PURPOSE: With the recent increase in underwater activity, the number of people at risk for decompression sickness has greatly increased. However, an organized medical system for emergency treatment, evacuation, and hyperbaric oxygen therapy of decompression sickness has not been established yet. We collected information about domestic hyperbaric chambers available for treating decompression sickness. METHODS: We identified 95 hyperbaric chambers in hospitals, hydrospace construction corporations, military, maritime police, 119 rescue services, and other organizations through a telephone survey. We visited the 95 chambers and collected information about location, operating institutes, chamber specifications, and operational status. Twenty-four oxygen capsules were excluded from the study because of inadequate working pressure. RESULTS: Seventy-one hyperbaric chambers available for hyperbaric oxygen therapy were identified among 59 organizations. The hyperbaric chambers were distributed evenly along coastal lines; that is, 21 on the east coast, 26 on the west coast, 21 on the southern coast, and three on Jeju Island. Thirty-eight chambers with maximal working pressure of > or =5 atm could be used for severe decompression sickness and arterial gas embolism treatment. Twenty-nine chambers had a seating capacity equal to-or more than three patients. Twenty-eight chambers had two or more compartments; thus, they could handle complex medical situations. Thirty-eight chambers with medical locks were useful for severe decompression sickness treatment. CONCLUSION: A sufficient number of domestic hyperbaric chambers available for treating decompression sickness were distributed evenly along the coastal lines. However, potential barriers need to be overcome to establish an efficient decompression sickness treatment system.
Academies and Institutes ; Capsules ; Decompression ; Decompression Sickness ; Diving ; Embolism, Air ; Emergency Treatment ; Humans ; Hyperbaric Oxygenation ; Military Personnel ; Oxygen ; Police ; Republic of Korea ; Telephone

Dural arteriovenous fistulas (AVFs) are uncommon, representing only 10% to 15% of all intracranial AVFs. Here we present the case of a patient with cerebral infarction who experienced a dural AVF after craniotomy for superficial temporal artery (STA) to middle cerebral artery (MCA) bypass surgery. A 48-year-old man presented with dysarthria and right side hemiparesis. A brain magnetic resonance imaging scan revealed multiple acute infarctions and severe stenosis of the left MCA. Therefore, STA-MCA bypass surgery was performed. A follow-up angiography performed 2 weeks after the surgery showed an abnormal vascular channel from the left middle meningeal artery (MMA) to the middle meningeal vein (MMV) just anterior to the border of the craniotomy margin. This fistula originated from a screw used for cranial fixation. The screw injured the MMA and MMV, and this resulted in the formation of a fistula. The fistula was successfully treated with transarterial embolization. Surgeons should be careful when fixing bones with screws and plates as fistulas can develop if vessels are injured.
Angiography ; Brain ; Central Nervous System Vascular Malformations* ; Cerebral Infarction ; Cerebral Revascularization ; Constriction, Pathologic ; Craniotomy ; Dysarthria ; Fistula ; Follow-Up Studies ; Humans ; Infarction ; Magnetic Resonance Imaging ; Meningeal Arteries ; Middle Aged ; Middle Cerebral Artery* ; Paresis ; Temporal Arteries* ; Veins

OBJECTIVE: We examined the factors influencing subjective memory complaints among community dwelling elderly in urban area. METHODS: The subjects of this research were 160 community-dwelling elderly people without dementia and major depressive disorder. The questionnaires regarding the socio-demographic characteristics were conducted by each person. They include Korean version of Subjective Memory Complaints Questionnaires (SMCQ), Korean version of Short Geriatric Depression Scale (SGDS-K) and Korean version of Mini-Mental State Examination (K-MMSE). Subjective memory complaints were defined as above 4 points of SMCQ. RESULTS: 39.38% of the subjects had subjective memory complaints. There were significant associations between subjective memory complaints and SGDS-K (p < 0.001), physical illness (p=0.001), but there was no association with K-MMSE (p=0.383). CONCLUSION: There is a discrepancy between subjective memory complaints and actual cognitive impairments. This discrepancy suggests that the depressive disorders including minor depressive disorder and subsyndromal depression, might play a role in the subjective memory complaints rather than actual cognitive impairments in community-dwelling elderly people. Therefore, the treatments for the depressive disorders should be considered in dealing with the subjective memory complaints.
Aged* ; Cognition Disorders ; Dementia ; Depression ; Depressive Disorder ; Depressive Disorder, Major ; Humans ; Independent Living* ; Memory*

