Medical Act is the substantial law regulating medical service providers' qualification, rights and obligations, and regulating establishment and management of medical institutions. The Korean Medical Act was enacted in 1951 in the commencement, and revised about 30 times until now. But, there were only 2 total revision, in 1962 and 1973. From that on, for the purpose of adopting to changing medical circumstances and easing unnecessary regulations, the necessity of total revision was proposed continuously. At last in August 2006, Ministry of Health and Welfare (Department of Medical Care Policy) established 'Medical Act Revision Task Force Team', and then 9 conferences were held. But, The Korean Medical Association objected to the revised bill very intensively. The first reason is that the bill was made in a mad rush, and the second reason is that the bill restricts medical doctors' self-regulation and discretion too much.
Advisory Committees ; Congresses as Topic ; Human Rights ; Jurisprudence ; Social Control, Formal

An informed consent is a document signed by the patient or the patient's legal guardian(s) that signifies the acceptance that the patient will undertake a specific medical treatment suggested and explained by the health care provider(s). Recently, there have been an increasing number of circumstances where obtaining an informed consent is mandatory. However, a standard form and required content of the informed consent, as well as laws, regulations, and analyses regarding the concept of informed consent are not available. This article introduces an observation of the legal force of informed consent forms that are used in practice, and of the legal issues in connection with them.
Consent Forms ; Delivery of Health Care ; Humans ; Informed Consent* ; Jurisprudence ; Medical Records ; Social Control, Formal

Intramuscular injection is a commonly used route of parenteral drug administration. Many types of complications following intramuscular injection into the gluteal muscles have been described. A retrospective review of 32 patients requiring surgical treatment for local compli-caations of the buttock injections in children was made at the Taegu Fatima Hospital from March 1990 to December 1997. Local complications consisted of acute inflammatory compli-cations including cellulitis and abscess (71.9%), fat necrosis (21.9%), and injection granu-loma (6.2%). Over the half of complications were situated in the upper outer quadrant of the buttock but the other 43.7% of them were in the upper inner or lower outer quadrant which were unsuitable sites for intramuscular injection. And the majority of complications were de-veloped within fat tissue (90.6%) rather than within muscle (9.4%). Two thirds of the patients were under 2 years of age, which suggested that there were some difficulties in accurate intra-muscular injection in small children who had smaller muscle masses compared with subcuta-neous fat and were irritable during injection. In patients with abscess, Staphylococcus aureus was the predominant organism, isolated in 84.6% of the patients. The treatment consisted of needle aspiration, incision and drainage or curettage, and surgical excision. In conclusion, we think that the major factor contributing development of complications following intramuscular injection in the buttock was inadvertent intrafat injection instead of intramuscular injection. In order to prevent those complications, it is necessary to inject accurately into the muscle with a knowledge of pelvic anatomy and complications associated with intramuscular injection.
Abscess ; Buttocks* ; Cellulitis ; Child* ; Curettage ; Daegu ; Drainage ; Fat Necrosis ; Humans ; Injections, Intramuscular* ; Muscles ; Needles ; Retrospective Studies ; Staphylococcus aureus

Panner's disease, osteonecrosis of the capitellum of the elbow, was first reported by Panner in 1927. The disease occurs mainly in boys between 6 and 15 years old and shows unilateral distribution. Pain, stiffness, localized tenderness over the lateral condyle of the elbow, and decreased range of motion are the typical clinical symptoms. Conservative treatment is generally recommended for patients in the early stage of this disease. A few cases of Panner's disease have been reported and few are related to long-term follow-up results. To the best of our knowledge, all reported cases were over six years. Therefore, we report on a five-year-old boy diagnosed as Panner's disease that showed resorption and regeneration of the humeral capitellum with no limitation of motion over three years. The current study was exempted from review by the institutional review board because it was a single retrospective case report. Informed consent was obtained from the patient's guardian.
Child* ; Elbow ; Ethics Committees, Research ; Follow-Up Studies ; Humans ; Informed Consent ; Male ; Osteochondrosis ; Osteonecrosis ; Range of Motion, Articular ; Regeneration ; Retrospective Studies

No abstract available.
Germ Cells* ; Neoplasms, Germ Cell and Embryonal* ; Prognosis*

