Dieulafoy's lesion is a rare condition that may cause intermittent or massive gastrointestinal bleeding. It is characterized by the exteriorization of an arterial vessel into the lumen of the affected organ, generally the upper digestive tract, through an apparently normal mucosa or a small tear or erosion. We report two patients with Dieulafoy's lesions, one in whom the lesion was misdiagnosed as a submucosal tumor and endoscopic biopsy resulted in fatal bleeding.
Autopsy ; Biopsy ; Endoscopy ; Gastrointestinal Hemorrhage* ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Mucous Membrane

In the 2009 edition of the Journal of Korean Neurosurgical Society, we published an article entitled "Ideal Internal Carotid Artery Trapping Technique without Bypass in a Patient with Insufficient Collateral Flow" (Volume 45, Pages 260-263), which was written by Joon Ho Chung, M.D.,1 Yong Sam Shin, M.D.,1 Yong Cheol Lim, M.D.,2 Minjung Park, M.D.3. The first author's name is mistyped. Thus, we correct the first author's name from Joon Ho Chung to Joonho Chung.

PURPOSE: This study aims at increasing our understanding of first-year medical students' learning behaviors, major satisfaction, and study skills. We investigate different features of freshmen's behavior in relation to learning and explore the extent to which freshmen were satisfied with their major and perceived their study skills. METHODS: A total of 106 freshmen participated in this study. At midyear, first-year medical students were asked to complete a questionnaire that included the learning behaviors, major satisfaction, and study skills. The data collected from the survey were analyzed using t-test, ANOVA, chi-square test, correlation analysis, and multiple regression analysis. RESULTS: The study reported that most of freshmen had a lot of difficulties in studying at medical school by lack of prior learning. Despite first-year students, they were studying hard their major. Freshmen spent studying an average of 1 hour or less than 2 hours every day. The study also indicated that of major satisfaction, the overall satisfaction of the department was the highest and the satisfaction in learning environment was the lowest. There were significant differences among the freshmen on the major satisfaction due to admission process, academic performance, and housing type. Of 11 study skills, while freshman highly perceived their teamwork, stress management, and reading skills, their weak study skills identified in this study were writing, note taking, time management, and test taking skills. There were significant differences among the freshmen on the study skills due to gender and academic performance. Finally, freshmen's learning behaviors and major satisfaction were significantly associated with some of study skills. CONCLUSION: This study may have implications for the academic adjustment and learning processes in the first year. We need to consider variables such as learning behaviors, major satisfaction, and study skills, when discussing about how to maximize the learning potential of medical students. It is also important that we develop education program so that all students acquire these necessary skills and continue to improve positive behaviors related to learning.
Housing ; Humans ; Learning ; Personal Satisfaction ; Schools, Medical ; Students, Medical ; Test Taking Skills ; Time Management ; Writing ; Surveys and Questionnaires

Subvalvular aortic aneurysms are rare but can be a cause of sudden death. This case report involves a 36-year-old male who died suddenly from rupture of a subvalvular aortic aneurysm with resultant hemopericardium with tamponade. He had a bicuspid aortic valve with acute infective endocarditis. A review of the literature enlightens the association between bicuspid aortic valve and subvalvular aortic aneurysm. The pathogenesis of the diseases of the aortic root will be discussed.
Adult ; Aortic Aneurysm ; Aortic Valve ; Bicuspid ; Death, Sudden ; Endocarditis ; Heart Valve Diseases ; Humans ; Male ; Pericardial Effusion ; Rupture

Objective: The purpose of the present study was to screen the prevalence of aneurysms in migraineurs; to differentiate presenting features in migraineurs with and without aneurysm; and also to correlate the locations of aneurysm to the clinical features of migraine. Methods: A total of 4,416 subjects were interviewed and completed self-reported questionnaires on headache. Of these, 1,773 subjects diagnosed to have migraines based on the International Classification of Headache Disorders II (ICHD-II) criteria were screened for aneurysm by magnetic resonance angiography (MRA). When aneurysm was suspected, further investigation with trans femoral cerebral angiography (TFCA) or three dimensional computerized tomography (CT) angiography was performed. Based upon MRA findings, subjects were grouped into unruptured aneurysm migraine patients (UAMP) and no aneurysm migraine patients (NAMP). Results: The prevalence of aneurysm was 3.6% (63 of 1,773) with the mean age of 56.0 years, which were not different from those of general population. There was no difference in migraine subtypes between UAMP and NAMP. Aggravation of headache by estrogen replacement therapy during menopause (p=.039), history of migraine in young age (p= .021), diplopia (p=.026), and retroauricular pain (p=.025) were significantly associated with presence of aneurysm. Although aneurysms were detected more in anterior circulation, there was no correlation between aneurysm site and headache location. The average size of aneurysm was 3.5 ± 2.1 mm and none were ruptured. Interventional therapy of aneurysm did not alter the feature of migraine. Conclusions: The incidence of aneurysm was not different in migraine patients as compared to the general population. Some features which significantly differentiate whether migrainuers have aneurysm or not warrant further study to have a predictive and localizing value.

