Background: Many countries need help with the problem of an unbalanced distribution of physicians and hospitals. Moreover, various policies and strategies have been proposed to solve this problem. This study aimed to examine the determinants of the unbalanced distribution of physicians. Methods: From the 2020 Korean Physician Survey data, 4,181 physicians practicing in Korea were limited to the subjects of the study. We analyzed the factors influencing physicians’ choice of practice location and their willingness to change their practice location from an urban to a rural area. Results: The region of physicians’ hometown, medical school, and residency training hospitals determined their choice of practice location. The type of affiliated healthcare organization and the location of physicians’ hometown, medical school, and residency training hospitals affected their willingness to change their practice location from an urban to a rural area. Furthermore, the concordance rate of the regions of physicians’ hometown, medical school, and residency training hospitals with the region of their practice location was 24.9%. Conclusion In South Korea, policies for doctors have been designed without considering why they are reluctant to work in rural hospitals. To have a balanced distribution of physicians and hospitals, it is necessary to accurately analyze the status of medical resources based on regions and identify the current and future medical demand. The social situation, such as future demographic change and regional extinction, must also be fully considered. Furthermore, policies should be implemented that encourage physicians to work in rural hospitals.

STUDY DESIGN: This is a retrospective study that focused on the perioperative complications when performing posterior arthrodesis for treating degenerative lumbar disorders in elderly patients. OBJECTIVES: We wanted to analyze the perioperative risk factors and the complications associated with posterior lumbar decompression and arthrodesis in patients who were sixty-five years of age or older. SUMMARY OF LITERATURE REVIEW: Lumbar arthrodesis is commonly done in elderly patients to treat degenerative spine problems. These patients may be at an increased risk for complications because of their age and their associated medical conditions. MATERIALS AND METHODS: We studied 111 patients who were over 65 years old and they were able to be followed up for more than 3 months after performing posterior arthrodesis during the recent 5 years. Sixty-one patients who had undergone posterolateral fusion (PLF) were classified as group A, and 50 patients who had undergone posterior lumbar interbody fusion (PLIF) using a PEEK cage were classified as group B. We analyzed their rates of complications and the causative factors, according to operative methods and age, and these complications occurred within 12 weeks after the operations. RESULTS: Complications occurred for 43 patients of group A, and for 26 patients of group B. The differences in the rates of complications were statistically significant, and group A had a more complications than did group B. The relations between medical problems and the incidence of perioperative complications were statistically significant for both groups. CONCLUSIONS: Elderly patients with medical problems should be made aware that they are at an increased risk for surgical complications, and attention hould be paid to controlling the blood loss and limiting the operative time. The PLIF using a PEEK cage was identified as a procedure that could reduce the perioperative complications.
Aged ; Arthrodesis ; Decompression ; Humans ; Incidence ; Ketones ; Operative Time ; Polyethylene Glycols ; Retrospective Studies ; Risk Factors ; Spine

PURPOSE: To report a case of bilateral acute myopia and angle-closure with ciliochoroidal detachment in Vogt-Koyanagi-Harada (VKH) syndrome. CASE SUMMARY: A 43-year-old Korean woman diagnosed with VKH syndrome underwent intravenous methylprednisolone steroid pulse treatment. After oral medication was given for 2 days, the anterior chambers became shallow in both eyes. Intraocular pressure (IOP) increased to 25 mm Hg in the right eye and 23 mm Hg in the left eye. Subretinal fluid increased and visual acuity decreased with myopic shift in both eyes. IOP did not decrease despite maximum tolerated medical therapy. Ultrasound biomicroscopy (UBM) revealed that ciliochoroidal effusion caused forward displacement of the lens-iris diaphragm, which resulted in anterior chamber shallowing and angle closure in both eyes. The patient was treated with cycloplegic eyedrops and intravenous steroid pulse therapy. After intravenous steroid pulse treatment was given for 2 days, the anterior chambers became deep in both eyes. IOP reduced to 13 mm Hg and 14 mm Hg in the right and left eye respectively. Visual acuity increased with normalization of myopic shift. UBM revealed that the ciliochoroidal effusion had resolved in both eyes.
Adult ; Anterior Chamber ; Diaphragm ; Displacement (Psychology) ; Eye ; Female ; Humans ; Intraocular Pressure ; Methylprednisolone ; Microscopy, Acoustic ; Myopia ; Ophthalmic Solutions ; Subretinal Fluid ; Uveomeningoencephalitic Syndrome ; Visual Acuity

Nedocromil sodium is an anti-inflammatory medication for the treatment of mild to moderate asthma. The most common side effect of the nedocromil sodium is an unpleasant and bitter taste. However it is rare, less than 3%, to stop the treatment because of this side effect. Other side effects includes cough, headache, throat irritation and nausea which are reported as mild and transient. A 7-year-old female had a severe headache and dizziness during the treatment of asthma with nedocromil sodium. The symptoms subsided after nedocromil sodium was replaced by budesonide. We experienced a case of a severe headache and dizziness due to nedocomil sodium that lead to withdraw of the nedocromil sodium.
Asthma ; Budesonide ; Child ; Cough ; Dizziness* ; Female ; Headache* ; Humans ; Nausea ; Nedocromil* ; Pharynx ; Sodium

