OBJECTIVES: The purpose of this study was to investigate Korean dentists' perceived experience with and contents of education on National Health Insurance, and their competence in the practice of cases involving a health insurance claim. METHODS: A survey was conducted with 600 dentists who secured their dentist license during 2000-2004. A systemic stratified sampling, with "school graduated from" as a stratum, was conducted on a population of 3,947 dentists, using the register of the Korean Dental Association. A survey request and questionnaire sample was mailed, and responses were collected using a web-based replying method. The impact of the experience of education related to health insurance on the frequency of, and perceived competence on health insurance claims was analyzed using the chi-square test. RESULTS: Only 21% dentists replied that they had educational experiences related to health insurance when they were dental students, and the content of this education was 'health insurance system' (69%) and 'health insurance law' (59%). Only 28% of the respondents replied that they had practiced cases related to health insurance claims at dental schools. The rate of dentists who had educational experiences related to health insurance after their graduation was 73%. The experience of education related to health insurance and the perceived competency on handling health insurance claims showed a statistically significant correlation (P<0.01). CONCLUSIONS: It is necessary to develop a standardized curriculum related to health insurance and health insurance claims in dental schools.
Curriculum ; Surveys and Questionnaires ; Dentists* ; Education* ; Humans ; Insurance ; Insurance, Health ; Licensure* ; Mental Competency ; National Health Programs* ; Postal Service ; Schools, Dental ; Students, Dental

Extrahepatic metastasis of hepatocellular carcinoma (HCC) is occasionally seen in the lung, bone, adrenal gland, and lymph nodes. It is well known that HCC sometimes invades the biliary system. Since there is no peritoneum between the gallbladder and the liver fossa, a gallbladder cancer easily invades the liver; however, HCC seldom invades the gallbladder because it rarely destroys the muscle layer or the collagen fibers of the gallbladder wall. Routes of gallbladder metastasis of HCC include direct invasion, extension to the biliary system, and invasion of the adjacent hepatic vascular system. Some cases of gallbladder metastasis of HCC without direct invasion have been reported. We report here a case of HCC that directly invaded the gallbladder, and that resembled gallbladder carcinoma invading the liver.
Adult ; Carcinoma, Hepatocellular/*diagnosis/pathology/ultrasonography ; Diagnosis, Differential ; Gallbladder Neoplasms/diagnosis/*secondary ; Humans ; Liver Neoplasms/*diagnosis/pathology/ultrasonography ; Male ; Neoplasm Invasiveness ; Tomography, X-Ray Computed

Although skin metastasis from a malignant tumor of an internal organ usually occurs at an advanced disease stage, there has been no prior report of a cutaneous acral metastasis from ampullary carcinoma to date. We report a 71-year old male patient with cutaneous metastasis from an ampullary adenocarcinoma. The patient had a history of pylorus preserving pancreaticoduodenectomy for carcinoma of the ampulla of Vater two years prior to presentation. Physical examination revealed ill-defined, painful and hard erythematous nodules at the left thumb and distal phalanx of the right middle finger. The computed tomography scan showed low density masses in the retroperitoneum; the histological examination of a nodule from the right middle finger showed a metastatic adenocarcinoma. This case illustrates that cutaneous metastasis from ampullary carcinoma has a poor prognosis.
Skin Neoplasms/*secondary ; Prognosis ; Male ; Humans ; Fatal Outcome ; Common Bile Duct Neoplasms/*pathology ; Ampulla of Vater/*pathology ; Aged ; Adenocarcinoma/*pathology

BACKGROUND/AIMS: This study evaluated the prevalence and location of colonic adenomatous polyps in asymptomatic adults. METHODS: A total of 2,849 asymptomatic adults underwent colonscopic screening as a part of health evaluation from January 2003 to September 2005. Completed questionnaires as well as the colonoscopic and pathologic findings were analyzed. RESULTS: There were 406 (14.3%) subjects with adenomatous polyps including 78 (2.7%) with advanced polyps. There was a trend toward an increased prevalence of adenomatous polyps with age. The relative risk of a proximal polyp according to the distal findings was 5.7 (95% CI 4.3 ~ 7.4) for adenoma, 4.9 (95% CI 3.0 ~ 7.7) for advanced adenoma compared with that for no adenomatous polyp. There were no index polyps at the distal colon in 30% of the 406 subjects. CONCLUSIONS: Though distal polyps are associated with the proximal polyps, 30% of asymptomatic adults with proximal polyps are not associated with any distal index polyps. For those without any contraindication to the procedure, colonoscopy performed by experienced colonoscopists as a screening test is feasible for detecting those patients with colorectal polyps.
Adenoma ; Adenomatous Polyps ; Adult* ; Colon* ; Colonic Neoplasms* ; Colonoscopy* ; Humans ; Mass Screening* ; Polyps ; Prevalence ; Surveys and Questionnaires

