PURPOSE: Intraventricular hemorrhage(IVH) is a major risk factor for neurodevelop- mental handicap in very low birth weight infant. So we carried out to determine the efficacy of indomethacin in reducing the incidence of intraventricular heorrhage in very low birth weight infant. METHODS: A prospective, random trial was carried out to determine the efficacy of indomethacin in preventing intraventricular hemorrhage. A total of 46 infants of less than 1500g birth weight admitted to NICU of IL Sin Christian Hospital from August 1995 to June 1997 were analyzed. Randomly, 23 infants were given indomethacin and 23 infants were not given as control group. Serial cranial ultrasound examination was performed. RESULTS: There were no differences in the birth weight, gestational age, sex, Apgar score, blood pressure, intake and output within the first 3 days between the indornethacin and control groups. Of 23 infants given indomethacin, four had germinal matrix or intraventricular hemorrhage, in comparison with 10 of 23 control infants(P=0.045). CONCLUSION: Prophylactic indomethacin lowers the incidence of IVH in very low birth weight infants.
Apgar Score ; Birth Weight ; Blood Pressure ; Gestational Age ; Hemorrhage* ; Humans ; Incidence ; Indomethacin* ; Infant ; Infant, Very Low Birth Weight ; Prospective Studies ; Risk Factors ; Ultrasonography

It has been known that childhood bipolar disorder is rare, especially combined with attention deficit hyperactivity disorder (ADHD). But, recent studies reported that childhood bipolar is more common than our guess. Many symptoms of childhood mania overlapped with ADHD, so it is difficult to differentiate from ADHD. It also often reported that psychostimulants, medication for ADHD, induce manic symptoms. Clinically, childhood mania has several characteristics. It is frequently chronic, mixed type, rapid cycling and often refractory to treatment. So it is important to diagnose, differentiate, treat childhood bipolar disorder and ADHD, but there is no report about comorbidity, treatment, clinical characteristics about that. We report a patient combined ADHD, mental retardation and childhood bipolar disorder.
Attention Deficit Disorder with Hyperactivity* ; Bipolar Disorder* ; Child* ; Comorbidity ; Humans ; Intellectual Disability*

Proper education about dermatology in medical college would have physicians appropriately diagnose and treat common dermatoses without referring patients to dermatologists. However, physicians who are not dermatologists have difficulty in diagnosing and treating common dermatoses. We have made up a questionnaire about treatment and a slide test for clinical diagnosis of common dermatoses in order to evaluate the knowledge of physicians about common dermatoses, which reflects indirectly the current status of medical education of dermatology in Korea and can be used as a basic data for modifying directions for education in medical college. Total 654 physicians answered the questionnaire, including 125 just graduated general physicians, 111 general physicians who had just finished internship and 418 medical specialists. 11 data from dermatologists were analyzed as a control for evaluation. The result showed that 84%(545) of them have difficulty in diagnosing dermatologic diseases. The probable causes answered by them are lack of easy illustrative textbook for general physician(48%), inadequate education of dermatology in their medical colleges(27%) and so on. In the field of therapy in the questionnaire, only 53% of them had proper knowledge about indication of topical steroids, 56% about acne therapy, 22% about treatment of tinea pedis, 35% about scabies and 41% about urticaria. The average score was 53%. The score of family medicine group and urologist group was 69% and 66% each, which were significantly higher than that of other major groups except 98% of dermatologist group. In the slide test for clinical diagnosis, the average score was 71%. The score of family medicine group which had received postgraduate education on dermatology in their resident training was 84%, also significantly higher than that of other major groups except 100% of dermatologist group. The percentage of correct responders about tinea faciei is only 13%, tinea versicolor 42%, tinea cruris 49%, impetigo 53%, pityriasis rosea 60%, atopic dermatitis 67%, psoriasis 72% and fixed drug eruption 74%, etc. The average score was 71%. In conclusion, this study showed that physicians who are not dermatologists have difficulty in diagnosing and treating even common dermatoses. We think it is important to put stress on the common dermatoses in the field of dermatologic education in medical college. Moreover we could find the importance and need of postgraduate education on dermatology in the resident training of primary care physicians such as not only family medicine doctors but also internists and pediatricians.
Acne Vulgaris ; Dermatitis, Atopic ; Dermatology ; Diagnosis ; Drug Eruptions ; Education ; Education, Medical ; Humans ; Impetigo ; Internship and Residency ; Korea ; Physicians, Primary Care ; Pityriasis Rosea ; Psoriasis ; Scabies ; Skin Diseases* ; Specialization ; Steroids ; Tinea ; Tinea Pedis ; Tinea Versicolor ; Urticaria ; Surveys and Questionnaires

