The mobile medical service has been operated for many years by a number of medical schools and hospitals as a most convenient means of medical service delivery to the people residing in such area where the geographical and socioeconomic conditions are not good enough to enjoy modern medical care. Despite of official appraisal showing off simply with numbers of outpatients treated and medical persons participated, however, as well recognized, the capability (in respect of budget, equipment and time) of those mobile medical teams is so limited that it often discourages the recipients as well as medical participants themselves. In the midst of rising need to secure medical service of good quality to all parts of the country, and of developing concept of primary health care system, authors evaluated the effectiveness of and problems associated with mobile medical service program through the community diagnosis of a village (Ope-Myun, Kwangju-gun) to obtain the information which may be helpful for future improvement. 1. Owing to the nationwide Sae-Maul movement powerfully practiced during last several years, living environment of farm villages generally and remarkably improved including houses, water supply and wastes disposal etc. Nevertheless, due to limitations in budget, time and lack of knowledge (probably the most important), these improvements tend to keep up appearances only and are far from the goal which may being practical benefit in promoting the health of the community. 2. As a result of intensive population policy led by the government since 1962, there has been considerable advances in understanding and the rate of practicing family planning through out the villages and yet, one should see many things, especially education, to be done. Fifty eight per cent of mothers have not received prenatal check and the care for most(72%) delivery was offered by laymen at home. 3. Approximately seven per cent of the population was reported to have chronic illness but since only a few(practically none) of the people has had physical check up by doctors, the actual prevalence of chronic diseases may reach many times of the reported. The same fact was observed also in prevalence of tuberculosis; the patients registered at local health center totaled 31 comprising only 0.51% while the numbers in two neighboring villages (designated as demonstration area of tuberculosis control and mass examination was done recently) was 3.5 and 4.0% respectively. Prevalence rate of all diseases and injuries experienced during one month(July, 1977) was 15.8%. Only one tenth of those patients received treatment by physicians and one fifth was not treated at all. The situation was worse as for the chronic patients; 84% of all cases either have never been treated or discontinued therapy, and the main reasons were known to be financial difficulty and ignorance or indifference. 4. Among the patients treated by our mobile clinic, one third was chronic cases and 45% of all patients, by the opinion of doctors attended, were those who may be treated by specially trained nurses or other paramedics (objects of primary care). Besides, 20% of the cases required professional managements of level beyond the mobile team's capability and in this sense one may conclude that the effectiveness(performance) of present mobile medical team is quite limited. According to above findings, the authors would like to suggest following for mobile medical service and overall medicare program for the people living in remote country side. 1. Establishment of primary health care system secured with effective communication and evacuation (between villages and local medical center) measures. 2. Nationwide enforcement of medical insurance system. 3. Simple outpatient care which now constitutes the main part of the most mobile medical services should largely be yielded up to primary health care unit of the village and the mobile team itself should be assigned on new and more urgent missions such as mass screening health examination of the villagers, health education with modern and effective audiovisual aids, professional training and consultant services for the primary health care organization.
Allied Health Personnel ; Ambulatory Care ; Audiovisual Aids ; Budgets ; Chronic Disease ; Consultants ; Diagnosis ; Education ; Family Planning Services ; Health Education ; Humans ; Insurance ; Mass Screening ; Medicare ; Missions and Missionaries ; Mobile Health Units ; Mothers ; Outpatients ; Prevalence ; Primary Health Care ; Public Policy ; Schools, Medical ; Tuberculosis ; Water Supply

No abstract available.
Colorectal Neoplasms*

BACKGROUND: bFGF, a member of the fibroblast growth factor family, potently induces vascular smooth muscle cell proliferation and decreased synthesis of the collagens. OBJECTIVE: For further investigation of the effect of bFGF on extracellular matrix homeostasis in the skin, we evaluated the expression of type I and type VII collagen gene at the transcriptional levels. METHOD: We examined that recombinant human bFGF affects the expression of genes involved in ECM synthesis and remodeling in human dermal fibroblasts cultures as judged by Northern blot analysis. RESULTS: The steady state levels of type I and VII collagen gene mRNA were decreased with age dependent pattern up to 0.13 and 0.44 folds respectively. The transcriptional levels of type I collagen mRNA were increased by TGF-B, treatment but markedly decreased by bFGF as well as TNF-a. But there were no synergistic effects bFGF and TNF-a on type I collagen gene expression. The levels of type VII collagen gene expression were increased by both bFGF and TGF-B,. The TNF-a showed slightly antagnostic effects on type VII collagen gene expression. CONCLUSION: The type I and VII collagen gene expression in dermal fibroblasts is clearly subjected to modulation by the cytokines including bFGF with uncoordinate regulatory pathway. In addition to its function of vascular proliferation, bFGF also may play a major role in physiologic skin condition and in repair process such as formation of a stable dermoepidermal junction during skin wound healing.
Blotting, Northern ; Cell Proliferation ; Collagen Type I ; Collagen Type VII ; Collagen* ; Cytokines ; Extracellular Matrix ; Fibroblast Growth Factors ; Fibroblasts* ; Gene Expression* ; Homeostasis ; Humans ; Methods ; Muscle, Smooth, Vascular ; RNA, Messenger ; Skin ; Wound Healing

