SMAS(Superior Mesenteric Artery Syndrome) is a disease caused by a chronic obstruction of the duodenum(transverse portion), which is hardly detectable. However, it is known that when the superior mesenteric artery and abdominal aorta form a narrow angle, that the transverse portion of the duodenum is pressed down between the superior mesenteric artery and the abdominal aorta, and that this can lead to obstruction of the duodenum. Measuring this angle is a complicated job using conventional angiography, and results often turns out to be inaccurate. In addition, no attempt has been made to determine the value of this angle in Koreans. In this study, we conducted abdominal CT angiography using MIP(maximum intensity projection) on patients with no clinical evidence of SMAS in order to determine the angle at which the superior mesenteric artery branches from the abdominal aorta by using PC based software(Rapidia ver. 1.2) for the image reconstruction. Accordingly, we found that the mean angle between the abdominal aorta and the superior mesenteric artery was 50.05+/-15.87 degrees on average, and that the angle in men(53.64+/-16.57 degrees) is higher than in women(46.46+/-14.98 degrees). We hope that the angles determined by our study will serve as an important indicator for detecting SMAS.
Angiography ; Aorta, Abdominal* ; Duodenum ; Hope ; Humans ; Image Processing, Computer-Assisted* ; Mesenteric Arteries ; Mesenteric Artery, Superior* ; Superior Mesenteric Artery Syndrome ; Tomography, X-Ray Computed

SMAS(Superior Mesenteric Artery Syndrome) is a disease caused by a chronic obstruction of the duodenum(transverse portion), which is hardly detectable. However, it is known that when the superior mesenteric artery and abdominal aorta form a narrow angle, that the transverse portion of the duodenum is pressed down between the superior mesenteric artery and the abdominal aorta, and that this can lead to obstruction of the duodenum. Measuring this angle is a complicated job using conventional angiography, and results often turns out to be inaccurate. In addition, no attempt has been made to determine the value of this angle in Koreans. In this study, we conducted abdominal CT angiography using MIP(maximum intensity projection) on patients with no clinical evidence of SMAS in order to determine the angle at which the superior mesenteric artery branches from the abdominal aorta by using PC based software(Rapidia ver. 1.2) for the image reconstruction. Accordingly, we found that the mean angle between the abdominal aorta and the superior mesenteric artery was 50.05+/-15.87 degrees on average, and that the angle in men(53.64+/-16.57 degrees) is higher than in women(46.46+/-14.98 degrees). We hope that the angles determined by our study will serve as an important indicator for detecting SMAS.
Angiography ; Aorta, Abdominal* ; Duodenum ; Hope ; Humans ; Image Processing, Computer-Assisted* ; Mesenteric Arteries ; Mesenteric Artery, Superior* ; Superior Mesenteric Artery Syndrome ; Tomography, X-Ray Computed

We used the fluorophotometry to investigate the corneal epithelial barrier function after excimer laser photorefractive keratectomy (PRK). Twenty-five eyes of 21 subjects (13 women, 8 men) underwent PRK to correct rnyopia. Corneal epithelial healing time was measured and corneal epithelial permeability to sodiurn fluorescein was evaluated by fluorophotoinetry at I, 2, and 3 weeks after surgery. The corneal epithelial permeability increased significantly 1 week after surgery and returned to preoperative level 2 weeks after surgery. The permeability differences according to epithelial healing days and corrected diopters were not statistically significant(p>0. 05). These results suggest that PRK delays complete reconstruction of corneal epithelial barrier function. The corneal epithelium regained its functional barrier 2 weeks after PRK in patients, so, at least, during the first 2 weeks, care should be taken to miniinize further epithelial trauma from topical inedication or surgical manipulation.
Epithelium, Corneal ; Female ; Fluorescein ; Fluorophotometry ; Humans ; Lasers, Excimer* ; Permeability ; Photorefractive Keratectomy*

This study aimed to ascertain whether medical students would enter a closed area where there was a raging epidemic of an infectious disease with a high fatality rate, and includes reasons for the students entering or refusing to enter. Participants included 50 second-year medical students. They were assigned to read a novel entitled 28, written by Youjeong Jeong, and discuss it in groups. Using their book reports, their decisions of whether or not to enter Hwayang, the city from the novel, and the reasons for their decisions were analyzed; we furthermore investigated the factors affecting their decisions. Among the 50 respondents, 18 students (36%) answered that they would enter, and the remaining 32 students (64%) answered that they would not enter the zone. The reasons given for entering were responsibility (44%), sense of ethics (33%), social duty (17%), and sense of guilt (6%). The reasons the students provided for not entering were inefficiency (44%), worry regarding family (28%), needlessness of sacrifice (19%), and safety not ensured (9%). Students who had four or fewer family members were more likely to enter Hwayang than were students who had five or more family members (odds ratio, 1.85). Students who had completed over 100 hours of volunteer work were more likely to enter Hwayang than were students who had volunteered less than 100 hours (odds ratio, 2.04). Owing to their "responsibility" as a doctor, 36% of medical students answered that they would enter an exclusion zone in an infected district with a high fatality rate. However, 64% answered they would not enter because of "inefficiency." For the medical students it is still a question 'To enter or not to enter?'
Communicable Diseases ; Surveys and Questionnaires ; Ethics ; Guilt ; Humans ; Mortality* ; Odds Ratio ; Rage ; Students, Medical* ; Volunteers ; Writing

