PURPOSE: Pancreatoduodenectomy is a common procedure for periampullary cancer, but pancreatic leakage is the most dreaded complication after pancreatoduodenectomy. The aim of our study was to evaluate the correlation between the level of amylase in the drain fluid and the level of development of the complications that are related to pancreatic leakage after pancreatoduodenectomy. METHODS: Fifty-one consecutive patients who underwent pancreatoduodenectomy and pancreaticojejunostomy by two surgeons between January 1998 and August 2002 were evaluated retrospectively. A pancreaticojeunotomy was performed by intussuscepting end-to-end anastomosis with an internal stent. Amylase level of the drain fluid was checked every 2 days (postoperative 1, 3, 5, 7 day). Synthetic somatostatin was infused postoperatively for 7 days. RESULTS: The mean age of the 51 patients was 64.8 years, and the male to female ratio was 1.4: 1. The classification by pathologic diagnoses were 20 cases of common bile duct cancer (39%), 19 cases of pancreas head cancer (38%), 6 cases of chronic pancreatitis (12%), 4 cases of ampullar of Vater cancer (8%), and 2 cases of duodenal cancer (4%). There were 24 (47%) postoperative complications. Of these complications, the most occurring complication was the 5 (10%) cases of delayed gastric emptying. The other complications were 4 (8%) cases of pancreaticojejunostomy leakage, 4 (8%) cases of intraabdominal abscess, wound infection, and pulmonary complications. The patients were divided into a complication group related to pancreatic leakage and a non-complication group. There were 14 cases allocated to the complication group, and 37 cases were allocated to the non-complication group. The level of amylase in the drain fluid was higher in the complication group (P<0.05). Four cases of pancreaticojejunostomy leakage developed after pancreatoduodenectomy. All cases had symptoms of high fever, leukocytosis, and abdominal tenderness. CONCLUSION: The occurrence of complications related to pancreaticojejunostomy leakage is suspected if the level of amylase in the drain fluid is higher than the normal serum amylase level after 5 days post operation, and fever, leukocytosis, or abdominal tenderness were the typical complication symptoms.
Abscess ; Amylases* ; Classification ; Common Bile Duct ; Diagnosis* ; Duodenal Neoplasms ; Female ; Fever ; Gastric Emptying ; Head and Neck Neoplasms ; Humans ; Leukocytosis ; Male ; Pancreas ; Pancreaticoduodenectomy* ; Pancreaticojejunostomy ; Pancreatitis, Chronic ; Postoperative Complications ; Retrospective Studies ; Somatostatin ; Stents ; Wound Infection

OBJECTIVES: Patients with schizophrenia often present idea of reference in social situations, but there has been a limitation in quantitatively measuring their reactions to the social stimuli. The aim of this study was to investigate behavioral characteristics of patients with schizophrenia in social situations in which idea of reference can be provoked. METHODS: Forty subjects with schizophrenia (21 males) and 26 healthy volunteers (17 males) performed the idea-of-reference-provoking task, which was composed of movie clips with scenes of two women sitting on a bench of 1 or 5 m away. The conditions consisted of "referential conversation", "non-referential conversation" or "no conversation". The reactions of the participants were rated by the questionnaires for self-referential perception, malevolent interpretation and anxiety reaction. RESULTS: There were significant group differences in the reactions on self-referential perception, malevolent interpretation and anxiety reaction. After the treatment, patients with schizophrenia showed improved scores of the reactions. In particular, score changes of malevolent interpretation and anxiety reaction in patients with schizophrenia were correlated with change of paranoia scale (rs=0.65, p<0.05 and rs =0.73, p<0.05, respectively). CONCLUSION: Patients with schizophrenia revealed self-referential bias and paranoid responses to social situations, which were improved after psychiatric treatment. Self-referential perceptions and paranoid responses may be state dependent rather than trait of schizophrenia.
Anxiety ; Bias (Epidemiology) ; Female ; Healthy Volunteers ; Humans ; Paranoid Disorders ; Surveys and Questionnaires ; Schizophrenia* ; Social Perception*

