BACKGROUND: Congenital bronchoesophageal fistula(BEF) presented in adult life is a rare disorder and has characteristic clinical findings such as paroxysmal cough after water ingestion and recurrent respiratory infections. It usually manifested recurrent pneumonia and chronic cough with purulent phlegmon which was mis-or under-diagnosed as chronic bronchitis, bronchiectesis or lung abscess so forth. METHODS: We reviewed retrospectively 13 cases of congenital BEE in adult of Paik Hospital, College of Medicine, Inje University including 22 cases of congenital BEE previously reported in literature of Korea from 1979 through 1995. RESULTS: The mean age at diagnosis was 40.2 +/- 14.3. There was no difference in sex ratio(Male: Female 18 : 17). The mast common symptom was cough(91.4%), follwed by chronic sputum(74.3), hemoptysis(25.7), and paroxysmal nocturnal cough at specific position(20%). Twenty one of 31 patients who were able to review have the most specific sign, Ono's sign presented as paroxysmal cough after liquid ingestion. By classification of Braimbridge-Keith, Fourteen(45.1%) of 31 patients were group I (associated with esophageal diverticulum), 15(48.4%) were group II (simple fistula), and group III arid IV was one case in each. The opening of fistula confined to right lower lobe in 26(76.5%), left lower lobe in 6(176%), arid left main bronchus in 2(5.9%) cases. CONCLUSION: Congenital bronchoesophageal fistula is uncommon disorder which has characteristic histories and specific symptoms such as chronic and recurrent lower respiratory infections, and paroxysmal cough after liquid ingestion. Medical attention and careful history should be done in patients who have localized recurrent lower respiratory infections in right lower lobe.
Adult* ; Bees ; Bronchi ; Bronchitis, Chronic ; Cellulitis ; Classification ; Cough ; Diagnosis ; Eating ; Female ; Fistula* ; Humans ; Korea* ; Lung Abscess ; Pneumonia ; Respiratory Tract Infections ; Retrospective Studies

No abstract available.

Medical appraisal has emerged as a medico-social problem. There are more medical appraisal errors than expected. Physicians are trained in the process of scientific thinking, and then can make a medical appraisal error. Medical appraisal requires both legal knowledge and medical experience. Medical appraisal is neither commentary nor advice for the best ideal medicine. The ideal medical practice described in textbooks and the implementation of the guidelines are different from the medical reality. Medical appraisal should reflect the real-time changing medical field. Medical appraisal experts must consider the level of medical care at the time the incident occurred, the facility, region, environment of the medical institution, and the patient's underlying disease, sequelae, and complications. Since the medical appraisal doctor conducts a retrospective analysis with all the data and time to review, it should be kept in mind that the medical appraisal may differ from the judgment of the actual medical field. Medicine is an evolving but limited science because it is the youngest science. For the fairness of medical appraisal, the medical professionalism and appraisal education of medical appraisers are essential. The Korean Medical Practice Review Authority was established in 2019 led by the Korean Medical Association. The appraisal education program was implemented to strengthen the expertise of appraisers and to develop appraisal skills. The medical field, especially gastroenterology, is the most common subject of medical appraisal. The principles and errors of medical appraisal were reviewed by focusing on the gastroenterology appraisal cases.

Medical appraisal has emerged as a medico-social problem. There are more medical appraisal errors than expected. Physicians are trained in the process of scientific thinking, and then can make a medical appraisal error. Medical appraisal requires both legal knowledge and medical experience. Medical appraisal is neither commentary nor advice for the best ideal medicine. The ideal medical practice described in textbooks and the implementation of the guidelines are different from the medical reality. Medical appraisal should reflect the real-time changing medical field. Medical appraisal experts must consider the level of medical care at the time the incident occurred, the facility, region, environment of the medical institution, and the patient's underlying disease, sequelae, and complications. Since the medical appraisal doctor conducts a retrospective analysis with all the data and time to review, it should be kept in mind that the medical appraisal may differ from the judgment of the actual medical field. Medicine is an evolving but limited science because it is the youngest science. For the fairness of medical appraisal, the medical professionalism and appraisal education of medical appraisers are essential. The Korean Medical Practice Review Authority was established in 2019 led by the Korean Medical Association. The appraisal education program was implemented to strengthen the expertise of appraisers and to develop appraisal skills. The medical field, especially gastroenterology, is the most common subject of medical appraisal. The principles and errors of medical appraisal were reviewed by focusing on the gastroenterology appraisal cases.

