BACKGROUND: Recently preventive clinical care has been proved important to the health. A number of recommendations or programs for preventive health services have been developed. The government made laws for health promotion of the people and for medical check-up for the insured in the district medical insurance association, who had been alienated from reimbursement for periodic health examination. As a result, above 95% of Korean people could took the periodic health check-up by this legislation. According to the national data, however, about 20% of the insured participated in the health screening program which was carried for the first time by the district medical insurance association in 1995. The reason that the compliance of health screening program was much lower than expected has not been clear yet. The purpose of this study is to define the facors affecting on the compliance of the health screening program. METHODS: Two hundreds of compliers and as many non-compliers of the health screening program was selected by the stratified sampling in one district medical insurance association which consisted of one town and eight township within the National Capital region. The telephone survey was performed from June 1 to 15 in 1996. The questionnaire was framed by health belief model with other demographic data. The data was analyzed by chisquare test, wilcoxon rank sums test, and logistic regression for the comparison of the characteristics between compliers and non-compliers. RESULTS: There was no difference of demographic data and medical history of chronic disease between compliers and non-compliers. 73.3% of the subjects knew they had been the expectant examinee of the health examination, and among them, 68% took the health examination. However, 53% of non-compliers did not know that they had been the expectant examinee. The most common reason that non-compliers didnt took the health examination was they didnt know(43.5%). Among 73 families of compliers which had more than 2 expectant examinees of the health screening program, 44 families(60.3%) had more complier other than study subjects. In contrast, among 74 families of non-compliers, only 7 famiies(9.5%) had more complier other than study subjects. Compliers showed lower reliability of the health screening program than non-compliers. Non-compliers had more perception about the severity of the target disease for the examination and had more confidence about self health status than compliers. There was no difference of the answer about the benefit of the health examination, perceived susceptibility about target disease, cue to action, and perceived barriers. The odds ratio of compliance of other family member was 21.2, perceived severity, 0.70, and cue to action, 1.36. CONCLUSIONS: The main reason of low compliance of health screening program for the insured in the district mecical insurance association was lack of public information. By the fact that non-compliers had more perception about the severity of the target disease and there was no difference of perceived benefit of the health examination between two groups, public information should be focused on the benefit and efficacy of periodic health check-up than severity and susceptibility of target disease. Because the health screening program on study subjects was carried for the firt time, only compliers had experience of the examination. The fact that compliers relied on the examination less than noncompliers meant that the examinees was satisfied much less than expected. Therefore, further study of the expectation of the examinees about the health examination is expected.
Chronic Disease ; Compliance* ; Cues ; Emigrants and Immigrants ; Health Promotion ; Humans ; Insurance* ; Jurisprudence ; Logistic Models ; Mass Screening* ; Odds Ratio ; Preventive Health Services ; Telephone ; Surveys and Questionnaires

We retrospectively reviewed the MRI findings of 100 temporomandibular joints in 78 patients who had complained temporomandibular joint dysfunction. MRI findings were classified according to Wilke's staging criteria. And these findings were compared with arthrographic findings in 22 joints and surgical findings in 44 joints. According to Wilkes's staging. They were classified into 6 stages of abnormality: stage 0 (33 cases), stage I (19 cases), stage II (10 cases), stage III (18 cases), stage IV (6cases), stage V (14 cases). Among the 22 cases in which arthrography and MRI were done, both studies were well correlated in 10 joints. In 7 joints, MRI was superior to arthrography, which correctly demonstrated the meniscal displacement in 2 joints and . Meniscal deformity in 5 joints. In 5 joints, arthrography was superior to MR, which demonstrated the perforation (1 joint), adhesion (2 joint) and recapture of meniscus (2 joints). Compared with surgical findings, MRI correctly demonstrated the displacement of meniscus in all 44 joints. However, in case of the 10 meniscal perforation, MRI demonstrated the meniscal discontinuity in only 4 joints. Retrospective MR findings in 10 proven cases were the defect in posterior attachment in 4, far anterior meniscal displacement without recapture in 8m condylar spur in 4, and close bone to bone contact in 1. In conclusion, MRI as a primary Fiagnostic modality of temporomandibular joint derangment, is superior for the grading of displacement and deformity of meniscus but inferior for the evaluation of perforation, adhesion and recapture of meniscus to conventional arthrography. In case of the suspected meniscal perforation, arthrographic correlation is recommanded preoperatively.
Arthrography ; Congenital Abnormalities ; Humans ; Joints ; Magnetic Resonance Imaging* ; Retrospective Studies ; Temporomandibular Joint*