No abstract available.
Hernia*

OBJECTIVE: Adult onset Still s disease is an acute systemic inflammatory disorder. There are no pathognomonic symptoms or specific laboratory abnormalities. In recent reports, serum ferritin concentration is increased in active disease phase and decreased after defervescence. Our purpose was to determine the clinical significance of serum ferritin as an indicator for disease activity. METHODS: Seven patients who were diagnosed as adult onset Still s disease at Samsung Medical Center between October 1994 and March 1997, were reviewed. In these patients we checked leukocyte count, ESR, CRP and serum ferritin concentrations at the time of diagnosis and during follow-up periods and recorded febrile events during follow-up periods. RESULTS: At the time of diagnosis and during febrile periods, the concentrations of ferritin were extremely high(927ng/ml to 96,650ng/ml normal 10-290.8 ng/ml). The values were unrelated to other manifestations of the disease or laboratory findings. The ferritin concentrations decreased rapidly after adequate treatment. Eleven febrile reattacks happened in 7 patients. Serum ferritin concentrations were increased in 8 febrile attacks, while leukocyte count, ESR, and CRP were increased in 5, 5, 6 febrile attacks respectively, There were 10 events of increased serum ferritin concentrations in 7 patients during follow-up periods and 8 events were related with fever. The increases of other laboratory tests were similar. CONCLUSIONS: In all patients, serum ferritin concentrations were increased at the time of diagnosis and closely related to fever. During follow-up periods, serum ferritin concentrations are helpful in monitoring disease activity and guiding decisions about treatment.
Adult* ; Diagnosis ; Ferritins* ; Fever ; Follow-Up Studies ; Humans ; Leukocyte Count ; Still's Disease, Adult-Onset*

Four cases medical accidents related to the iatrogenic injury of neck vessels are reported. The first case was a 54-year-old woman. Under the diagnosis of the herniated cervical disc, the operation was performed. After five hours from starting the operation, respiratory difficulty, facial cyanosis and syncope were found, suddenly. The autopsy finding were large hematoma at the posterior portion of neck organ and perforation of right carotid artery. The second case was a 61-year-old woman. Under the diagnosis of the aneurysm of the anterior communicating artery, the coiling and embolization were performed. After one hour from removal of catheter of right carotid artery, respiratory difficulty, facial cyanosis and syncope associated with right neck hematoma were found, suddenly. Eventually, she died after 41 days due to hypoxic brain injury. The third case was a 55-year-old woman. Under the diagnosis of the thyroid cancer, total thyroidectomy was performed. After three hours from operation, respiratory difficulty, facial cyanosis and syncope associated with severe neck hematoma were found, suddenly. Eventually, she died after 25 days due to hypoxic brain injury. The last case was a 34-year-old man. He visited the hospital due to stab wound of left neck. The irrigation and simple suture were performed at the first visit. After he went home, respiratory difficulty and syncope were found, suddenly. He returned the hospital and cardiopulmonary resuscitation was performed. However, he died. The autopsy finding were large hematoma around the neck organ and stab wound of left carotid artery.
Adult ; Aneurysm ; Arteries ; Autopsy* ; Brain Injuries ; Cardiopulmonary Resuscitation ; Carotid Arteries ; Catheters ; Cyanosis ; Diagnosis ; Female ; Hematoma ; Humans ; Middle Aged ; Neck* ; Sutures ; Syncope ; Thyroid Neoplasms ; Thyroidectomy ; Wounds, Stab

