OBJECTIVES: The aim of this study is to develop Treatment Guidelines for Alcohol Use Disorder-the Korean Addiction Treatment Guidelines-using the Adaptation method. METHODS AND PROCEDURES: As the Adaptation method of Guidelines, the ADAPTE Manual, which is developed by ADAPTE collaboration is applied. In Part 1 : preparatory work prior to the beginning of Adaptation is performed. In Part 2 : the core phase of the Adaptation in which we searched the guidelines and performed a systematic review of the literature. The two guidelines (of the AU and the UK) are selected by gone through the methodological quality and currency evaluation for guidelines. And, in order to choose the proper recommendations, the contents were evaluated with regard to the applicability and acceptability of guidelines to the domestic. Finally, in Part 3 : the adapted guideline is reviewed externally, with review and plan update. Therefore, in this way, the Korean Guidelines for Treatment of Alcohol Use Disorder, comprised of 55 recommendations, was developed. CONCLUSION: In this study, Korean Guidelines for Treatment of Alcohol Use Disorder were developed by application of the Adaptation method of ADAPTE. These are the first evidence-based Korean Guidelines for Treatment of Alcohol Use Disorder, which were modified and accepted in accordance with Korean circumstances within the range not damaging the validity of the treatment worth, and it is expected to contribute to improvement in quality and efficiency enhancement of Korean treatment of Alcohol Use Disorder.
Cooperative Behavior

OBJECTIVE: Our aim was to evaluate the changes in blood glucose control and lipid profiles after 2-months of smoking cessation in healthy males. METHODS: Smoking abstinence was evaluated through self-report and urine cotinine levels. 12 individuals who succeeded in quitting smoking were analyzed. Fasting values of glucose and insulin were used to estimate the beta-cell activity and insulin resistance was evaluated using the Homeostasis Model Assessment (HOMA) and Quantitative Insulin Sensitivity Check Index (QUICKI). RESULTS: The data showed that the subjects had a significant increase in weight, body mass index and fasting plasma glucose levels after smoking cessation. The HOMA-Insulin Resistance and the HOMA beta-cell function increased significantly (p=0.005, p=0.047 respectively). The QUICKI showed a significant decrease (p=0.005). In addition, the low-density lipoprotein cholesterol levels decreased significantly (p=0.028); however, changes in the high-density lipoprotein cholesterol, the triglyceride and total cholesterol levels were not significant (p=0.284, p=0.445 respectively). CONCLUSION: During the initial stage of smoking abstinence, insulin resistance increased and insulin sensitivity decreased due to elevated body weight and fat composition. Therefore, it is important to educate individuals that stop smoking about the necessity of weight control during smoking cessation programs.
Blood Glucose ; Body Weight ; Cholesterol ; Cotinine ; Fasting ; Glucose ; Homeostasis ; Humans ; Insulin ; Insulin Resistance ; Lipoproteins ; Male ; Plasma ; Smoke ; Smoking ; Smoking Cessation

