PURPOSE: Four pediatric patients with isolated (the adult form) and complex (the infantile form) scimitar vein anomalies were reviewed and compared with patients with meandering right pulmonary veins. MATERIALS AND METHODS: From January 1990 to December 2006, 4 female patients, aged 2 days to 3.5 years, with isolated and complex scimitar vein anomalies were retrospectively studied. The clinical features, chest radiographs, echocardiography, magnetic resonance imaging, magnetic resonance angiography, computer tomography, bronchography, cardiac catheterization with angiography, surgery, and autopsy were reviewed to substantiate the diagnosis of isolated and complex scimitar vein anomalies. RESULTS: Clinical manifestations were lung infections with radiographic scimitar signs in 4 patients (3 right; 1 left), respiratory distress, congestive heart failure, pulmonary hypertension and/or cyanosis in 3 patients, dextrocardia, heterotaxy, and/or right atrial isomerism in 2 patients, as well as dextroversion, right bronchial isomerism, bronchial stenosis, and/or sepsis in 1 patient. Two patients with right atrial isomerism expired. CONCLUSION: The clinical discrimination between scimitar vein anomaly with and without cardiovascular and bronchopulmonary malformations is crucial for the outcomes vary.
Angiography ; Child, Preschool ; Diagnosis, Differential ; Echocardiography ; Female ; Heart Catheterization ; Humans ; Infant ; Infant, Newborn ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Pulmonary Veins/*abnormalities ; Retrospective Studies ; Scimitar Syndrome/*pathology ; Tomography, X-Ray Computed

Mr Tan, 60, a smoker with diabetes mellitus (DM), hypertension and chronic kidney disease (CKD) Stage 3, and recurrent gout flares last five weeks of increasing intensity and duration. He assumes it is due to frequent travel and lack of exercise. He comes today for routine review of his chronic diseases. Current laboratory results are creatinine 106, eGFR 56, uric acid 490, HbA1c 7.3%, random hypocount 8.5 mmol/L. He is on glipizide 5mg bd, Metformin 250mg BD, Amlodipine 5mg OM. He complains of severe gout pain. He had always been reluctant to start definitive treatment which you had previously mentioned. What will you do next?

Sleep deprivation is not uncommon among children in Singapore. Children with deprived sleep may present with poor academic performance, learning disabilities and behavioural disorders. As a result of sleep deprivation, performance in complex tasks involving higher brain functions is affected more than simple memory tasks. Sleep quality rather than sleep quantity is associated with good cognitive learning and memory function. Regular sleep-wake patterns with good sleep schedules will reinforce this. Causes of sleep deprivation include insufficient sleep, fragmentation of sleep and increased need for sleep. The BEARS questionnaire is a useful screening tool for sleep deprivation. A clinical approach to exclude medical conditions that may cause excessive daytime sleepiness should be conducted and focused physical examination be performed. A two-week sleep log about the child's sleep habits and sleep-wake cycles should be recorded. Referrals to a sleep specialist should be made if any sleep disorders is suspected.

Mr Tan, 60, a smoker with diabetes mellitus (DM), hypertension and chronic kidney disease (CKD) Stage 3, and recurrent gout flares last five weeks of increasing intensity and duration. He assumes it is due to frequent travel and lack of exercise. He comes today for routine review of his chronic diseases. Current laboratory results are creatinine 106, eGFR 56, uric acid 490, HbA1c 7.3%, random hypocount 8.5 mmol/L. He is on glipizide 5mg bd, Metformin 250mg BD, Amlodipine 5mg OM. He complains of severe gout pain. He had always been reluctant to start definitive treatment which you had previously mentioned. What will you do next?

Premature rupture of membrane is the most frequent cause of low birth weight infant delivery which increase the maternal and fetal morbidity and perinatal mortality. A retrospective case-control study was performed on 315 mothers who delivered low birth weight infants(< or = 2.5kg) with premature rupture of membrane and as control group 546 mothers who delivered normal birth weight infants(2.9-3.7kg) without premature rupture of membrane were chosen. The results obtained from this study were as follows: 1. The proportion of low birth weight infants due to premature rupture of membrane among all low birth weight infant deliveries was 14.5%, and this is equivalent to 1.1% among all deliveries. 2. The most significant maternal risk factor of low birth weight infant deliveries with premature rupture of membrane was infections on vagina, cervix and uterus during pregnancy. Compared with control, adjusted odds ratio was 7.61(95% confidence interval(CI) 1.88-30.88, p=0.004). Other significant maternal risk factors were the history of induced abortion, spontaneous abortion, and the experience of premature delivery. The risk ratios were 1.82, 2.07, 4.42, respectively. 3. Breech presentation did increase the risk of low birth weight infant delivery with infant delivery with premature rupture of membrane against control(Adjusted odds ratio=2.66, 95% CI 1.35-5.26, p=0.005). 4. Mothers who had not taken antenatal care were having higher risk of low birth weight infant delivery with premature rupture of membrane against control(Adjusted odds ratio=1.73, 95% CI 1.35-5.26, p=0.004). These study results show that maternal factors such as the infection of genital organs during pregnancy, the history of induced abortion and breech presentation are significantly associated with the premature rupture of membrane in the low birth weight deliveries, and that most of these risk factors are controllable ones through proper antenatal cares.
Abortion, Induced ; Abortion, Spontaneous ; Birth Weight ; Breech Presentation ; Case-Control Studies ; Cervix Uteri ; Female ; Genitalia ; Humans ; Infant ; Infant, Low Birth Weight* ; Infant, Newborn ; Membranes* ; Mothers ; Odds Ratio ; Perinatal Mortality ; Pregnancy ; Retrospective Studies ; Risk Factors ; Rupture* ; Uterus ; Vagina

