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

Twin-twin transfusion syndrome(TTTS) is a serious complication of monozygotic mu-ltiple pregnancy. TTTS is associated with high perinatal mortality rate. The acute form has been attributed to rapid transfer of blood through superficial artery-to-artery or vein-to- vein anastomoses during labor and delivery, resulting in a hypovolemic, anemic donor twin and a hypervolemic, plethoric recipient twin of similar birth weight. The authors present a case of acute twin-twin transfusion syndrome with a review of literature.
Birth Weight ; Humans ; Hypovolemia ; Perinatal Mortality ; Pregnancy ; Tissue Donors ; Veins

INTRODUCTION: Hypomagnesemia, major cause of hypocalcemia, is developed due to insufficient oral intake in hospitalized patient and high prevalence in intensive care unit (ICU) patient. It is important to monitoring ionized magnesium in ICU patient because hypomagnesemia has been implicated in the development of cardiovascular dysfunction. So, in this study we determine the relation between ionized calcium and ionized magnesium and validate the measurement of ionized magnesium. MATERIAL AND METHOD: From March 2005 to may 2005, total 2876 samples were enrolled, which was requested to measure ionized calcium. We measured ionized calcium and ionized magnesium using NOVA CCX (Nova Biomedical, Waltman, MA, USA). Reference range of ionized calcium and ionized magnesium was 3.9~4.5 and 1.1~1.5 mg/dL, respectively. The patients were grouped as adult above 18 years old and pediatric below 18 years old. The ward was intensive care unit (ICU), general ward, outpatient and emergency room. We investigate the frequency of hypocalcemia and hypomagnesemia. RESULTS: The prevalence of ionized hypocalcemia (Ca2+ < 3.9mg/dL) was 22.2% and the prevalence of ionized hypomagnesemia (Mg2+ < 1.1mg/dL) was 41.9%. Of 2876 samples, 377 samples had ionized hypocalcemia and ionized hypomagnesemia simultaneously. Fifty-nine percent samples showing ionized hypocalcemia had ionized hypomagnesemia. In pediatric patients 13.3% of all patients had ionized hypocalcemia, 20.0% showing ionized hypercalcemia and 37.6% showing ionized hypomagnesemia. In adult patients 24.3% of all patients had ionized hypocalcemia, 14.3% showing ionized hypercalcemia, 48.2% showing ionized hypomagnesemia and one patient had ionized hypermagnesemia. When considering total cases of ionized calcium, the average level of ionized calcium was lowest in emergency room. When considering in case of patients, ICU showed the lowest level of ionized calcium. CONCLUSION: Ionized hypomagnesemia had known to be one of the major causes of ionized hypocalcemia and is common in ionized hypocalcemia. It is easy to found by measuring simultaneously. We found high coincidence rate of ionized hypocalcemia and ionized hypomagnesemia. We recommend that all samples ordered to be measuring ionized calcium must be checked ionized magnesium simultaneously.
Adolescent ; Adult ; Calcium ; Emergency Service, Hospital ; Humans ; Hypercalcemia ; Hypocalcemia* ; Intensive Care Units ; Magnesium ; Outpatients ; Patients' Rooms ; Prevalence ; Reference Values

PURPOSE: The selectin family of adhesion molecules plays a role in the initiation of endothelium-leukocyte interaction of inflammation and ischemia-reperfusion. P-selectin, a rapidly expressed endothelial cell adhesion molecule, is essential for both neutrophil rolling after endothelial stimulation and neutrophil transmigration. P-selectins were expressed after brain injury and could play an important role in the pathogenesis of ischemic brain injury in adult animal. However, the mechanisms leading to post-hypoxic-ischemic injury in immature brain are unknown yet. We hypothesize that P-selectin might mediate post-hypoxic-ischemic injury in immature rat brain. We evaluated the expression of mRNA and protein of P-selectin in post-hypoxic-ischemic immature rat brain. METHODS: In isoflurane-anesthetized P7(Postnatal day 7) Sprague-Dawley rats(n=81), the right carotid artery was isolated and coagulated. 1-2 h later animals were exposed to 8% oxygen(balanced with nitrogen) for 2 h in glass chambers, in a warm air incubator (temperature maintained at 36.5 degrees C). Control included carotid artery coagulation alone, hypoxia alone, and normal(neither hypoxia nor coagulation). For RNA extraction, the rats were decapitated at 0, 2, 4, 8, 12, 24 and 48 h after hypoxic-ischemic injury. For Western blot analyses with P-selectin, rats were decapitated at 0, 15, 30 min, 1, 2, 4, 8, 12, 24 and 48 h after hypoxic-ischemic injury. Control or hypoxia alone rats were sacrificed 8 h after the respective intervention. RESULTS: There was no expression of P-selectin mRNA in control groups(carotid artery coagulation alone, hypoxia alone, or normal). P-selectin mRNA expression in the ipsilateral(right) hemisphere reached a peak at 8 h after hypoxia-ischemia and then barely detected after 24 h. Expression of P-selectin protein was not observed in brain tissue of control rats. P-selectin protein was detected as early as 15 min and 30 min at both hemisphere in experimental rats and decreased at 1 h. P-selectin protein increased in right hemisphere at 4 h post-hypoxia-ischemia, peaked at 8 h and no longer detectable at 24 h. CONCLUSION: Hypoxic-ischemic injury leads to P-selectin expression in neonatal rats brain. The temporal profiles of post-hypoxic-ischemic P-selectin mRNA and protein expression are consistent with a role in the evolution of subsequent brain injury.
Adult ; Animals ; Anoxia ; Arteries ; Blotting, Western ; Brain Injuries* ; Brain* ; Carotid Arteries ; Endothelial Cells ; Glass ; Humans ; Hypoxia-Ischemia, Brain ; Incubators ; Inflammation ; Neutrophils ; P-Selectin* ; Rats* ; Rats, Sprague-Dawley ; RNA ; RNA, Messenger*

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