Background: A total of 8,303 individuals (4.3%) with adverse reactions (n=191,860) after vaccination developed serious conditions or died. Such health developments could cause people not vaccinated yet or waiting for a booster shot to become fearful of the vaccination. Methods: The 3-month (July–September 2021) clinical data of 41 patients from the family medicine department of a single medical center were analyzed retrospectively to determine risk factors and to investigate the clinical course to identify the cause of symptoms in detail. Results: A significant number of older adults aged over 50 years reported experiencing general weakness (P=0.026) but fewer incidences of fever than patients aged 50 years or younger (P=0.011). Eighteen of the 41 patients were requested to visit more than twice or consult a specialist. In 14 patients, the symptoms were explained by other medical causes. Conclusion The primary physician has a pivotal role in thoroughly evaluating patients who complain of adverseeffects after vaccination, considering the broad multitude of symptoms and medical conditions presented. To thoroughlyevaluate and appropriately advise patients with adverse reactions to their chosen vaccine, taking detailedmedical history and nutritional counseling are required to identify possible underlying causes, resolve symptoms,and educate them on self-care and regarding vaccines.

Objective: : Surgical site infection is the most detrimental complication following cranioplasty. In other surgical fields, intrawound vancomycin powder application has been introduced to prevent surgical site infection and is widely used based on results in multiple studies. This study evaluated the effect of intrawound vancomycin powder in cranioplasty compared with the conventional method without topical antibiotics. Methods: : This retrospective study included 580 patients with skull defects who underwent cranioplasty between August 1, 1998 and December 31, 2021. The conventional method was used in 475 (81.9%; conventional group) and vancomycin powder (1 g) was applied on the dura mater and bone flap in 105 patients (18.1%; vancomycin powder group). Surgical site infection was defined as infection of the incision, organ, or space that occurred after cranioplasty. Surgical site infection within 1-year surveillance period was compared between the conventional and vancomycin powder groups with logistic regression analysis. Penalized likelihood estimation method was used in logistic regression to deal with zero events. All local and systemic adverse events associated with topical vancomycin application were also evaluated. Results: : Surgical site infection occurred in 31 patients (5.3%) and all were observed in the conventional group. The median time between cranioplasty and detection of surgical site infection was 13 days (range, 4–333). Staphylococci were the most common organisms and identified in 25 (80.6%) of 31 cases with surgical site infections. The surgical site infection rate in the vancomycin powder group (0/105, 0.0%) was significantly lower than that in the conventional group (31/475, 6.5%; crude odds ratio [OR], 0.067; 95% confidence interval [CI], 0.006–0.762; adjusted OR, 0.068; 95% CI, 0.006–0.731; p=0.026). No adverse events associated with intrawound vancomycin powder were observed during the follow-up. Conclusion : Intrawound vancomycin powder effectively prevented surgical site infections following cranioplasty without local or systemic adverse events. Our results suggest that intrawound vancomycin powder is an effective and safe strategy for patients undergoing cranioplasty.

OBJECTIVE: Osteoporotic compression fracture is an increasing issue in this community and its diagnosis depends on the magnetic resonance images (MRI). Although T1- and T2-weighted images (T1WI and T2WI) have high sensitivity and specificity, the fat suppression technique gives more clear delineation of this abnormalities. Accordingly, we re-evaluated its exact sensitivity and specificity for the imaging diagnosis of osteoporotic compression fractures in our cases. For additional information about the osteoporotic compression fractures, we evaluate the fracture lines, fluid sign and adjacent discs change on the MRI. METHODS: Retrospectively, total 85 patients who had been diagnosed with acute osteoporotic compression fracture were enrolled. They all had been underwent MRI including T1WI, T2WI and T2- Spectral Adiabatic Inversion Recovery (SPAIR) sequence. RESULTS: In this study, the incidence of high signal intensity on T2-SPAIR image was very high (0.9917). The fluid sign was seen in 56.7% on the SPAIR image. The fracture lines were more observed on the T2WI than T1WI (p=0.0062). The adjacent discs change on T2WI and T2-SPAIR image were higher than T1WI (p<0.001). CONCLUSION: For the acute osteoporotic compression fracture, T2-SPAIR image is the most specific sequence of the all sequences. The fluid sign is another suggestive finding when considered other studies. T2WI is more useful to find the fracture line than T1WI. Abnormal signal intensity on the adjacent discs may provide additional information for the acute osteoporotic compression fractures.
Fractures, Compression ; Humans ; Incidence ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Osteoporosis ; Retrospective Studies ; Sensitivity and Specificity

