Congenital M llerian anomalies of uterus are so infrequently encountered and endometriosis, primary infertility, hematometra, and urinary tract anomalies are claimed to be common complaints in women with unicornuate uterus. We report one case of rudimentary horn associated with agenesis of right kidney and pelvic endometriosis which is presented with brief review of literature about anomaly of the female genital tract.
Animals ; Endometriosis* ; Female ; Hematometra ; Horns* ; Humans ; Infertility ; Kidney* ; Urinary Tract ; Uterus

Dysgenetic streak gonads were removed laparoscopically from a phenotypic female with Swyer syndrome(ie, XY karyotype, sexual infantalism, primary amenorrhea, and Mullerian structures). Pathologic examination revealed a dysgerminoma in one of her gonads. We report a case of dysgerminoma with 46,XY Swyer syndrome and review of literature.
Amenorrhea ; Dysgerminoma* ; Female ; Gonadal Dysgenesis, 46,XY* ; Gonads ; Humans ; Infant ; Karyotype

Diabetic ketoacidosis (DKA) is an acute complication related to severe hyperglycemia. While the mortality rate for DKA is low with appropriate therapy, several complications may lead to deterioration of the clinical course. Here, we report a case of a 23-year-old patient with DKA who suffered from a rare but hemodynamically unstable cardiac arrhythmia, polymorphic ventricular tachycardia with prolonged QT interval, or Torsades de Pointes. During the recovery phase of DKA, three episodes of Torsades de Pointes suddenly occurred, and were recovered by immediate defibrillation. The patient did not have structural heart disease or a genetic predisposition. To the best of our knowledge, this is the first report of an adult with DKA complicated with QT prolongation related to Torsades de Points after correction of ketosis. To manage DKA, more attention may be needed on changes in the QT interval as well as risk factors for Torsades de Points.

BACKGROUND: The medically unexplained symptoms present one of the most common problems in medical practice and the role of primary care physicians is becoming greater to manage them. Our goal was to investigate how the primary care physicians conceive and deal with patients complaining of medically unexplained symptoms (MUS). METHODS: A group of 840 primary care physicians, 524 internist and 316 family physicians in Seoul were surveyed. The questionnaire regarding the perception and the way of consultation about MUS was posted by mail. RESULTS: A total of 180 questionnaires were collected via mail and fax. Ten of them were uncompleted, and the response rate was 22%. Over half of the respondents felt that the consultation of MUS was difficult and they were concerned about the possibility of overlooking some of organic problems (57.6%). Average consultation rate of MUS in daily practice was 14%. The anxiety toward failure of treatment was the most common concern during the MUS consultation. Seventeen percent answered they knew the efficient method to deal with MUS patients. Respondents complained of the deficiency of contents and experiences to deal with MUS during the period of training (80%). More family physicians compared to internists perceived patients with MUS to have personality problems and they often tended to prescribe psychotropic drugs. Family physicians also answered that the training courses provided proper knowledge and contents regarding MUS consultation more than the internists. CONCLUSION: MUS consultation imposes a burden on primary care physicians. Therefore, continuing education not only for residency but for post graduates should be considered for effective management for MUS.
Animals ; Anxiety ; Surveys and Questionnaires ; Education, Continuing ; Humans ; Internship and Residency ; Mice ; Physicians, Family ; Physicians, Primary Care* ; Postal Service ; Primary Health Care* ; Psychotropic Drugs ; Seoul

PURPOSE: Medical direction is an integral part of proper prehospital care, which is performed by EMS providers. In Gyunggi province, a number of measures have been implemented to improve the direct medical direction system. We aimed to report on the process and results of the newly implemented medical direction system. METHODS: This is a descriptive analysis of the newly implemented medical direction system for community EMS providers from June 2014 to October 2014. Direct medical direction was requested by emergency medical technicians (EMTs) during the study period, as follows: when a destination hospital was selected, EMTs requested medical direction from the physicians at the destination hospital. During the study period specially-trained advanced EMTs were permitted to perform intravenous (IV) access for fluid or glucose infusion without direct medical direction. EMTs were asked to complete records when they requested direct medical direction and performed IV access without medical direction. These records were collected and used in the analysis. RESULTS: Of 5949 direct medical direction requests, 5527 were analyzed; 2958 (53.5%) cases were requested to the destination hospitals, 2569 (46.5%) were requested to the centralized dispatch center. 'Patient evaluation' was the most common reason for EMTs to request medical direction to the destination hospitals (1680, 54.4%) and centralized dispatch center (980, 38.1%). EMTs' degree of satisfaction did not differ significantly between destination hospitals and the centralized dispatch center (4.12+/-0.82 and 4.09+/-0.84, p=0.053). IV access rate for hypotensive patients increased 6.1% during the study period compared to the same period of 2013 (17.6% and 11.5%, p<0.01). CONCLUSION: We found that it is feasible to request direct medical direction to the destination hospitals and perform IV access for fluid or glucose infusion without direct medical direction for specially-trained advanced EMTs. Continuing efforts to establish an optimized medical direction system would be required for proper pre-hospital care.
Emergency Medical Service Communication Systems ; Emergency Medical Services ; Emergency Medical Technicians ; Glucose ; Humans ; Korea

