In recent years, the Korean Medical Association has undertaken the feat of establishing the Korean Standard Terminology of Medical Procedures with the dedicated help of 32 medical academic societies. However, because the project is being conducted by several different circles, it has yet to see a clear system of classification. This thesis, therefore, proposes the three principles of scientific properties, usefulness and ideology as the basis for classification system and has developed the Classification System of Medical Procedures in Korea upon their foundation. The methodology and organization of this thesis as follows. First, by adopting scientific classification system of Feinstein(1988), an analysis of the classification systems of the medical procedures in the United States, Japan, Taiwan, Who Was carried out to reveal the framework and the basic principles in each system. Second, the direction of classification system has been constructed by applying the normative principle of medical field in order to show the future direction of the medical field and realize its ideology. Third, a finalized framework for the classification system will be presented as based on the direction of classification system. Of the three basis principles mentioned above, the analysis on the principles of usefulness was left out of this thesis due to the difficulty of establishing specific standards of analysis. The results of the study are as follows. The overall structure of the thesis is aimed at showing the 'Prevention-Therapy-Rehabilitation' quality of comprehensive health care and consists of six chapters; I. Prevention and Health Promotion. II. Evaluation and Management . III. Diagnostic Procedures. IV. Endoscopy. V. Therapeutic Procedures. VI. Rehabilitation. Chapter three Diagnostic Procedures is divided into four parts; Functional Diagnosis, Visual Diagnosis, Pathological Diagnosis, Biopsy and Sampling. Chapter five Therapeutic Procedures is divided into Psychiatry, Non-Invasive Therapy, Invasive Therapy, Anaesthesia and Radiation Oncology. Of these sub-divisions, Functional Diagnosis, Biopsy and Sampling, Endoscopy and Invasive Therapy employs the anatomical system of classification. On the other hand, Visual Diagnosis, Pathological Diagnosis, Anesthesia and Diagnostic Radiology, namely those divisions in which there is little or no overlapping in services with other divisions, used the classification system of its own division. The classification system introduced in this thesis can be further supplemented through the use of the cluster analysis by incorporating the advice and assistance of other specialists.
Anesthesia ; Biopsy ; Classification* ; Comprehensive Health Care ; Diagnosis ; Endoscopy ; Hand ; Health Promotion ; Japan ; Korea* ; Radiation Oncology ; Rehabilitation ; Specialization ; Taiwan ; United States

Meigs' syndrome is defined as a hydrothorax with ascites and a pelvic tumor, both of which resolve on removal of the tumor. Pseudo-Meigs' syndrome is a variant not possessing the original tumor cell types described by Meigs. Both these syndromes should be considered in otherwise healthy women who present with either new or recurrent hydrothorax and ascites. Pseudo-Meigs' syndrome occurs with the clinical triad of (1)ascites, (2)pleural effusion and (3)Brenner tumors, struma ovarii, benign thecomas, extreme ovarian edema, uterine leiomyomas or other benign pelvic tumors. A case of Pseudo-Meigs' syndrome associated with Brenner tumor is presented with a brief review of literatures.
Ascites ; Brenner Tumor ; Edema ; Female ; Humans ; Hydrothorax ; Leiomyoma ; Meigs Syndrome ; Struma Ovarii ; Thecoma