A total of 181 cases of industrial ocular injuries hospitalized and treated at the St. Mary's Hospital, Seoul during the 5-year period was studied on their epidemiological characteristics. Of there patients 96.7% were males, and 43.6% were in twenties, 49.7% of the cases were injured on left eyes. There were no statistically significant differences in frequencies of study subjects by day of the week and month of the year. Most common injury hour were between 10- < 12 AM(13.6%) and between 2- < 4 PM(20%). Of the total 101 cases, 37.6% were working less than 6 months, and 73.7%, less than 2 years. Of the total, 42.3% were involved in machinery work and 13.9%, in construction work. According to the American National Standard Method of recording basic facts relating to the nature and occurrence of work injuries, 62% among all source of injuries was metal item and the most common accident type was struck by flying objects(76.2%). Among 181 cases, only 2 cases wearing protective equipment when the accidents occurred.
Diptera ; Humans ; Male ; Seoul

More people are traveling to remote places for leisure and business. It is not uncommon for patients to get medication and advice for travel to high altitudes. Although high altitude cerebral and pulmonary oedemas are more frequent at very high and extreme altitudes, they may sometimes occur at lower altitudes and lead to fatalities. Even though acute mountain sickness (AMS) is generally deemed benign, it can easily wreck a holiday. The Lake Louise Score Questionnaire is a useful screening tool for AMS and it can be self-administered during travel. Non-pharmacological means in the prevention and treatment of AMS, especially acclimatisation, are the most important. Pharmacological prevention and treatment strategies should be used as a useful adjunct. This paper provides an approach to the provision of education and advice for high altitude travel in the primary care setting.

Carotid Artery, Internal ; diagnostic imaging ; Cerebrovascular Disorders ; diagnostic imaging ; physiopathology ; Extremities ; physiopathology ; Humans ; Ischemic Attack, Transient ; complications ; diagnostic imaging ; drug therapy ; Male ; Middle Aged ; Middle Cerebral Artery ; diagnostic imaging ; Thromboembolism ; diagnostic imaging ; physiopathology ; Ultrasonography, Doppler, Transcranial

This study was designed to investigate the difference of somatization and hypochondriacal trends between labor workers and managerial workers. The subjects consisted of 302 workers who were employed at 13 small scale industries in a city of Kyung Kee province. Data collection was done from February 25, 1993 to March 10, 1993. Symptom Check List-90-Somatization(SCL) and Illness Attitude Scale(IAS) which are composed of self-report questionnares were used as measuring instruments. The results were as follows: 1. Mean scores of SCL-90-R-Somatization in labor workers were significantly higher than those in managerial workers and there were significant differences in 7 subscales (pain in heart or chest, nausea of upset stomach, muscle soreness, trouble breathing, hot or cold spells, numbness, lump sensation in throat between to two groups. 2. There was no significant difference in mean scores of illness attitude Scales between labor workers and managerial workers. However, among the subscale of IAS mean scores of "hypochondriacal beliefs" and "effects of symptom" in labor workers, the mean scores of IAS in labor workers were significantly higher than those in managerial workers. 3. When compared by educational level, middle school graduates and college graduates of labor workers showed significantly higher mean scores of SCL than those of managerial workers. 4. When compared by employment duration, labor workers who worked less than 5 years showed significantly higher mean of SCL and IAS than those of managerial workers. 5. There were no significant differences in mean scores of SCL and IAS between the levels of subjectively evaluated environmental conditions by the workers themselves of the illumination, organic solvent, noise and dust.
Data Collection ; Dust ; Employment ; Heart ; Humans ; Hypesthesia ; Lighting ; Myalgia ; Nausea ; Noise ; Pharynx ; Respiration ; Sensation ; Stomach ; Thorax ; Weights and Measures

Multiple Choice Question(MCQ) method of examination has long been used as the national medical licensing examination in Korea. If properly used, the MCQ method of examination has considerable value fo r evaluation, and in fact, it has become popular due to its economy of scale, ease of marking and consistency. Moreover, with this method of examination, a large number of candidates can be tested at once and the marking can even be read by automatic readers. However, MCQ does not lend itself so well to problem-solving, which is a far more real-life situation than having to choose between a number of pre-formed alternatives. This, again, however, can be much improved by increasing the proportion of question items associated with interpretation and problem solving level of cognitive domain, and adopting various types of MCQ. This study was planned to examine the proportions of question items by their levels of cognitive domains and the types MCQ together with the contents of medical knowledge of the Korean National Medical Licensing Examinations (NMLE) conducted in 1992 and 1993. All 880 question items (440 question items in each year) were reviewed one by one by three medical education specialists and the levels of cognitive domains, types of MCQ and contents of questions were judged by test subjects. Major findings obtained from the study are as follows: 1) In both years of 1992 and 1993, recall level question items formed 68.0% of all MCQ question items of NMLE. Problem-solving level question items were only 77.% in 1992 and 11.1% in 1993. 2) Major types of MCQ were 'best answer type' one correct answer type'. They were 40.7% and 30.9% of all respectively in 1992, and 35.0% and 32.0% respectively in 1993. Some subjects such as urology and internal medicine were adopting more 'combined response type' MCQ than other subjects. 3) Knowledge contents asked in the NMLE varied very much from subject to subject. However, the names of diseases were the most prevalent answers asked and they were 21.6% in 1992 and 18.2% in 1993. This study suggests that the Korean NMLE should increase the proportion of question items measuring the interpretation and/or problem-solving level of knowledge, and adopt several different types of MCQ.
Education, Medical ; Internal Medicine ; Korea ; Licensure* ; Problem Solving ; Specialization ; Urology