PURPOSE: To compare the clinical outcomes between high and low fluid-dynamic parameter settings during phacoemulsification. METHODS: In this retrospective study we analyzed 183 consecutive eyes with senile cataracts that underwent cataract surgery between October 2010 and January 2015. The phacoemulsifications were performed with high and low fluidic parameter settings, which were designated by different fluid heights, aspiration flow rates, and vacuum settings. We measured and compared the intraoperative factors including fluid consumption, cumulative dissipated energy (CDE), ultrasound time, intraoperative complications, and pupil size changes during the phacoemulsification. Central corneal thickness (CCT), endothelial cell density (ECD), uncorrected visual acuity (UCVA), and best corrected visual acuity (BCVA) were measured and compared preoperatively and postoperatively. RESULTS: There was no statistically significant difference in the fluid consumption, CDE, or ultrasound time during phacoemulsification between the 2 groups. The frequencies of intraoperative complications were not statistically significant. UCVA, BCVA, and ECD were not statistically significantly different between the 2 groups during the postoperative follow-up. The low parameter group showed the lower increase in CCT on postoperative day 30. CONCLUSIONS: The phacoemulsifications with low fluid-dynamic parameter resulted in less damage to intraocular tissue without any significantly different postoperative findings. The phacoemulsification with low fluid-dynamic parameter setting is more advantageous due to stable and safe aspects.
Cataract ; Endothelial Cells ; Follow-Up Studies ; Intraoperative Complications ; Phacoemulsification* ; Pupil ; Retrospective Studies ; Ultrasonography ; Vacuum ; Visual Acuity

Hemangiomas are the most common benign tumors of infancy. Fifteen to 30% of these patients have multiple hemangiomas. Diffuse neonatal hemangiomatosis (DNH) is a disease that often has a fatal outcome if left untreated, and is characterized by multiple cutaneous and visceral hemangiomas. Corticosteroids are the commonly accepted first line treatment, but if no effect is seen, further treatment is required such as interferon, surgical excision, embolization and radiotherapy. Interferon is effective, but the neurologic sequela including spastic diplegia can be a complication. We experienced a case of DHN in a neonate. In this case, the baby presented with multiple cutaneous and visceral hemangiomas with Kasabach-Merritt syndrome (KMS) that included thrombocytopenia and consumptive coagulophthy. The baby was successfully treated with vincristine after the failure of steroid therapy.
Adrenal Cortex Hormones ; Cerebral Palsy ; Fatal Outcome ; Hemangioma ; Humans ; Infant, Newborn ; Interferons ; Kasabach-Merritt Syndrome ; Prednisolone* ; Radiotherapy ; Thrombocytopenia ; Vincristine*

PURPOSE: To report a case of a recurrent macular hemorrhage that developed after surgical removal of the internal limiting membrane (ILM) for subintimal hemorrhage due to retinal macroaneurysm. CASE SUMMARY: A 75-year-old female was admitted to the hospital complaining of decreased vision in the left eye which had started 3 weeks previously. The best corrected visual acuity (BCVA) of the right and left eye was 0.7 and 0.03, respectively. The intraocular pressure (IOP) of the right and left eye was 10 mm Hg and 12 mm Hg, respectively. On the fundus examination, macular preretinal and subretinal hemorrhage was observed and a diagnosis of retinal arterial macroaneurym of the inferonasal major artery was made. Vitrectomy was performed. After indocyanine green dye staining, the sub-ILM hemorrhage was treated with removal of the ILM. At postoperative day 3, the annular chorioretinal folds were observed due to the hypotony (4 mm Hg). However, the absence of leakage was confirmed through the sclerotomy site. At postoperative day 8, recurrent submacular hemorrhage occurred and the hemorrhage was observed to have spread after intravitreal C3F8 gas injection and when the patient was placed in the prone position. At postoperative 4 months, the hemorrhage that had invaded the macular area was completely resolved. The BCVA was 0.3, respectively. CONCLUSIONS: When removing a sub-ILM hemorrhage due to retinal macroaneurysm, recurrent hemorrhage can occur especially in a patient with ocular hypotony, as in the present case report. Physicians should be aware of this possibility and the proper treatment the condition requires.
Aged ; Arteries ; Eye ; Female ; Hemorrhage ; Humans ; Indocyanine Green ; Intraocular Pressure ; Membranes ; Ocular Hypotension ; Prone Position ; Retinaldehyde ; Vision, Ocular ; Visual Acuity ; Vitrectomy