The purpose of this study is to investigate the changes in NF-kappaB and proinflammatory cytokines expression following courses of reperfusion after various cycles of ischemic preconditioning in the rat kidney. Thirty five weeks old Sprague Dawley rats were subjected to 3, 6 and 10 cycles of ischemic preconditioning that composed of 5 min ischemia and 5 min reperfusion at the left common iliac artery using rodent vascular clamp. The left kidney obtained after 0, 3, 6, 24 and 72 hours of reperfusion followed by each cycle. The expression patterns of NF-kappaB, TNF-alpha, IL-1beta and ICAM-1 were detected by immunohistochemical staining and Western blotting methods. Apoptosis were detected by TUNEL assay. The results were as follows; In the ischemic preconditioning group, the mortality increased from 24 hours after reperfusion when cyclic episodes of short ischemia and reperfusion were increased. The highest level of NF-kappaB expression in outer medulla of the kidney from 0 hr to 24 hrs of reperfusion is detected after 10 cycles of ischemic preconditioning. The highest level of NF-kappaB expression at 72 hrs of reperfusion is revealed after 3 cycles of ischemic preconditioning. The highest level of TNF-alpha expression in outer medulla of the kidney at 0 hr and 6, 24, 72hrs of reperfusion is shown after 10 cycles of ischemic preconditioning. After 3 hrs of reperfusion, all ischemic preconditioning groups shows similar expression. The highest level of IL-1beta and ICAM-1 expression in outer medulla of the kidney is observed at all of reperfusion times after 10 cycles of ischemic preconditioning. The highest level of apoptosis in rat kidney outer medulla at all of reperfusion times is shown after 10 cycles of ischemic preconditioning. In conclusion, 3 or 6 times of remote ischemic preconditioning in the common iliac artery could reduce the expression of NF-kappaB, TNF-alpha, IL-1beta, and ICAM-1. However, more than 10 times of remote ischemic preconditioning increased ischemia-reperfusion injury, caused by increased expression of NF-kappaB, TNF-alpha, IL-1beta, and ICAM-1.
Animals ; Apoptosis ; Blotting, Western ; Cytokines* ; Iliac Artery* ; In Situ Nick-End Labeling ; Intercellular Adhesion Molecule-1 ; Ischemia ; Ischemic Preconditioning ; Kidney* ; Mortality ; NF-kappa B ; Rats* ; Rats, Sprague-Dawley ; Reperfusion ; Reperfusion Injury ; Rodentia ; Tumor Necrosis Factor-alpha

PURPOSE: Retroperitoneal laparoscopic nephrectomy for inflammatory renal conditions remains technically challenging, but can prevent intraperitoneal contamination by inflammatory or pathologic materials and decrease the risk of visceral injury or peritoneal morbidity. We evaluated retroperitoneal laparoscopic nephrectomy in terms of feasibility, safety, and efficacy in inflammatory renal disease. MATERIALS AND METHODS: Between March 2003 and June 2006, retroperitoneal laparoscopic nephrectomy was performed in 39 patients with benign renal disease. Of the 39 patients, 18(group 1) had inflammatory renal diseases with perinephric stranding on CT, which was confirmed as an adhesion during surgery. The remaining 21 patients(group 2) had nonfunctioning kidneys without significant inflammation. Intraoperative and postoperative clinical parameters were analyzed and compared between the 2 groups. RESULTS: Retroperitoneal laparoscopic nephrectomy was successful in all 39 patients without conversion to open surgery. Group 1 included tuberculous pyelonephritic kidney(n=11), xanthogranulomatous pyelonephritis (n=3), pyonephrosis(n=2) and renal abscess(n=2). Group 2 included chronic pyelonephritis(n=12), ureteropelvic junction obstruction(UPJ) stricture(n=6), and cystic disease(n=3). The mean operating time and the mean estimated blood loss were significantly different between the 2 groups(p<0.001). The mean time to oral intake and ambulation, and the mean duration of hospitalization were not different between the 2 groups. There were 1 major and 2 minor complications in group 1 and 2 minor complications in group 2. CONCLUSIONS: Retroperitoneal laparoscopic nephrectomy is a feasible and safe treatment modality in inflammatory renal diseases as well as other benign renal diseases.
Conversion to Open Surgery ; Hospitalization ; Humans ; Inflammation ; Kidney ; Laparoscopy ; Nephrectomy ; Pyelonephritis, Xanthogranulomatous ; Walking

BACKGROUND: There has been controversy about predicting difficult LMA insertion and suboptimal position. Our aim was to evaluate bedside predictors for difficult LMA ProSeal(TM) (PLMA) insertion and suboptimal position. METHODS: As the potential predictive factors for difficult PLMA insertion and suboptimal position, we considered male gender, increased body mass index (BMI), seven individual items suggesting difficult airway [modified Mallampati classification > or = III, inter-incisor distance < or = 5 cm, thyromental distance < or = 6.5 cm, head/neck movement < or = 90degrees, history of difficult intubation, buck of teeth > or = moderate, upper lip bite test (ULBT) > or = II] and > or = 3 of total airway score which is the sum of scores assessed by a score of 0, 1, 2 in seven individual items. The PLMA position was assessed by fiberoptic bronchoscopy to determine whether these predictors predict suboptimal position of PLMA (fiberoptic score < 3, as graded on a standard fiberopitc scale). We also investigated the effect of predictive factors on the failure of the first insertion of PLMA and time required for successful Proseal LMA insertion on the first attempt. RESULTS: 154 patients were enrolled in the study. The total airway score did have a significant relationship with the fiberoptic findings. The male gender and ULBT I of investigated predictors did significantly correlate with failure on the first insertion of PLMA. We did not find any significant relationship between the predictive factors and PLMA insertion time on the first attempt. CONCLUSIONS: The male gender and ULBT I indicate difficult PLMA insertion, and the total airway score > or = 3 indicates suboptimal position of PLMA.
Body Mass Index ; Bronchoscopy ; Classification ; Humans ; Intubation ; Laryngeal Masks* ; Lip ; Male ; Tooth

