Ethical problems in an emergency department (ED) are much more common than is usually recognized. But these difficult ethical dilemmas have not been dealt with by general medical ethicists. Most medical ethics guidelines tend to concentrate on chronic or at least relatively stable situations rather than on the acute, episodic cases that are typical in the ED. most ethical problems such as abortion, euthanasia, and professionalism can be solved after reflection and deliberation, and after a process of communication that reveals the values and interests of the patient or the patient's family. In contrast, when health care professionals in the ED recognize ethical problems, they often don't have enough time for an ethical consultation such as a Hospital Ethics Committee. Ethical principles such as autonomy, beneficence, nonmaleficence, and justice need to be applied to the unique setting of emergency medicine. Hence, it is necessary to develop ethics guidelines in emergency medicine and ethics education for health care professionals in emergency departments. At first, we collected cases involving ethical problems and reviewed the ethical and legal aspects of those cases. In this article, we summarize the ethical issues in emergency medicine, deal with actions in emergency medical services, and also consider the relationships between ethical issues and act on emergency medical services. We want to present the important factors that should be considered in ethical decision making within an emergency medicine department including patient decision making capacity, legal custody, and ethical principles.
Beneficence ; Decision Making ; Delivery of Health Care ; Emergencies ; Emergency Medical Services ; Emergency Medicine ; Ethicists ; Ethics Committees, Clinical ; Ethics, Medical ; Euthanasia ; Humans ; Jurisprudence ; Social Justice

No abstract available.
Transsexualism*

No abstract available.
Ear*

No abstract available.
Nipples*

No abstract available.
Fractures, Open*

Osteogenesis imperfecta is a relatively rare genetic condition of breakable bones with an incidence of 1 per 20,000~60,000. The clinical, genetic, and biochemical heterogeneity in osteogenesis imperfecta allows to least four subtypes to be distinguished. Prenatal diagnosis of osteogenesis imperfecta type II have been reported several times with ultrasonography. We recently experienced a case of osteogenesis imperfecta diagnosed in uterus by ultrasonogram and confirmed after termination and autopsy. We report here with a brief review of the literature.
Autopsy ; Incidence ; Osteogenesis Imperfecta* ; Osteogenesis* ; Population Characteristics ; Prenatal Diagnosis ; Ultrasonography* ; Uterus*

OBJECTICES AND METHODS: The purpose of this study was to examine availabilities of stop-signal task as a screening test for ADHD and as a research tool. Stop-signal task was applied to 40 ADHD patients and 18 normal children. Followings are the results of this study. RESULTS: There were significant differences between ADHD group and control group in ZRFT, mean delay x block and primary-RT of stop-signal task performance(p<0.05). There was no significant difference in results of continuous performance test. SSRT of stop-signal task had significant correlation with hit reaction time of continuous performance test, and primary-RT and primary-SD with attentiveness and hit reaction time of continuous performance test. There was no significant correlation between scores of ADDES-HV and stop-signal task performance. In change of primary-SD according to intelligence, primary-SD decreased as intelligence increased but made plateau after IQ 110, and in change of SSRT according to age, SSRT decreased as intelligence increased but made plateau after 10 year-old. In discriminant ability, mean delay x block and primary-RT showed highest discriminant ability (each 75%). In addition P-inhibit showed 63.89%, SSRT showed 58%, ZRFT showed 67%, and primary-SD showed 58% in discriminant ability. There was no significant difference in stop-signal task performance between ADHD with hyperactivity and ADHD without hyperactivity. CONCLUSION: In this point of view, stop-signal task was proved to be a useful research tool for attention deficit hyperactivity disorder as well as useful screening test tool.
Attention Deficit Disorder with Hyperactivity* ; Child* ; Executive Function ; Humans ; Intelligence ; Mass Screening ; Reaction Time ; Task Performance and Analysis

