The purpose of this study is to analyze degree of geographic maldistribution of physicians and changes in the distributional pattern in Korea over the years 1980-1985. In assessing the degree of distribution and in identifying changes in the distribution pattern, the Gini index of concentration was used. The geographical units selected for computation of the Gini index in this analysis are districts (Gu), cities (Si), and counties (Gun). Locational data for 1980 and 1985 were obtained from the population census data in the Economic Planning Board and regular reports of physicians in the Korean Medical Association. The rates of physician located countries to whole physicians were 10.4% in 1980 and 9.6% in 1985. In term of the ratio of physicians per 100,000 population, rural area had 9.18 physicians in 1980 and 12.95 in 1985, 7.13 general practitioner in 1980 and 7.29 in 1985, and 2.05 specialists in 1980 and 5.66 in 1985. Only specialists of general surgery and preventive medicine were distributed over 10% in county and distribution of every specialists except chest surgery in county increased in 1985, comparing with that rates of 1980. The Gini index computed to measure inequality of physician distribution in 1985 indicate as follows; physicians 0.3466, general practitioners 0.5479, and specialists 0.5092. But the Gini index for physicians and specialists fell -15.40% and -10.42% from 1980 to 1985, indication more even distribution. The changes in the Gini index over the period for specialists from 0.3639 to 0.4542 for districts, from 0.2510 to 0.1949 for cities, and 0.5303 for countries indicate distributional change of 24.81%, -22.35%, and 10.65% respectively. The Gini indices for specialists of neuro-surgery, chest surgery, plastic surgery, ophthalmology, tuberculosis, preventive medicine, and anatomical pathology in 1985 were higher than Gini indices in 1980.
Censuses ; General Practitioners ; Humans ; Korea ; Ophthalmology ; Pathology ; Preventive Medicine ; Rural Population ; Socioeconomic Factors ; Specialization ; Surgery, Plastic ; Thorax ; Tuberculosis

Adrenal cortical carcinoma is a rare disease both in adults and in children. Most of these tumors are functional, especially in children, producing endocrine syndromes such as virilization, Cushing syndrome, hyperaldosteronism or feminization. We experienced a case of adrenal cortical carcinoma in a 7yr old boy who showed features of virilization such as rapid growth rate, penile enlargement, and pubic hair. This case was diagnosed with typical hormonal findings and abdominal MRI and confirmed by pathologic findings. He was successfully treated by total left adrenalectomy and has been followed up without problem over eight months.
Adrenalectomy ; Adrenocortical Carcinoma* ; Adult ; Child ; Cushing Syndrome ; Feminization ; Hair ; Humans ; Hyperaldosteronism ; Magnetic Resonance Imaging ; Male ; Rare Diseases ; Virilism

No abstract available.
Ectoderm* ; Ectodermal Dysplasia*

No abstract available.
DiGeorge Syndrome*

Iatrogenic Cushings syndrome is caused by administration of systemic steroids for some disorders, and is clinically characterized by truncal obesity, hypertension, fatigability, amenorrhea, hirsutism, abdominal striae, edema, glucosuria and osteoporosis. We report herein a case of iatrogenic Cushings syndrome in the treatment of atopic dermatitis. The patient, a 32-year-old male, had been diagnosed with atopic dermatitis and was intermittently treated with topical and systemic steroids for 12 years. He revealed facial edema, truncal obesity and striae distensae in both the axilla and abdomen. Steroids are one of the important agents in the treatment of atopic dermatitis but care must be taken in their administration.
Abdomen ; Adult ; Amenorrhea ; Axilla ; Cushing Syndrome* ; Dermatitis, Atopic* ; Edema ; Female ; Hirsutism ; Humans ; Hypertension ; Male ; Obesity ; Osteoporosis ; Steroids ; Striae Distensae

We observed a 55-year-old man who had granuloma pyogenicum on the medial border of the right fifth toe which developed after scratching of the wound. Histopathological findings showed many newly formed capillaries that had prominant endothelial cells and showed varying degrees of dilation without appearance of epidermal collarette signs. We tried intralesional treatment with triamcinolone acetonide (10mg%, 1/week*3). After 3 sessions of treatment, the lesion dramatically regressed nearly to normal size.
Capillaries ; Endothelial Cells ; Granuloma* ; Granuloma, Pyogenic* ; Humans ; Middle Aged ; Toes ; Triamcinolone Acetonide* ; Triamcinolone* ; Wounds and Injuries

