Corrected transposition of the great arteries is usually characterized by inverted ventricles and transposition of the great arteries. This combination without cardiac anormalies results in normal arterial oxigen content, hence the term corrected. Unfortunately, the condition rarely exists without other major cardiac anormalies. The authors report a case of situs inversus that was associated with corrected TGA, VSD, PS and ASD. The girl was admitted for evaluation of systolic ejection murmur on the both lower sternal border. Doppler echocardiography and cardiac angiography showed the diagnosis and so valvulotomy and closure operation of VSD and ASD was done.
Angiography ; Arteries ; Diagnosis ; Echocardiography, Doppler ; Female ; Humans ; Situs Inversus ; Systolic Murmurs

Malignant mixed mullerian tumor (MMMT) is a tumor in which carcinoma (an epithelial malignancy) is mixed with sarcoma (a nonepithelial malignancy). Extrauterine MMMTs are extremely rare, and only 32 cases are reported according to the literature. We experienced a case of primary peritoneal MMMT and repot with a brief review of literature.
Peritoneum* ; Sarcoma

Trisomy 9p syndrome was first described by Rethore, et al in 1970 and about 150 cases have been reported. Trisomy 9p has been reported as either partial or complete. The term "duplication 9p syndrome" instead of "trisomy 9p syndrome" is used since most of the reported patients had only partial duplication rather than the whole arm duplication of 9p. Duplication of 9p syndrome is characterized by growth and developmental retardation, microbrachycephaly, deep and wide set eyes with down-slanting palpebral fissures, "globular" nose, down-turned corners of the mouth, prominent apparently low-set ears, and short fingers and toes with small nails. A 10- month-old male was referred to our department of pediatrics because of hypotonia and delayed development. Karyotype revealed 46, XY, dup(9)(p12p24) by GTC-Banding. We report a case of a duplication 9p syndrome diagnosed by GTC-banding.
Arm ; Ear ; Fingers ; Growth and Development ; Humans ; Karyotype ; Male ; Mouth ; Muscle Hypotonia ; Nose ; Pediatrics ; Toes ; Trisomy*

PURPOSE: Some studies indicate that vital signs such as blood pressure, heart rate, respiration rate, body temperature correlate with each other. However, no study has rigorously confirmed the correlations between vital signs due to study limitations. The aim of this study is to determine the relationship of pain to vital sings and to assess its clinical utility in ureter stone patients. METHODS: All 371 patients with ureter stone admitted to the Emergency Department (ED) at Kyung Hee University Hospital from September 1, 2005 to August 31, 2006 were prospectively involved in our study. We recorded vital signs of all patients 3 times every 10 minutes before analgesic injection and determined mean values. We analyzed the data by using the SPSS 13.0 statistics program. RESULTS: The means for systolic and diastolic blood pressure, heart rate and respiration rate were significantly different in pain score (p<0.05), but were not different by body temperature. Correlations of pain grade to vital signs were calculated, and blood pressure, heart rate and respiration rate showed positive correlation with pain grade (p<0.05). In multivariate analysis by general linear analysis, only systolic blood pressure and respiration rate were significantly associated with pain scores (p<0.05). CONCLUSION: In general, we have a tendency to underestimate the importance of the respiration rate relative to blood pressure, heart rate, and body temperature except in special circumstances, such as COPD or asthma exacerbation. Self-reported pain scores of patients correlate with vital signs, especially blood pressure and respiration rate.
Asthma ; Blood Pressure ; Body Temperature ; Emergency Service, Hospital ; Heart Rate ; Humans ; Multivariate Analysis ; Prospective Studies ; Pulmonary Disease, Chronic Obstructive ; Respiratory Rate ; Ureter* ; Urinary Calculi ; Vital Signs*

PURPOSE: The purpose of this study was to evaluate the diagnostic accuracy of abdominal ultrasonography (USG) as performed by emergency physicians (EP) after systematic training and to compare it with the performance of a radiologist. METHODS: From 4 March, to 3 October, 2006, we enrolled 368 patients with suspected acute appendicitis and 177 patients with suspected acute cholecystitis. During night hours, abdominal USG was performed by EPs who had been trained for more than 2 years (Group I), and during day, it was performed by a radiologist (Group II). In group I, 201 patients were suspected to have acute appendicitis and 103 patients were suspected to have acute cholecystitis. In group II, 167 patients were suspected to have acute appendicitis and 74 patients were suspected to have acute cholecystitis. We reviewed pathology reports and the final diagnoses of all patients after one month. We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for each group and then compared the diagnostic accuracy for group I with that of group II using the chisquare test. RESULTS: With suspected acute appendicitis patients, the sensitivity, specificity, PPV, NPV and accuracy of USG were 92.0%, 85.2%, 88.9%, 89.3%, and 89.1% for group I and 94.2%, 85.7%, 91.6%, 90.0%, and 91.0% for group II. With suspected acute cholecystitis patients, the sensitivity, specificity, PPV, NPV and accuracy of USG were 87.2%, 93.8%, 89.5%, 92.3%, and 91.3% for group I and 92.0%, 93.9%, 88.5%, 95.8%, and 93.2% for group II. There was no significant difference in the diagnostic accuracy between the two groups. (p=0.533, p=0.630) CONCLUSION: In this study, there was no significant difference between EPs and a radiologist in diagnostic accuracy of abdominal USG. This result suggests that diagnostic abdominal USG for acute abdominal diseases, such as acute appendicitis and acute cholecystitis can be appropriately used as a diagnostic modality by emergency physicians who are properly trained in a systematic educational program.
Appendicitis* ; Cholecystitis ; Cholecystitis, Acute* ; Diagnosis ; Emergencies* ; Humans ; Pathology ; Sensitivity and Specificity ; Ultrasonography*