OBJECTIVES: Patients with schizophrenia often present the idea of reference in social situations ; however, the number of research studies examining the nature of the idea of reference and the visual searching pattern in social situations is limited. The aim of this study was to investigate behavioral and visual searching characteristics of patients with schizophrenia in social situations in which the idea of reference can be provoked. METHODS: Eighteen subjects with schizophrenia (eight males) and 18 healthy volunteers (seven males) performed the idea-of-reference-provoking task, which was composed of movie clips with scenes of two women sitting on a bench 1 m away. The participants' reactions were rated using questionnaires for self-reference, malevolent intentions, and anxiety. Visual scan path was monitored during performance of the task. RESULTS: There were significant group differences in the reactions on self-reference, malevolent intentions, and anxiety. The visual searching pattern in patients with schizophrenia was to avoid looking at the women's body area in every movie clip. However, there was no significant difference in the face area in both groups. CONCLUSION: A distinct visual strategy in schizophrenia may affect the self-referential bias and paranoid response. The absence of difference in attention to a core information region (face) may suggest the possibility of inferential errors as well as the cause of self-referential bias and paranoid responses.
Anxiety ; Bias (Epidemiology) ; Female ; Healthy Volunteers ; Humans ; Intention ; Surveys and Questionnaires ; Schizophrenia*

OBJECTIVES: In July 2019, there were multiple reports on patients with hepatitis A among the visitors of a restaurant in Busan. The current study presents the results of an epidemiological investigation and outlines the supplementary measures that would help with hepatitis A control. METHODS: A cohort study was conducted for all 2,865 customers who visited restaurant A from June to July. Using a standardized questionnaire, participants reported the presence of hepatitis A symptoms and whether they had consumed any of 19 food items. As for participants who had visited public health centers, their specimens were collected. RESULTS: From the study cohort, 155 participants (5.4%) had confirmed hepatitis A. The epidemic curve was unimodal, and the median number of days from the restaurant visit to symptom onset was 31 days. A genotype analysis indicated that 89 of 90 tested patients had hepatitis A virus (HAV) genotype 1A. The results of a multivariate logistic regression analysis indicated that the ingestion of salted clams increased the risk of hepatitis A by 68.12 times (95% confidence interval [CI], 9.22 to 510.87). In an unopened package of salted clams found and secured through traceback investigation, HAV genotype 1A was detected. CONCLUSIONS To prevent people from ingesting uncooked clams, there needs to be more efforts to publicize the dangers of uncooked clams; the food sampling test standards for salted clams should also be expanded. Furthermore, a laboratory surveillance system based on molecular genetics should be established to detect outbreaks earlier.

Purpose: Concomitant ankle injuries associated with tibial shaft fractures can affect postoperative ankle joint pain and various postoperative ankle complications. This study compared the clinical outcomes between surgical treatment and conservative treatment of concomitant ankle injuries associated with tibial shaft fractures. Materials and Methods: From January 2015 to June 2020, a retrospective study was conducted on 118 tibia shaft fractures at the orthopedics department of the hospital. Associated ankle injuries were analyzed using plain radiographs, computed tomography (CT), magnetic resonance imaging (MRI), and intraoperative stress exams. The clinical outcomes were compared using the pain visual analog scale (pain VAS), American Orthopaedic Foot and Ankle Society Ankle-Hindfoot score (AOFAS score), and Karlsson–Peterson ankle score (KP score). Results: Seventy-two (61.02%) of the 118 cases were diagnosed with associated ankle injuries. Fifty-six cases underwent surgery for the ankle injury, and 16 cases underwent conservative treatment. The clinical results (according to the pain VAS score, AOFAS score, the KP score) were 1.79±1.26, 94.48±4.03, and 94.57±3.60, respectively, in the surgical treatment group, and 3.00±1.03, 91.06±3.02, and 91.25±3.31, respectively, in the conservative treatment group. Conclusion Surgical treatment showed better clinical outcomes than conservative treatment in concomitant ankle injury in tibia fractures. Therefore, surgical treatment produces better clinical outcomes than conservative treatment in concomitant ankle injuries in tibia fractures. Hence to improve the clinical outcomes, more attention is needed on ankle joint injury in tibial shaft fractures for selecting suitable surgical treatments for those patients.