OBJECTIVE: Delirium is very common in orthopedic elderly patients and increase comorbidity and mortality rates. By controling the risk factors of delirium, prevention strategy can be effective and reduce negative outcomes. The purpose of this study was to explore the usefulness of delirium risk assessment with some simple collateral questionaires. METHODS: The subjects were 50 elderly patients (≥65 years old) who admitted to a department of orthopedic surgery for operations of lower extremity fractures. They were evaluated with Diagnostic and Statistical Manual of Mental Disorders, fifth edition, Confusion Assessment Method and Korean Dementia Screening Questionnaire (KDSQ) by psychiatrists. The demographic data, medical histories, and orthopedic chart were checked through medical records of patients. RESULTS: 27 subjects (54.0%) were diagnosed as delirium. There was a significant difference between delirium group and control group with all KDSQ scores. Depressive category of KDSQ score had the highest correlation (coefficient=0.399) and can be independent risk factor of delirium (p=0.045). CONCLUSION: Cognitive impairment and depressive symptoms have high correlation with delirium. We found that just a few questions of cognitive impairment and depressive symptoms by caregivers can evaluate the risk factors of delirium. The simple collateral questionaires can be useful tool for exploring delirium risk factors.
Aged* ; Caregivers ; Cognition Disorders ; Comorbidity ; Delirium* ; Dementia ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Lower Extremity* ; Mass Screening ; Medical Records ; Methods ; Mortality ; Orthopedics ; Psychiatry ; Risk Assessment ; Risk Factors

Objective: The coronavirus disease 2019 (COVID-19) outbreak is currently ravaging the world and is a major threat to public health. Healthcare workers (HCWs) are at a high risk of acquiring and transmitting COVID-19. Hence, HCWs are also experiencing emotional and behavioral changes. The purpose of this study was to compare emotional changes and stress between occupations and to investigate the impact of emotions of HCWs during the COVID-19 outbreak. Methods: An anonymous, self-administered, previously validated questionnaire was given to HCWs at a hospital dedicated to infectious diseases in Korea during the COVID-19 outbreak. The participants were asked to evaluate stress factors, depressive moods, trauma, reasons for continuing to work, things that helped them work, coping strategies to reduce stress, motivators that could help them work during future outbreaks, and what they would like to do after the outbreak was over. Results: The total number of participants was 400. The average age of participants was 34.69±9.44. Stress and depressive moods showed variations in the job-to-job comparisons. Ethical duty and the professionalism of the HCWs pushed them to continue with their jobs. The news of a decline in the number of patients was helpful to HCWs. The implementation of personal hygiene programs helped in reducing stress. The provision of adequate personal protective equipment was a factor that would encourage them to work during any future outbreak. The participants wanted to go on a trip after the outbreak was over. Conclusion Our findings indicate that the COVID-19 outbreak had a significant emotional impact on HCWs. The concerns of HCWs may affect their work efficiency in an outbreak and should be addressed by incorporating appropriate management strategies while planning to combat an outbreak.

Objective: The coronavirus disease 2019 (COVID-19) outbreak is currently ravaging the world and is a major threat to public health. Healthcare workers (HCWs) are at a high risk of acquiring and transmitting COVID-19. Hence, HCWs are also experiencing emotional and behavioral changes. The purpose of this study was to compare emotional changes and stress between occupations and to investigate the impact of emotions of HCWs during the COVID-19 outbreak. Methods: An anonymous, self-administered, previously validated questionnaire was given to HCWs at a hospital dedicated to infectious diseases in Korea during the COVID-19 outbreak. The participants were asked to evaluate stress factors, depressive moods, trauma, reasons for continuing to work, things that helped them work, coping strategies to reduce stress, motivators that could help them work during future outbreaks, and what they would like to do after the outbreak was over. Results: The total number of participants was 400. The average age of participants was 34.69±9.44. Stress and depressive moods showed variations in the job-to-job comparisons. Ethical duty and the professionalism of the HCWs pushed them to continue with their jobs. The news of a decline in the number of patients was helpful to HCWs. The implementation of personal hygiene programs helped in reducing stress. The provision of adequate personal protective equipment was a factor that would encourage them to work during any future outbreak. The participants wanted to go on a trip after the outbreak was over. Conclusion Our findings indicate that the COVID-19 outbreak had a significant emotional impact on HCWs. The concerns of HCWs may affect their work efficiency in an outbreak and should be addressed by incorporating appropriate management strategies while planning to combat an outbreak.