BACKGROUND: In Korea, doctors are tend to prescribe digestive system drugs to the patients who have no digestive symptoms. The purpose of this study was to describe the prescription tendency toward digestive system drugs among residents of family practice. METHODS: Among outpatients who were consulted by residents of family practice in S hospital from Jan. 1995 to Jul. 1996, the patients without digestive symptoms were selected and their medical records were reviewed about prescribed drugs. RESULTS: The total number of eligible patients were 308. The number of residents who examined the eligible patients were 25 and they consulted average 12.3(S.D 5.1, range 521) patients. The proportion of patints who were given digestive system drugs was 43.2%. The proportions were 48.3%, 35.4% and 54.8% in patients who were examined by 1st, 2nd and 3rd grade reridents, respectively. There were no differences in the proportions between patients sex groups, among patients age groups, and also among groups of number of major drugs. The proportion was 58.6% in patients with common cold, 39.4% in patients with respiratory diseases other than common cold, 70.2% in patients with musculoskeletal diseases, 50.0% in patients with headache, 45.0% in patients with neurosis. The three most common categories of digestive system drugs were enzyme digestives, motility regulators and antacids. The proportion of total prices of digestive system drugs to total price of prescribed drugs was 19.8 % in all patients and 36.3% in patients who were given digestive system drugs. CONCLUSIONS: Residents of family practice in S hospital were tend to prescribe digestive system drugs to the patients who have no digestive symptoms and therefore there need more efforts to improve prescription behavior.
Antacids ; Common Cold ; Digestive System* ; Family Practice ; Headache ; Humans ; Korea ; Medical Records ; Musculoskeletal Diseases ; Outpatients ; Prescriptions*

BACKGROUND: If two or more doctors prescribe for one patient, each doctor must be careful to minimize the number of drugs and the frequency of admistration, and also be careful to avoid duplicating drugs. The purpose of this study is to evaluate the appropriateness of prescription for the patient who visits two or more doctors. METHODS: In a tertiary hospital, outpatients who received prescriptions simultaneously from two or more doctors were selected, and the number of drugs, the frequency of admistration and duplication of drugs were evaluated. RESULTS: The number of eligible patients was 887. The number of drugs was 5.2 for patients who visited 2 doctors, and 8.1 for patients who visited 3 doctors. 13% of patients who visited 2 doctors received more than 8 drugs, and 32.6% of patients who visited 3 doctors received more than 10 drugs. The frequency of administration per day was 3.7 for patients who visited 2 doctors, and 5.0 for patients who visited 3 doctors. 12% of patients who visited 2 doctors had to take drug more than 6 times a day and 9.3% of patients who visited 3 doctors had to take drug more than 8 times a day. 9.2% of total patients received duplicated drugs. The duplication of drugs was more frequent among patients who visited 2 doctors than who visited 3 doctors. CONCLUSIONS: For the patients who visited two or more doctors, the number of drugs and frequency of admistration was inappropriate and duplication of drugs was found, therefore the doctors should make more efforts to avoid inappropriate prescription.
Drug Prescriptions* ; Humans ; Inappropriate Prescribing ; Outpatients ; Prescriptions ; Tertiary Care Centers

A case of traumatic internal carotid artery injury associated with skull base fracture, Le Fort II fracture and mandible fracture after maxillofacial blunt trauma which resulted in delayed blindness is presented. This condition would appear to be a rare consquence of maxillofacial trauma. Internal carotid artery injury including dissection is an important consequence of blunt craniomaxillofacial trauma with potentially devastating consquences. It should be emphasized that skull base fracture involving the course of the internal carotid artery provides an important clue to significant vascular injury and, when present, provides the impetus for vascular imaging study.
Blindness* ; Carotid Artery, Internal* ; Mandible ; Skull Base ; Vascular System Injuries

