BACKGROUND: The external jugular vein (EJV) is a useful intravenous (IV) cannulation site for anesthesiologists, although it has a relatively high failure rate. Unlike other central veins, visualization of the EJV is important during IV cannulation, and the Valsalva maneuver distends the jugular venous system. However, the relationship between the maneuver and EJV visibility remains unknown. This study compared EJV visibility before and after the Valsalva maneuver. METHODS: This was a prospective observational study that included 200 participants. After the induction of anesthesia, EJV visibility grade, depth from the skin to the EJV superficial surface (EJV depth), and EJV cross-sectional area (CSA) before the Valsalva maneuver were measured. The same parameters were measured after the Valsalva maneuver was performed. The EJV visibility grade was defined as grade A: good appearance and good palpation, grade B: poor appearance and good palpation, and grade C: poor appearance and poor palpation. RESULTS: Patient body mass index and EJV depth affected the EJV visibility grade before the Valsalva maneuver (p < 0.05), although EJV CSA did not. The Valsalva maneuver distended EJV CSA and reduced EJV depth, although these changes were not correlated with EJV visibility grade. With regard to EJV visibility, 34.0% of grade B cases and 20.0% of grade C cases were improved by the Valsalva maneuver. CONCLUSIONS: Although the Valsalva maneuver improved EJV CSA and EJV depth, it did not greatly affect EJV visibility grade.
Anesthesia ; Body Mass Index ; Catheterization ; Humans ; Jugular Veins* ; Observational Study ; Palpation ; Prospective Studies ; Skin ; Ultrasonography ; Valsalva Maneuver* ; Veins

No abstract available.
Child* ; Colon* ; Constipation* ; Enema* ; Fecal Incontinence* ; Humans

In order to adapt to the rapidly changing medical environment, it is important to advance not only the basic medical education in medical schools but also that of residents. The quality of the training environment and educational goals for residency must also be improved for specialists. Although each institute including internal medicine, general surgery, family medicine, etc., strives to standardize, sets educational goals, and develops content to train capable specialists, the education programs focus on special techniques and competency of medical care for patients. The training environment of each residency program is different in each trainee hospital, and hospitals are making an effort to set education goals for the residents and improve their education programs. In Korea, there is no common core education program for residents, while in the United States, the Accreditation Council for Graduate Medical Education is responsible for the development and evaluation of a standardized curriculum for residents, and in Canada, CanMEDs presents a basic curriculum to help residents develop competency. Fully capable specialists have more than just clinical competency; they also need a wide range of abilities including professionalism, leadership, communication, cooperation, in addition to taking part in continuous professional development/continuing medical education activities. We need to provide a core curriculum for residency to demonstrate attention to and knowledge about health problems of the community.
Accreditation ; Canada ; Clinical Competence ; Curriculum ; Education ; Education, Medical ; Education, Medical, Graduate ; Humans ; Internal Medicine ; Internship and Residency ; Korea ; Leadership ; Professionalism ; Schools, Medical ; Specialization ; United States

STATEMENT OF PROBLEM: Proper finishing and polishing enhance both the esthetics and the longevity of restored teeth. Blade finishing technique would be suited for smoothing and finishing. Evaluation of this technique are necessary. PURPOSE: The purpose of this study was to evaluate the blade finishing and polishing procedures on the surface profile and roughness of ormocer-based composite resin and nanohybrid composite resin. MATERIAL AND METHODS: The material included a ormocer-based composite resin (Admira(R) & Admira(R) Flow); a nanohybrid composite resin (Grandio(R) & Grandio(R) Flow). One hundred forty specimens of each group were prepared using a mylar strip and randomly divied into blade finishing and rubber polishing groups (n=10). The average surface roughness (Ra) in micrometers was measured and the surface profile was examined by scanning electron microscopy (SEM) (Magnification X 200). The data were analyzed by Mann-Whitney Test at 0.05 significance level. CONCLUSION: The results of this study indicated that the mylar strip produced the smoothest surface on all materials and among the finishing-polishing methods was not significanct difference (P>0.05). Ormocer-based flowable composite resin performedthe lowest variability in initial surface roughness among the tested materials.
Composite Resins ; Esthetics ; Longevity ; Microscopy, Electron, Scanning ; Polyethylene Terephthalates ; Rubber ; Tooth