No abstract available.
Bronchi* ; Ethanol* ; Humans

ABBREVIATIONS: Akt/PKB protein kinase B, ALI acute lung injury, ARDS acute respiratory distress syndrome, CREB C-AMP response element binding protein, ERK extracelluar signal-related kinase, fMLP fMet-Leu-Phe, G-CSF granulocyte colony-stimulating factor, IL interleukin, ILK integrin-linked kinase, JNK Jun N-terminal kinase, LPS lipopolysaccharide, MAP mitogen-activated protein, MEK MAP/ERK kinase, MIP-2 macrophage inflammatory protein-2, MMP matrix metalloproteinase, MPO myeloperoxidase, NADPH nicotinamide adenine dinucleotide phosphate, NE neutrophil elastase, NF-kappaB nuclear factor-kappa B, NOS nitric oxide synthase, p38 MAPK p38 mitogen activated protein kinase, PAF platelet activating factor, PAKs p21-activated kinases, PMN polymorphonuclear leukocytes, PI3-K phosphatidylinositol 3-kinase, PyK proline-rich tyrosine kinase, ROS reactive oxygen species, TNF-alpha tumor necrosis factor-alpha.
Abbreviations ; Acute Lung Injury* ; Carrier Proteins ; Granulocyte Colony-Stimulating Factor ; Interleukins ; Leukocyte Elastase ; Macrophages ; N-Formylmethionine Leucyl-Phenylalanine ; NADP ; Neutrophil Activation* ; Neutrophils* ; NF-kappa B ; Nitric Oxide Synthase ; p21-Activated Kinases ; p38 Mitogen-Activated Protein Kinases ; Peroxidase ; Phosphatidylinositol 3-Kinase ; Phosphotransferases ; Platelet Activating Factor ; Protein Kinases ; Protein-Tyrosine Kinases ; Proto-Oncogene Proteins c-akt ; Reactive Oxygen Species ; Respiratory Distress Syndrome, Adult ; Response Elements ; Signal Transduction ; Tumor Necrosis Factor-alpha

Patient safety has been one of the hottest issues of healthcare quality in Korea since two years ago. Patient safety is defined as avoiding risk and minimizing harm. It is a new concept to transform all services to add value in healthcare, not only to address the effectiveness of treatment but also errors, inefficiency, preventable complications, and unnecessary treatment. To reduce risk and improve the effectiveness of health care quality, health care organizations should operate a patient safety reporting system and learning program. For the purpose of promoting improvements in health care quality and patient safety of hospitals, patient safety standards in an accreditation system were implemented by the Korea Institute for Healthcare Accreditation. Lessons from an error reporting system provide important solutions to management of sentinel events in health care organizations. The current status of policies, strategies, and reporting systems for patient safety were reviewed and in addition, a few suggestions have been added to advance patient safety in Korea.
Accreditation ; Delivery of Health Care ; Humans ; Korea ; Learning ; Nitriles ; Patient Safety ; Pyrethrins ; Quality Improvement ; Quality of Health Care

Solitary fibrous tumors (SFTs) most often involve the pleura and also may encompass the peritoneum and nonserosal sites. They occur as solitary encapsulated tumors and pursue a relatively benign clinical course. The usual criteria for malignancy are high cellularity, mitotic activity (more than 4 per 10 high-power fields), cellular pleomorphism, hemorrhage and necrosis as well as infiltrative growth. We report a case of malignant SFT of pleura who presented with an anterior mediastinal mass. Grossly, it was a 10x8x6.5 cm sized, encapsulated and well-demarcated, solid neoplasm with areas of extensive necrosis. Microscopically, parallel or haphazard arrangement of spindle cells with variable degrees of collagenous background were noted. Storiform fascicle formation, hemangiopericytoma-like pattern, and epithelioid cell clusters were often intermingled. Nodular areas with high cellularity and mitotic activity (> or =10/10 HPFs) were scattered throughout the neoplasm, however no definite cellular pleomorphism was encountered. Tumor cells were immunoreactive for vimentin and CD-34, which distinguished them from the mesothelial cells. Electron microscopically, they revealed fibroblastic and myofibroblastic differentiation.
Collagen ; Epithelioid Cells ; Fibroblasts ; Hemorrhage ; Mediastinum ; Myofibroblasts ; Necrosis ; Peritoneum ; Pleura ; Solitary Fibrous Tumor, Pleural* ; Solitary Fibrous Tumors* ; Vimentin

From July 1997, Authors have reconstructed the posterior cruciate ligament(PCL) deficient knees with two graft tendons; an autogenous bone-patellar tendon-bone (BPTB) and a semitendinosus tendon. At Femoral side, the two graft tendons were fixed through the two tunnels which were made at the site of foot print of PCL. The original site of anterolateral bundle of the PCL was reconstructe(I with the autogenous BPTB and the original site of posteromedial bundle with the semitendinosus tendon. At tibial side, the two graft tendons were fixed by modified inlay technique; the BPTB was fixed with a cancellous screw and the semitendinosus tendon with staples. Seven cases were followed up more than six months and authors evaluated the results with the KT-1000TM arthrometer and the posterior stress radiographs by Telos stress dcvice and compared the resu]t of injured knee with the uninjured side of each patient. The results of manual maximal displacement test with arthrometer were less than 4 mm in six patients and 8 rnm in one patient at last follow up. The average distance of posterior displacement on stress radiographs was 10.3 mm preoperatively and 2.7 mm at final follow up period. Six of the seven patients had a good stability on posterior stress radiographs compared with the uninjured side. One patient had posterior knee insta- bility on stress radiographs due to loosening of the grafted tendon and retightening of the grafted tendon was performed through the posterior approach to the proximal tibia. The original idea of femoral dual tunnel method in PCL reconstructiori is to reconstruct the PCL more anatomically and the modified tibial inlay technique can solve the problern of graft tendon abrasion at the posterior opening of the tibial tunnel in transtibial tunnel method and retightening of the loose grafted tendon is simple than the other methods of PCL reconstruction. Authors expect that this combined femoral dual tun- nel and modified tibial inlay method may improve the quality of the outcome of the arthroscopic PCL reconstruction.
Arthroscopy ; Follow-Up Studies ; Foot ; Humans ; Inlays* ; Knee ; Posterior Cruciate Ligament* ; Tendons* ; Tibia ; Transplants*