OBJECTIVES: Our aims of this study is to analyze the clinical characteristics and the prognos is of the disease which develops in patient swith chronic liver disease as acutely exacerbated hepat it is accompanied by myosit is. Finally we try to identify and is olate the causative agent. METHODS: The patient swith chronic liver diseases, who developed muscle weakness and paralysis, were classified to group A or group B, according to the level of creatinine kinase ( CK) activity. The group A consists of patients with less than 3-fold increase of normal CK activity and the group B includes patients with over 3-fold increase of it. We evaluated clinical characteristics, blood chemistry, clinical course, and causes of deathin patients of study groups, compared with those of patients with chronic liver disease with normal CK activity as controls. The causative agent was suggested by conventional culture and RT-PCR analysis in two cases of group B. RESULTS: 1. There was no significant differences in age, sex, underlying disease, or liver function test bet ween control and study group ( control and group A or B) before entry. 2. The clinical symptoms and signs , such as drowsy mental state, generalized weakness/myalgia caused by hepatic encephalopathy and myositis , occurred frequently in the study group. 3. Significant elevation of aspartic acid transaminase (AST ) and alaninetr ans aminase ( ALT ) was noted in Group B. AST / ALT ratio is over 2 in group A or B. Synthetic function of the liver such as prothrombin time ( PT ) or serum albumin level is significantly decreased. Blood urea nitrogen ( BUN) and creatinine were increased as a result of impaired renal function. 4. Culture of coxs ackievirus was positive by immunofluor escence as say IFA) as a caus ative agent and also was positive in reverse transcription-polymerase chain reaction (RT-PCR) analys is using universal primer of enterovirus in two recent cases of group B. 5. Death rate increased significantly in study group, compared with that of control group ( 20.7% versus 5.6%). Major cause of death, 12 patients died of which, is hepatic failure. CONCLUSION: The patients with chronic liver disease abruptly developed a exacerbated hepaticdys function and muscle paralysis and/or weakness. This exacerbated hepatitis accompanied by myositis was suggested to be caused by coxsackie B viral infection. Furthermore, this infection increase deathrate and resulted in poor prognosis. Thus, further study should be continue to confirm the causative agent and classify the subtype.
Aspartic Acid ; Blood Urea Nitrogen ; Cause of Death ; Chemistry, Clinical ; Creatinine ; Enterovirus ; Hepatic Encephalopathy ; Hepatitis* ; Humans ; Liver Diseases* ; Liver Failure ; Liver Function Tests ; Liver* ; Mortality ; Muscle Weakness ; Myositis* ; Paralysis ; Phosphotransferases ; Prognosis ; Prothrombin Time ; Serum Albumin

Microscopic polyangiitis is a systemic small-vessel vasculitis, which may involve multiple organs, but cardiac involvement is relatively rare. We report a case of microscopic polyangiitis with multiple organ involvement, in which myocardial infarction was the early manifestation of the disease. A 53-year-old man presented with sudden papulovesicular eruptions and swellings on the face, posterior neck, dorsa of both hands and fingers, and with diffuse erythematous patches on the back. He had suffered from renal dysfunction, arthralgia, and hypertension for more than 8 years. He had been admitted to the department of cardiology for acute myocardial infarction and had suffered from recurrent gastrointestinal bleeding, renal failure, acute pancreatitis and sepsis during the admission. Histopathologically, small-vessel leukocytoclastic vasculitis with out granuloma was seen. Direct immunofluorescence showed no immune deposite. A high serum level of P-ANCA was detected by ELISA.
Acute Kidney Injury ; Antibodies, Antineutrophil Cytoplasmic ; Arthralgia ; Cardiology ; Enzyme-Linked Immunosorbent Assay ; Fingers ; Fluorescent Antibody Technique, Direct ; Granuloma ; Hand ; Hemorrhage ; Humans ; Hypertension ; Microscopic Polyangiitis* ; Middle Aged ; Myocardial Infarction* ; Neck ; Pancreatitis ; Sepsis ; Vasculitis

Duodenal diaphragm is a rare congenital anomaly among the congenital duodenal obstructions. Its symptom and sign usually appear since birth if obstruction is complete. The clinical manifestations of incompletely obstructive duodenal diaphragm are intermittent vomiting, abdominal pain and poor weight gain. Diagnosis may be delayed in this case. Authors experienced a case of incomplete duodenal diaphragm with a central hole. A 29 months old girl presented failure to thrive, intermittent episodes of bloating, abdominal discomfort and occasional vomiting. The patient vomited every 10-14 days, then the abdominal pain and distention were relieved. She overate for about 10 days until the next projectile vomiting. The vomitus frequently contained food ingested several days previously. Plain x-ray films of abdomen showed marked gastric distention. Upper gastrointestinal series revealed marked distention of the duodenum with windsock configuration and radiolucent line at the third portion of the duodenum. On gastroscopic examination, gastric bezoar impacting the pyloric canal and antrum was noted. At operation, we found mucosal membrane in the third portion of the duodenum and bezoar(Chinese cabbage) above the membrane. Side-to-side duodeno-jejunostomy was performed and bezoar was removed. She was discharged on the 13th postoperative day without any complication.
Abdomen ; Abdominal Pain ; Bezoars ; Bulimia* ; Child, Preschool ; Diagnosis ; Diaphragm* ; Duodenal Obstruction ; Duodenum ; Failure to Thrive ; Female ; Humans ; Membranes ; Parturition ; Vomiting ; Weight Gain ; X-Ray Film