BACKGROUND: Vibrio vulnificus is an estuarine bacterium which is capable of causing rapidly fatal infections in humans following either ingestion of raw seafoods or entry from seawater into wounds. Although V. vulnificus sepsis (called as Vibrio sepsis) has been well known in Korea since 1982 and was designated as a legal communicable disease (group III) since August 2000, many patients occurr annually. OBJECTIVE: We investigated the epidemiological features of Vibrio sepsis to offer basic data such as correlation among disease occurrence, seawater temperature, salinity and pH, amount of rainfall, incidence rate and consumed seafoods, in order to further prevent this disease. METHODS: We reviewed the epidemiologic data on monthly disease occurrence, history of raw seafood consumption and kinds of consumed seafoods in 141 patients with Vibrio sepsis obtained from 105 admitted patients in hospitals and 36 case reports published in the Korean medical journals between 1982 and 2004. Environmental data on seawater temperature, salinity and pH were obtained from the National Fisheries Research & Development Institute. The monthly amount of rainfall was obtained from the Korea Meteorological Administration. The yearly occurrence of Vibrio vulnificus regional areas was obtained from the Korea Center for Disease Control & Prevention. Population data were obtained from the Korea National Statistical Office. RESULTS: Patients began to develop in June when mean seawater temperature was over 18.9degrees C, and with a peak from July to September when seawater temperature was over 22degrees C. The majority of the patients were found in the southern and western coastal areas of Korea, especially, estuaries, where sea mud is abundant. Also disease occurrence was positively correlated with the amount of rainfall which can lower the salt concentration of seawater. Yearly occurrence of patients by regional area was the highest in the Jellanam-do during the 5 years since August 2000. The incidence rates per 100,000 population were highest in the Jellanam-do (0.69), lowest in the Jeju-do (0.01) and 0.10 in the whole areas. Seventy two percent of patients ingested 38 kinds of seafoods raw such as blue crab, goby, blood ark shell and many kinds of fishes and shellfishes. 9% of patients had not eaten seafood and 17% had either no records or unknown. 2% developed sepsis resulted from exposure of wounds to seawater. CONCLUSION: Vibrio sepsis develops in summer months with much rain and mostly in the estuaries. These results suggest that Vibrio vulnificus multiply well in the warm and in relatively low salt seawater. We think that weather, environmental and geographic factors are important for the outbreak of Vibrio sepsis.
Arcidae ; Brachyura ; Centers for Disease Control and Prevention (U.S.) ; Communicable Diseases ; Eating ; Epidemiologic Studies ; Estuaries ; Fisheries ; Fishes ; Geography ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Korea ; Rain ; Salinity ; Seafood ; Seawater ; Sepsis ; Shellfish ; Vibrio ; Vibrio vulnificus ; Weather

Mesenteric panniculitis is an extremely rare inflammatory condition of the adipose tissue of unknown etiology. It is characterized by extensive, progressive fibrosis of the mesenteric fat tissue, leading to tumor formation. Clinical manifestations vary according to the process involving the structures. Abdominal pain accompanied by nausea, malaise, pyrexia, and weight loss and a poorly defined mass are common presentations. Major pathologic changes include (1) degeneration of mesenteric fat, (2) an inflammatory reaction, and (3) fibrosis of the adipose tissue. We present four patients with an aggressive form of mesenteric pannicultis with characteristic histopathologic features. We discuss the relationship between the histopathologic features and the surgical intervention in these cases.
Abdominal Pain ; Adipose Tissue ; Fever ; Fibrosis ; Humans ; Nausea ; Panniculitis, Peritoneal* ; Weight Loss

Chronic exogenous steroid therapy can result in hypothalamic-pituitary-adrenal axis dysfunction; this usually results from systemic steroid therapy, and is rarely associated with topical steroid therapy. We report a case of suspected iatrogenic Cushing syndrome that developed after the treatment of annular pustular psoriasis. The patient applied clobetasol-17-propionate cream (Betabate(R)) 15~30 g daily, for 4 months, without a dermatologist's prescription. After 4 months of application, the following symptoms developed; a moon face; facial flushing; hypertrichosis; central obesity; purple striae; and multiple erythematous scaly annular patches. The development of Cushing syndrome from exogenous corticosteroid treatment was supported by the typical clinical manifestations and the low basal state of the blood cortisol level, which was perhaps due to secondary suppression of the hypothalamic pituitary-adrenal axis. Steroid-containing drugs, especially during childhood, should be used with caution and monitored carefully.
Axis, Cervical Vertebra ; Cushing Syndrome* ; Flushing ; Humans ; Hydrocortisone ; Hypertrichosis ; Obesity, Abdominal ; Prescriptions ; Psoriasis

Vitiligo and morphea are two distinct entities of unknown etiology, although their existence implies that the immune system and/or the central or peripheral nervous system has been incriminated. Only a few reports of their simultaneous occurrence are on record. Here we report a case of a 39 year old woman affected with both vitiligo of the face, chest and hand and morphea of shoulder and trunk. Since the two diseases appeared after bone marrow transplantation, if could be deduced that there is a possible association between them. Two diseases observed simultaneously in this patient may be derived from the common pathomechanism. An autoimmune etiology is thought to play a part in both of these diseases.
Adult ; Bone Marrow Transplantation* ; Bone Marrow* ; Female ; Hand ; Humans ; Immune System ; Peripheral Nervous System ; Scleroderma, Localized ; Shoulder ; Thorax ; Vitiligo