Hemobilia is a status of bleeding into the biliary tract, which is caused by abnormal communication between the intrahepatic blood vessels and biliary tract, and is a rare cause of upper gastrointestinal hemorrhage. Most cases of the hemobilia originating in the gallbladder are related to gallstones. However, hemobilia is a rare complication of calculous cholecystitis. We report a case of hemobilia as a complication of calculous cholecystitis in a patient given continuous aspirin medication.
Aspirin ; Biliary Tract ; Blood Vessels ; Cholecystitis* ; Gallbladder ; Gallstones ; Gastrointestinal Hemorrhage ; Hemobilia* ; Hemorrhage ; Humans

Common metastaic sites of hepatocellular carcinoma include lung, peritoneum, adrenal gland and bone, but rarely, skin can be metastatic sites. Although hepatocellular carcinoma is the third commonest malignancy in Korea, cutaneous metastasis from hepatocellular carcinoma was rarely reported. Cutaneous metastasis from malignant neoplasm of the internal organ occur at the variable stage and the growth pattern of cutaneous lesions is nonspecific and various, so the differential diagnosis of skin lesions must be considered to other malignant condition. We report a case of cutaneous metastasis from recurrent hepatocellular carcinoma that was confirmed by skin biopsy with immunohistochemical stain.
Carcinoma, Hepatocellular/*diagnosis/*secondary ; Humans ; Liver Neoplasms/*diagnosis/pathology ; Male ; Middle Aged ; Neoplasm Recurrence, Local/*diagnosis/pathology ; Skin Neoplasms/pathology/*secondary ; Tomography, X-Ray Computed

BACKGROUND/AIMS: The prevalence of hepatitis delta virus (HDV) infection has been estimated as being approximately 5% among global HBsAg carriers. The anti-delta positive rate in Koreans had been reported as being 0.85% in 1985. While the prevalence of HBV has been decreased from nearly 10% to 5% during the past twenty years, there have been no more studies on the anti-delta prevalence in Koreans. The aim of this study was to estimate the anti-delta prevalence in Koreans and to study the clinical characteristics of anti-delta positive patients in a single center. METHODS: Serum anti-delta was measured in one hundred ninety four HBsAg-positive patients who were admitted to our hospital from February 2003 to August 2003. We checked the genotypes of the HBV in the anti-delta positive patients. The clinical features of the anti-delta positive patients were compared to those clinical features of the anti-delta negative patients from the aspect of age, gender, mode of transmission, the positivity of HBeAg and serum HBV DNA. RESULTS: Serum anti-delta was positive in seven patients among the 194 subjects, giving a 3.6% positive rate. Among these seven patients, six had hepatocellular carcinoma (HCC) and the other one had cholangiocarcinoma. All of the anti-delta positive patients had the C genotype of HBV. The anti-delta positive patients showed significantly suppressed HBV DNA replication compared to the anti-delta negative patients. CONCLUSIONS: In Koreans, anti-delta was positive mainly in HCC patients with an approximate prevalence of 4%, and this rate has not changed much for the past twenty years. HBV DNA replication was suppressed by HDV infection.
Adult ; Carcinoma, Hepatocellular/virology ; English Abstract ; Female ; Hepatitis Antibodies/analysis ; Hepatitis D/complications/*epidemiology/immunology ; Hepatitis Delta Virus/immunology ; Hepatitis delta Antigens/analysis ; Humans ; Korea/epidemiology ; Liver Neoplasms/virology ; Male ; Middle Aged ; Prevalence

