Senile entropion is caused by following pathophysiology: 1) Dehiscence or disinsertion of lower lid retractors from lower tarsus, 2) Preseptal orbicularis overriding pretarsal orbicularis, 3) Horizontal lid laxity from involutional changes of medial canthal ligament, lateral canthal ligament and tarsal plate, 4) Relative enophthalmos from absorption of orbital fat. There have been numerous procedures to correct senile entropion, but lack of adequate correction of all of the underlying anatomic defects resulted in high recurrence rate. Authors performed a combined procedure including the reinsertion of disinserted or dehisced lower lid retractor to lower tarsus, the excision of overriding preseptal orbicularis, and the correction of the lower lid laxity using lateral tarsal strip procedure all at once Among 11 cases of 10 patients, 10 cases had cosmetically and functionally good lid position during the mean follow up periods of 13.4 months. There was one case of ectropion as a complication which was corrected by further lateral tarsal strip procedure.
Absorption ; Ankle ; Collateral Ligaments ; Ectropion ; Enophthalmos ; Entropion* ; Follow-Up Studies ; Humans ; Ligaments ; Orbit ; Recurrence

Inflammatory polyposis of the colon is rare portion of the colon polyp entity. We experienced three patieats who suffered from colitis of unknown'etiology and discovered membranous retkular with/ without filiform polyp in the distal sigmoid colon of the them. Case 1, 56-year-old female, combined with basaloid cercinoma of the rectal canal that confirmed by pathology after abdominoperineal resection. So we obtained specimen of inflammtory polyp end tried to evaluate the mechanism of it. We found healed ulcer under the mucosal bridge. Case 2. 55-year-old male, had been suffered from irritable bowel syndrome. Prior to visit outpatient clinic, he complained tenesmus with diarrhea for a week. Inflammatory polyp was discovered by colonoacopy but his symptoms relieved by tranqulizers only. Case 3. 57-year-old male, has been a good health. He undertook colonoscopy for routine check thst revealed membranous reticular with filiform inflammatory polyp from distal sigmoid colon to hepatic flexure. Such shape of inflammatory polyp was not documented in Korea, so we reported three cases of it with review of the literature.
Ambulatory Care Facilities ; Colitis ; Colon* ; Colon, Sigmoid ; Colonoscopy ; Diarrhea ; Female ; Humans ; Irritable Bowel Syndrome ; Korea ; Male ; Middle Aged ; Pathology ; Polyps* ; Ulcer

Papillary and solid epithelial neoplasm is a rare pancreatic tumor of low-grade malignancy. We report a case of a 23 year old female having solid and papillary neoplasm of the pancreatic tail with mutiple omental and peritoneal metastases. Microscopically, the main tumor showed typical histologic findings including solid and papillary areas with cystic change. But the metastasizing nodules were largely solid and the tumor cells demonstrated increased nuclear pleomorphism, hyperchromasia and an increased mitotic rate. The tumor cells contained considerable amount of intracellular and extracellular eosinophilic inclusions which were ultrastructually zymogen-like granules. These inclusions were more frequently found in the metastatic nodules. By flow cytometric study, the tumor was hyperdiploid. The DNA index was not significant.
Female ; Humans ; Neoplasm Metastasis

Peritoneal mesothelioma is a rare disease which arises from the mesothelial lining cells in the peritoneum and spreads to the peritoneal wall, omentum and other abdomina1 organs. Aabestos is one etiologic factor and the other factors are genetic cause, radiation, exposure to toxic materials and recurrent yeritonitis. We experienced a case of multiple small nodular peritoneal mesothelioma after exposure to asbestos for over 20 years. He was a sailor and had worked in the engine department of the ship, in which he wrapped up the pipe of engine in asbestos. This person came to our hospital because of inconvenience due to a distended abdomen. Tumor markers were all within normal limits and there was no evidence of tuberculosis in the abdomen and chest. The CT findings of the abdomen were as follows: There was abundant ascites in the abdominal cavity and multiple small nodules on the parietal peritoneum and especially on the lower abdomen. The omentum thickened diffusely. It was difficult to distinguish from peritoneal mesothelioma and peritoneal carcinomatosis or intestinal tuberculosis. The laparoscopic findings were as follows: There were multiple small nodules on the parietal peritoneum and omentum. The small nodules were a gray white color and uneven compared to tuberculous peritonitis. Therefore, we observed the malignant mesothelial cells by means of the light microscope and electron microscope and concluded that this case was peritoneal mesothelioma.
Abdomen ; Abdominal Cavity ; Asbestos ; Ascites ; Carcinoma ; Humans ; Mesothelioma* ; Military Personnel ; Omentum ; Peritoneum ; Peritonitis, Tuberculous ; Rare Diseases ; Ships ; Thorax ; Tuberculosis ; Biomarkers, Tumor