OBJECTIVE: The presence of the various cytokines in human peritoneal fluid has been evaluated incompletely. Changes in cytokine lefels may be related to activation of peritoneal macrophage and T-lymphocyte, development of endometriosis, and infertility. This study assesses peritoneal fluid levels of interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10) and tumor necrosis factor-alpha (TNF-alpha) in infertile women with endometriosis and normal women without endometriosis. Design : Prospective and case-control study in university hospital. MATERIALS AND METHODS: Cytokine levels in peritoneal fluid obtained during laparotomy or laparoscopy from 21 patients in infertile patients in infertile patients with endometriosis and 24 controls undergoing laparotomy or laparoscopy with no evidence of pelvic endometriosis were determined by enzymelinked immunosorbent assay. RESULTS: The mean levels of interleukin-6 in infertile patients with endometriosis and controls were 72.7+/-23.7 pg/ml and 18.5+/-9.7 pg/ml respectively (p=0.02). Similarly, the mean levels of interleukin-8 in infertile patients with endometriosis was significantly higher than that of controls (445.0+/-89.6, vs 45.1+/-48.4, p=0.04). The mean concentration of interleukin-10 in infertile patients with endometriosis was significantly lower than that of controls (1.09+/-0.04 vs 2.19+/-0.03, p=0.03). The level of tumor necrosis factor-alpha was not significantly different between the two study groups. CONCLUSIONS: Increased IL-6 and IL-8 and decreased IL-10 levels in the peritoneal fluid may be related to pathogenesis in the endometriosis and infertility, suggesting that partially contribute to the disturbed immune regulation observed in infertili women with endometriosis.
Ascitic Fluid* ; Case-Control Studies ; Cytokines ; Endometriosis* ; Female ; Humans ; Infertility ; Interleukin-10 ; Interleukin-6 ; Interleukin-8 ; Laparoscopy ; Laparotomy ; Macrophages, Peritoneal ; Prospective Studies ; T-Lymphocytes ; Tumor Necrosis Factor-alpha

It has been well known that variable complications oecur in multiple organs in chronic renal failure patients. Of them gastrointestinal complications are also variable including nausea, vomiting, gastritis, peptic ulcer, gastrointestinal bleeding, hepatitis, pancreatitis, telangiectasia, angiody- splasia etc. Of such complications the incidence of peptic ulcer had been known to be high, but after endoscopic study, the incidence of nonulcer mueosal lesion has been more common. So we evaluated tbe upper gastrointestinal mucosal lesion in chronic renal failure patients by endoscopic examination. 129 subjects(mean age, 42 years, creatinine clearance ratio<10 ml/min) participated in this study. After overnight fasting the subjects were premedicated with simethicon and benoxinate. The mucosal lesion was diagnosed by two endoscopists with observing the TV monitor of electronic endoscope Fujinon EVG-FP. Of the 129 patients, 78 patients(76%) were revealed to abnormal endoscopic finding. Of the abnormal findings, the incidence of gastritis was most common in 34.9%, and then gastic erosion, duodenal erosion, gastric petechiae, gastric telangiectasia, duodenitis, gastric ulcer, gastric xanthoma, esophageal erosion, duodenal ulcer, esophageal uicer in orders. There was no difference in abnormal finding according to therapeutic type. From our study, we conclude that the incidence of nonulcer mucosal lesion is higher than ulcer disease in chronic renal failure patient, moreover those lesion can be diagnosed only by endoseopy. So we think that upper gastrointestinal endoscopy is necessory for evaluation of upper gastrointestinal tract in chronic renal failure patient.
Creatinine ; Duodenal Ulcer ; Duodenitis ; Endoscopes ; Endoscopy, Gastrointestinal ; Fasting ; Gastritis ; Hemorrhage ; Hepatitis ; Humans ; Incidence ; Kidney Failure, Chronic* ; Nausea ; Pancreatitis ; Peptic Ulcer ; Purpura ; Stomach Ulcer ; Telangiectasis ; Ulcer ; Upper Gastrointestinal Tract ; Vomiting ; Xanthomatosis

Purpose: The purpose of this study was to compare the sensitivity of MicroFlow Imaging (MFI) with that of color and power Doppler imaging (CDI and PDI, respectively) in detecting the vascularity of hepatocellular carcinomas (HCCs). Methods: This prospective study enrolled 51 patients diagnosed with HCC between August 2018 and December 2018. CDI, PDI, MFI, and contrast-enhanced ultrasound (CEUS) were performed. Two radiologists evaluated the presence and pattern of tumoral vascularity on CDI, PDI, and MFI. Vascular presence was graded on a 5-point scale (0, absent; 4, >50% of the tumor). The vascular pattern was chosen from following categories: basket, vessels in tumor, spot, detouring, mixed, or others. Two additional radiologists assessed CEUS images for the presence and pattern of tumoral vascularity, which served as the reference standard. If the tumoral vascular pattern on each examination matched that of the CEUS images, the Wilcoxon test and McNemar test, respectively, were used to compare the sensitivity for detecting tumoral vascularity between MFI and CDI, and between MFI and PDI. Logistic regression analysis was performed to identify factors associated with MFI detectability of tumoral vascularity. Results: CEUS demonstrated tumoral vascularity in 98.0% (50 of 51) of patients. MFI (58.0%, 29 of 50) demonstrated a higher sensitivity than CDI (14.0%, 7 of 50) or PDI (14.0%, 7 of 50) (P<0.001 for both) in detecting tumoral vascularity, provided that the vascular pattern was correctly depicted. Only tumor depth was associated with the MFI detectability of tumoral vascularity. Conclusion The sensitivity of MFI was higher than that of CDI or PDI in detecting the vascularity of HCCs when the vascular pattern was considered. MFI better detected the vascularity of shallow tumors.