OBJECTIVE: To estimate the long-term skeletal responses to hormone replacement therapy(HRT) with or without active vitamin D(VD) by using short-term changes of bone markers in postmenopausal women (PMW). METHODS: Biochemical markers of bone formation(osteocalcin,OC) and (&) resorption(deoxypyridinoline, Dpd ) at 3 months & lumbar bone mineral density(BMD) at 1 year were measured in 64 natural PMW taking HRT(n=41) & HRT with calcitriol 0.25 microgram/day(n=23). The correlation of percent changes of bone markers after 3 months of Tx with those in lumbar BMD after 1 year was evaluated. RESULTS: 1. serum-OC & urine-Dpd showed decrease of 20.9% & 30.1% at 3months respectively & BMD increase of 3.8% after 1 year of Tx. 2. Among 58 PMW with decreased u-Dpd change, 49 (84.5%) revealed increase in BMD, while 40 (81.6%) among 49 PMW with decreased serum-OC change showed increased BMD. 3. Bone gainers showed significant decrease in changes of serum-OC(18.1% vs 9.2% p<0.05) & urine-Dpd(32.6% vs 20.4%, p<0.05) compared with those of bone losers. 4. No correlations of change of serum-OC (r=-0.174 p>0.05) & urine-Dpd (r=-0.091 p>0.05) at 3month with BMD changes at 1year were seen in total PMW, but urine-Dpd changes in HRT without active VD group revealed significantly inverse correlation(r=-0.376 p<0.05). CONCLUSION: Short-term changes of bone markers did not precisely predict the long-term changes of BMD in total PMW except urine- Dpd in HRT without active VD.
Biomarkers ; Bone Density* ; Calcitriol ; Estrogen Replacement Therapy* ; Female ; Humans ; Osteocalcin ; Vitamin D* ; Vitamins*

BACKGROUND: Video assisted thoracic sympathectomy or sympathicotomy is a safe and effective therapy for the treatment of palmar hyperhidrosis with immediate symptomatic imporvement. However the degree of satisfaction may diminish with time due to cmpensatory sweating or excessive hand dryness. Therefore by comparing and assessing the degree of symptomatic improvement or compensatory sweating following sympathectomy or sympathicotomy at various levels we aim to determine the optimal level of sympathetic nerve block which will result in minimal side effects and maximal benefit. MATERIAL AND METHOD: Among 194 patients having undergone video assisted thoracic sympathectomy or sympathicotomy between January 1996 and June 1999, 137 patients who responded to either telephone interview or questionnaire were included in the current study. The patients were divided into three groups. Group I(n=61) ; patients having undergone T2,3,4 sympathectomy group II(35) ; patients having undergone T2 sympathicotomy and group III(41) ; patients having undergone limited T2 sympathicotomy which consist of block of interganglionic neuronal fiber on the third rib. The parameters studied comprised of pre- and post-operative palmar temperature change treatment satisfaction the degree of compensatory sweating or discomfort from palmar dryness postoperative complication and changes in plantar sweating. RESULT: There was no difference in age and sex among the groups and the mean postoperative elevation in palmar temperature was 21.59degrees C without any differences among the groups. Patients expressing satisfaction were 65.6%, 62.9% and 90.24% in groups I, II and III, respectively(p<0.05) Moderate to severe compensatory sweating was present in 65.6% 51.4%, and 24.39%, in group I, II, and III, respectively (p<0.05) Slight but comfortable amount of palmar humidness was expressed in decreasing order group III(41.6%) group I(24.6%) and group II(5.7%) (p<0.05) Ineffectiveness or recurrence was present in 5patients in group I(8.2%) 1 patient in group II(2.9%) and none in group III. With regards to plantar sweating decrease in sweating was expressed in 43 patients(31.4%) while similar degree of sweating in 61 patients(44.5%) and increase in sweating in another 33 patinets(24.1%). CONCLUSION: Limited T2 sympathicotomy resection of the lower interganglionic neuronal fiber of the second sympathetic ganglion on the third rib showed immediate effect in palmar hyperhidrosis and caused lesser compensatory sweating and hand dryness.
Autonomic Nerve Block ; Ganglia, Sympathetic ; Hand ; Humans ; Hyperhidrosis* ; Interviews as Topic ; Neurons ; Postoperative Complications ; Surveys and Questionnaires ; Recurrence ; Ribs ; Sweat ; Sweating ; Sympathectomy