OBJECTIVES: This study aimed to reveal the epidemiologic characteristics of the outbreak of gastroenteritis caused by Salmonella enterica serovar Thompson in Busan Metropolitan City and to identify points for improvement to prevent of food-borne disease outbreak. METHODS: This was a case-control study. The control group comprised asymptomatic students in the same classes of the cases. The presence or absence of symptoms, ingestion of each food provided by school meal service, and commonly ingested foods in addition to those foods in meal service were investigated. Moreover, specimens collected from rectal swab, preserved foods, and environmental surface were tested. RESULTS: Of the 6,092 subjects, 1,111 (1,083 students, 22 school personnel, and 6 foodservice employees) were included in the case group; this corresponded to an 18.4% attack rate. Symptoms included diarrhea (n=1,051, 94.6%), abdominal pain (n=931, 83.8%), febrile sensation (n=502, 45.2%), and vomiting (n=275, 24.8%). The epidemic curves of each 10 schools were unimodal. Investigation of food intake showed a significantly high odds ratio for chocolate cake in 5 out of the 10 schools. Laboratory test detected Salmonella enterica serovar Thompson both in rectal swab specimens of 9 schools and in collected preserved chocolate cakes of 9 schools. Pulsed-field gel electrophoresis test result showed that Salmonella enterica seorvar Thompson isolated from human and foods were the same. CONCLUSIONS The source of infection for the Salmonella enterica serovar Thompson outbreak in the 10 schools of Busan Metropolitan City is chocolate cake. Traceback investigation for origin of contaminated food in food-borne disease outbreak and safety control during food production should be more enhanced.

OBJECTIVES: This study aimed to reveal the epidemiologic characteristics of the outbreak of gastroenteritis caused by Salmonella enterica serovar Thompson in Busan Metropolitan City and to identify points for improvement to prevent of food-borne disease outbreak.METHODS: This was a case-control study. The control group comprised asymptomatic students in the same classes of the cases. The presence or absence of symptoms, ingestion of each food provided by school meal service, and commonly ingested foods in addition to those foods in meal service were investigated. Moreover, specimens collected from rectal swab, preserved foods, and environmental surface were tested.RESULTS: Of the 6,092 subjects, 1,111 (1,083 students, 22 school personnel, and 6 foodservice employees) were included in the case group; this corresponded to an 18.4% attack rate. Symptoms included diarrhea (n=1,051, 94.6%), abdominal pain (n=931, 83.8%), febrile sensation (n=502, 45.2%), and vomiting (n=275, 24.8%). The epidemic curves of each 10 schools were unimodal. Investigation of food intake showed a significantly high odds ratio for chocolate cake in 5 out of the 10 schools. Laboratory test detected Salmonella enterica serovar Thompson both in rectal swab specimens of 9 schools and in collected preserved chocolate cakes of 9 schools. Pulsed-field gel electrophoresis test result showed that Salmonella enterica seorvar Thompson isolated from human and foods were the same.CONCLUSIONS: The source of infection for the Salmonella enterica serovar Thompson outbreak in the 10 schools of Busan Metropolitan City is chocolate cake. Traceback investigation for origin of contaminated food in food-borne disease outbreak and safety control during food production should be more enhanced.
Abdominal Pain ; Busan ; Cacao ; Case-Control Studies ; Diarrhea ; Eating ; Electrophoresis, Gel, Pulsed-Field ; Food, Preserved ; Foodborne Diseases ; Gastroenteritis ; Humans ; Korea ; Meals ; Odds Ratio ; Salmonella enterica ; Salmonella Infections ; Salmonella ; Sensation ; Serogroup ; Vomiting