OBJECTIVES: This study is designed to develop a large group phychodrama for light delin-quent adolescents (hereinafter called as "Psychodrama") thereby determining therapeutic factors for dealing with them. METHODS: The study was conducted in the program of Seoul Metropolitan Youth Centre called "the class of love" during the period of July through December, 1998. The subjects consisted of a total of 827 young delinquents (759 boys and 68 girls, with the average age of 15.9 years old). To develop "this psychodrama", after we composed of therapeutic team centered by psychiatrists, we prepared from January to June, 1998 by practicing psychodrama with delinquent adolescents and by analyzing the results. "This psychodrama" has three basic steps: (1) warming-up (small group me-eting), (2) action (situation drama and main drama), (3) sharing. A survey of treatments, from a pool of participating adolescents, based on evaluation sheets and 13 therapeutic factors scale followed every session of this psychodrama. RESULTS: "This psychodrama" was helpful for 47.4%, interesting for 49.2%, not helpful for 12.1% and not interesting for 16%. In the whole group of subjects, the important therapeutic factors were existential factor, universality, identification with the therapist and the instillation of hope in the order of rank. When categorized in four different groups (audience, participants in situation drama, auxiliary egos, participants in sharing) the 4 groups displayed different results to one another. First, the therapeutic factors of audience were similar to that of the whole group. Second, participants in situation drama showed a higher catharsis than others. Third, auxiliary egos were leading in the guidance of members and therapists. Fourth, participants in sharing displayed higher group cohesiveness. CONCLUSION: As it is getting harder to find program's suitable for the treatment of increasing number of delinquents due to limited budget and experts, this psychodrama could be more cost-effective than any other measures.
Adolescent* ; Budgets ; Catharsis ; Drama ; Ego ; Female ; Hope ; Humans ; Psychiatry ; Psychodrama* ; Seoul

No abstract available.
Asthma* ; Child* ; Eosinophils* ; Humans

The alert regarding the emergence of novel influenza was issued by the WHO on April 24th, and the government has taken immediate actions to respond to the situation since then. Based on the presumption that a pandemic was imminent, countermeasures for the H1N1 influenza pandemic have been prepared by establishing and implementing effective public health crisis strategies over the past few years. Our main strategy during the pandemic influenza crisis has shifted in accord with the corresponding National Disaster Phases. In the Caution (Containment) Phase, our main goal was to contain the influx of disease from overseas. We focused on measures such as entry screening and quarantine inspection while monitoring travelers arriving from affected countries. In the Alert Phase I, our aim was deceleration and prevention of secondary community outbreaks through enhanced early detection. We intensified our surveillance and response system for possible mass outbreaks. During Alert Phase II, as the influenza had spread widely, our tactics switched to minimizing social and economic impact and preventing severe cases with early administration of antiviral agents, especially among high-risk patients. In the current Severe Phase, we are trying to reduce mortality cases with intensive care. Since we have implemented mass vaccination, we predict an early termination of the pandemic.
Antiviral Agents ; Critical Care ; Containment of Biohazards ; Deceleration ; Disasters ; Disease Outbreaks ; Humans ; Influenza, Human ; Mass Screening ; Mass Vaccination ; Pandemics ; Public Health ; Quarantine ; Vaccination

BACKGROUND: In these days of increasing need for medical treatment, and the trend of changing lifestyles for personal health care, the position of medical treatment has led to the increase of careful and various services to every member of the community. But the reality of medical treatment, including the present situation of the emergency room in general hospital is recognized as the cause of those dissatisfactions and complaints of both patients and their caregivers. So this study aims at contributing to the harmonious relation between doctor and patient. METHODS: This study has been carried out by the questionnaire method on the basis of the relatively reasonable 331 papers among 430 questionnaire papers of the patients and their caregivers hospitalized by way of the emergency room in Cheonju Yeong Dong Hospital from Sep. 1994 to Apr. 1995. RESULTS: Among 331 subjects of this questionnaire, there were 121 male patients(36.6%), 76 female patients(23.0%), 80 male caregivers(24.2%), 54 female caregivers. The subjects were compaced of 23 teenagers(7.8%), 74 in their twenties(22.4%), 135 in their thirties(40.8%), 52 in their fourties(15.7%), 29 in their fifties(8.8%), 12 in their sixties(3.6%), 6 in their seventies(1.8 %). Both patients and their caregivers seemed to have a great dissatisfactions and complaints, which can be extraneous to medical treatment. Many patients complained of the unbearable situations such as delayed pain control before after a first-aid treatment, as well as various poor condition of medical treatment in emergency room. Their caregives complained of the lack of a thought explanation of diagnosis and prognosis, as well as the tedious waiting time before taking medical teratment. There were many cases where the emergent patients took medical treatment with some dissatisfa'ctions and complaints of medical staffs or medical donditions. CONCLUSIONS: When using the emergency room in a general hospital, both patients and their caregivers experiance a great deal of dissatisfactions and complaints, which can be followed by a distrust of the hospital and an obstacle of medical treatment. The medical staff, such as the hospital authorities, doctors, and nurses should make various improvements upon the medical conditions of the emergency room in general hospital.
Caregivers ; Delivery of Health Care ; Diagnosis ; Emergencies* ; Emergency Service, Hospital* ; Female ; Hospitals, General ; Humans ; Life Style ; Male ; Medical Staff ; Prognosis ; Surveys and Questionnaires