BACKGROUND: Estrogens act on estrogen receptors distributed in articular cartilages, synovial membrane, and ligaments, which are thought to be related with degenerative changes. Meanwhile, progesterone is known to have a weak anabolic action on bone formation This study evaluates the effects of estrogen and progesterone hormone on bone/cartilage turnover in ovariectomized (OVX) rats. METHODS: Thirty-five 7-month-old female Sprague-Dawley rats were randomly divided into 5 groups and then ovariectomized bilaterally except the sham control group. The first and the second group acting as controls did not receive hormonal therapy, the third group received estrogen, the fourth group received progesterone, and the fifth group received combination of both hormones 10 weeks after surgery. Evaluations were done using the serum levels of cartilage oligomeric matrix protein (COMP) for cartilage turnover, collagen type I C-telopeptide (CTX-1) and osteocalcin (OC) for bone turnover at 11, 15, 19 weeks after OVX and histology using the Osteoarthritis Research Society International (OARSI) osteoarthritis (OA) cartilage histopathology assessment system. RESULTS: Significantly less cartilage degradation (decreased levels of COMP) was found in the combined hormone treated group in comparison with OVX group. Similarly, both hormonal treatment resulted in increased bone formation and decreased bone resorption i.e., a low overall bone turnover status (decrease in the serum OC and CTX-1 levels). CONCLUSIONS: Combined estrogen and progesterone therapy was found to be convincing in terms of reducing the severity of OA in this experimental model.
Animals ; Biological Markers/blood/metabolism ; Bone Remodeling/*drug effects ; Bone and Bones/chemistry/drug effects ; Cartilage/chemistry/*drug effects ; Collagen Type I/blood/metabolism ; Disease Models, Animal ; Estrogens/*pharmacology ; Extracellular Matrix Proteins/blood/metabolism ; Female ; Glycoproteins/blood/metabolism ; Histocytochemistry ; Hormone Replacement Therapy/*methods ; Osteoarthritis/blood/*drug therapy ; Osteocalcin/blood/metabolism ; Ovariectomy ; Progesterone/*pharmacology ; Rats ; Rats, Sprague-Dawley

BACKGROUND: It is well known that opioids induce coughing. Many drugs such as lidocaine and ketamine are used to effectively prevent the coughing induced by opioids and this has been revealed to be effective. In this study, we evaluated the preventive effect of a graded escalation of the remifentanil concentration using a target controlled infusion pump and we compared this with the effect of lidocaine. METHODS: One hundred fifty ASA I and II patients who were scheduled for elective surgery were randomly divided into 3 groups. The patients were pretreated with 2% lidocaine 1 mg/kg (Group L) or saline (Group S) and remifentanil infusion (an effect site concentration of 4.0 ng/ml) was followed 1 minute later by using a target controlled infusion pump. Group R was pretreated with saline and this was followed by remifentanil infusion (effect site concentration of 2.0 ng/ml at first and then it was reset to 4.0 ng/ml). We evaluated the incidence, severity and onset time of cough after remifentanil infusion. RESULTS: The incidence of coughing was significantly decreased in Group R (6 cases, 12%) and Group L (7 cases, 14%), as compared to that of Group S (17 cases, 34%) (P < 0.05), but there was no significant difference between Group R and Group L. The groups showed no significant difference in the severity and the onset time of coughing. CONCLUSIONS: This study demonstrated that administering graded escalation of the remifentanil concentration suppresses remifentanil-induced coughing as effectively as lidocaine 1 mg/kg pretreatment.
Analgesics, Opioid ; Cough ; Humans ; Incidence ; Infusion Pumps ; Ketamine ; Lidocaine ; Piperidines

BACKGROUND: Hypertension in the immediate postoperative period, if sufficiently high, can cause left heart failure, arrhythmia, myocardial infarction, and cerebral hemorrhage. The causes of postoperative hypertension are hypertension history, pain, hypoxia, emergence excitement, reaction to endotracheal tube, hypothermia, excess fluid administration, hypercarbia, etc. To know the predictable factors for the postoperative hypertension the authors tried to investigate perioperative patient care of the postoperative hypertensive cases. METHODS: One hundred twenty surgical patients in both sexes between the age of 40~60 were sampled randomly and devided into two groups. The normotensive (N) group included the patients with postoperative blood pressure below 140/90 mmHg and the hypertensive (H) group, above 140/90 mmHg. The incidence of hypertension history, hypertension on admission, hypertension on ward, change of systolic blood pressure above 20% during surgery, intra or postoperative use of antihypertensives or inotropic agents were compared between the groups. RESULTS: The incidence of history of hypertension was higher in H group (20%) than N group (6.7%). Hypertension on admission was higher in H group (43.3%) than N group (23.3%). Systolic blood pressure change above 20% was only in H group (6.7%). Use of antihypertensive was more frequent in H group (33.3%) than N group (3.3%) and use of inotropic agents was only in N group (8.3%). The blood pressure at ward, preinduction, and after induction were higher in H group. Within the group the blood pressure between preinduction and after induction has no difference. CONCLUSION: Immediate postoperative hypertension can be expected in case of history of hypertenion, hypertension on admission (above 140/90 mmHg), change of systolic blood pressure above 20%, use of antihypertensive during operation, and hypertension just before induction.
Anoxia ; Antihypertensive Agents ; Arrhythmias, Cardiac ; Blood Pressure ; Cerebral Hemorrhage ; Heart Failure ; Humans ; Hypertension* ; Hypothermia ; Incidence ; Myocardial Infarction ; Patient Care ; Postoperative Period*