OBJECTIVE: To investigate new signal transduction cascade through integrin, FAK and ERK in the suppressed cell proliferation by GnRH-I and -II. METHOD: Human endometrial cancer cells (HEC1A) were cultured under the following condition: DMEM/F12 (10% FBS). GnRH-I and -II were treated time (0, 5, 10, 15, 20, 30 min; 100 nM) and dose (10 nM or 100 nM; 20 min) dependent manner according to experimental purposes. Cell proliferation was measured using [3H] thymidine incorporation assay. Immunoblotting was utilized to detect proteins. RESULTS: GnRH-I and -II inhibited proliferation of HEC1A cells and induced expression of integrin beta3. Phosphorylation of FAK and ERK were induced by GnRH-I and -II. CONCLUSION: GnRH inhibited cell proliferation via the expression of integrin and FAK, ERK phosphorylation.
Cell Proliferation* ; Endometrial Neoplasms* ; Female ; Gonadotropin-Releasing Hormone* ; Humans ; Immunoblotting ; Integrin beta3 ; Phosphorylation ; Signal Transduction ; Thymidine

No abstract available.
Neoplasm Metastasis* ; Neuroblastoma*

Marjolin's ulcer is a malignant degeneration of cicatrical tissue, especially in chronic burn scar. Since the first description by Jean Nicholas Marjolin(1828), many studies for Marjolin's ulcer have been performed and reported. From 1985 to 1997, we experienced 20 cases in 14 patients diagnosed as Marjolin's ulcer clinically, and we analysed malignant transformation rate, induction period of Marjolin's ulcer and prevention of Marjolin's ulcer, etc. The results are summarized as follows. 1) The sex distribution was predominant in male(64.3%). 2) The most common cause of injury was flame burn(78.6%). 3) The mean age at the time of diagnosis was 45.6 years and the average lag period was 20.6 years. 4) The pathologic types of Marjolin's ulcer were squamous cell carcinoma(57.2%), followed by dyspasia(28.6%), acnthosis and hyperkeratosis(14.2%). 5) The locations of ulcers were frequently on the lower extremity(42.9%), followed by upper extremity(35.7%) and trunk (21.4%). 6) The lymph node involvements were 3 patients out of the 8 patients who were confirmed as squamous cell carcinoma. 7) The modalities of treatment were skin graft (18 cases, 12 patients), myocutaneous flap(1 case, 1 patient), fasciocutaneous flap(1 case, 1 patient).
Burns ; Carcinoma, Squamous Cell ; Cicatrix ; Diagnosis ; Humans ; Lymph Nodes ; Sex Distribution ; Skin ; Transplants ; Ulcer*

PURPOSE: This study addressed the feasibility and effect of surgical treatment of metachronous periampullary carcinoma after resection of the primary extrahepatic bile duct cancer. The performance of this secondary curative surgery is not well-documented. METHODS: We reviewed, retrospectively, the medical records of 10 patients who underwent pancreaticoduodenectomy (PD) for secondary periampullary cancer following extrahepatic bileduct cancer resection from 1995 to 2011. RESULTS: The mean age of the 10 patients at the second operation was 61 years (range, 45-70 years). The primary cancers were 7 hilar cholangiocarcinomas, 2 middle common bile duct cancers, and one cystic duct cancer. The secondary cancers were 8 distal common bile duct cancers and 2 carcinomas of the ampulla of Vater. The second operations were 6 Whipple procedures and 4 pylorus-preserving pancreaticoduodenectomies. The mean interval between primary treatment and metachronous periampullary cancer was 20.6 months (range, 3.4-36.6 months). The distal resection margin after primary resection was positive for high grade dysplasia in one patient. Metachronous tumor was confirmed by periampullary pathology in all cases. Four of the 10 patients had delayed gastric emptying (n = 2) or pancreatic fistula (n = 2) after reoperation. There were no perioperative deaths. Median survival after PD was 44.6 months (range, 8.5-120.5 months). CONCLUSION: Based on the postoperative survival rate, PD may provide an acceptable protocol for resection in patients with metachronous periampullary cancer after resection of the extrahepatic bile duct cancer.
Ampulla of Vater ; Bile Ducts, Extrahepatic* ; Cholangiocarcinoma ; Common Bile Duct ; Cystic Duct ; Gastric Emptying ; Humans ; Medical Records ; Neoplasms, Second Primary ; Pancreatic Fistula ; Pancreaticoduodenectomy* ; Pathology ; Reoperation ; Retrospective Studies ; Survival Rate