PURPOSE: The purpose of this study was to identify factors associated with smartphone overdependency in preschool children based on an analysis of mother, child, and their mutual dyadic relationships. METHODS: Data were collected from 171 mothers of preschool children enrolled at daycare centers and kindergartens from January to March 2018. The data were analyzed by descriptive statistics, the t-test, analysis of variance with Scheffé post hoc test, Pearson correlation coefficient, and hierarchical regression analysis using SPSS version 24. RESULTS: The self regulation of preschool children (β=−.358, p < .001) was the factor most closely associated with smartphone overdependency. The second most closely associated factor was children's use of a smartphone 0.5–1 hour daily (β=−.249, p=.005). Additional associated factors were mothers' use of a smartphone for 3–4 hours daily (β=.217, p=.002), children's use of a smartphone for less than 0.5 hour daily (β=−.212, p=.006), and children's use of a smartphone for 1–2 days per week (β=−.205, p=.026). CONCLUSION: Based on the results of this study, it is necessary to try to develop guidelines and programs to prevent smart phone overdependency in preschool children.
Child ; Child, Preschool* ; Humans ; Mothers ; Self-Control ; Smartphone*

Deaths of suspects or inmates while in custody and incarceration is a tragedy for families and could become a public issue. Such deaths occur within a complicated brew of ethical and legal hurdles that must be handled with caution. We conducted a survey about these deaths. We collected and reviewed 85 cases of death that occurred while in custody and incarceration in Seoul and the Gyeonggi province, including e postmortem examinations between 2004 and 2011. Natural causes (most commonly cardiovascular diseases) accounted for nearly half of the deaths in custody, and unnatural causes accounted for nearly all of the remainder. Suicidal strangulation (hanging and self-strangulation) was the most common cause, followed by poisoning. Natural deaths by cardiovascular disease and unnatural deaths by suicidal strangulations, poisoning accounted for most cases of death while in custody and during incarceration. We hope this study can facilitate policy proposals to address this problem, helping authorities to reduce the occurrences of these preventable and untimely deaths of individuals in custody and incarceration.
Autopsy ; Cardiovascular Diseases ; Humans ; Police

Fascioliasis is a zoonotic disease caused by Fasciola Hepatica that infects mainly cattle, sheep, and goats. Humans can be infected by water or aquatic plants contaminated with metacercariae. The authors encountered two cases of F. hepatica infection. One patient reported abdominal discomfort with marked eosinophilia. The other patient had chest discomfort with marked eosinophilia. The abdominal CT images revealed hypodense lesions in the liver. The ultrasonography-guided liver biopsy findings in both patients were indicative of parasitic infections. Serological tests confirmed the definite diagnoses. Both patients were treated with a single dose of triclabendazole, which is the treatment of choice for fascioliasis. These findings suggest that a diagnosis of fascioliasis, particularly in the acute phase, should be considered in patients with abdominal pain, marked eosinophilia, and hypodense hepatic lesions on CT.

Recently, fatal nicotine intoxications with electronic cigarette liquid have increased in Korea, but various kinds of cigarettes and smoking cessation aids may also cause fatal poisoning. We report cases of fatal nicotine intoxications involving causes other than the use of liquid nicotine. A 29-year-old woman (case 1) found dead in a hotel room with about 70 patches (21 mg dose) of nicotine on her body. Blood nicotine levels were 7.68 mg/L (heart) and 3.25 mg/L (femoral). A toxic level of zolpidem was also detected. A 28-year-old Uzbekistan man (case 2) was found dead in his uncle's room with his face covered with chewing tobacco. Blood nicotine levels were 7.3 mg/L (heart) and 4.6 mg/L (femoral). Blood alcohol level was 0.139%. A 55-year-old man (case 3) bit his tongue. As he was taken to the hospital, his wife put tobacco powders in his mouth for hemostasis, and he died of cardiac arrest. Blood nicotine levels were 2.01 mg/L (heart) and 0.96 mg/L (femoral). Nicotine-related deaths can be caused by various types of administration including transdermal and transmucosal routes, and relatively small doses may cause death, so meticulous investigation should be taken when such deaths are suspected.

OBJECTIVES: We aimed to examine clinical efficacy of Korean FRAX model with respect to prediction of osteoporotic fracture risk and eligibility of osteoporosis treatment in Korean patients with hip fractures. MATERIALS & METHODS: In 41 elderly patients with a proximal femoral fracture (mean age=78.7 years, range: 63~99 years), fracture probabilities were calculated using FRAX models from Korea and Japan. We then performed comparative analyses between ten-year probabilities of major / hip osteoporotic fractures and the osteoporosis treatment eligibilities based on the FRAX model from Korea and Japan. RESULTS: The mean ten-year probabilities of major osteoporotic fractures and hip fractures using the Korean FRAX model (11.5% and 5.9%, respectively) were significantly lower than those using the Japanese FRAX model (21.5% and 9.2%, respectively, P<0.001). In addition, based on the National Osteoporosis Foundation guideline, pharmacological treatment of osteoporosis would be recommended in 38 patients (92.7%) by the Japanese FRAX model, while only in 30 patients (73.2%) by the Korean FRAX model (P=0.037). CONCLUSIONS: Our results suggest that the Korean FRAX model might underestimate osteoporotic fracture probabilities and eligibility of osteoporosis treatment in Korean patients with hip fracture.
Aged ; Asian Continental Ancestry Group ; Femoral Fractures ; Hip ; Hip Fractures ; Humans ; Japan ; Korea ; Osteoporosis ; Osteoporotic Fractures