Under median sternotomy and left thoracotomy, extra-anatomic aorta bypass between ascending aorta and descending thoracic aorta without cardiopulmonary bypass support has been done effectively and easily without complications for a selected case of atypical coarctation associated with hypoplasia of aortic arch. It should be considered as an alternative operative technique for complex aortic arch reconstruction.
Aorta* ; Aorta, Thoracic ; Aortic Coarctation ; Cardiopulmonary Bypass ; Sternotomy ; Thoracotomy ; Transplants*

Renal infarction usually occurs in patients with atrial fibrillation, valvular heart disease, trauma, renal artery stenosis, atherosclerosis, vasculitis, and hypercoagulable state. Protein C or S deficiency is an uncommon condition among hypercoagulable states and manifests deep vein thrombosis, pulmonary thromboembolism, cerebrovascular accident. In this report, we present a case of renal infarction occurred in 36-year-old male without underlying diseases except a family history of thromboembolism. He was admitted to our hospital due to an abrupt and continuous left flank pain. He had no previous history of an arterial or venous thrombosis. Tomography and renal angiography showed a left renal artery occlusion. He was treated with heparin and warfarin therapy. In laboratory tests, Protein C antigen level and protein S activity was 51.80% (72-160%) and 48% (65-140%). Thus, we concluded that renal infarction was secondary to combined type 1 protein C deficiency and type 2 protein S deficiency.
Adult ; Angiography ; Atherosclerosis ; Atrial Fibrillation ; Flank Pain ; Heart Valve Diseases ; Heparin ; Humans ; Infarction* ; Male ; Protein C Deficiency ; Protein C* ; Protein S ; Protein S Deficiency ; Pulmonary Embolism ; Renal Artery ; Renal Artery Obstruction ; Stroke ; Thromboembolism ; Vasculitis ; Venous Thrombosis ; Warfarin

A 27-year-old female patient was referred due to an edematous left lower extremity. Both saphenous veins had been ablated with an endovenous laser procedure used to treat varicose veins. Venography revealed that the left common femoral vein had been divided and that thrombosis was present at the site of division. No veins were available around the thighs. The patient was treated using a staged procedure. During the first stage, a ringed polytetrafluoroethylene graft was used to repair the common femoral vein, and an arteriovenous fistula was constructed from the femoral artery to the graft using a short segment of cephalic vein to increase graft patency. The edema was relieved postoperatively and the graft was patent. During the second stage, which was performed 6 months later, the fistula was occluded by coil embolization. The staged procedure described herein provides an alternative for venous reconstruction when autologous vein is unavailable.
Adult ; Arteriovenous Fistula* ; Edema ; Embolization, Therapeutic ; Female ; Femoral Artery ; Femoral Vein* ; Fistula ; Humans ; Lower Extremity ; Phlebography ; Polytetrafluoroethylene ; Saphenous Vein ; Thigh ; Thrombosis ; Transplants* ; Varicose Veins ; Veins

BACKGROUND: Guidelines for esophagogastroduodenoscopy (EGD) in the West allow the continued use of warfarin under therapeutic international normalized ratio (INR) level. In Korea, no guidelines have been issued regarding warfarin treatment before EGD. The authors surveyed Korean cardiac surgeons about how Korean cardiac surgeons handle warfarin therapy before EGD using a questionnaire. Participants were requested to make decisions regarding the continuation of warfarin therapy in two hypothetical cases. METHODS: The questionnaire was administered to cardiac surgeons and consisted of eight questions, including two case scenarios. RESULTS: Thirty-six cardiac surgeons at 28 hospitals participated in the survey, and 52.7% of the participants chose to stop warfarin before EGD in aortic valve replacement patients without risk factors for thromboembolism. When the patient’s INR level was 2, 31% of the participants indicated that they would choose to continue warfarin therapy. For EGD with biopsy, 72.2% of the participants chose warfarin withdrawal, and 25% of the participants chose heparin replacement. In mitral valve replacement patients, 47.2% of the participants chose to discontinue warfarin, and 22.2% of the participants chose heparin replacement. For EGD with biopsy in patients with a mitral valve replacement, 58.3% of the participants chose to stop warfarin, and 41.7% of the participants chose heparin replacement. CONCLUSION: This study demonstrated that attitudes regarding warfarin treatment for EGD are very different among Korean surgeons. Guidelines specific to the Korean population are required.
Anticoagulants ; Aortic Valve ; Biopsy ; Endoscopy* ; Endoscopy, Digestive System ; Heart Valve Prosthesis ; Hemorrhage ; Heparin ; Humans ; International Normalized Ratio ; Korea ; Mitral Valve ; Risk Factors ; Surgeons ; Thromboembolism ; Warfarin*