Marchiafava-Bignami Disease is a rare disorder characterized pathologically by demyelination of the corpus callosum. This disease could be related with chronic alcoholism although a proven etiology has not been reported. Marchiafava-Bignami Disease (MBD) could cause the fatal acute phase symptoms (seizure, coma, and death), various neurological symptoms (tremor, dysarthria, gait disturbance, apraxia), and cognitive impairments (memory impairment, disorientation). It is also reported that MBD causes a dementia. Approximately 250 cases have been reported regarding the MBD since it was first reported in 1903. However, only 20 cases have revealed a favorable prognosis. We found a case of MBD with personality change and chronic alcoholism subsequent to the repeated improvement and aggravation for 4 years. This case is demonstrated a atrophy of splenium of corpus callosum by Magnetic Resonance Imaging. The case also is diagnosed the personality changes, such as emotional irritability, impulsivity, and indignation-expose due to general medical condition, as described in Diagnostic and Statistic Manual of Mental Disorder 4th edition (DSM-IV). However, in early phase this diagnosis did not revealed. The patient was improved in impulse control and behavior by treatment with the Carbamazepine. We investigate the etiology, pathogenesis, symptom &sign, and treatment regarding the MBD in neuropsychiatric aspect.
Alcoholism ; Atrophy ; Carbamazepine ; Coma ; Corpus Callosum ; Dementia ; Demyelinating Diseases ; Diagnosis ; Dysarthria ; Gait ; Humans ; Impulsive Behavior ; Magnetic Resonance Imaging ; Marchiafava-Bignami Disease* ; Mental Disorders ; Prognosis

It has been demonstrated that the epidermal growth factor receptor(EGFR) gene, the normal human counterpart of the viral erb-B oncogene, is amplified and overexpressed in 40-50% of malignant astrocytomas. Although little is known about the functional status of the overexpressed protein molecule, overexpression of a growth factor receptor evenly distributed throughout a tumor would be an ideal target for monoclonal antibody or growth factor receptor targeted therapy. We undertook the immunohistochemical study of the EGFR with malignancy grade. The results were as follows 1) Expression of EGFR was deteced in 1 case(6.7%) of low grade astrocytoma, 14 cases(63.6%) of anaplastic astrocytoma and 19 cases(73.1%) of glioblastoma multiforme. It was more frequent in malignant astrocytoma that low grade astrocytoma(p<0.01). 2) The distributed proportion and staing density of EGFR-expressed tumor cells was more increased in glioblastoma multiforme than anaplastic astrocytoma. 3) Regional heterogeneity of EGFR-expressed tumor cells was recognized in cases of EGFR expressed malignant astrocytoma. These results suggest that overexpression of EGFR would be involved in malignant progression of astrocytoma, and the use of monoclonal antibody or growth factor receptor targeted therapy maybe limited due to heterogeneity of EGFR expressed tumor cells in malignant asrotcytoma.
Astrocytoma ; Epidermal Growth Factor* ; Glioblastoma ; Humans ; Oncogenes ; Population Characteristics ; Receptor, Epidermal Growth Factor*

A case is reported of downbeat nystagmus associated with compression of the root of vestibulocochlear nerve by vertebral arteries, which was revealed by magnetic resonance imaging. Chief complain of the patient was positional vertigo, which aggrevated at left decubitus position. Downbeat nystagmus was increased in left Dix-hall pike test. Tetsuo et al, reported downbeat nystagmus with compression of dolichoectatic vertebral arteries to the medulla oblongata and surgical neurovascular decompression of the dolichoectasia reverses the progression of symptoms if permanent neurologic damage has not already occurred.
Decompression ; Esocidae ; Humans ; Magnetic Resonance Imaging ; Medulla Oblongata ; Nystagmus, Pathologic ; Vertebral Artery* ; Vertebrobasilar Insufficiency ; Vertigo ; Vestibulocochlear Nerve*