Congenital hepatic fibrosis (CHF) is an autosomal recessive disease, presenting principally in children or young adults with portal hypertension, and infrequently associated with cholangitis. It is associated with renal malformation and Caroli's disease. The diagnosis of CHF is usually confirmed by its typical histological features. Cholangitis is a severe and frequently fatal complication. We report a 22-year-old man with congenital hepatic fibrosis who showed the cholangitis without radiological features of cystic dilatation or stone of intrahepatic ducts.
Acute Disease ; Adult ; Cholangitis/*complications/diagnosis ; Humans ; Liver Cirrhosis/*complications/*congenital/diagnosis ; Male

BACKGROUND/AIMS: Although the viral load is correlated with HBcAg, liver injury was not correlated to viral load in HBeAg positive patient. We aimed to study the inter-relationship of clinical parameters such as the level of HBV-DNA, the level of aminotransferase, intrahepatic expression of HBcAg and severity of histological liver damage in the young male chronic HBV carriers according to HBeAg status. METHODS: The study group included 85 young male patients (mean age: 19.8) with biopsy-proven chronic hepatitis B (HBeAg-positive group: n=60, HBeAg-negative group: n=25). RESUTLS: Serum levels of HBV-DNA and the expression of intrahepatic HBcAg in the HBeAg-positive group were significantly higher than in the HBeAg-negative (p<0.001), but fibrosis score was lower (p<0.01). Serum levels of HBV-DNA positively correlated with lobular activity, portal/periportal activity, biochemical activities in the HBeAg-negative group but negatively correlated in the HBeAg-positive group. There were no significant differences in histological activity according to the pattern of expression of intrahepatic HBcAg in both groups. The lobular activity correlated positively with biochemical activity in both groups, and portal/periportal activity correlated with biochemical activity only in the HBeAg-positive group. CONCLUSIONS: There are close correlations among liver injury, intrahepatic expression of HBcAg, and detectable HBV-DNA in the young male chronic HBV carriers with HBeAg-negativity, but in the HBeAg-positive group, the correlations are diversified.
Adolescent ; Adult ; DNA, Viral/*analysis ; English Abstract ; Hepatitis B Core Antigens/*analysis ; Hepatitis B virus/genetics/*isolation & purification ; Hepatitis B, Chronic/pathology/*virology ; Humans ; Liver/*pathology/virology ; Male ; Viral Load

BACKGROUND AND OBJECTIVES: Electrical dyssynchronicity (Dsyn) appears to be prognostic of survival in congestive heart failure (CHF). Recent study has shown some discrepancy between the electrical Dsyn and the Doppler tissue image (DTI) assessed mechanical Dsyn. The aim of our study was to evaluate the relationship between the QRS duration and DTI assessed Dsyn. SUBJCETS AND METHODS: One hundred and forty patients, with CHF and left ventricular ejection fractions < or =40%, were enrolled. DTI was performed on 5-basal and 5-mid segments to assess the time from the R-wave to the peak systolic velocity (RS time). A QRS duration >130 msec, standard deviation (SD) of the RS time >40 msec, or a difference in the maximal and minimal RS times (RS time-diff) >100 msec were indicators of'Dsyn'. RESULTS: The prevalence of myocardial Dsyn, by QRS duration, SD of the RS time and the RS time-diff were 19, 43 and 47%, respectively. The SD of the RS time (49.8+/-23.6 vs. 36.6+/-20.7, p<0.01) and the RS time-diff (139.2+/-63.2 vs. 98.0+/-54.3, p<0.01) were prolonged in the wide (>130 msec) compared with the narrow QRS group. There was also a weak positive correlation between the QRS duration and the SD of the RS time (R=0.34, p<0.001) and the RS time-diff (R=0.38, p<0.001). However, from a cross-tabulation analysis, more than one third of patients had a discrepancy between QRS duration and DTI assessed mechanical Dsyn. From a multivariate analysis, a major determinant of the SD of the RS time was the QRS duration. CONCLUSION: Although a major determinant of the DTI assessed Dsyn was the QRS duration, more than one-third of patients had a discrepancy between electrical and mechanical Dsyn. Therefore, not only the QRS duration, but the DTI assessed Dsyn, should be measured when considering cardiac resynchronization therapy.
Cardiac Resynchronization Therapy ; Diagnosis* ; Electrocardiography* ; Estrogens, Conjugated (USP)* ; Heart Failure* ; Humans ; Multivariate Analysis ; Prevalence ; Stroke Volume