Hemangiomas are the most common benign tumor of soft tissue. They are frequently seen on the trunk and extremities. In addition, most of them exist at the skin and subcutaneous layer, but fewer than 1% does in the intramuscular layer. For the diagnostic images of the intramuscular cavernous hemangioma, ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) are used currently. Multiple therapeutic methods are used, but surgical excision is considered as the most ideal treatment. We describe the recurred cavernous hemangioma occurred between the trapezius and splenius capitis muscle. The mass was well demarcated but scattered and infiltrated into the adjacent muscle layer, therefore, extensive resection was unavoidable. When determining a treatment regime for the hemangioma, it is essential to consider the size of the mass, cosmetic and functional aspects of the patient.
Caves ; Cosmetics ; Extremities ; Hemangioma ; Hemangioma, Cavernous ; Humans ; Magnetic Resonance Imaging ; Muscles ; Skin

Hemangiomas are the most common benign tumor of soft tissue. They are frequently seen on the trunk and extremities. In addition, most of them exist at the skin and subcutaneous layer, but fewer than 1% does in the intramuscular layer. For the diagnostic images of the intramuscular cavernous hemangioma, ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) are used currently. Multiple therapeutic methods are used, but surgical excision is considered as the most ideal treatment. We describe the recurred cavernous hemangioma occurred between the trapezius and splenius capitis muscle. The mass was well demarcated but scattered and infiltrated into the adjacent muscle layer, therefore, extensive resection was unavoidable. When determining a treatment regime for the hemangioma, it is essential to consider the size of the mass, cosmetic and functional aspects of the patient.
Caves ; Cosmetics ; Extremities ; Hemangioma ; Hemangioma, Cavernous ; Humans ; Magnetic Resonance Imaging ; Muscles ; Skin

BACKGROUND: Coronary artery disease (CAD) has recently become one of the major causes of mortality and morbidity in Korea. However, not much epidemiologic and demographic data has yet been reported. The purpose of this study was to investigate the clinical features as well as the prognostic factors of patients with CAD. METHODS: We prospectively enrolled 1,665 consecutive patients with CAD who had been admitted to the Catholic University Hospitals from December 1999 to April 2003. RESULTS: Acute myocardial infarction (AMI) was the most common cause of admission (n=715, 42.9%). Dyslipidemia, hypertension and smoking were the most common risk factors. More than 70% of the patients who underwent percutaneous coronary intervention (PCI) received stent implantation. A total of 965 (612 males) patients were followed at least for 6 months (the mean follow-up duration was 23.8+/-12.2 months). The incidence rates of major adverse cardiac events (MACE: cardiac death, acute myocardial infarction, target vessel revascularization) and cardiac death were 15.1% (n=146) and 2.2% (n=21), respectively. There was no difference in overall survival between the patients treated with medical therapy and those treated with PCI. By Cox regression analysis, the independent prognostic factors for MACE were PCI (95% CI: 1.75-4.85; p<0.01) and multivessel disease (95% CI: 1.03-2.04; p<0.05), and the independent prognostic factors for cardiac death were medical therapy (95% CI: 1.08-14.41; p<0.05) and old age (95% CI: 1.13-16.13; p<0.05). CONCLUSIONS: There was no difference in overall survival between the patients treated with medical therapy and those treated with PCI. However, PCI was superior to medical therapy for preventing death of the patients with acute coronary syndrome.
Acute Coronary Syndrome ; Coronary Artery Disease* ; Coronary Disease ; Coronary Vessels* ; Death ; Dyslipidemias ; Follow-Up Studies ; Heart* ; Hospitals, University ; Humans ; Hypertension ; Incidence ; Korea ; Mortality ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Prognosis ; Prospective Studies ; Risk Factors ; Smoke ; Smoking ; Stents

PURPOSE: Insufficient teaching of clinical microbiology, often caused by limited resources in medical schools, might be a reason for inaccurate diagnosis and treatment of infectious diseases by doctors. The purpose of this study is to develop and assess a multimedia self learning tool (MSLT) for clinical microbiology course. METHODS: We developed the MSLT based on existing self-directed learning tools. This tool was used by second- and third-year medical students. We randomly assigned 67 participating students to two groups: one (29) with lectures only and the other (38) with the MSLT only. We conducted pre- and post-tests. RESULTS: There are no differences in the pre- and post-test scores between the lecture group and the MSLT group in knowledge of bacterial classification, understanding of infectious diseases, proper use of laboratory tests, and proper selection of antimicrobials. However, post-test scores were significantly higher in both groups. CONCLUSION: The MSLT was found to be as equally effective as lectures, at least, test scorewise. Teachers could use either this tool alone or combined with conventional lectures to improve and enhance teaching in clinical microbiology. The results shed new insights into the possibility of introducing new teaching methods in clinical microbiology for future medical education.
Classification ; Communicable Diseases ; Computer-Assisted Instruction ; Diagnosis ; Education, Medical ; Humans ; Learning* ; Lectures ; Multimedia* ; Schools, Medical ; Students, Medical* ; Teaching