The Ehlers-Danlos syndromes(EDS) are a heterogenous group of inherited connective tissue disorders characterized clinically by skin fragility, skin hyperextensibility, joint hypermobility, and excessive bruising. At least 11 different subtypes of EDS have been classified based on genetic, biochemical, and clinical characteristics. We report a 25-year-old man with EDS type II who presented mild extensibility of skin and joint, skin fragility, and "cigarette paper" like atrophic scar. The EDS type II is more common than other different subtypes. While it may present with subtle clinical features, recognition is important so that good advice can be given to reduce the risks associated with certain careers and sports and to prevent the potential complications of pregnancy and surgery.
Adult ; Cicatrix ; Connective Tissue ; Ehlers-Danlos Syndrome ; Humans ; Joint Instability ; Joints ; Molecular Biology ; Pregnancy ; Skin ; Sports

OBJECTIVE: To evaluate the risk factors for postoperative urinary retention in women who underwent vaginal hysterectomy for symptomatic pelvic organ prolapse. METHODS: The medical records of 221 women who underwent vaginal hysterectomy with anterior and posterior colporrhapy were reviewed. Urinary retention after catheter removal was defined as the presence of at least one of the following three conditions: 1) failure of first voiding trial necessitating catheterization, 2) first residual urine volume after self-voiding ≥150 mL, and 3) Foley catheter re-insertion. RESULTS: Urinary retention occurred in 60 women (27.1%). Multivariate and receiver operating characteristic curve analysis revealed that age (>63 years) and early postoperative day of catheter removal (day 1) was independent predictor for postoperative urinary retention. The incidence of urinary retention was significantly higher in women who removed indwelling catheter at day 1 (35.2%) than those at day 2 (12.0%, P=0.024), or day 3 (21.3%, P=0.044), but was similar to those at day 4 (25.0%, P=0.420). In women ≤63 years, urinary retention rate was not associated with the time of catheter removal after surgery; however, in women >63 years, the rate was significantly higher in day 1 removal group than day 2 to 4 removal group. CONCLUSION: Age and postoperative day of catheter removal appear to be associated with postoperative urinary retention in women undergoing vaginal hysterectomy for pelvic organ prolapse. Keeping urinary catheter in situ at least for one day after vaginal prolapse surgery could be recommended, especially, in women older than 63 years.
Catheterization ; Catheters ; Catheters, Indwelling ; Female ; Humans ; Hysterectomy, Vaginal* ; Incidence ; Medical Records ; Pelvic Organ Prolapse* ; Postoperative Period ; Risk Factors* ; ROC Curve ; Urinary Catheterization ; Urinary Catheters ; Urinary Retention* ; Uterine Prolapse

Localized primary cutaneous amyloidosis consists of three types: nodular, macular, and lichenoid amyloidosis. Lichen amyloidosis is characterized by the appearance of paroxysmally itchy lichenoid papules on the shins. Although the origin of the amyloid is controversial and can not provide any definite answer, some of amyloid substances can be derived from epidermal cells and others from degenerative collagen fibers. We suggested the origin of amyloid in our cases as epidermal keratinocyte and collagen degenerations. Because degeneration of basal keratinocyte is observed on electron microscopy and degeneration of collagen is in H&E and Masson's trichrome stain although amyloid materials are negatively stained against pankeratin antibody and collagen antibody. The skin lesion was improved after triamcinolone intralesional injections which reduce collagen synthesis. We report two cases of lichen amyloidosis which stained negatively for antikeratin antibodies and improved with triamcinolone intralesional injection.
Amyloid ; Amyloidosis* ; Antibodies* ; Collagen ; Injections, Intralesional ; Keratinocytes ; Lichens* ; Microscopy, Electron ; Skin ; Triamcinolone

