Fetal bilateral renal agenesis is a lethal congenital anomaly. An early and reliable prenatal diagnosis is extremely important as it may offer options for pregnancy termination as early as possible. The criteria for the ultrasonographic diagnosis of bilateral renal agenesis are severe oligohydramnios, nonvisualization of the bladder, and the empty renal fossa. However, severe oligohydramnios makes it difficult to diagnose the disease because of poor sonographic resolution. We present two cases of bilateral renal agenesis, one is diagnosed by ultrasonography after amnioinfusion at 24 weeks gestation, the other is diagnosed postnatally after term delivery.
Diagnosis ; Female ; Oligohydramnios ; Pregnancy ; Prenatal Diagnosis ; Ultrasonography ; Urinary Bladder

We report a two-generation Korean family in which 2 siblings have congenital cataract and phenotype i. This report is a first case in Korean people and shows the evidence suggesting the linkage of Ii blood group with a recessive form of congenital cataracts.
Cataract* ; Humans ; Phenotype* ; Siblings*

PURPOSE: This study aimed at evaluation of the learning curve for laparoscopic colorectal surgery with varied operative procedures. METHODS: From June 2004 to May 2010, 269 consecutive patients underwent laparoscopic colorectal surgery. Patients were divided into four groups according to operative methods: right-side colectomy, left-side colectomy, rectal resection, and total colectomy group. Each group was divided into three-early, middle, and late-groups according to operation numbers. Learning curves were generated for each group using moving average methods. Prospective collection and retrospective review of data on operative outcomes, including open conversion, operation time, intra-operative blood loss, postoperative hospital stay, and postoperative complication were performed. RESULTS: Operations included 75 right-side colectomies, 12 left-side colectomies, 178 rectal resections, four total colectomies, and seven open conversions (2.6%). The mean operative time for right-side colectomy and rectal resection showed a significant decline from the early group to the middle and late groups, while the left-side colectomy group showed no significant difference. Operation time was platitude after 50 cases of whole laparoscopic colorectal surgery, 11 cases in the right-side colectomy group, eight cases in the left-side colectomy group, and 34 cases in the recto-sigmoid resection group. CONCLUSION: For the surgeon, laparoscopic colorectal surgery can be performed more independently after 50 cases. The learning curve may be determined according to the general skill of laparoscopic colorectal surgery. The question of whether the learning curve is determined by varied operative procedures has not yet been resolved.
Colectomy ; Colorectal Surgery ; Humans ; Laparoscopy ; Learning ; Learning Curve ; Length of Stay ; Operative Time ; Postoperative Complications ; Postoperative Hemorrhage ; Prospective Studies ; Retrospective Studies ; Surgical Procedures, Operative

BACKGROUND: The family medicine residency program consists mainly of clinical rotations in other specialties and the family medicine-specific training. We conducted this study to investigate how family medicine residents evaluated their training program that include family-oriented medicine, clinical preventive medicine, behavioral science and research in primary care. METHODS: In 2009, third-year residents of 129 training hospitals in Korea were surveyed to investigate the current state and their expectation of the residency program. The contents of questionnaires included training periods, conferences, procedures, interview techniques, outpatient and inpatient consultations, and written thesis. RESULTS: Total 133 out of 142 residents (93.7%) responded that 3 years of training is ideal or pertinent. Residents responded that the types of conference that they need most are journal review (81%), staff lecture (73.2%), and clinical topic review (73.2%), in that order. Procedures and interview techniques that the residents want to learn most were gastroscopy (72.5%), abdominal ultrasonography (65.2%), and pain management (46.4%). Hospitals where family medicine residents do not see hospitalized patients or patients in the outpatient clinic were 7.9% and 6.5%, respectively, whereas hospitals that maintain continuous family medicine outpatient clinics were only 40.8%. Education in outpatient clinic and articlewriting seminars was done less frequently in the secondary hospitals than in the tertiary hospitals. CONCLUSION: Evaluation and quality improvement of family medicine training program as well as specialty rotations should be considered in order to foster better family physicians. The efforts have to be made to minimize the difference in quality of each family medicine residency program.
Ambulatory Care Facilities ; Behavioral Sciences ; Clinical Medicine ; Congresses as Topic ; Family Practice ; Gastroscopy ; Humans ; Inpatients ; Internship and Residency ; Korea ; Outpatients ; Pain Management ; Physicians, Family ; Preventive Medicine ; Quality Improvement ; Referral and Consultation

No abstract available.
Diagnosis* ; Thrombosis*

BACKGROUND: In modern industrial society, the complexity and diversity of social structure has deeply influenced job stress, and thereby threatens mental health of jobholders more than ever. Therefore, the purpose of this study was to examine the effect of job stress in jobholders on propensity of anxiety. METHODS: Initially, 235 jobholders living in Cheonan, Asan or Seoul, from May to June 2003, were the subjects of this questionnaire. Only 233 jobholders were evaluated due to inadequate responses from two subjects. The questionnaire was made up of three contents: socio-demographic characteristic, Extended Karasek questionnaire for evaluation of job stress, and the Korean version of Goldberg anxiety scale for evaluation of anxiety. The data were analyzed by chi-square test and multiple logistic regression analysis. RESULTS: Univariate analysis of propensity to anxiety showed a statistical significance on age, monthly income and job characteristics. Moreover, in terms of multivariate analysis, in accordance with age, 40 to 49 (OR: 6.1), showed the highest odds ratio of propensity to anxiety, followed by 30 to 39 (OR: 5.2) and 10 to 29 (OR: 5.4). In job characteristics, high strain group (OR: 3.7) showed highest odds ratio, but neither low strain group nor active group revealed any statistical significance. In monthly income, there was no statistical significance. CONCLUSION: Job stress in jobholders and propensity to anxiety was positively associated; especially, the more stress jobholders got, the higher propensity to anxiety was.
Anxiety* ; Chi-Square Distribution ; Chungcheongnam-do ; Logistic Models ; Mental Health ; Multivariate Analysis ; Odds Ratio ; Seoul ; Surveys and Questionnaires