BACKGROUND: Chlamydia pneumoniae has recently been established as an important cause of acute respiratory tract infections such as pneumonia and bronchitis in humans. We introduced a 'touchdown' PCR method for detection of C. pneumoniae from sputum. METHODS: A total of 474 patients with respiratory infection were enrolled in the study. The sputum samples were tested for C. pneumoniae by the 'touchdown' PCR and cultured for Chlamydia. The sputum samples were pretreated with 5% NaOH for mucolysis. In 'touchdown' PCR, the first round PCR amplified DNA from both C. pneumoniae and Chlamydia psittaci, while the second round specifically targeted C. pneumoniae, allowing the two species to be differentiated. RESULTS: The 'touchdown' PCR could detect 10-2 inclusion forming unit (IFU) in the 1st round and 10-3 IFU in the second round PCR. None of the C. trachomatis serovars, C. psittaci and other organisms tested was amplified. 'Touchdown' PCR detected C. pneumoniae DNA in 24 (5%) of the 474 sputum samples. Nine patients with C. pneumoniae had community acquired pneumonia. Another nine patients had pulmonary tuberculosis of which three had coexisting pneumonia. Two patients had lung cancer, another two had chronic bronchitis, one had pharyngitis, and one person was a normal healthy individual. CONCLUSIONS: The sputum preparation with 5% NaOH and the 'touchdown' PCR method are effective in the detection of C. pneumoniae. C. pneumoniae is one of the most common causative agents for pulmonary infection.
Bronchitis ; Bronchitis, Chronic ; Chlamydia* ; Chlamydophila pneumoniae* ; Chlamydophila psittaci ; DNA ; Humans ; Lung Neoplasms ; Pharyngitis ; Pneumonia ; Polymerase Chain Reaction* ; Respiratory Tract Infections ; Sputum ; Tuberculosis, Pulmonary

BACKGROUND: Diabetes mellitus is a common condition, and the majority of patients have one or more cutaneous complications. Among them, xerosis is well known to be closely related to diabetics. The xerosis is inversely reflected upon skin surface hydration, the state of which can be exactly assessed with various investigating instruments, such as a hydrometer and corneometer. OBJECTIVE: Our purpose was to compare the hydration state of diabetics with normal persons by the use of a corneometer and hydrometer. METHODS: A total of 267 diabetics were asked whether they felt xerosis or pruritus. In a subgroup of 31 patients, the water content was evaluated and compared by the parameters of diabetic severity. Forty-one non-diabetics were selected for the normal control.
Diabetes Mellitus ; Humans ; Pruritus ; Skin* ; Water

PURPOSE: This paper reports on the development a program to foster 'good doctors' who care for their patients with humanism and self-directed learning ability. METHODS: In order to develop the program, Korea University College of Medicine established educational committees. In collaboration, these committees discussed the direction for curriculum reorganization, performed a needs analysis of specified programs, and built realistic strategies for program management. Based upon the needs analyses, through literature review and survey studies, committee discussions and benchmarking of other medical schools, three programs were developed for rearing humanism and self-directed learning ability in medical students were developed: Service learning by experiential learning; Doctoring by small group activities; and Communication skills program by various small group activities. RESULTS: The evaluation by the pre-medical students who participated in the service learning program for one week reveals that through service learning, pre-medical students had an opportunity to obtain the attitudes that encompass the sanctity and dignity of human life and an understanding of cultural, social and religious customs and beliefs that differ from his or her own. In addition, the pre-medical students came to realize that patients' most difficult problems might be caused by non-medical factors as well as medical factors. CONCLUSION: It is needed to grope for the way that leads the active participation of students in the continuous linkage of substantial post-work evaluation and next learning of volunteering in order to make the program of educating the public spirit more than self-learning of experience.
Benchmarking ; Cooperative Behavior ; Curriculum* ; Education, Medical ; Humanism ; Humans ; Korea ; Learning* ; Problem-Based Learning ; Schools, Medical ; Students, Medical