BACKGROUND: E-cadherin is the prime mediator of cell-cell adhesion in epithelial cells and the beta-catenin is the associated protein with E-cadherin in the formation of adhesion complexes in normal and tumor cells related with tumor spread. The present study aimed to find the distribution of E-cadherin and beta-catenin in fetal skin during development. OBJECTIVE: The purpose of this study was to observe the distribution of above two adhesion related proteins in the fetal skin during development, to find its relationship by expression and their distribution patterns. METHODS: Skin was obtained from the scalp, chest, and sole of 21 human fetuses, ranging from 13 to 37 weeks of gestational age. Immunohistochemical staining was performed by avidin biotin peroxidase complex method on paraffin embedded tissue using anti-human monoclonal antibody against the human E-cadherin and beta-catenin. RESULTS: E-cadherin and beta-catenin were expressed in cell membrane of intermediate cell layer of epidermis at 13th week followed by increased basal cell expression at 15th week and adult pattern in 24th week of gestation. Both showed similar distribution pattern in skin. Difference was that E-cadherin was expressed only in cell membrane, but beta-catenin was expressed in both cell membrane and cytoplasm, stronger in cell membrane. beta-catenin also expressed in mesenchymal tissue. In the skin adnexae, E-cadherin and beta-catenin were also expressed very similar distribution pattern both in hair follicular development and eccrine duct epithelium. CONCLUSION: Both E-caherin and beta-catenin showed the same expression in the fetal stage and distribution pattern suggesting that both adhesion molecules are highly related each other in function and development of epidermis and adnexae of the skin in fetal stage, though their expression are not noted in all epithelial cells.
Adult ; Avidin ; beta Catenin ; Biotin ; Cadherins* ; Cell Membrane ; Cytoplasm ; Epidermis ; Epithelial Cells ; Epithelium ; Fetus ; Gestational Age ; Hair ; Humans ; Paraffin ; Peroxidase ; Pregnancy ; Scalp ; Skin* ; Thorax

PURPOSE: Radiocontrast media are widely used in medical imaging to improve diagnostic accuracy. However, studies on the adverse reactions of radiocontrast media in children are limited. We aimed to describe the characteristics of adverse reactions to radiocontrast media among children who had a computed tomography scan or magnetic resonance imaging in a tertiary university hospital. METHODS: We retrospectively collected data on adverse reactions to radiocontrast media by the reporting system of a tertiary university hospital. We selected data from children under the age of 19 from July 2011 to December 2017 and analyzed their characteristics. We focused mainly on the characteristics of the index case which is defined by the first adverse event of each subject. RESULTS: During the period, a total of 88,050 radiocontrast media-enhanced imaging studies were performed and 184 cases of adverse reactions were reported. A total of 71 were identified as index cases. Forty-nine (69.0%) were male and the mean age was 12.7±3.2 years. The incidence of radiocontrast media-related adverse reactions was 0.09% and severe reactions were 0.002%. The most common clinical feature was skin manifestations (54.9%), followed by gastrointestinal symptoms (40.8%) and neuropsychiatric symptoms (7.4%). CONCLUSION: Adverse reactions to radiocontrast media rarely occur in children and the incidence of severe reactions is low. Most reactions are mild and are related to the skin and gastrointestinal system. This report would provide good evidence for establishing a management strategy in children scheduled for imaging studies using radiocontrast media.
Child* ; Contrast Media* ; Diagnostic Imaging ; Humans ; Incidence ; Magnetic Resonance Imaging ; Male ; Retrospective Studies ; Skin ; Skin Manifestations