PURPOSE: An attempt to establish the neuroprotection effect of ascorbic acid in ischemic retinal injury. METHODS: A rat anterior chamber was cannulated with a 30-gauge infusion needle connected to a container of balanced salt solution (BSS). The container was raised to a height of 3m during 60mins, thereby inducing retina ischemia by high intraocular pressure (HIOP). The effect of ascorbic acid was demonstrated by hematoxylin-eosin (H and E) stain and neuronal nitric oxide synthase (nNOS) immunohistochemical stain. The effect was classified into three HIOP-induced groups: without ascorbic acid treatment, ; ascorbic acid-treated at 24 hr and just before experiment; and ascorbic acid-treated at 24hr, just before experiment and every 24hr after experiment. RESULTS: After retinal ischemia, in the ascorbic acid-treatment groups (Ed- confirm the plural here; from above there are two ascorbic acid-treated groups), the thickness of each retinal layer was preserved more than that in the non-ascorbic acid treated group. There was little difference according to ascorbic acid administration time and period. By nNOS immunohistochemical stain, in the non-ascorbic acid administration group, nNOS immune reactive cells were increased remarkably, in the Inner Nuclear layer (INL) and Ganglion Cell Layer (GCL). In the ascorbic acid-treated groups (Ed-agin confirm), nNOS immune reactive cells were stained in a similar pattern to that of the control group. CONCLUSIONS: The neuroprotection effect of ascorbic acid in ischemic retinal injury was demonstrated, as was the suppression of nNOS expression in the ischemic retina tissue by ascorbic acid administration.
Animals ; Anterior Chamber ; Ascorbic Acid* ; Ganglion Cysts ; Intraocular Pressure ; Ischemia ; Needles ; Nitric Oxide Synthase Type I ; Rats ; Retina ; Retinaldehyde*

No abstract available.
Cataract* ; Nephrotic Syndrome*

Steam autoclaving and ethylene gas sterilization method have been used for arthroscopes,but recently cold sterilization method using 2% glutaraldehyde solution was recommended.Although this method is economic, quick and excellent method, there has been a growing awareness of the minor complication associated with arthroscopy, particulsrily effusion and wound healing. So, we attemped to evaluate the effect of activated glutaraldehyde solution in knee arthroscopy. We have done so as follows : 1. Observed the intra-articular response (grossly, light and electron microscopically) of rabbit knees, three weeks after a single injection of glutaraldehyde at concentration of 0 to 1000 ppm. 2. Measured the glutaraldehyde concentration in the rinse solution using a sensitive spectrophotometric technique. 3. Measured the glutaraldehyde concentration in the intraoperative joint irrigation solution as same as above technique. The results were as follows : 1. Grossly, diffuse synovitis was observed with dose of 100 ppm or greater, and the degree of inflammation was proportional to the glutaraldehyde concentration. We have observed microscopic evidence of a few leukocyte infiltration and vascular congestion in the synovium of rabbit knees, injected with 5 ppm glutaraldehyde. At concentration of 50ppm, vascular hemorrhage and synovial edema, at 500ppm, focal synovial necrosis and fibrosis were observed. At 1000ppm, chondrolysis was observed. Electron microscopically we have observed synovial cells proliferation, especially type B cells and interstitial edematous changes, injected with 5-10 ppm glutaraldehyde. At concentration 50 ppm, synovial cells are decreased in number and marked vacuolization changes, at 100 ppm, synovial cells are denuded on the surface. 2. The concentration of glutaraldehyde present in the rinse basin was 16–30 ppm by thefirst rinsing procedure, if the same rinse solution was used for subsequent cases, the lutaraldehyde concentration was 117–149 ppm by the sixth rinsing procedure. 3. The concentration of glutaraldehyde present in the intraoperative joint irrigation solution was less than 1 ppm.
Arthroscopy ; B-Lymphocytes ; Edema ; Estrogens, Conjugated (USP) ; Fibrosis ; Glutaral ; Hemorrhage ; Inflammation ; Joints ; Knee ; Leukocytes ; Methods ; Necrosis ; Steam ; Sterilization ; Synovial Membrane ; Synovitis ; Wound Healing