Spinal epidural and subdural hematomas are uncommonly recognized conditions. These conditions can result in severe irreversible neurologic deficits, if left untreated. Like intracranial lesions, these hematomas can expand rapidly and cause sudden spinal cord and/or cauda equina compression. This case is very rare in which is a concurrence of cervical spinal epidural and subdural hematoma after motor vehicle accident without spine fracture. The pathophysiology of these entities are discussed and the radiologic diagnosis focused on MR findings are reviewed. The importance of prompt surgical treatment is emphasized to facilitate good postoperative outcome.
Cauda Equina ; Diagnosis ; Hematoma ; Hematoma, Epidural, Spinal ; Hematoma, Subdural* ; Hematoma, Subdural, Spinal ; Motor Vehicles ; Neurologic Manifestations ; Spinal Cord ; Spine*

PURPOSE: To evaluate the intrahepatic anatomy of the hepatic vein and right portal venous system, as seen on 3-D CTAP, and to assess the avascular zone between the anterior and posterior segments of the right lobe in relation to the right hepatic vein. MATERIALS AND METHODS: Fifteen patients in whom nodular hepatocellular was suspected underwent spiral C-TAP. 3-D images of the portal and hepatic vein were obtained using the maximal intensity projection technique. We examined the portal venous branching pattern and the draining pattern of the hepatic venous system to the inferior vena cava, as well as variation of the right hepatic vein and the avascular zone between the anterior and posterior segments of the right lobe. RESULTS: In 13 patients, three hepatic veins were clearly visualized, and in ten, the middle and left hepatic veins conjoined before draining to the IVC. In three patients, three hepatic veins drained separately into the IVC. Two right hepatic veins were seen in three patients. The right portal venous system was clearly visualized in 13 patients a classical branching pattern in 11, trifurcation in one, and four simultaneous branching patterns in one. Lateral projection showed that the angle of the avascular zone declined posteriorly by 26 degree - 64 degree ( 47.5 degree) in relation to the right hepatic vein. CONCLUSION: We observed the drainage pattern of the hepatic vein and variation of the right portal venous system on 3-D image, and confirmed that since the avascular zone declined posteriorly, the right hepatic vein is an inappropriate landmark for right hepatic segmentation.
Drainage ; Hepatic Veins ; Humans ; Imaging, Three-Dimensional ; Portography* ; Tomography, Spiral Computed* ; Vena Cava, Inferior

PURPOSE: To evaluate the intrahepatic anatomy of the hepatic vein and right portal venous system, as seen on 3-D CTAP, and to assess the avascular zone between the anterior and posterior segments of the right lobe in relation to the right hepatic vein. MATERIALS AND METHODS: Fifteen patients in whom nodular hepatocellular was suspected underwent spiral C-TAP. 3-D images of the portal and hepatic vein were obtained using the maximal intensity projection technique. We examined the portal venous branching pattern and the draining pattern of the hepatic venous system to the inferior vena cava, as well as variation of the right hepatic vein and the avascular zone between the anterior and posterior segments of the right lobe. RESULTS: In 13 patients, three hepatic veins were clearly visualized, and in ten, the middle and left hepatic veins conjoined before draining to the IVC. In three patients, three hepatic veins drained separately into the IVC. Two right hepatic veins were seen in three patients. The right portal venous system was clearly visualized in 13 patients a classical branching pattern in 11, trifurcation in one, and four simultaneous branching patterns in one. Lateral projection showed that the angle of the avascular zone declined posteriorly by 26 degree - 64 degree ( 47.5 degree) in relation to the right hepatic vein. CONCLUSION: We observed the drainage pattern of the hepatic vein and variation of the right portal venous system on 3-D image, and confirmed that since the avascular zone declined posteriorly, the right hepatic vein is an inappropriate landmark for right hepatic segmentation.
Drainage ; Hepatic Veins ; Humans ; Imaging, Three-Dimensional ; Portography* ; Tomography, Spiral Computed* ; Vena Cava, Inferior