No abstract available.

Miller Fisher syndrome is a syndrome of acute external ophthalmoplegia, ataxia and areflexia without significant motor or sensory deficit in the limbs and usually results in complete recovery without specific treatment. It's accurate anatomic lesion sites and pathogeneiss is still unknown. Recently we experienced a 57 year old man who had the sudden onset of ophthalmoplegia, ataxia, areflexia and albuminocytologic dissociation in CSF and completely recovered 2 1/2 months later.
Ataxia* ; Extremities ; Humans ; Middle Aged ; Miller Fisher Syndrome* ; Ophthalmoplegia

Miller Fisher syndrome is a syndrome of acute external ophthalmoplegia, ataxia and areflexia without significant motor or sensory deficit in the limbs and usually results in complete recovery without specific treatment. It's accurate anatomic lesion sites and pathogeneiss is still unknown. Recently we experienced a 57 year old man who had the sudden onset of ophthalmoplegia, ataxia, areflexia and albuminocytologic dissociation in CSF and completely recovered 2 1/2 months later.
Ataxia* ; Extremities ; Humans ; Middle Aged ; Miller Fisher Syndrome* ; Ophthalmoplegia

Various cancer types have been associated with cancer-related cerebral infarction. In this study, we describe the first case of cancer-related cerebral infarction in which the underlying disease was primary bone marrow lymphoma (PBML). A 79-year-old man presented with abruptly developed bilateral lower extremity weakness and confusion. Diffusion-weighted imaging on admission showed multiple cortical and subcortical embolic infarction lesions in multiple vascular territories. Diagnostic evaluations to determine the embolic source revealed no abnormalities. Laboratory testing demonstrated elevated D-dimer (2.59 μg/mL) but no other prothrombotic abnormalities. In suspicion of cancer-related stroke, we performed chest CT, abdomen CT, and FDG-PET to detect the hidden malignancy. Findings revealed no evidence of cancer; however, they did reveal signs of anemia (hemoglobin 9.0 g/dL). Bone marrow aspiration biopsy showed large atypical B cell involvement suggestive of high-grade B cell lymphoma. The patient was diagnosed with primary bone marrow diffuse large B-cell lymphoma initially presenting with ischemic stroke. Our case suggests that primary bone marrow cancer may be a candidate for the differential diagnosis of hidden malignancy in patients with suspected cancer-related stroke. Bone marrow biopsy may be essential for establishing an appropriate differential diagnosis in patients with abnormal hematologic findings.

PURPOSE: The purpose of this study was to examine the effect of professional autonomy, organizational commitment, and perceived patient safety culture on patient safety management activities of nurses in medium and small-sized hospitals.METHODS: A cross-sectional design was employed. Self-reported questionnaires were completed by 121 nurses with at least 3 months of working experience in medium and small-sized hospitals located in B city. Data were analyzed using descriptive statistics, a t-test, a one-way ANOVA, Pearson correlation coefficients, and a multiple regression analysis.RESULTS: Professional autonomy (r=.22, p=.016), organizational commitment (r=.34, p < .001), and perceived patient safety culture (r=.55, p < .001) had a statistically significant positive correlation with patient safety management activities. The factors that might affect patient safety management activities were professional autonomy (β=.23, p=.003) and perceived patient safety culture (β=.55, p < .001). The explanatory power of these factors for patient safety management activities was 33.5% (F= 21.19, p < .001).CONCLUSIONS: The development of repetitive and continuous education programs is needed to improve a nurse's professional autonomy and perceived patient safety culture.
Education ; Humans ; Organizational Culture ; Patient Safety ; Professional Autonomy ; Safety Management

No abstract available.
Humans

Varicose veins are consistent with physically dilated superficial veins ≥3 mm. Physiologically, chronic venous insufficiency is an advanced chronic venous disease with functional abnormalities. Essentially, the shape of the vein is directly influenced by hydrostatic pressure. Ambulatory venous pressure is increased as shunt formation and vein will be dilated by the connection with deep venous refluxes. Hydrostatic parodox in varicose veins is that the ambulatory venous pressure is not directly related with vein diameter but with shunt formation with valve insufficiency. Mean ambulatory venous pressure of 10–30 mmHg is considered as normal, 31–45 mmHg as intermediate and >45 mmHg as severe venous hypertension. Diameter measurement is used in the diagnosis of varicose veins, but treatment need to be more focused to remove hydrostatic pressure rather than diameter of vein in respect to improve symptoms related with varicose veins. Nevertheless, there are some concerns for the treatment of large veins. From the guidelines endothermal ablation is recommended than non-thermal ablation for >10 mm large varicose vein. Large veins might increase the incidence of endothermal heat induced thrombosis. Caprini score more than 7 will be benefited from chemoprophylaxis for large vein. For the compression therapy, inelastic compression is recommended than elastic compression to improve the function of calf muscle pump.