PURPOSE: We undertook this study to evaluate the educational benefits at each steps of expository cardiopulmonary resuscitation (CPR) training by immediate remediation for non-healthcare providers in our hospital. METHODS: The 150 office staffs who worked in our hospital participated in this study. Following an educational session consisting of a one-hour video tape and slides, we tested single-rescuer BLS performance (15 checklists) with Fullbody SkillReporter(TM) Resusci(R) Anne and Skillmeter Resusci(R) Anne according to 2005 AHA guidelines for CPR. Three tests and two remediations were given to each person, and data were collected after each trial. A statistical analysis was done using the SPSS statistical software package. A pvalue<0.05 was considered to be statistically significant. RESULTS: Staff pass rates were improved in 13 checklists after remediation of CPR training. In the initial testing, the highest rate of pass was in assessment of responsiveness (0.89+/-0.31) and the lowest rate of pass was in the looking of in the checking-breathing test items (0.23+/-0.42). The highest rate of pass after two remediations was in the checking-breathing within 10 seconds (0.94+/-0.23) and the lowest rate of pass was in the rate of chest compression (0.52+/-0.50). The difference between males and females was in the rate of chest compression (p=0.001), but there is no difference of the educational benefits after two remediations by age-group. CONCLUSION: We found that the rate of passing in each steps of CPR training was improved by two remediations. Therefore, many iterations of remediation of CPR training for non-healthcare providers are necessary.
Cardiopulmonary Resuscitation ; Checklist ; Female ; Humans ; Male ; Thorax

Myocardial infarction (MI) is a complication that can occur after endoscopic submucosal dissection (ESD). However, very few reports are available about this complication. A 71-year-old male, who had two drug eluting stents inserted due to ischemic heart disease, was referred to the Division of Gastroenterology for ESD of a lesion suspicious of early gastric cancer. ESD was performed after dual antiplatelet agents were discontinued and bridging therapy with low molecular weight heparin (LMWH) was initiated. However, MI occurred immediately after the ESD procedure. A coronary angiogram did not show any significant stent thrombosis or restenosis. The patient recovered spontaneously. Here, we report a case of MI that occurred after ESD under bridging therapy with LMWH.
Aged ; Drug-Eluting Stents ; Gastroenterology ; Heparin ; Heparin, Low-Molecular-Weight* ; Humans ; Male ; Myocardial Infarction* ; Myocardial Ischemia ; Platelet Aggregation Inhibitors ; Stents ; Stomach Neoplasms ; Thrombosis

PURPOSE: An internship is a very generally a stressful period during medical training in general. Working in the Emergency Department (ED) is especially difficult and stressful because of its unique clinical environment. Our goal was to determine the level of the depression, fatigue, sleep disorders and stress of interns in the ED. METHODS: A questionnaire was distributed to 430 interns who are working or had worked in the ED. The questionnaire included questions about general characteristics and scales relating to symptoms of depression, fatigue, sleep disorder and stress. RESULTS: Of the 430 questionnaires given out, 178(41.4%) were returned. The mean age of the participants was 28.4+/-2.9, and 123(69.5%) were male. Also, 112(63.3%) participants were working at an alumni-affiliated hospital or at related hospital. The interns at an unrelated hospital experienced more discrimination than those working at an alumni-related hospital (21.5% vs. 9.8%, respectively, p=0.031). Also, female interns experienced more sexual harassment than male interns (16.7% vs. 2.4%, respectively, p=0.001). The average score for medical outcomes study MOS sleep scale, Beck Depression Inventory, Fatigue Severity Scale and Cohen Perceived Stress Scale were 16.2+/-4.0, 8.0+/-7.8, 4.3+/-1.2 and 19.4+/-5.4, respectively. The degree of participation in treating patients first hand (OR 2.33, 95% CI=1.19-4.57), experiencing discrimination (OR 3.17, 95% CI=1.15-8.73) and long working hours (OR 2.02, 95% CI=1.05-3.86) had a significant effect on stress and depression. CONCLUSION: The interns who worked at an ED had higher fatigue and stress scores compared to ordinary person. Also, participation, discrimination and working hours may be good to mention. Therefore, more research and effort is required to improve the factors that cause fatigue, stress and depression of the interns in ED.
Depression ; Discrimination (Psychology) ; Emergencies ; Emergency Medicine ; Fatigue ; Female ; Hand ; Humans ; Internship and Residency ; Male ; Surveys and Questionnaires ; Sexual Harassment ; Sleep Wake Disorders ; Weights and Measures