For many years, NO2 has been regarded as one of the elements among indoor air pollutants of urban homes, leading to increased public concerns on this gas. For the purpose of preparing the fundamental data for the evaluation and control of health effect relevant to NO2 levels, authors measured the indoor (kitchen, living room, bedroom) and outdoor NO2 levels categorized by the type of house(apartment, detached dwelling) and cooking fuel(L.P.G., briquette) in the winter and summer, and surveyed the variables(kitchen ventilation, family size, parental smoking) may effect the indoor NO2 levels. The level of NO2 was measured by Palmes tube, and this survey was carried out at 110 homes in the Pusan area from October 1984 to September 1985. The obtained results were as follows: 1) The mean indoor and outdoor NO2 level in winter and summer, respectively, was 0.029+/-0.012 ppm and 0.022+/-0.012 ppm in the kitchen, 0.022+/-0.009 ppm and 0.018+/-0.010 ppm in the living room, 0.017+/-0.008 ppm and 0.016+/-0.010 ppm in the bed room, and 0.021+/-0.007 ppm and 0.016+/-0.007 ppm outdoors. 2) In the category of the type of house and cooking fuel, the highest mean indoor and outdoor NO2 level in the winter was in apartments using briquettes, and in the summer, the highest level was in apartments using L.P.G. 3) In the category of the type of house, the mean indoor and outdoor NO2 level in the winter and summer was higher in the apartment group compared to detached dwelling. 4) In the category of the type of cooking fuel, the mean indoor and outdoor NO2 level in the winter was higher in the briquette group, and in the summer, the L.P.G. group was higher. 5) In the category of the kitchen ventilation, family size, parental smoking and asthma attack history of children, there was an insignificant difference in the indoor NO2 levels.
Air Pollutants ; Asthma ; Busan ; Child ; Cooking ; Family Characteristics ; Humans ; Parents ; Smoke ; Smoking ; Ventilation