Congenital renal arteriovenous malformations are rare. Moreover, rupture of congenital arteriovenous malformations in the unilateral renal agenesis with uterine malformation is more rare. We present a case of acute urinary retention due to large hematoma of spontaneously ruptured congenital arteriovenous malformation of unilateral renal agenesis in a 33-years-old woman.
Arteriovenous Malformations* ; Female ; Hematoma ; Humans ; Rupture ; Urinary Retention*

A case of a 39-year-old woman with corrected transposition of the great vessels without significant intracardiac anomaly or coronary disease is reported. The clinical diagnosis of coronary arterial disese was supported in this patient by electrocardiographic changes of probable old anteroseptal myocardial infarction. Coronary arteriographic study showed the morphologic left coronary artery supplied the right-sided ventricle, and the right coronary artery supplied the left-sided ventricle, and the right coronary artery supplied the left-sided ventricle. Although the condition is theoretically compatible with a normal life span, few patient with this lesion survive past 40 years of age because of the subsequent heart block or functioning as a systemic ventricle.
Adult* ; Anterior Wall Myocardial Infarction ; Coronary Angiography* ; Coronary Disease ; Coronary Vessels ; Diagnosis ; Electrocardiography ; Female ; Heart Block ; Humans

STATEMENT OF PROBLEM: Over the past decade, increased demand for esthetically pleasing restorations has led to the development of all-ceramic systems. Recent reports suggest that the all-ceramic crowns have excellent physical properties, wear resistance, and color stability. In addition, numerous ceramics have excellent biocompatibility, a natural appearance, and improved physical bonding with resin composite luting agents. However, the brittle nature of ceramics has been a major factor in their restriction for universal usage. Functional occlusal loading can generate stress in the luting agent, and the stress distribution may be affected by the marginal geometry at the finish line. Tooth preparation for fixed prosthodontics requires a decision regarding the marginal configuration. The design dictates the shape and bulk of the all ceramic crowns and influences the fit at the margin. PURPOSE: The purpose of this study was to evaluate the stress distribution within marginal configurations of all- ceramic crowns (90-degree shoulder, 110-degree shoulder, 135-degree shoulder). MATERIAL AND METHODS: The force is applied from a direction of 45 degrees to the vertical tooth axis. Three-dimensional finite element analysis was selected to determine stress levels and distributions. RESULTS AND CONCLUSION: The result of stress level for the shoulder marginal configuration was more effective on stress distribution at 135-degree shoulder margin. But the stresses concentrated around at 135-degree shoulder margin. The stress decreased apically at the surface between cements and alumina core, and increased apically at the surface between alumina core and veneering porcelain.
Aluminum Oxide ; Axis, Cervical Vertebra ; Ceramics ; Collodion ; Crowns ; Dental Cements ; Dental Porcelain ; Finite Element Analysis ; Prosthodontics ; Shoulder ; Tooth ; Tooth Preparation