BACKGROUND: Lesch types 2 (L2, anxiety model) and 3 (L3, depressive model) of alcoholism exhibit different responses to anti-craving agents, and most treatment guidelines provide differential treatment strategies for bipolar depression (DEP) and unipolar DEP. We compare the psychological characteristics of L2 and L3 alcoholism and between the unipolar and bipolar subgroups.METHODS: We reviewed medical records of patients who were diagnosed with alcohol use disorder using the DSM-5 diagnostic criteria and classified as L2 and L3 using Lesch Alcohol typology software. All patients completed self-report scales (Alcohol Use Disorders Identification Test [AUDIT], Beck Anxiety Inventory [BAI], Beck Depression Inventory-II [BDI-II], and Korean Symptom Checklist-95 [KSCL95]). The data were analyzed using descriptive statistics, the Wilcoxon Rank-Sum test, and ANOVA.RESULTS: Of the 43 patients, 23 were assigned L2, and 20 were assigned L3. The scores for the KSCL95 subscales fell generally in the increasing order of the L2-unipolar (L2U, n=10), L2-bipolar (L2B, n=13), L3-unipolar (L3U, n=11), and L3-bipolar (L3B, n=9) types. The L3B scores were greater than the L3U scores for most KSCL95 subscales, by contrast with the DEP and BAI scores.CONCLUSION: We found psychological differences between L2 and L3 and identified the unique psychological characteristics for each subgroup by polarity. The psychological characteristics of these subgroups of alcohol use disorder may help improve the treatment success rates through individualized treatment strategies.
Alcoholism ; Anxiety ; Bipolar Disorder ; Depression ; Depressive Disorder ; Humans ; Medical Records ; Weights and Measures

Purpose: Digital Imaging and Communications in Medicine (DICOM), a standard file format for medical imaging data, contains metadata describing each file. However, metadata are often incomplete, and there is no standardized format for recording metadata, leading to inefficiency during the metadata-based data retrieval process. Here, we propose a novel standardization method for DICOM metadata termed the Radiology Common Data Model (R-CDM). Materials and Methods: R-CDM was designed to be compatible with Health Level Seven International (HL7)/Fast Healthcare Interoperability Resources (FHIR) and linked with the Observational Medical Outcomes Partnership (OMOP)-CDM to achieve a seamless link between clinical data and medical imaging data. The terminology system was standardized using the RadLex playbook, a comprehensive lexicon of radiology. As a proof of concept, the R-CDM conversion process was conducted with 41.7 TB of data from the Ajou University Hospital. The R-CDM database visualizer was developed to visualize the main characteristics of the R-CDM database. Results: Information from 2801360 cases and 87203226 DICOM files was organized into two tables constituting the R-CDM. Information on imaging device and image resolution was recorded with more than 99.9% accuracy. Furthermore, OMOP-CDM and RCDM were linked to efficiently extract specific types of images from specific patient cohorts. Conclusion R-CDM standardizes the structure and terminology for recording medical imaging data to eliminate incomplete and unstandardized information. Successful standardization was achieved by the extract, transform, and load process and image classifier. We hope that the R-CDM will contribute to deep learning research in the medical imaging field by enabling the securement of large-scale medical imaging data from multinational institutions.

A lymphatic cyst of the stomach is rare benign tumor which is composed of thin-walled lymphatic space lined by benign-appearing endothelial cells. It rarely manifests clinical symptoms, so it is found incidentally in most cases. Recently, a case of submucosal lymphatic cyst associated with early gastric cancer was experienced. An endoscopy revealed a slightly elevated, edematous lesion adjacent to the malignant ulcer. This case is herein reported with a brief review of related literature.
Endoscopy ; Endothelial Cells ; Lymphocele* ; Stomach ; Stomach Neoplasms* ; Ulcer

BACKGROUND/AIMS: Many studies have reported the correlation between the spot urine protein to creatinine (P/C) ratio and 24-hour urinary protein amounts in patients with glomerulonephritis. This correlation has also been reported in Western patients with kidney transplants, but no prior study has reported on this association in Eastern populations. We compare the correlation between the spot urine P/C ratio and 24-hour urinary protein amounts and the associating factors in Korean patients with kidney transplants. METHODS: The study included 66 patients with kidney transplants from our hospital. The subjects had urine samples evaluated between January 2005 and July 2010. We compared 24-hour urinary protein amounts with a spot urine P/C ratio collected in the morning and analyzed the factors affecting the correlation in each group. RESULTS: The 24-hour urinary protein amounts were 1.31 +/- 1.69 g/day and the spot urine P/C ratio was 1.29 +/- 1.70 in all subjects. A strong positive linear correlation was observed between the 24-hour urinary protein amounts and the spot urine P/C ratio (r = 0.95). The primary factor affecting accurate quantitation of proteinuria using the spot urine P/C ratio was gender (p = 0.003). The spot urine P/C ratio and the 24-hour urinary protein levels were 1.05 +/- 1.51 and 1.26 +/- 1.68 g/day in males (p = 0.005) and 1.57 +/- 1.88 and 1.36 +/- 1.72 g/day in females (p = 0.047), respectively. CONCLUSIONS: We determined that the spot urine P/C ratio provides an accurate estimate of 24-hour urinary protein levels in Korean patients with kidney transplants.
Creatinine ; Female ; Glomerulonephritis ; Humans ; Kidney ; Kidney Transplantation ; Male ; Proteinuria ; Transplants