PURPOSE: The aim of this study was to test the feasibility and the clinical usefulness of detection and measurement of distal left anterior descending coronary artery (LAD) flow using transthoracic echocardiography. METHODS: We prospectively examined 200 consecutive subjects(age 56+/-12 yrs, M:F=23:77). Of these subjects, 79 patients underwent coronary angiography. After obtaining the tubular color flow signals of distal LAD using an ultra-band transducer (5-12 MHz) with a special preset program of a low velocity range, the width and length of color Doppler signals, peak diastolic and systolic pulsed Doppler velocity (PDV) and velocity time integral(VTI) were measured. The echocardiographic findings of distal LAD flow were compared with the coronary angiogram. RESULTS: 1. In 142 of 200 subjects (71%), the color and pulsed Doppler signals with clear envelops were identified. 2. Forward biphasic flow in 86(60.6%) subjects and only diastolic flow in 56(39.4%) subjects were detected. 3.The mean length and width of color flow signals were 4.7+/-2.8mm (range 1.1-15.0 mm) and 1.6+/-0.7 mm (range 0.5-4.7 mm), respectively. 4.The mean PDV and VTI were 21.4+/-9.0 cm/sec(range 7.7-58.0 cm/sec) and 8.4+/-4.1 cm(range 2.8-26 cm), respectively. 5. The mean velocity range for obtaining the optimal Doppler signals of distal LAD was 13.0+/-4.2 cm/sec (range 6.4-32 cm/sec). 6. 14 of 22 (63%) subjects who distal LAD color flow signals were not identified showed the total or near total occlusion of LAD on the coronary angiogram. CONCLUSION: Detection and measurement of distal LAD flow are feasible in a high percentage of subjects by use of high frequency transthoracic Doppler echocardiography. The color and pulsed Doppler signals of distal LAD using transthoracic echocardiography at resting state may give the useful clinical information about coronary artery disease.
Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels* ; Echocardiography ; Echocardiography, Doppler ; Humans ; Prospective Studies ; Transducers

Presence of persistent left superior vena cava(PLSVC) is considered to be one of the most frequently encountered anomalies of the systemic venous return. The incidence of PLSVC is reported to be 0.3% to 0.5% in the general population, and in 3% to 10% of patients with congenital heart disease. The presence of PLSVC draining into the coronary sinus is of no hemodynamic significance. However, it is important to recognize this condition, as it can have important clinical implications. The diagnosis can be established by two demensional echocardiography. It should be suspected by the presence of dilated coronary sinus, and confirmed by contrast echocardiography. A 61-year-old man with chronic atrial fibrillation was diagnosed as PLSVC by contrast transthoracic echocardiography(TTE) using agitated saline. Contrast TTE allowed visualization of the time sequence of the echo-contrast within the right atrium first following injection of right antecubital vein. Following injection of left antecubital vein, opacification of the dilated coronary sinus first and then the right atrium was seen.
Atrial Fibrillation* ; Coronary Sinus ; Diagnosis ; Dihydroergotamine ; Echocardiography* ; Heart Atria ; Heart Defects, Congenital ; Hemodynamics ; Humans ; Incidence ; Middle Aged ; Veins ; Vena Cava, Superior*

OBJECTIVE: Previous pathologic and roentgenographic studies have suggested a relation between aortic plaque and coronary artery disease but have lacked clinical utility. The study was undertaken to elucidate whether atherosclerotic aortic plaque detected by transesophageal echocardiography can be a clinically useful marker for significant obstructive coronary artery disease. METHODS: Clinical and angiographic features and intraoperative transesophageal echocardiographic findings were prospectively analyzed in 131 consecutive patients (58 women and 73 men, aged 17 to 75 years [mean 54 +/- 12]) undergoing open heart surgery. Significant obstructive coronary artery disease was defined as > or = 50% stenosis of > or = 1 major branch. RESULTS: Seventy-six (58%) of 131 patients were found to have obstructive coronary artery disease. In 76 patients with significant coronary artery disease, 71 had thoracic aortic plaque. In contrast, aortic plaque existed in only 10 of the remaining 55 patients with normal or minimally abnormal coronary arteries. The presence of aortic plaque on transesophageal echocardiographic studies had a sensitivity of 93%, a specificity of 82% and positive and negative predictive values of 88% and 90%, respectively, for significant coronary artery disease. There was a significant relationship between the degree of aortic intimal changes and the severity of coronary artery disease (r = 0.74, P < 0.0001). Multivariate logistic regression analysis of patient age, sex, risk factors of cardiovascular disease and transesophageal, echocardiographic findings revealed that atherosclerotic aortic plaque was the most significant independent predictor of coronary artery disease. CONCLUSION: This study indicates that transesophageal echocardiographic detection of atherosclerotic plaque in the thoracic aorta is useful in the noninvasive prediction of the presence and severity of coronary artery disease.
Adolescence ; Adult ; Aged ; Aorta, Thoracic/ultrasonography* ; Arteriosclerosis/ultrasonography ; Coronary Disease/ultrasonography* ; Echocardiography, Transesophageal ; Female ; Human ; Male ; Middle Age ; Prospective Studies ; Risk Factors