PURPOSE: The purpose of this study was to identify whether the maternal-fetal attachment is related to choose the rooming-in of postpartum women. METHOD: This is a retrospective descriptive study. The data was collected from April 1 to May 31, 2001. Subjects who had NSVD were 68 mothers who opted the rooming-in and 98 mothers who did not choose the rooming-in at one hospital in Seoul, Korea. The research questionnaire consisted of 14 items on general characteristics, and 24 items on maternal fetal attachment developed by Cranley(1981). RESULT: 1. There was significant statistical difference in general characteristics between rooming-in and non rooming-in groups in prenatal class attendance, and husband attendance during the delivery. 2. There was significantly higher level of maternal fetal attachment score in the rooming-in group. 3. There was higher level of maternal fetal attachment score in the group which had participated in childbirth education than the group which didn't had participated. CONCLUSION: It could be concluded that the maternal fetal attachment is identified as a significant factor choosing the rooming in for postpartum women. Therefore it is needed to increase maternal fetal attachment of pregnant women before making decision for whether they choose the rooming-in or non-rooming in after delivery.
Female ; Humans ; Korea ; Mothers ; Postpartum Period* ; Pregnant Women ; Prenatal Education ; Surveys and Questionnaires ; Retrospective Studies ; Seoul ; Spouses

BACKGROUND: One of the problem in emergency room(ER) of university hospital is over-crowdedness that causes exhaustion of medical resources (personnel, device, space) and disturbes optimal treatment. METHODS: This is an evaluative research for the purpose of promoting efficient operation system in ER of university hospital. RESULTS: 1) In 387 visitors, mean age was 47.5 years, and male to female ratio 1.21:1. As the specialty in charge, 28.9%f them were internal medicine, 26.6%mergency medicine, 9.9%eurology, and 8.5%eurosurgery. 24%f visitors have come by ambulances. The patients stayed for average 16.1 hours. The admission rate of ER visitors was 33.4 %60.3 %returned home after some management. 2) The visitors had various causes without correlation between the severity of conditions and the choice of high level hospital ER. They perceived their situations emergent in 78.4% but after triage only 25.6%were classified emergent. 48.6%of the visitors were the patients of out-patient department of this hospital due to chronic diseases. 3) The patients were assessed within 9.5 minutes after arrival at ER by nurse and within 34 minutes by doctor. If they were in need of consultation to second/third department, they waited for 141.5/460 minutes respectively to see the doctor. They waited for 59.9/52.7 minutes to get routine laboratory sampling/radiologic examination respectively. 4) Every 2.3 new patients visited this ER per hour. Average 63.2 patients were taken over to next shirt of nurse duty, and 60%of them had chronic degenerative diseases. CONCLUSION: The causes of overcrowding in ER of the university hospital were (1) huge number of patients at out-patient department of the hospital, (2) shortage of beds compared to the number of patients waiting admission, (3) too many kinds of procedures performed in ER, (4) cooperation failure among doctors of different specialty, and (5) no definite criteria of admission/discharge into/from ER. To solve these problems, conversion of ER management policy from complete examination and treatment to more simple and rapid one is necessary.
Ambulances ; Chronic Disease ; Emergencies* ; Emergency Service, Hospital* ; Female ; Hospitals ; Humans ; Internal Medicine ; Male ; Outpatients ; Triage

PURPOSE: To describe a transconjunctival sutureless technique for pars plana vitrectomy using conventional 20-gauge instruments. METHODS: We performed transconjunctival sutureless pars plana vitrectomy (TSV) using conventional 20-gauge instruments in 36 eyes of 35 patients. We made 20-gauge transconjunctival beveled sclerotomies using microvitreoretinal (MVR) blades and used traditional 20-gauge instruments for the operations. RESULTS: Eighty-three (81.4%) of 102 sclerotomies self-sealed without the need for sutures. The sutureless rate was even higher in the last one-third of the patients: 32 (94.1%) of 34 sclerotomy sites were sutureless. No serious complications were observed in our series, including postoperative hypotony, wound leakage, or endophthalmitis. CONCLUSIONS: The 20-gauge TSV technique is safe and can be utilized for almost all vitreoretinal diseases, without incurring additional cost for new instruments.
Eye ; Humans ; Sutures ; Vitrectomy