Sagittal synostosis is the most common isolated craniosynostosis and usually recognized in early infancy. Numerous surgical techniques including strip craniectomy, the pi procedure, subtotal calvariectomy have been used, and they are usually successful if carried out in early infancy. Unfortunately, some children with sagittal synostosis are not considered for surgical correction by the age of 2 years. From March 2001 to February 2002, we have experienced two children older than 2 years of age with sagittal synostosis, and in all cases, performed total cranial vault remodeling with minimal bony defect. Reconstruction consisted of shortening of the sagittal midline strut, barrel stave osteotomy of temporal region, and right angled Z-osteotomy of parieto-occipital region. Using right angled Z-osteotomy, we can easily reshape and fix parieto-occipital bone flap with good stability and esthetic results. We report our technique for the late correction of scaphocephaly in two children with satisfactory results
Child ; Craniosynostoses* ; Humans ; Osteotomy

A median cleft lip has been broadly defined as any congenital vertical cleft through the center of the upper lip. In the Tessier 0 cleft, the location of the median cleft of the upper lip has a spectrum of dysmorphic gradation. This varies from a simple central vermillion notch to a wide cleft accompanied by a bifid nose and hypertelorism. Despite its extreme variability, the median cleft is quite rare and has a reported incidence amongst cleft patients alone of 0.43 to 0.73%. We experienced two cases of incomplete median cleft lip without other craniofacial anomalies. One of them who had reverse V-shaped defect of upper vermilion and fibrous band in her oral mucosa, was corrected with orbicularis oris muscle union and Z-plasty. The other patient had triangular shaped upper lip and deficiency of vermilion. We reviewed the classifications of median cleft lip and devised new classification, so that it helps understanding of median cleft lip.
Classification* ; Cleft Lip* ; Humans ; Hypertelorism ; Incidence ; Lip ; Mouth Mucosa ; Nose

Epithelioid hemangioma was firstly described by Enzinger and Weiss. It belongs to a group of unusual vascular proliferation accompanying prominent eosinophilic infiltration and synonymous with angiolymphoid hyperplasia with eosinophilia(ALHE). Histopathologically, the lesion is characterized by localized, marginated and relatively symmetrical proliferation of capillaries around a medium-sized vessel with an epithelioid hyperplasia of endothelial cell and marked infiltration of inflammatory cells, eosinophils and lymphocytes. The lesion occurs usually in the dermal and subcutaneous tissue of the head and neck area. We report a case of epithelioid hemangioma occuring on the nasal tip in a 72-years-old man. Microscopically, the lesion consisted of a proliferating vessels surrounded by inflammatory infilatration predominantly composed of eosinophils and lymphocytes. But vessels were lined by conventional-appearing endothelial cells.
Angiolymphoid Hyperplasia with Eosinophilia ; Capillaries ; Endothelial Cells ; Eosinophils ; Head ; Hemangioma* ; Hyperplasia ; Lymphocytes ; Neck ; Subcutaneous Tissue

Xeroderma pigmentosum is rare autosomal recessive disease, characterized by extreme sensitivity to ultraviolet light and leading to development of multiple malignant skin tumors. Among multiple malignant skin tumors, basal cell carcinoma and squamous cell carcinoma are common. Treatments of xeroderma pigmentosum are palliative or radiation treatment, but surgical resection is necessary if xeroderma pigmentosum is transited to malignant skin tumors. We report a case of a 32-years-old female xeroderma pigmentosum patient, who developed radiation resistant basal cell carcinoma on right alar nasi. Radiaton theraphy(300cGy, fractions: 10, total dose: 3000cGy) was not effective, so surgical excision and local skin flap coverage was made and no specific wound complications occurred. During 11 months follow-up period, no evidence of recurrence was found.
Carcinoma, Basal Cell* ; Carcinoma, Squamous Cell ; Female ; Follow-Up Studies ; Humans ; Ichthyosis* ; Recurrence ; Skin ; Ultraviolet Rays ; Wounds and Injuries ; Xeroderma Pigmentosum*