Absent right superior vena cava in visceroatrial situs solitus is rare. It has been known the absent right superior vena cava is usually accompanied with persistent left superior vena cava. And this anomaly could be combined witk additional congenital heart disease and rhythm disturbances. We experienced one case of absent right superior vena cava accompanied by persistent left superior vena cava, secundum type atrial septal defect, and transient post-operative sinus node dysfunction.
Heart Defects, Congenital ; Heart Septal Defects, Atrial ; Sick Sinus Syndrome ; Vena Cava, Superior*

BACKGROUND/AIMS: Although it is generally known that the risk for all types of cancer increases with adult height, combined and for several common site-specific cancers (including colon and rectal), evidence is limited for adenomas, which are precursors to colorectal cancer. We evaluated the association between height and risk of colorectal adenoma at various stages of the adenoma-carcinoma pathway. METHODS: We conducted a retrospective study using data from patients who had undergone a complete colonoscopy as part of a health examination at the Health Promotion Center of Samsung Medical Center between October 13, 2009 and December 31, 2011. A total of 1,347 male subjects were included in our study. Multivariate logistic regression analysis was used to evaluate the association between height and colorectal adenoma. RESULTS: Each 5-cm increase in height was associated with 1.6% and 5.3% higher risks of advanced colorectal adenoma and high-risk colorectal adenoma, respectively, but associations were not significant after adjusting for age, body mass index, metabolic syndrome, alcohol intake, smoking, family history of colorectal cancer, and regular aspirin use (p = 0.840 and p = 0.472, respectively). CONCLUSIONS: No clear association was found between colorectal adenoma risk and height. Unlike other site-specific tumors reported to have a consistent relationship with height, the association between colorectal tumor and height remains controversial.
Adenoma* ; Adult ; Aspirin ; Body Height ; Body Mass Index ; Body Weight ; Colon ; Colonoscopy ; Colorectal Neoplasms ; Health Promotion ; Humans ; Logistic Models ; Male ; Retrospective Studies ; Risk Factors* ; Smoke ; Smoking

PURPOSE: This study was aimed to identify application motives and to explore the impact of motives on school adjustment in medical school students. METHODS: Fifty-one third-year medical students were individually interviewed by two independent interviewers to evaluate application motives and school adjustment. Fisher's exact test and two-way analysis of variance were used to examine group differences in school adjustment and academic performance according to application motives and personal characteristics. RESULTS: On the basis of Marcia's identity status model, four types of application motives were identified including "objective orientation", "achievement orientation", "heteronomy" and "objective diffusion." Students who were classified into either objective orientation or achievement orientation did not have any adjustment problem. However, half the students classified into either heteronomy or objective diffusion had academic or social problems. The students in the first two classifications achieved higher grades in basic science courses than those of the later two. Conclusions: These results suggest that application motives tend to impact school adjustment and academic performance. Motive-based admission policies and student guidance should be considered as alternative measure for improving school adjustment and academic performance in medical school students.
Classification ; Diffusion ; Humans ; Schools, Medical* ; Social Problems ; Students, Medical

