Background: Upper gastrointestinal endoscopy is becoming a common technique used by primary care physicians, so appropriate education using adummy is beneficial for the trainees. However, because dummies are expensive, only a few hospitals have dummies. In this study, we investigatedwhether a simplified upper gastrointestinal endoscopic simulator created using recycled materials can be useful in endoscopic education. Methods: The simplified upper gastrointestinal endoscopic simulator was prepared using materials that were readily available around us. Focus groupinterviews were conducted with five family medicine trainees for 60 minutes using a semi-structured questionnaire. All conversations were recordedand transcribed after they provided informed consent. Data were analyzed using qualitative analysis methods. Results: Family medicine trainees believe that upper gastrointestinal endoscopic training is essential for primary care physicians and can be helpful intheir job after training. However, they were concerned about the possibility of endoscopic complications and difficulty in endoscopy operation. Allof them said that the simplified upper gastrointestinal endoscopic simulator helped reduce their fear and also helped them become familiar withanatomic positions. The simplified upper gastrointestinal endoscopic simulator also aroused their interest and motivated them to learn. Conclusion Overall, the simplified upper gastrointestinal endoscopy simulator seemed helpful for trainees of upper gastrointestinal endoscopy. Theuse of a simplified upper gastrointestinal endoscopy simulator could be considered in training hospitals that do not have enough financial resources.Further quantitative studies are needed to generate further evidence.

The peritoneal equilibration test(PET) is used as a tool for determining the characteristics of the peritoneal membrane. Initial PET is recommended at least 1 month after peritoneal dialysis, but PET after 1 month may be difficult to perform on an out- patients basis. Two standard PETs(D/P4Cr) were per- formed in 60 CAPD patients(DM:non DM=22:38). Initial PETs, within one week after starting CAPD and follow up PETs, at least 3 months after CAPD were performed. The initial PET values were compared with subsequent PET values. Clinical data (age, sex, body surface area, BMI, presence of diabetes mellitus, ascites) and laboratory indices(serum albumin, dialysate creatinine clearance, KT/V, protein catabolic rate) were compared with the results of the PETs. In initial PET result, there was negative correlation between D/P4Cr and serum albumin(r=-0.522, p<0.001 N=60). There was no significant difference between initial and follow up(mean+/-S.D.:8.84+/-5.2months after CAPD) D/P4Cr(0.68+/-0.14 vs 0.68+/-0.13). But with passage of time, delta D/P4Cr and delta serum albumin were also negatively correlated (r=-0.459, p<0.001). According to the linear regression analysis, the factor significantly associated with D/P4Cr was serum albumin(coefficients -0.111). In conclusion, serum albumin level is the most important predictor of the peritoneal membrane transport characteristics, and it seems that the timing of PET does not matter, rather the changes of with time are strongly correlated with the changes of the serum albumin level.
Body Surface Area ; Creatinine ; Diabetes Mellitus ; Follow-Up Studies ; Humans ; Linear Models ; Membranes ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Serum Albumin

Recently, we experienced a case where the diagnosis and management of a deep femoral artery rupture was delayed. This vascular complication occurred during the insertion of a distal interlocking screw of a proximal femoral nail for the fixation of an intertrochanteric femur fracture. A 79-year-old male patient was diagnosed with a right intertrochanteric fracture after a fall. We fixed the fracture with a proximal femoral nail (Zimmer® Natural Nail™ System). One day after the procedure, the patient complained of pain and swelling on the anteromedial side of his middle thigh followed by hypotension, anemia and prolonged thigh swelling. Computed tomography angiography was performed 7 days after the procedure. We found a pseudoaneurysm of the perforating artery caused by injury to the deep femoral artery and an intramuscular hematoma in the anterior thigh muscle. We successfully treated the pseudoaneurysm using coil embolization. Throughout the management of intertrochanteric femoral fractures, it is important to be aware and monitor signs and symptoms related to the possibility of blood vessel damage. When a patient presents with swelling and pain on the middle thigh and/or unexplained anemia postoperatively, the possibility that these symptoms are caused by an injury to the femoral artery must be considered.
Aged ; Anemia ; Aneurysm, False ; Angiography ; Arteries ; Blood Vessels ; Diagnosis ; Embolization, Therapeutic ; Femoral Artery* ; Femoral Fractures ; Femur ; Hematoma ; Hip Fractures ; Humans ; Hypotension ; Male ; Rupture* ; Thigh

Contrast-enhanced ultrasound is one of method for evaluating renal perfusion. The purpose of this project was to assess perfusion patterns and dynamics in normal micropig kidney using ultrasonographic contrast media. Eight young healthy micropigs were included in this study. Micropigs were anesthetized with propofol and received an intravenous bolus of microbubble contrast media through an ear vein. Time/mean pixel value (MPV) curves were generated for selected regions in the right renal cortex and medulla. The parenchyma was enhanced in two phases. The cortex was first enhanced followed by a more gradual enhancement of the medulla. A significant difference in perfusion was detected between the cortex and medulla. Following the bolus injection, the average upslope was 0.68 +/- 0.27 MPV/sec, downslope was -0.27 +/- 0.13 MPV/sec, baseline was 73.9 +/- 16.5 MPV, peak was 84.6 +/- 17.2 MPV, and time-to-peak (from injection) was 17.5 +/- 6.6 sec for the cortex. For the medulla, the average upslope was 0.50 +/- 0.24 MPV/sec, downslope was -0.12 +/- 0.06 MPV/sec, baseline was 52.7 +/- 7.0 MPV, peak was 65.2 +/- 9.3 MPV, and time-to-peak (from injection) was 27.5 +/- 5.0 sec. These data can be used as normal reference values for studying young micropigs.
Animals ; Contrast Media/*diagnostic use ; Image Processing, Computer-Assisted ; Injections, Intravenous/veterinary ; Kidney/*blood supply/ultrasonography ; Kidney Function Tests/veterinary ; Linear Models ; Microbubbles/diagnostic use/veterinary ; Reference Values ; Renal Circulation ; Sulfur Hexafluoride/diagnostic use ; Swine ; Swine, Miniature/*physiology ; Ultrasonography/*methods/veterinary

Background: Previous studies suggested the correlation between thyroid and kidney functions, especially the high prevalence of hypothyroidism in chronic kidney disease. This study aimed to evaluate the influence of hypothyroidism on kidney function in Korean adults by using data from a representative nationwide survey. Methods: This was a cross-sectional study composed of 5,250 individuals aged ≥19 years who were enrolled in the sixth Korea National Health and Nutrition Examination Survey. The participants were classified into three groups of patients with euthyroidism, subclinical hypothyroidism, and overt hypothyroidism according to thyroid function. Chronic kidney disease was defined as having a decreased estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2. Univariate and multivariate logistic regression analyses were used to evaluate the prevalence and adjusted odds ratio (aOR) of chronic kidney disease. Results: Compared with the euthyroidism group, the subclinical and overt hypothyroidism groups showed higher prevalence rates of chronic kidney disease in both sexes. This tendency was significant in the elderly people aged ≥65 years. In the multivariate logistic regression analysis, the subclinical hypothyroidism group did not show a significant difference (adjusted odds ratio [aOR], 1.78; 95% confidence interval [CI], 0.82–3.87) from the euthyroidism group. In the overt hypothyroidism group, the aOR of chronic kidney disease was significantly higher (aOR, 5.90; 95% CI, 1.73– 20.15) than that in the euthyroidism group. Conclusion Overt hypothyroidism was associated with decreased eGFR and may be considered as an independent risk factor of chronic kidney disease.