Idiopathic intracranial hypertension, a syndrome of obscure origin, occurs particularly in fat adolescent girls and young women. The usual symptoms are headache, blurred vision, a vague dizziness, horizontal diplopia and transient visual obscurations etc., and ophthalmoscopic examination reveals papillederma, due to increased ICP. Visual field testing usually shows slight peripheral constrictions with enlargement of the blind sports. CSF pressure is elevated in the range of 250 to 450 mm of water. Radiological or the other laboratory tests show no specific abnormalities. Treatment for idiopathic intracranial hypertension is focused on early detection and prevention of vision loss, the only permanent morbidity. Many different modes of medical treatment, including weight reduction, repeated lumber puncture, corticosteroids, diuretics, glycerol or carbonic anhydrase inhibitors, have successfully been tried up to 90% of the patients. In the remaining patients, particularly in those with measurable impairment of vision that does not respond to conventinal medical therapies, surgical procedure should be considered. We report a case of idiopathic intracranial hypertension successfully treated with optic nerve sheath fenestration.
Adolescent ; Adrenal Cortex Hormones ; Carbonic Anhydrase Inhibitors ; Constriction ; Diplopia ; Diuretics ; Dizziness ; Female ; Glycerol ; Headache ; Humans ; Optic Nerve* ; Pseudotumor Cerebri* ; Punctures ; Sports ; Visual Field Tests ; Water ; Weight Loss

Marfan syndrome (MFS) is an inherited connective tissue disorder with a mutation in the fibrillin-1 (FBN1) gene. Fibrillin is a major building block of microfibrils, which constitute the structural component of the connective tissues. A 10-year-old girl visited our hospital with the chief complaint of precocious puberty. According to her medical history, she had a pulmonary wedge resection for a pneumothorax at 9 years of age. There was no family history of MFS. Mid parental height was 161.5 cm. The patient's height was 162 cm (>97th percentile), and her weight was 40 kg (75th-90th percentile). At the time of initial presentation, her bone age was approximately 11 years. From the ophthalmologic examination, there were no abnormal findings except myopia. There was no wrist sign. At the age of 14 years, she revisited the hospital with the chief complaint of scoliosis. Her height and weight were 170 cm and 50 kg, respectively, and she had arachnodactyly and wrist sign. We performed an echocardiograph and a test for the FBN1 gene mutation with direct sequencing of 65 coding exons, suspecting MFS. There were no cardiac abnormalities including mitral valve prolapse. A cytosine residue deletion in exon 7 (c.660delC) was detected. This is a novel mutation causing a frameshift in protein synthesis and predicted to create a premature stop codon. We report the case of a patient with MFS with a novel FBN1 gene missense mutation and a history of pneumothorax at a young age without cardiac abnormalities during her teenage years.
Arachnodactyly ; Child ; Clinical Coding ; Codon, Nonsense ; Connective Tissue ; Cytosine ; Exons ; Female ; Humans ; Marfan Syndrome* ; Microfibrils ; Mitral Valve Prolapse ; Mutation, Missense ; Myopia ; Parents ; Pneumothorax* ; Puberty, Precocious ; Scoliosis ; Wrist

Jra is a high-frequency red cell antigen, and antibodies to Jra (anti-Jra) are rarely found. The clinical significance of anti-Jra has been under debate. We report a case of a Jra negative patient having anti-Jra who was urgently transfused with Jra-positive red blood cells (RBCs) during an aortic valvuloplasty. As Jra-negative RBCs were not available, this 57 year-old female patient was transfused with six units of Jra-positive RBCs during the surgery. The hemoglobin concentration decreased from 13.0 g/dL to 7.7 g/dL due to excessive bleeding, but increased up to 13.2 g/dL after the transfusion of an additional four units of Jra-positive RBCs. A direct antiglobulin test (DAT) was positive on day 3 and day 10 after surgery. Twenty days following surgery at the outpatient clinic, the hemoglobin concentration was 10.4 g/dL and the patient had no clinical symptoms related to anemia. The DAT was negative 6 months after the transfusion. It seems to be relatively safe to transfuse Jra-positive RBCs to the patient with anti-Jra in an emergency situation.
Ambulatory Care Facilities ; Anemia ; Antibodies ; Coombs Test ; Emergencies ; Erythrocytes* ; Female ; Hemorrhage ; Humans ; Middle Aged