OBJECTIVES: This study aimed to reveal the epidemiologic characteristics of the outbreak of gastroenteritis caused by Salmonella enterica serovar Thompson in Busan Metropolitan City and to identify points for improvement to prevent of food-borne disease outbreak. METHODS: This was a case-control study. The control group comprised asymptomatic students in the same classes of the cases. The presence or absence of symptoms, ingestion of each food provided by school meal service, and commonly ingested foods in addition to those foods in meal service were investigated. Moreover, specimens collected from rectal swab, preserved foods, and environmental surface were tested. RESULTS: Of the 6,092 subjects, 1,111 (1,083 students, 22 school personnel, and 6 foodservice employees) were included in the case group; this corresponded to an 18.4% attack rate. Symptoms included diarrhea (n=1,051, 94.6%), abdominal pain (n=931, 83.8%), febrile sensation (n=502, 45.2%), and vomiting (n=275, 24.8%). The epidemic curves of each 10 schools were unimodal. Investigation of food intake showed a significantly high odds ratio for chocolate cake in 5 out of the 10 schools. Laboratory test detected Salmonella enterica serovar Thompson both in rectal swab specimens of 9 schools and in collected preserved chocolate cakes of 9 schools. Pulsed-field gel electrophoresis test result showed that Salmonella enterica seorvar Thompson isolated from human and foods were the same. CONCLUSIONS: The source of infection for the Salmonella enterica serovar Thompson outbreak in the 10 schools of Busan Metropolitan City is chocolate cake. Traceback investigation for origin of contaminated food in food-borne disease outbreak and safety control during food production should be more enhanced.
Abdominal Pain ; Busan ; Cacao ; Case-Control Studies ; Diarrhea ; Eating ; Electrophoresis, Gel, Pulsed-Field ; Food, Preserved ; Foodborne Diseases ; Gastroenteritis ; Humans ; Korea ; Meals ; Odds Ratio ; Salmonella enterica ; Salmonella Infections ; Salmonella ; Sensation ; Serogroup ; Vomiting

OBJECTIVE: The purpose of the present study was 1) to identify factors that may influence academic stress in medical students and 2) to investigate the causal relationships among these variables with path analysis. METHODS: One hundred sixty medical students participated in the present study. Psychological parameters were assessed with the Medical Stress Scale, Minnesota Multiphasic Personality Inventory, Hamilton Depression Scale, Beck Depression Inventory, and Academic Motivation Scale. Linear regression and path analysis were used to examine the relationships among variables. RESULTS: Significant correlations were noted between several factors and Medical Stress scores. Specifically, Hamilton Depression Scale scores (beta=0.26, p=0.03) and amotivation (beta=0.20, p=0.01) and extrinsically identified regulation (beta=0.27, p<0.01) response categories on the Academic Motivation Scale had independent and significant influences on Medical Stress Scale scores. A path analysis model indicated that stress, motivation, and academic performance formed a triangular feedback loop. Moreover, depression was associated with both stress and motivation, and personality was associated with motivation. CONCLUSION: The triangular feedback-loop structure in the present study indicated that actions that promote motivation benefit from interventions against stress and depression. Moreover, stress management increases motivation in students. Therefore, strategies designed to reduce academic pressures in medical students should consider these factors. Additional studies should focus on the relationship between motivation and depression.
Depression ; Humans ; Linear Models ; MMPI ; Models, Structural ; Motivation ; Schools, Medical ; Students, Medical

A pulmonary arteriovenous malformation (PAVM) is a rare pulmonary vascular anomaly presenting as dyspnea or recurrent epistaxis. Ebstein's anomaly (EA), a congenital cardiac malformation, is also a rare condition. There have been no reports concerning the co-existence of PAVM with hereditary hemorrhagic telangiectasia (HHT) and EA. A 40-year-old woman was admitted with a 2-month history of increasing dyspnea and several years of recurrent epistaxis. On transthoracic echocardiography, she was diagnosed with EA and agreed to undergo surgical treatment. A chest CT angiography showed a 12-mm serpiginous vascular structure suspicious for a PAVM and a liver CT suggested HTT. Although it is unclear whether or not a concurrent PAVM and EA have an embryologic or genetic relationship, we report a case of a PAVM with EA. Further genetic and embryonic studies are needed to identify a possible relationship of the two medical conditions.
Adult ; Angiography ; Arteriovenous Malformations ; Dyspnea ; Ebstein Anomaly ; Echocardiography ; Epistaxis ; Female ; Humans ; Liver ; Lung ; Telangiectasia, Hereditary Hemorrhagic ; Thorax