BACKGROUND AND OBJECTIVES: The incidence of inflammatory heart diseases is not yet as high as those of other cardiovascular diseases; however, inflammatory heart diseases do have relatively high mortality rate. Therefore, update information on the economic burden of inflammatory heart diseases are necessary in order to appropriate policy making on these diseases. MATERIALS AND METHODS: This study used a number of resources to obtain data, national health insurance statistics, the Korean Health Panel, and the causes of death report by the Korean National Statistical Office. The total costs of inflammatory heart diseases were estimated as the sum of direct medical care costs, direct non-medical care and indirect costs. RESULTS: The total direct cost of inflammatory heart disease was higher in Korean men than that of Korean women and cost due to inpatient was higher than that of outpatients cost. The costs to cover premature death were highest among all of the components used to determine the total costs for inflammatory heart disease, representing 66.3% of these costs in Korea. CONCLUSION: Inflammatory heart disease has a relatively high mortality rate, and the costs that are associated with premature deaths consume the greatest proportion of the costs associated with this disease. In spite of some limitations of study, this could be a reliable evidence of economic burden of inflammatory heart disease.
Cause of Death ; Cost of Illness ; Endocarditis ; Female ; Health Care Costs ; Heart ; Heart Diseases ; Humans ; Incidence ; Inflammation ; Inpatients ; Korea ; Male ; Mortality, Premature ; National Health Programs ; Outpatients ; Policy Making

We reports a woman's death caused by massive intraabdominal hemorrhage, who was in chronic alcoholic state with advanced liver cirrhosis and found dead in her room. No macroscopic source for the bleeding was found in her intraabdomen and there was no circumstances of traumatic forces to the individual's body around the death. The presenting unsuspected death could be consistent with the forensic pathological cases described as sudden, unexpected death due to massive nontraumatic intraabdominal hemorrhage in association with liver cirrhosis by DiMaio in 1987.
Alcoholics ; Hemorrhage* ; Humans ; Liver Cirrhosis* ; Liver*

A schwannoma is a benign neurogenic tumor derived from Schwann cells. A rare case of a large painful schwannoma in the foot with metatarsal deformity was presented. Due to suspicion of malignancy, amputation had been recommended previously. We report on a rare case of a large forefoot schwannoma causing pain and paresthesia of the forefoot.
Amputation ; Foot ; Foot Deformities ; Neurilemmoma* ; Paresthesia ; Schwann Cells

PURPOSE: To present clinical results of proximal first metatarsal opening wedge osteotomy and low profile plate fixation in hallux valgus deformity. MATERIALS AND METHODS: Thirty-two patients (39 feet) underwent surgery for hallux valgus deformity. Fourteen patients (18 feet; Group A) underwent proximal first metatarsal opening wedge osteotomy fixed with low profile titanium plate (Arthrex(R)), and 18 patients (21 feet; Group B) underwent proximal chevron osteotomy with two K-wires. Improvement in hallux valgus angle (HVA), 1, 2 intermetatarsal angle (IMA), range of motion of 1st metatarsophalangeal joint, VAS score, and the length of first metatarsal on weight-bearing radiograph were evaluated preoperatively and at final follow-up. RESULTS: HVA improved from 36.2+/-6.6 degrees to 11.7+/-5.1 degrees, and 1, 2 IMA improved from 15.7+/-2.6 degrees to 7.2+/-1.9 degrees. VAS score improved from 7.2+/-1.2 to 1.4+/-0.9. There were no significant differences clinically and radiologically. CONCLUSION: Proximal first metatarsal opening wedge osteotomy with stable fixation using low profile plate may be an effective surgical option for correction of hallux valgus deformity.
Congenital Abnormalities ; Follow-Up Studies ; Foot ; Hallux Valgus* ; Hallux* ; Humans ; Metatarsal Bones ; Metatarsophalangeal Joint ; Osteotomy* ; Range of Motion, Articular ; Titanium ; Weight-Bearing