Focal segmental glomerular sclerosis (FSGS) is known to recur in 20-40% of the renal allografts with graft loss in about half of these cases. We report a successful treatment of a recurrent FSGS after kidney transplantation with rituximab and plasmapheresis. An 16-year-old patient whose primary kidney disease was FSGS developed recurrence of proteinuria after living donor kidney transplantation despite preemptive plasmapheresis and one dose of rituximab (375 mg/m2). After kidney transplantation, nephrotic range proteinuria was detected. Kidney biopsy was done and showed recurrent FSGS. She undergone 11 times of plasmapheresis in the first 4 week post transplantation. In addition, she received additional one dose of rituximab (375 mg/m2) on day 14. Proteinuria was decreased below nephrotic range at 37 day. Ten months later, proteinuria was at 30 mg/day with excellent graft function. No significant adverse events related to rituximab or plasmapheresis were observed. Rituximab with plasmapheresis may be another option for recurrent FSGS after kidney transplantation.
Adolescent ; Antibodies, Monoclonal, Murine-Derived ; Biopsy ; Glomerulosclerosis, Focal Segmental ; Humans ; Kidney ; Kidney Diseases ; Kidney Transplantation ; Living Donors ; Plasmapheresis ; Proteinuria ; Recurrence ; Sclerosis ; Transplantation, Homologous ; Transplants ; Rituximab

PURPOSE: PTEN is a novel tumor suppressor gene located on chromosomal band 10q23.3. The detection of PTEN mutations in Cowden disease and in breast carcinoma cell lines suggests that PTEN may be involved in mammary carcinogenesis. Among several series of breast carcinomas, the frequency of loss of flanking markers around PTEN is approximately 30 to 40% and the somatic intragenic PTEN mutation frequency is less than 5%. METHODS: The expression of PTEN was stuided immunohistochemically studied in 41 invasive ductal carcinomas of the breast. We examined the correlation between PTEN expression and clinicopathologic factors such as age, tumor size, lymph node metastasis, histologic grade, nuclear grade, stage, as well as estrogen and progesteron receptors. RESULTS: Among the 41 infiltrating ductal carcinomas, studied 7 (17.1%) were immunohistochemically negative, and 19 (46.3%) demonstrated reduced expression. Among the clinicopathologic factors, tumor size, lymph node metastasis, high stage, and negative progesteron receptor displayed a significant relationship with the decrease of PTEN expression, however age, nuclear grade, and estrogen receptor had less of a relationship with PTEN expression. CONCLUSION: These results suggest that PTEN does play some role as a prognostic factor for carcinogenesis, but this hypothesis requires further study.
Breast Neoplasms ; Breast* ; Carcinogenesis ; Carcinoma, Ductal* ; Cell Line ; Estrogens ; Genes, Tumor Suppressor ; Hamartoma Syndrome, Multiple ; Lymph Nodes ; Mutation Rate ; Neoplasm Metastasis

Duodenal abscess is a form of phlegmonous enterocolitis and is a rarely reported disease throughout the entire world. Duodenal abscess mostly develops from complications of duodenal ulcer perforation, and may result in a clinically fatal course because it is difficult to differentiate from some diseases such as gastric ulcer, gastric cancer, hepatobiliary disorders etc.. The therapeutic gold standard is surgical intervention including abscess removal and drainage. We experienced a case of duodenal abscess that expressed non-specific symptoms, weight loss and epigastric pain, and diagnosed by gastrointestinal endoscopy, abdominal computed tomography. We successfully treated it through surgical intervention with intravenous antibiotics.
Abscess ; Anti-Bacterial Agents ; Cellulitis ; Drainage ; Duodenal Ulcer ; Endoscopy, Gastrointestinal ; Enterocolitis ; Foreign Bodies ; Stomach Neoplasms ; Stomach Ulcer ; Weight Loss