PURPOSE: To evaluate the CT and MR findings of bronchial anthracofibrosis. MATERIALS AND METHODS: Forty-one patients with ronchoscopically confirmed bronchial anthracofibrosis were included in this study. Thirty-six were female and five were male, and all were aged between 53 and 89 (mean, 70) years. The CT (n=41) and MR findings (n=5) were retrospectively analysed with regard to bron-chostenosis, atelectasis, air-space consolidation, lymph node enlargement, calcified lymph node, mass and bronchial wall thickening, as seen on CT, and signal intensity of the mass and lymph nodes, as seen on MR. RESULTS: CT scans revealed the presence of bronchostenosis (n=34, 83%), atelectasis (n=24, 59%), pneumonic consolidation (n=26, 63%), enlarged mediastinal lymph node (n=39, 95%), calcified lymph node (n=22, 54%), mass (n=4,10%), and thickening of bronchial wall (n=1, 2.4%). Multifocal involvement of bron-chostenosis, atelectasis, and air-space consolidation occurred in 61%, 50% and 30% of cases, retrospectively. MR imaging showed low signal intensity of mass (n=3) and lymph nodes (n=10) on T1WI and T2WI. but in one case, mass and lymph node showed central high signal intensity on T2WI. CONCLUSION: A multiplicity of bronchostenosis, atelectasis, air-space consolidation and enlarged mediastinal lymph nodes were characteristic CT findings of bronchial anthracofibrosis. Most MR findings included relatively low signal intensity of masses and lymph nodes on T2WI, possibly indicating the benign nature of the diseases
Female ; Humans ; Lung ; Lymph Nodes ; Magnetic Resonance Imaging ; Male ; Pneumoconiosis ; Pulmonary Atelectasis ; Retrospective Studies ; Tomography, X-Ray Computed

PURPOSE: Incidence of cancer has been increasing each years. The incidence of genitourinary cancer are also being increased. We aim to describe the time trends in genitourinary cancer incidence in Jeju province. MATERIALS AND METHODS: Age-standardized rates for incidence of genitourinary tract cancer in Korea and world standard population were calculated using the databases from the Jeju Cancer Rigistry from 1999 to 2012. RESULTS: Cancer incidence in Jeju was increased approximately 2-fold from 1217 cases 1999 to 2376 cases in 1999. Prostate cancer occurred most frequently followed by bladder tumor, and kidney cancer in 2012. In the prostate cancer, incidence was increasing every year from 18 cases in 1999 to 110 cases in 2012. Age-standardized incidence rate (ASR) was approximately four time increased, from 3.0 cases in 1999 and 11.2 cases in 2012. Incidence of bladder cancer were 43 cases in 1999 and 27 cases in 2012, ASR of bladder cancer was increased from 5.0 cases in 1999 to 7.5 cases in 2012. Kidney cancer showed constantly reducing the incidence. Peak is 60 cases in 2009 and recent incidence was 37 cases in 2012. There was no significant change in the incidence of testicular cancer, ureter cancer, renal pelvis cancer from 1999 to 2012. CONCLUSIONS: Incidence of cancer has been increasing in Jeju, similar to other area In Korea. Prostate cancer is the most common urological cancer in Jeju province, and kidney cancer incidence is recently decreasing. We should try to prevent genitourinary tract cancer caused obesity and smoking.
Incidence* ; Kidney Neoplasms ; Kidney Pelvis ; Korea ; Obesity ; Prostatic Neoplasms ; Smoke ; Smoking ; Testicular Neoplasms ; Ureteral Neoplasms ; Urinary Bladder Neoplasms ; Urogenital Neoplasms* ; Urologic Neoplasms

Differential diagnosis of invasive aspergillosis from other pulmonary fungal infections including mucormycosis is important because the treatment is pathogen-dependent. Clinically, invasive aspergillosis is often discriminated from other mold infections on the basis of typical histopathologic features in the biopsy specimen. However, biopsy alone is not always complete because different fungal species can display similar histopathologic features. Surrogate markers or molecular-based assays can be useful when the results of conventional diagnostic modalities are conflicting. Here, we present a case of invasive pulmonary aspergillosis histologically mimicking mucormycosis, which was confirmed by fungal polymerase chain reaction.
Aspergillosis ; Biomarkers ; Biopsy ; Diagnosis, Differential ; Fungi ; Invasive Pulmonary Aspergillosis* ; Lung Diseases, Fungal ; Mucormycosis* ; Polymerase Chain Reaction