No abstract available.
Diaphragm* ; Stomach Volvulus*

Intermittent positive pressure ventilation is used as a respiratory support for acute respiratroy failure. Adult respiratory distress syndrome(ARDS) revealed mortality rate of 70% as yet. Hypoxemia is foremost problem in ARDS. Though various ventilatory support is tried on ARDS, extracorporeal membrane oxygenation(ECMO) is to be recommended when hypoxemia and hypercarbia are refractory to conventional treatments. Neonatal venoarterial (VA) ECMO in USA is recognized as a therapeutic modality for neonatal respiratory failure and extracorporeal carhon dioxide removal(ECCO2R) in Europe is used for adult respiratory distress syndome. The partial bypass using the membrane oxygenator aims at lung rest while relieving the hard ventilatory setting on the diseased lung. VA ECMO can provide circulatory support as well but the right internal jugular vein and the right common carotid artery are ligated for the cannulation of draiaage and perfusion catheters. Recent follow up study shows that VA ECMO may not be completely free from neurologic complications such as embolism in the systemic circulation and ill effects due to the reduction of blood supply to the immature lungs. ECCO2R adopts low-flow venovenous(VV) bypass. It has been reported to be valuable for treatment of neonatal respiratory failure. VV bypass provides gas exchange but no cardiac support. Venous drainage and perfusion catheters are placed in the right atrium or vena cavae via the femoral or internal jugular veins. Compared to VA bypass, the consequences of embolizations are potentially fewer, no major artery is sacrificed. Highly oxygenated blood flows into pulmonary eirculatiom which may relieve pulmonary artery hypertension. Total respiratory support may be obtained by VV bypass, VV bypass requires approximately 20-50% more flow for total respiratory sopport due to recirculation of oxygenated blood. Recently VV bypass is chosen for neonatal resyiratoty failure in USA. They alliveate the entry criteria for ECMO using the parameter of oxygenation index(OI). VV ECCO2R using to-and-fro system is tried also for neonatal respiratory failure in Europe. A double lumen tube was developed to reduce the number of veins to be cannulated during VV bypass. It is constructed with the outer drainage cannula( 14 Fr.) and the inner perfusion cannula( 8 Fr.) whose opening is placed on the left side of outer cannula. If perfusion opening is placed on the right atrium facing the right ventricle, the venous blood can be drained from both superior and inferior vena cavae through several drainage opening. To evaluate the effectiveness of ECCO2R with a double lumen tube, we developed an experimental model of acute respiratory failure on 8 mongrel dogs. Under general anesthesia with i.v, pentobarbital, a double lumen tube was introduced via the right internal jugular vein and it was connected with the extracorporeal circuit. Without ventilating the oxygenator during VV bypass, respiratory failure was induced by hypoventilation. After obtaining control hemodynamic and blood gas values under hypoventilation, we proceed to apneic oxygenation(AO), extracorporeal CO2 removal(ECCO2R) and controlled mechanical ventilation(CMV) in that order. Arterial pH in control was 7.180.09(meanSD), and it was increased to 7.33+/-0.08 and 7.28+/-0.08 in ECCO2R and CMV, respectively. PaCO2 in control was 69+/-9mmHg and it was decreased to 41+/-4mmHg and 47+/-7mmHg in ECCO R and CMV respectively. PaCO2 in control was 62+/-15 mmHg and it was increased in AO, ECCO2R and CMV. Mixed venous blood gas analysis showed the same result as arterial blood gas analysis. There was no difference between ECCO2R and CMV. The bypass flow enough to remove CO2 was 30-50% of cardiac output. It is concluded that ECCO2R using a double lumen tube was effective to control the carbon dioxide tension in arterial blood, and a double lumen tube may permit the simplicity of an operation and patient care as well as minimizing the bleeding during extracorporeal respiratory support.
Adult ; Anesthesia, General ; Animals ; Anoxia ; Arteries ; Blood Gas Analysis ; Carbon Dioxide* ; Carbon* ; Cardiac Output ; Carotid Artery, Common ; Catheterization ; Catheters ; Dogs ; Drainage ; Embolism ; Europe ; Extracorporeal Membrane Oxygenation ; Heart Atria ; Heart Ventricles ; Hemodynamics ; Hemorrhage ; Humans ; Hydrogen-Ion Concentration ; Hypertension ; Hypoventilation ; Intermittent Positive-Pressure Ventilation ; Jugular Veins ; Lung ; Membranes ; Models, Theoretical ; Mortality ; Oxygen ; Oxygenators ; Oxygenators, Membrane ; Patient Care ; Pentobarbital ; Perfusion ; Pulmonary Artery ; Respiratory Insufficiency ; Veins ; Vena Cava, Inferior

No abstract available.
Nipples*

PURPOSE: Thymidylate synthase (TS) is the target enzyme for 5-fluorouracil (5-FU). It is known that TS is related to response, and resistance, following chemotherapy due to colorectal cancer. The object of this study was to identify the clinical significance of TS as a prognostic factor, and its influence on 5-FU based chemotherapy in colorectal cancer. METHODS: We performed a retrospective study on 105 consecutive patients who were operated on, at the Department of Surgery, Korea University, College of Medicine, for colorectal cancer between Jan. 1994 and Dec. 1995. We used formalin fixed, paraffin embedded tissues of resected specimens for our study. For the semi-quantitative study, the specific monoclonal antibody, TS106, was used for immunohistochemical staining. Interpretation of the immunohistochemical staining, for intratumoral TS expression, was divided into 4 grades: intensity 0, 1 , 2 , 3 were defined as, a total absence of TS immuno staining, less than 25%, 25~50% and more than 50%, of tumor staining positive, respectively. Grades 0, 1 , and 2 were regarded as low TS expression groups and 3 regarded as a high TS expression group. We then analyzed 5-year survival rates, according to Dukes' stage, and whether systemic chemotherapy was performed, or not, according to TS expression. RESULTS: Of the 105 patients, 91 (86.7%) showed TS expression, 21 (20%) with high TS expression and 84 (80%) were low TS expression. As Dukes' stage advanced, the incidence of high expression of TS increased (P=0.048). In Dukes' stage B2, 5-year survival rates for the low TS expressed group was better than for the high TS expressed group (P=0.0052). In patients who received postoperative chemotherapy, 5-year survival rates for the low TS expressed group were better than for the high TS expressed group (P=0.049). CONCLUSION: These data suggest the expression of intratumoral TS, studied by immunohistochemical staining, is relevant to the prognosis of colorectal cancer, especially Dukes' stage B2. It is also related to the response rate of 5-FU based systemic chemotherapy in colorectal cancer.
Colorectal Neoplasms* ; Drug Therapy ; Fluorouracil ; Formaldehyde ; Humans ; Incidence ; Korea ; Paraffin ; Prognosis ; Retrospective Studies ; Survival Rate ; Thymidylate Synthase*