PURPOSE: Although severe cutaneous adverse drug reactions (SCARs) are rare, they are associated with high morbidity and mortality, and thus early diagnosis and treatment are critical for improving prognoses. However, few studies have reported the characteristics of SCARs in children. Thus, we aimed to evaluate the clinical characteristics, current management and prognosis of pediatric SCARs. METHODS: We analyzed pediatric data in the Korean SCARs registry, which was built retrospectively in 2016 with SCAR cases treated in 34 tertiary referral university hospitals during 2010–2015. Using these cases, we descriptively analyzed detailed data regarding etiology, clinical and laboratory features, treatment strategies, and prognosis. RESULTS: Forty-seven pediatric SCAR cases from 15 tertiary referral hospitals were included. The median patient age was 10 (interquartile range, 3-15.5) years and 68.1% (n = 32) were males. The culprit drug was identified in 95.7% (n = 45) of the patients; antibiotics (44.7%) and antiepileptic drugs (19.1%) were the most common and second most common culprits, respectively. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) cases presented with the largest area of skin involvement without permanent sequelae. Stevens-Johnson syndrome (SJS) cases involved relatively small areas of skin but serious sequelae in two children. Of 4 patients with toxic epidermal necrolysis (TEN), 1 died. Of all patients assessed, 36 (76.6%) received systemic steroids and 21 (44.7%) received intravenous immunoglobulin (IVIG). Thirteen (27.7%) received both systemic steroids and IVIG. Cyclosporine was administered to only 1 patient along with a systemic steroid. CONCLUSIONS: In patients with pediatric SCARs, including those with DRESS, SJS and TEN, clinical presentations were variable. Thus, there was no clear continuous disease spectrum. Although the mortality rate was low (2.1%), clinical suspicion may be the best tool for proactive SCAR management.
Anti-Bacterial Agents ; Anticonvulsants ; Child ; Cicatrix ; Cyclosporine ; Drug Eruptions ; Drug Hypersensitivity Syndrome ; Drug-Related Side Effects and Adverse Reactions ; Early Diagnosis ; Hospitals, University ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Korea ; Male ; Mortality ; Prognosis ; Referral and Consultation ; Retrospective Studies ; Skin ; Steroids ; Stevens-Johnson Syndrome ; Tertiary Care Centers

OBJECTIVE: Human papillomavirus (HPV) test was incorporated into the triage of lesser abnormal cervical cytologies: atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion (LSIL). This study aimed to evaluate the impact of age on the efficacy of HPV testing in patients with lesser abnormal cervical cytologies. METHODS: A total of 439 patients with ASCUS or LSIL were included. The association between age groups and the diagnostic performances of HPV test for high-grade cervical intraepithelial neoplasia (CIN2+) was evaluated. RESULTS: Median age was 44 years (range, 17 to 75 years). ASCUS was more frequently observed in older patients while LSIL was more common in younger patients (P=0.002). CIN2+ was found in 11.3% (32/284) of the ASCUS patients and 12.9% (20/155) of patients with LSIL. Older patients with ASCUS showed lower HPV infection rates (P=0.025), but not LSIL (P=0.114). However, the prevalence of CIN2+ was similar between the age groups with ASCUS or LSIL. In patients with ASCUS, the false negative rate of HPV test for CIN2+ was 6.2%. The false negative rate of the HPV test became higher with increasing of the age after the age of 50 (P=0.034). CONCLUSION: Our findings suggest that false negative rate of the HPV test for CIN2+ in ASCUS patients older than 50 years might become higher with increasing of the age. Negative HPV results in patients of the age >50 years with ASCUS should be carefully interpreted.
Cervical Intraepithelial Neoplasia ; DNA* ; Human Papillomavirus DNA Tests ; Humans ; Prevalence ; Triage ; Uterine Cervical Dysplasia

Striae Distensae is a very common cosmetic problem. The effectiveness of various lasers, such as the 585-nm pulsed dye laser on the treatment of striae distensae has recently been reported. However, the potential pigmentary alteration of dark skin by pulsed dye laser is known. Thermage is a radiofrequency capable of delivering higher energy fluences to a greater volume of tissue than nonablative lasers, with no epidermal injury. We report three patients who had striae distensae. They were treated with Thermage and 585-nm pulsed dye laser. The treatment was effective and safe for dark skin.
Humans ; Lasers, Dye ; Skin ; Striae Distensae*