Hematemesis is a rare manifestation of a ruptured bronchial artery aneurysm (BAA) in the mediastinum. It is difficult to diagnose a ruptured BAA presenting as hematemesis, because it can be confused with other diseases, such as Boerhaave's syndrome, variceal disease, or a perforated ulcer. In this report, we describe a case of BAA resulting in hematemesis and mediastinal hemorrhage.
Aneurysm* ; Bronchial Arteries* ; Esophagus ; Hematemesis* ; Hemorrhage* ; Mediastinum ; Ulcer

OBJECTIVES: We investigated the status of the preplacement medical examination after the revision of the industrial safety and health law on Oct. 7, 2005 by the Ministry of Labor. METHODS: Preplacement medical certificates of 6,507 recruits issued by two hospitals in Busan, Kyeongnam Province from Jan. 1 to Dec. 31, 2006 were reviewed. Telephone interviews were performed to the recruits with disease and self-reported questionnaires were administrated to health and safety personnel from May 1 to Sep. 30, 2007. RESULTS: Interviews were conducted with 185(56.1%) recruits with disease, 51(27.4%) of whom were rejected for employment due to the preplacement medical certificate. The questionnaire survey for the health and safety personnel revealed that 39(22.9%) personnel were unaware of the annulment of the preemployment medical examination. Eighty(48.8%) of the health and safety personnel answered that they performed a preplacement medical examination after employment, and 63(37.3%) made a practical application of the workers' placement. The recruits with chronic conditions were refused employment: 20 (11.8%) due to hypertension, 21(12.4%) diabetes mellitus and 22(13.0%) hyperlipidemia. The recruits with work-related diseases were also refused employments: 76(44.4%) due to lumbar spine abnormality and 75(43.8%) hearing loss. CONCLUSIONS: Despite the annulment of the pre-employment medical examination, a preplacement medical examination was often used to discriminate among healthy and diseased recruits. Employers must respect the law for the point of time of the preplacement medical examination and the payment of cost. The government should publicize the revision of the objectives of the law. We suggest that health professionals elucidate the job fitness through the development of the assessment tools and maintain the confidentiality of recruits.
Confidentiality ; Diabetes Mellitus ; Employment ; Health Occupations ; Hearing ; Hyperlipidemias ; Hypertension ; Interviews as Topic ; Jurisprudence ; Questionnaires ; Spine

OBJECTIVES: This research aimed to know the actual condition and problems of medical information protection at a workplace with the target of industrial health care managers of small and medium-sized enterprises. METHODS: A self-administered questionnaire was given to industrial health-care managers of 216 enterprises from March 15 to May 17, 2010. The questionnaire was produced by referring to the Act on Personal Information Protection of Public Institutions, etc. This research evaluated agreement of cognition and practice according to 10 items of medical information protection using kappa and cross-analysis of significant factors between cognition and practice of medical information protection and general characteristics. RESULTS: Cognition about medical information protection appeared to be 85.4-97.1% and its practice appeared to be 44.1-95.3%, so practice was lower than cognition. In addition, the agreement of cognition and practice appeared significantly low (kappa 0.082-0.387). The practice of medical information protection tended to be lower when the managers were older and held a higher job title. Health examination results were being delivered only to workers except for an employer (94.2%), but there were many industrial health-care managers who felt discomfort about their work in group occupational health-care systems (58.1%). CONCLUSIONS: The practice of protecting medical information by industrial health-care managers was clearly lower than the cognition. Therefore, introduction of educational programs about personal information protection and provision of an independent place for group occupational health care service is urgent. In addition, in order to use the health examination results conveniently in group occupational health services, an institutional complement is necessary.
Cognition ; Complement System Proteins ; Computer Security ; Delivery of Health Care ; Humans ; Hypogonadism ; Mitochondrial Diseases ; Occupational Health ; Occupational Health Services ; Ophthalmoplegia ; Questionnaires