Chrome may have a corrosive, necrotizing effect on tissue, so repeated skin contact to chromate might induce perforations or ulcers on the skin. This condition is called a "chrome ulcer" or "chrome hole". It appears as a small, punched-out mark with a rolled-out border. It is rarely associated with pain, but a severe itching sensation is common. We report a case of a 33-year-old man who presented with a 3 month history of several ulcers on his abdomen. He was employed at a chromate alloying process. He had several hole-like atrophic scars and unbearable pruritus. After changing his occupation, plus treatment with oral corticosteroids and antihistamines, the lesions were healed and the itching sensation faded away. However, atrophic scarring remained.
Abdomen ; Adrenal Cortex Hormones ; Adult ; Cicatrix ; Histamine Antagonists ; Humans ; Occupations ; Pruritus ; Sensation ; Skin ; Ulcer*

Skin metastasis from internal malignancy is relatively rare. Skin metastasis from biliary tract cancer is known to be extremely uncommon (around 0.4~0.7%). In most cases, biliary tract cancer metastasizes into neighboring organs or other internal organs, but rarely into the skin. The authors have experienced a case of skin metastasis into a finger of a patient with carcinoma of Ampulla of Vater. This is thought to be the first case reported in Korea.
Ampulla of Vater* ; Biliary Tract Neoplasms ; Fingers* ; Humans ; Korea ; Neoplasm Metastasis ; Skin

PURPOSE: We conducted this study to assess the effect of oral application of bovine colostrum on the plasma endotoxin and TNF-alpha following the abdominal surgery. METHODS: 46 patients who underwent the abdominal surgery were evenly enrolled in a prospective, randomized, double blind and placebo-controlled study. The patients were preoperatively managed by oral application of 20 g of a bovine colostrums or placebo (nonfat dried milk) per a day for 3 days. In both groups, endotoxin was sequentially determined pre-, intra- and postoperatively by a modified limulus amebocyte lysate test. TNF-alpha and CRP were also measured. The clinical course was followed and compared in both groups. RESULTS: The colostrum group showed significantly lower level of endotoxin and TNF-alpha compared to the placebo group. CRP did not differ in both groups. Clinical event did not occur in both group until the discharge. Colostrum group tends to have a lower incidence of fever and leukocytosis without statistic significance. CONCLUSION: Prophylactic preoperative oral application of bovine colostrum lower the plasma level of perioperative endotoxin and TNF-alpha. Further studies were needed for the relation of clinical effect and preoperative oral application of bovine colostrum.
Colostrum* ; Endotoxemia* ; Fever ; Horseshoe Crabs ; Humans ; Incidence ; Leukocytosis ; Plasma ; Prospective Studies ; Tumor Necrosis Factor-alpha*

A neonate was dead 2 days after birth. He seemed to be healthy at birth. In autopsy we revealed severe aortic valve hypoplasia, hypoplasia of the ascending aorta, stenosis of the mitral valve and hypoplasia of the left ventricle. Multiple obstructions in the left heart-aorta complex have been associated with poor survival. We diagnosed this case as hypoplastic left heart syndrome(HLHS). Prenatal diagnosis using echocardiography can identify the fetus that has complex congenital heart disease and may improve early management and surgical outcome such as HLHS. Though HLHS can be frequently diagnosed prenatally, this has not been shown to improve surgical outcome. In forensic medicine field, we propose clinicians to use prenatal diagnostic instrument such as echocardiography to detect HLHS and the forensic pathologists should know HLHS as a primary cause of death of neonate who had normal appearances at birth. Here we report a case of HLHS and review articles.
Aorta ; Aortic Valve ; Autopsy ; Cause of Death ; Constriction, Pathologic ; Echocardiography ; Fetus ; Forensic Medicine ; Heart ; Heart Defects, Congenital ; Heart Ventricles ; Humans ; Hypoplastic Left Heart Syndrome* ; Infant, Newborn ; Mitral Valve ; Parturition ; Prenatal Diagnosis