PURPOSE: Among the materials for cranioplasty, autogenous bone is ideal because it is less susceptible to infection and has lower rates of subsequent exposure. However, the procedure is technically demanding to perform and requires a donor site. Disadvantages further exist when the defect is large and there are attendant limitations in donor site. The authors present their experience with reconstruction of large skull defect using right-angled zigzag osteotomized outer table of autogenous calvarial bone, overcoming the limitation in donor site. METHODS: From 2000 to 2006, 9 patients were retrospectively reviewed, who had undergone reconstruction with right angled zigzag osteotomized outer table of autogenous calvarial bone. RESULTS: Aesthetically satisfactory skull shape was achieved. Major complications of infection, hematoma, plate exposure, and donor site complications of dural tear with bleeding, cerebrospinal fluid leak, and meningitis were not seen. One patient had delayed wound healing and was successfully managed conservatively. CONCLUSION: Autogenous bone is the material of choice for cranioplasty, especially in complicated cases. Right angled zigzag osteotomy is a useful method in reconstruction of large skull defects with less donor site morbidity.
Cerebrospinal Fluid ; Hematoma ; Hemorrhage ; Humans ; Meningitis ; Osteotomy* ; Retrospective Studies ; Skull* ; Tears ; Tissue Donors ; Wound Healing

Rigid fixation techniques with absorbable plates and screws are recently utilized for the repair of craniofacial skeletal injuries or congenital anomalies. But no domestic literature are presented in treatments of mandible fracture. We present our early experience of absorbable plates and screws in fixation of mandible fracture. Eleven patients underwent fixation procedures for mandible fracture with absorbable plates and screws. Intraoperative stability was satisfactory in all cases. Significant problems, such as nonunion, malunion, delayed union and malocclusion from the use of absorbable plating system were not found, but there were two cases of localized inflammation. We also experienced advantages of absorbable plating system which are biodegradation, radiolucency and enough stability for reduction state. The use of absorbable plating system would eliminate potential effects on skeletal growth- restriction in child, problems associated with long- term palpability and visibility in X-ray, and cold sensitivity caused by traditional metal plating system. There are also several disadvantages of absorbable plates and screws. This plating system takes increased operative time and needs delicate technique relative to the traditional metal plating system. Nevertheless we concluded that absorbable plates and screws are good fixatives for mandibular fracture.
Child ; Electroplating ; Fixatives ; Humans ; Inflammation ; Malocclusion ; Mandible ; Mandibular Fractures* ; Operative Time

Merkel cell carcinoma is rare skin malignancy originated from epidermal mechanoreceptor of neural origin. The tumor usually affects older individuals at sun exposed area such as head, neck and extremity. Subclinical involvement of regional lymph node is reported frequently at the time of initial treatment. Thus even asymptomatic patients who present with clinically localized tumor should undergo evaluation with computed tomography and lymphangiography. Positron emission tomography(PET) scans can imaging the metabolic difference of malignant tumors. Increased glucose uptake of malignant tumor cells are detected by PET scanner. PET scans can provide qualitative and quantitative informations about systemic metastasis of tumors. Although there are no data that define the efficacy of PET scans in the initial diagnostic evaluation of head and neck cancer, they could be considered. Current standards of treatment of Merkel cell carcinoma is wide surgical excision and regional lymphadenectomy if there are suspicious lymph nodes. The author reported a patient with Merkel cell carcinoma of cheek. Wide surgical excision and postoperative PET/CT was done for evaluation of regional lymph node and distant metastasis. There were two hot-uptakes in patient's neck, so they were considered as metastatic node, but finally they were proved to be tuberculosis lymphadenitis after excision.
Carcinoma, Merkel Cell* ; Cheek ; Electrons* ; Extremities ; Glucose ; Head ; Head and Neck Neoplasms ; Humans ; Lymph Node Excision ; Lymph Nodes ; Lymphadenitis ; Lymphography ; Mechanoreceptors ; Neck ; Neoplasm Metastasis* ; Positron-Emission Tomography ; Positron-Emission Tomography and Computed Tomography ; Skin ; Solar System ; Tuberculosis