Benign gastrobronchial fistula (GBF) after Ivor Lewis operation is a very rare and serious complication. We describe a patient with GBF who was successfully managed on the single-stage repair, 15 months after the Ivor Lewis operation. After the division of the GBF, the bronchial and gastric defects were closed directly. The omental flap and the pedicled 5th. intercostal muscle flap were interposed between the closed defects. The literature of this subject is reviewed and discussed.
Esophageal Neoplasms ; Esophagectomy* ; Fistula* ; Gastric Fistula ; Humans ; Intercostal Muscles

PURPOSE: The thoracic aortic rupture due to a blunt thoracic trauma is a fatal condition and majority of affected patients die before arriving at the hospital. The purpose of this study was to report our experiences of the traumatic thoracic aortic rupture. METHOD: Between January 1998 and September 2002, 6 patients with traumatic aortic rupture were experienced at out institute. All the patients had been involved in a traffic accident. There were 5 males and a female with mean age 29.8+/-7.0 years, ranging from 18 to 36 years. Preoperative chest CT and aortography confirmed the thoracic aortic rupture around the aortic isthmus in all patients. One patient died while waiting for an operation. The records of the remaining 5 patients that undergone an urgent operation were retrospectively reviewed. RESULT: There was no operative mortality. The mean aortic cross clamp time was 67.6+/-14.7 minutes. The injured portion of the thoracic aorta was just below the aortic isthmus in all cases which was resected and replaced with an artificial vascular graft. Various kinds of distal perfusion technique were employed: left atrial to femoral artery bypass in 3, Gott's shunt in 1, and femoro-femoral bypass with hypothermic circulatory arrest also in 1 patient. No signs of spinal cord injury developed postoperatively. All patients are in good clinical condition for 4 to 47 months postoperatively. CONCLUSION: Favorable outcomes could be anticipated in patients with a descending aortic rupture due to blunt thoracic trauma, if prompt diagnostic work up and surgical treatment are applied. The surgical results are thought to be improved with the employment of the distal perfusion technique, thus avoiding distal ischemia.
Accidents, Traffic ; Aorta, Thoracic ; Aortic Rupture* ; Aortography ; Employment ; Female ; Femoral Artery ; Humans ; Ischemia ; Male ; Mortality ; Perfusion ; Retrospective Studies ; Spinal Cord Injuries ; Tomography, X-Ray Computed ; Transplants

BACKGROUND: Dilution of blood cardioplegia is not needed in IAWBC as it is in cold blood cardioplegia because it does not aggregate red blood cells on normal body temperature and does not compromise micro coronary circulation. This study was designed to evaluate the safety and efficacy of undiluted potassium solution in IAWBC. MATERIAL AND METHOD: Thirty patients who underwent CABG with IAWBC were grouped into dilutedplegia (n=14) and microplegia (n=16). Potassium was delivered conventionally with 4:1 delivery kit in the dilutedplegia group. The undiluted potassium was directly connected on the blood of oxygenator in the microplegia group. RESULT: There were no differences in sex, age, left ventricular ejection fraction, number of grafts, aortic cross clamping time, and the value of perioperative myocardial enzyme between the two groups. There were no perioperative myocardial infarction and hospital mortality. The amount of crystalloid cardioplegia was 1346+/-597 mL in dilutedplegia (mean+/-standard deviation, and 28+/-9 mL in microplegia (p<0.0001). The hematocrit during cardiopulmonary bypass was 21+/-4% in dilutedplegia and 24+/-3% in microplegia (p>0.05). 11 patients in dilultedplegia received blood transfusion, but 4 patients in microplegia received blood transfusion (p<0.05). The amount of urine and hemofiltration during the operation were more in dilutedplegia (1250+/-810 mL, 1689+/-548 mL) than in microplegia (959+/-410 mL, 1481+/-784 mL; p<0.05). CONCLUSION: The undiluted potassium of IAWBC in CABG operation is a safe, effective technique for myocardial protection to prevent fluid overload, and blood transfusion. There is no need to use the delivery kit.
Blood Transfusion ; Body Temperature ; Cardiopulmonary Bypass ; Constriction ; Coronary Circulation ; Erythrocytes ; Heart Arrest, Induced* ; Hematocrit ; Hemofiltration ; Hospital Mortality ; Humans ; Myocardial Infarction ; Oxygen ; Oxygenators ; Potassium* ; Stroke Volume ; Transplants

Hypereosinophilic syndrome is a rare disease characterized by marked peripheral eosinophilia and eosinophilic infiltration of many organs such as heart, lung, central nervous system, liver and spleen. This disease is defined by following criteria. First, sustained blood eosinophilia is greater than 1,500/mm3 longer than 6 months. Second, other apparent etiologies for eosinophilia must be absent, including parasitic infestation and allergic disease. Third, patients must have signs and symptoms of organ involvement. In Korea, some cases that eosinophil infiltrated lung, liver, gastrointestinal tract or skin were reported. In this report, we found a case showing myalgia, fatigue and eosinophilia in periodic health examination, and diagnosed hypereosinophilic syndrome.
Central Nervous System ; Eosinophilia ; Eosinophils ; Fatigue ; Gastrointestinal Tract ; Heart ; Humans ; Hypereosinophilic Syndrome* ; Korea ; Liver ; Lung ; Myalgia ; Preventive Health Services ; Rare Diseases ; Skin ; Spleen