Intractable pain from advanced carcinoma of the upper abdomen is difficult to manage. On method used to control pain associated with these malignancies is to block off the splanchnic nerve. In 1919 kappis described a technique by which the splanchnic nerve of the upper abdomen could be anesthetized, using a percutaneous injection. This method has been used for the relief of upper abdominal pain due to hepatoma and cancer of the pancreas, stomach, gall bladder, bile duct, and colon. During the period from November 1968 to January 1986, this method was used in 208 cases of malignancy at Severance Hospital and clinically evaluated. Patients were retroactively grouped according to the stage of development of technique used. Twelve patients who received the treatment in the period from November 1968 to March 1977 were designated as group 1, 26 patients from April 1977 to April 1979 as group 2, and 170 from May 1979 to January 1986 as group 3. The results are as follows: 1) The number of patients receiving splanchnic nerve block has been increasing since 1977. 2) A total of 208 patients, including 133 males and 75 females, ranging in age from 18 to 84 and averaging 51. 3) The causes of pain were stomach cancer 90, pancreatic cancer 69, and miscelianeous cancer 49 cases respectively. 4) There were 57.7% who had had surgery, and 3.7% of whom had had chemotherapy before the splanchnic nerve block was done. 5) These blocks were carried out with the patient in the prone position as described by Dr. Moore. Fro group 2 and 3 C-arm image intensifier was used. In group 1, a 22 gauze 10cm long needle was inserted at the lower border of the 12th rib on each side about 7cm from the midline. The average distance from the middle was 6.60+/-0.61cm on the left side and 6.60+/-0.83cm on the right side in group 2, and 5.46+/-0.76 on the left side and 5.49+/-0.69cm on the right side in group 3. The average depth to which the needle was inserted was 8.60+/-0.52cm on the left side and 8.74+/-0.60cm on the right side in group 2, and 8.96+/-0.63cm on the left side and 9.18+/-0.57cm on the right side in group 3. 6) The points of the inserted needles were positioned in the upper quarter anteriorly. 51.8% on the left side and 54.4% on the right side of the L1 vertebra by lateral roentgenogram in group 3. The inserted needle points were located in the upper and anterolateral part, of the L1 vertebra 68.5% on the left side and 60.6% on the right side, on the anteroposterior rentgenogram in group 3. The needle tip was not advanced beyond the anterior margin of the vertebral body. 7) In some case of group 3, contrast media was injected before the block was done. It shows the spread upward along the anterior margin of the vertebral body. 8) The concentration and the average amount of drug used in each group was as follows: In group 1, 39.17+/-6.69ml of 0.5% -1% lidocaine or 0.25% bupivacaine were injected for the test block and one to three days after the test block 40.00+/-4.26ml of 50% alcohol was injected for the semipermanent block. In group 2, 13.75+/-4.48ml of 1% lidocaine were used as the test block and followed by 46.17+/-4.37ml of 50% alcohol was injected as the semipermanent block. In group 3, 15.63+/-1.19ml of 1% lidocaine for test block followed by 15.62+/-1.20ml of pure alcohol and 16.05+/-2.58ml of 50% alcohol for semipermanent block were injected. 9) The result of the test block was satisfactory in all cases. However the semipermanet block was 83.3 percent of the patients in group 1 who received relief from pain for at least 2 weeks after the block, 73.1% in group 2, and 91.8% in group 3. In these unsuccessful cases, 2 cases in group 1 were controlled by narotics but 7 cases in group 2 and 14 cases in group 3 received the same splanchnic nerve block 1 or 2 times again within 2 weeks. But in some cases it was 3 to 5 months before the 2nd block and in 1 cases even 7 years. 10) The most common complications of splanchnic nerve block were hypotensino(25.5%) occasional flushing of the face, nausea, vomiting, and chest discomfort. 11) For the patients in group 3, the supplemental block most commonly used was a continuous epidural block; it was used as a diagnostic block and to afford relief from pain before the splanchnic nervel block was done. 12) The interval between the receiving of the alcohol block and discharge was from 5 to 8 days in 61 cases(31.1%) and from 1 to 2 days in 48 cases(24.5%). From the above results, it can be concluded that the splanchnic nerver block done in the prone position with pure and 50% alcohol immediately after an effective test block with 1% lidocaine under C-arm fluoroscopic control is satisfactory and reliable. How to minimize the repeat block is still a problem to be solved.
Abdomen ; Abdominal Pain ; Bile Ducts ; Bupivacaine ; Carcinoma, Hepatocellular ; Colon ; Contrast Media ; Drug Therapy ; Female ; Flushing ; Humans ; Lidocaine ; Male ; Nausea ; Needles ; Pain, Intractable ; Pancreatic Neoplasms ; Prone Position ; Ribs ; Spine ; Splanchnic Nerves* ; Stomach ; Stomach Neoplasms ; Thorax ; Urinary Bladder ; Vomiting

Cytomegalovirus(CMV) rarely causes cutaneous rnanifestations. But since the recent development of organ transplants and the increased prevalence of AIDS, various skin manifestations of CMV infection such as varicelliform eruptions, perineal hulcerations, papular, purpurc and vesiculobllous lesions are increasing in immunocompromised subjects, Perineal ulceration is a typical cytomegalovirus-induced skin manifestation which exhibits similar morphology to herpes simplex viral infection. We describe a case of CMV-induced ulcer on labia majora in an AIDS patient, proven by histologic findings and immunohistochemistry. The patient was treated with ganciclovir and the lesion improved two months later.
Cytomegalovirus* ; Ganciclovir ; Herpes Simplex ; Humans ; Immunohistochemistry ; Prevalence ; Skin Manifestations ; Transplants ; Ulcer*