A pulmonary artery catheter (PAC) is a useful monitoring device for measuring pulmonary artery pressure, pulmonary capillary wedge pressure and cardiac output, but its insertion brings about many complications including pulmonary artery rupture, infarction, thrombosis and infection. This case concerns the knotting of a PAC in a 27 year-old female patient who had undergone cardiac transplantation due to dilated cardiomyopathy. The PAC was inserted via the right subclavian vein to the pulmonary artery and withdrawn to the superior vena cava before heart was removed. After the weaning of the cardiopulmonary bypass (CPB), we tried to reinsert the PAC, which was neither advanced nor withdrawn. Postoperative chest x-ray revealed that the PAC appeared to be knotted in the subclavian vein. Two days later, we loosened the knot of the PAC and removed it via femoral and bracheal cineangiography techniques guided by fluoroscopy without any complications. In this case, we thought the knotting of the PAC occurred at insertion due to severe tricuspid regurgitation, and its size was reduced at withdrawal before the CPB and wedging to the subclavian vein. Knotting of PAC is very rare and unpredictable, but once it or other complications of the PAC is suspected, we recommend that the manipulation of the PAC should be stopped and x-ray should be checked.
Adult ; Cardiac Output ; Cardiomyopathy, Dilated ; Cardiopulmonary Bypass ; Catheters* ; Cineangiography ; Female ; Fluoroscopy ; Heart ; Heart Transplantation* ; Humans ; Infarction ; Pulmonary Artery* ; Pulmonary Wedge Pressure ; Rupture ; Subclavian Vein ; Thorax ; Thrombosis ; Tricuspid Valve Insufficiency ; Vena Cava, Superior ; Weaning

Background: Long-term care insurance for the elderly has been stably established along with the quantitative expansion of long-term care facilities. Indeed, the need for a paradigm about human rights-based service approach is being raised throughout society from a service perspective. Therefore, this study aimed to analyze the association between elderly human rights awareness and quality of service by considering human rights education as a moderate variable. Methods: This study conducted surveys with 138 caregivers working in long-term care facilities located in Seoul and Gangwon.General characteristics, awareness of human rights, and the level of service quality were examined using descriptive statistics, frequency analysis, and correlation analysis. And multi-variable linear regression with a hierarchical framework was employed. These analyses were performed using IBM SPSS ver. 25.0. Results: Of the 138 caregivers, 97.1% were female, 87.7% were more than 50 years old, and most of their education level was high-school graduates. Their length of employment ranged from more than 5 years to less than 10 years. The level of awareness regarding elderly human rights of the elderly was below normal (mean=2.21), but the quality of service was high (mean=4.21), and the need for human rights education was also high (mean=4.28). Among the general characteristics, the length of employment was significantly associated with awareness of elderly human rights. Moreover, political rights awareness, included as sub-domains of human rights, was positively associated with quality of service. However, the moderating variable, human rights education, was not significantly associated with the quality of service. Conclusion In this study, human rights education, as a moderating variable, did not have a statistically significant effect on caregivers’ human rights awareness in relation to service quality. This finding is inconsistent with previous research results. These results can be explained by the fact that the frequency of education in long-term care facilities was a significant factor in the practice of protecting the human rights of the elderly. Therefore ongoing encouragement for the frequency of current human rights education and improvements in the educational approach appear to be necessary. In addition, these findings reveal the need for strength of education policies and effective in-depth research about human rights and quality of service to respect the human rights of the elderly.

Umbilical venous catheter (UVC) insertion is a life-saving procedure in neonates who require neonatal intensive care unit (NICU). It is a relatively easy procedure and it is routinely performed on the NICU. This life-saving yet relatively easy procedure, however, can yield some undesirable complications if it is not administered correctly. One of them is a liver abscess. This is a case report of a preterm infant who developed a liver abscess after UVC insertion. We inserted UAC and UVC to a preterm of 35 weeks of gestational age and birth weight of 2,720 g for treatment of respiratory distress syndrome, patent ductus arteriosus, and sepsis. A liver abscess associated with UVC was suspected on screening abdominal sonogram performed for evaluation of infection at 8 days of life. UAC was removed at 5 days of life, however, UVC was still being used. The patient recovered after 4 weeks of antibiotic treatment with prompt elimination of UVC. This case along with a brief review of literature illustrates an importance of proper maintenance and casuistic use of UVC for preterm infants.
Birth Weight ; Catheterization ; Catheters ; Ductus Arteriosus, Patent ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Liver ; Liver Abscess ; Mass Screening ; Sepsis