This is a case report of pernicious anemia with neurologic deficits. The patient is a 69 years old male with generalized tingling sense. On examination, slight pale conjunctiva and beefy red tongue are noted. Laboratory stud show megaloblastic anemia with low serum vitamin B12 level, positive Schilling test, gastric achlorhydria and mild gastric atrophy. Neurologic examination reveals cerebral, spinal and peripheral involovement and EEG and EMG study support those things. On parenteral vitamin B12, the hematologic and neurological abnormalities are improved dramatically.
Achlorhydria ; Aged ; Anemia, Megaloblastic ; Anemia, Pernicious* ; Atrophy ; Conjunctiva ; Electroencephalography ; Humans ; Male ; Neurologic Examination ; Neurologic Manifestations ; Schilling Test ; Tongue ; Vitamin B 12

BACKGROUND: There has been widespread use of in-training examination for the evaluation of clinical competence of residents. The result of in-training examination seems to be helpful for improving the quality of residency programs using feedback system, further. We evaluated the relationship between residency program and the result of in-training examination. METHODS: Reports on the contents of residency program(82 programs) which were submitted in 1999 and in-training examination scores of 516 family medicine residents in 1998 were linked each other through the name of resident. Correlation analysis, t test, ANOVA analysis, and the multiple linear regression analysis were used. RESULTS: Mean score acquired by residents of tertiary hospital residency program(59.4+/-7.79) was significantly higher than that of secondary hospital(56.4+/-8.45) among all three residency years. Residents who have seen their own patients in ambulatory care clinic(58.5+/-8.14) and were given feedback by peer review of teaching faculty(60.2+/-7.71) acquired significantly better results compared to those who have not(56.1+/-8.35, 57.5+/-8.27). Residents in programs with moderate ratio of the number of residents to teaching faculty acquired significantly better results compared to those with smaller or larger ratio; the score were 56.2+/-6.90, 59.2+/-8.64, 58.7+/-7.90, 57.1+/-8.82 for the ratio of < or =3, 4-6, 7-9, and 9 <, respectively. Statistically significant but low correlation coefficients(less than 0.25) were observed between in-training examination score and the period of rotation to learn family medicine, general medicine, dermatology, musculo- skeletal problem, and the neuro-sensory problem. After controlling probable confounders, third year of residency, residency program in tertiary hospital, and the moderate ratio of residents to teaching faculty were significantly associated with the better result of in-training examination. CONCLUSION: For improving clinical competence of residents in family practice, limiting the ratio between residents and teaching faculty in residency program to appropriate level and substantiality in contents of hospital teaching rotation program should be needed.
Ambulatory Care ; Clinical Competence ; Dermatology ; Education, Medical ; Educational Measurement ; Family Practice ; Humans ; Internship and Residency* ; Linear Models ; Peer Review ; Tertiary Care Centers

We report a case of pneumomediastinum, subcutaneous emphysema, and mild pneumothorax that occurred after endotracheal intubation with a metallic endotracheal tube for the laser operation. Fortunately, pneumomediastinum and subcutaneous emphysema were self-limited. But potentially life-threatening events such as upper airway obstruction, tension pneumothorax, pneumopericardium, mediastinitis might be possible. These complications may result from mucosal perforation of upper airway. The use of a tube with rigid and relatively narrower internal diameter than polyvinylchloride endotracheal tube, tough endotracheal intubation technique, high peak inspiratory pressure, suction technique and negative pressure are included as complication factors.
Airway Obstruction ; Intubation, Intratracheal ; Mediastinal Emphysema* ; Mediastinitis ; Pneumopericardium ; Pneumothorax ; Subcutaneous Emphysema* ; Suction