-midline ratios in the Humanoid phantom were 103.4+/-9.0, 107.8+/-10.5, 91.1+/-6.1, 93.8+/-4.5, and 104.5+/-9.3%, respectively. Measured surface doses and estimated midline doses ranged from -8.9% to + 7.8%. Midline doses at the neck and the axilla level deviated more than 5% from the prescribed doses. The difference of the estimated midline doses at the neck and the axilla level and the actual doses were attributed to the thickness differences between the Humanoid phantom and the patients. CONCLUSION: Distribution of the midline doses as well as the surface doses were measured to be within -8.7 - +7.8% range. Actual dose distribution in the patient is expected to be better than the measured dose range mainly attributed to thickness difference between the patient and the Humanoid phantom.
Ankle ; Axilla ; Bone Marrow Transplantation ; Head ; Humans ; Leukemia ; Lymphoma ; Neck ; Seoul ; Thigh ; Whole-Body Irradiation*

Vascular complication of hip arthroplasty is relatively rare, and usually involves iatrogenic injury or thrombus formation of main vessels. No case of vascular injury associated with closed suction drainage has been reported. The current report describes an injury of a branch from the lateral circumflex femoral artery caused by a trocar of closed suction drainage in a 72-year-old man who had been treated with bipolar hemiarthroplasty because of a femoral neck fracture. We report on this case with a review of the literature in order to avoid similar complications.
Aged ; Arthroplasty ; Femoral Artery ; Femoral Neck Fractures ; Hemiarthroplasty* ; Hip* ; Humans ; Suction* ; Surgical Instruments* ; Thrombosis ; Vascular System Injuries

This in vitro study examined the effect of surface defects on cutting blades on the extent of the cyclic fatigue fracture of HEROShaper Ni-Ti rotary files using fractographic analysis of the fractured surfaces. A total of 45 HEROShaper (MicroMega) Ni-Ti rotary files with a #30/.04 taper were divided into three groups of 15 each. Group 1 contained new HEROShapers without any surface defects. Group 2 contained HEROShapers with manufacturing defects such as metal rollover and machining marks. Group 3 contained HEROShapers that had been clinically used for the canal preparation of 4-6 molars. A fatigue-testing device was designed to allow cyclic tension and compressive stress on the tip of the instrument whilst maintaining similar conditions to those experienced in a clinic. The level of fatigue fracture time was measured using a computer connected the system. Statistical analysis was performed using a Tukey's test. Scanning electron microscopy (SEM) was used for fractographic analysis of the fractured surfaces. The fatigue fracture time between groups 1 and 2, and between groups 1 and 3 was significantly different (p < 0.05) but there was no significant difference between groups 2 and 3 (p > 0.05). A low magnification SEM views show brittle fracture as the main initial failure mode. At higher magnification, the brittle fracture region showed clusters of fatigue striations and a large number of secondary cracks. These fractures typically led to a central region of catastrophic ductile failure. Qualitatively, the ductile fracture region was characterized by the formation of microvoids and dimpling. The fractured surfaces of the HEROShapers in groups 2 and 3 were always associated with pre-existing surface defects. Typically, the fractured surface in the brittle fracture region showed evidence of cleavage (transgranular) facets across the grains, as well as intergranular facets along the grain boundaries. These results show that surface defects on cutting blades of Ni-Ti rotary files might be the preferred sites for the origin of fatigue fracture under experimental conditions. Furthermore, this work demonstrates the utility of fractography in evaluating the failure of Ni-Ti rotary files.
Edible Grain ; Fatigue* ; Fractures, Stress* ; Microscopy, Electron, Scanning ; Molar