Akt, heat shock protein (HSP72)72, and HSP90 induced by ischemic preconditioning protect cells from the ischemic injury. The purpose of this study was to examine the alterations of the level of phospho-Akt, HSP72, and HSP90 in the rat tibialis anterior and soleus muscles after cyclic episodes of ischemic preconditioning. Sprague-Dawley rats aged 35 weeks were divided into control and ischemic preconditioning (IP) groups. The IP group was divided into 3 subgroups based on cycles of IP. Left common iliac artery was occluded 3, 6, and 10 times for 5 minutes, followed by 5 minutes reperfusion. The experimental animals were sacrificed at 0, 3, 6, 24, and 72 hours after reperfusion, and left tibialis anterior and soleus muscles were removed. The expression of phospho-Akt, HSP72, and HSP90 were examined with immunohistochemical methods and Western blot analysis. The results were as follows; 1. In the 3 and 6 times of IP groups, the expression of phospho-Akt (p-Akt) was increased at 0 and 3 hours after reperfusion, compared with control group. The expression of p-Akt in the 10 times of IP group was lower than that in 3 and 6 times of IP groups. At 72 hours after reperfusion, the expression of p-Akt showed no difference among the IP groups. The expression of p-Akt was higher in Soleus than that in Tibialis anterior. 2. The expression of HSP72 in 3 times of IP group increased at 0 and 3 hours after reperfusion, compared with 6 and 10 times of IP groups. The expression of HSP72 in the 10 times of IP group was lower than that in 3 and 6 times of IP groups. At 72 hours after reperfusion, the expression of HSP72 showed no difference among the IP groups. The expression of HSP72 was higher in Soleus than that in Tibialis anterior. 3. In the 3 and 6 times of IP groups, the expression of HSP90 increased at 0 and 3 hours after reperfusion, compared with control group. The expression of HSP90 in the 10 times of IP group was lower than that in 3 and 6 times of IP groups. At 24 hours after reperfusion, the expression of HSP90 showed no difference with increasing episode of IP. The expression level of HSP90 was higher in Soleus than that in Tibialis anterior. These findings suggest that ischemic preconditioning increases the expression of p-Akt, HSP72 and HSP90 at early phase after reperfusion in the rat tibialis anterior and soleus muscles. However, increased cycles of ischemic preconditioning may not induce the expression of them.
Animals ; Blotting, Western ; Heat-Shock Proteins ; Iliac Artery ; Ischemic Preconditioning* ; Muscles* ; Phosphorylation* ; Rats* ; Rats, Sprague-Dawley ; Reperfusion

BACKGROUND: SelexOn (Infopia, Korea) is a novel immunoassay instrument that measures the concentration of alpha-fetoprotein (AFP), creatine kinase isoenzyme (CK-MB), D-dimer, high-sensitivity C-reactive protein (hs-CRP), myoglobin, prostate-specific antigen (PSA), and thyroid-stimulating hormone (TSH) in whole blood. We evaluated the analytical performance of SelexOn. METHODS: The analytical performance of SelexOn was evaluated for precision and linearity, and compared with the ADVIA Centaur XP Immunoassay System (Siemens, Germany) and the STA-R coagulation analyser (Diagnostica Stago, France). RESULTS: Within-run CV ranged from 2.9% to 8.9% for all biomarkers. Between-run precision ranged from 1.6% to 11.3% for all biomarkers, except at low levels of D-dimer (16.1%). Observed linearity ranges were AFP, 8.7 to 47.0 ng/mL; CK-MB, 4.7 to 38.7 ng/mL; D-dimer, 393.2 to 2,760.3 ng/mL; hs-CRP, 2.1 to 9.0 mg/L; myoglobin, 67.2 to 441.5 ng/mL; PSA, 2.6 to 23.7 ng/mL; and TSH, 3.3 to 38.9 mIU/L. Upon comparing SelexOn with the Centaur XP and STA-R systems, values of AFP, CK-MB, hs-CRP, and PSA showed good correlation, with correlation coefficients greater than 0.975. The correlation coefficients of TSH, myoglobin, and D-dimer were 0.9723, 0.9649, and 0.8379, respectively. The concordance was excellent for hs-CRP (kappa [kappa]=0.958), PSA (kappa=0.854), and TSH (kappa=0.810); good for AFP (kappa=0.655), CK-MB (kappa=0.759), and myoglobin (kappa=0.783); and moderate for D-dimer (kappa=0.561). CONCLUSIONS: SelexOn demonstrated acceptable precision, linearity, and correlation with the Centaur XP and the STA-R for seven biomarkers. Because of its speed and performance, SelexOn may facilitate the rapid screening of patients for cardiovascular disease, thyroid disease, prostate cancer, and hepatocellular carcinoma.
alpha-Fetoproteins ; Biomarkers* ; C-Reactive Protein ; Carcinoma, Hepatocellular ; Cardiovascular Diseases ; Creatine Kinase ; Humans ; Immunoassay ; Mass Screening ; Myoglobin ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Thyroid Diseases ; Thyrotropin