No abstract available.

BACKGROUND: Pharmacists could dispense medicines without doctors' prescription in Korea before July 2000. The aim of this study was to compare the prescription behaviors of practicing doctors and pharmacists to common cold by the simulated patients. We selected the common cold as a subject of simulation because it was the most frequent health problem to visit doctors and pharmacists and the abuse of antibiotics might be prevalent in management of it. METHODS: Seventy five private clinics and drug stores were selected in Seoul, Korea. The simulated patients were selected and trained standardized symptoms of common cold. The simulated patients recorded the prescription behaviors of doctors and pharmacists. RESULTS: Average number of prescribed medicines were 5.0 and 5.6 in clinic and drug store respectively. 54.7% of the clinics and 61.3% of the drug stores prescribed antibiotics respectively with no significant difference between them. The most frequently prescribed antibiotics were penicillines. About 7% of the doctors and 11% of the pharmacist prescribed glucocorticoid to simulated patients respectively. About 20% of the pharmacists performed some kinds of physical examination to the simulated patients. Both doctors and pharmacist gave little information or advice on use of medicines, possible side effects and past side effects of medicines. CONCLUSION: There were frequent abuse of antibiotics and occasional use of glucocorticoid in private clinics and drug stores. Both doctors and pharmacists did not give enough information on use of medicines to the simulated patients.
Anti-Bacterial Agents ; Common Cold* ; Humans ; Korea ; Patient Simulation ; Penicillins ; Pharmacists* ; Physical Examination ; Prescriptions* ; Seoul

BACKGROUND: Oral isotretinoin has been widely used in severe acne patients and is known as a very effective drug. Recently it is being used in any grades and any types of acne. However we have few reports of clinical study about oral isotretinoin in our country. OBJECTIVE: To investigate clinical efficacy, factors influencing the result and side effects of oral isotretinoin in mild to moderate acne patients in Korea, prospectively. NATERIALS AND METHODS: The patients with mild to moderate acne visiting out-patient dermatology clinics of four university hospitals have taken oral isotretinoin 0.3-1.0mg/kg/day over 16 weeks. The clinical improvement was assessed by the scores using photographs before treatment and at 8 weeks, 12 weeks, 16 weeks, 20 weeks after treatment, and by the satisfaction of patients and physicians at the end of treatment. The side effects were recorded and SGOT, SGPT, cholesterol and triglyceride were checked at regular intervals. RESULTS: The grade of acne was much improved proportional to the duration of treatment. The factors showing better results were dosage and duration of oral isotretinoin, older age, more severe acne and severe acne in the past. About 90% of patients and physicians were satisfied with the result at the end of treatment. The side effects, mainly mucocutaneous symptoms were expectable and tolerable in the most cases. The values of SGOT, SGPT, cholesterol and triglyceride were increased after treatment but within normal reference range. CONCLUSION: Oral isotretinoin is a very effective agent in Korean patients with mild to moderate acne. We expect the better result in patients having high dose and long duration of oral isotretinoin, old ages and more severe acne. If we understand it's side effects enough, we can use it very safely.
Acne Vulgaris* ; Alanine Transaminase ; Aspartate Aminotransferases ; Cholesterol ; Dermatology ; Hospitals, University ; Humans ; Isotretinoin* ; Korea ; Outpatients ; Prospective Studies ; Reference Values ; Triglycerides

Purpose: Recently the incidence of vancomycin resistant enterococcus (VRE) infection and colonization has increased in the hospitalized patients. The purpose of present study is to examine the clinical significance of VRE infection and colonization in liver transplantation (LT) patients and to investigate the outcome. Methods: Among 194 patients who underwent LT from January 2001 to July 2004, 15 patients had at least one report of culture positive of VRE (VRE(+)). We compared the clinical outcome of 15 VRE(+) patients with those of VRE(-) patients. Results: One year mortality was higher in VRE(+) patients than VRE(-) patients (27% vs 4%; P=0.0001). Causes of death were primary graft non-function, infective endocarditis, MRSA sepsis and CMV pneumonitis. Mean duration of hospital stay was 102+/-63 days in VRE(+) patients, which shows significant difference with 51+/-30 days in VRE(-) patients (P=0.008). Cases who underwent gastroscopy (1.00+/-1.51 vs. 0.12+/-0.47; P=0.04) and percutaneous catheter drainage (1.33+/-1.49 vs. 0.40+/-1.05; P=0.03) were significantly more frequent in VRE(+) patients. The findings of gastroscopy were upper gastrointestinal bleeding (n=4), and bile duct obstruction (n=1). The contents of percutaneous catheter drainage were hematoma (n=3), bile juice (n=3) and ascites (n=1). Conclusion: VRE infected patients experienced more frequently gastrointestinal tract complications including bleeding or biliary complication and they showed higher 1-year mortality rate, although these patients died of causes other than VRE infection.
Ascites ; Bile ; Catheters ; Cause of Death ; Cholestasis ; Colon ; Drainage ; Endocarditis ; Enterococcus* ; Gastrointestinal Tract ; Gastroscopy ; Hematoma ; Hemorrhage ; Humans ; Incidence ; Length of Stay ; Liver Transplantation* ; Liver* ; Methicillin-Resistant Staphylococcus aureus ; Mortality ; Pneumonia ; Sepsis ; Transplants ; Vancomycin*

PURPOSE: Primary malignant lymphomas of the salivary glands are uncommon, representing only 1.7% to 3.1% of all salivary neoplasms and 0.6% to 5% of all tumors and tumor-like lesions of the parotid gland. Lymphomas of the parotid glands are usually manifestations of a systemic disease process but primary lymphomas of the parotid glands are rare. Most of these lesions are classified as extranodal non-Hodgkin's lymphoma. We report the clinicopathological features of primary malignant lymphoma of the parotid gland based on an analysis of our cases. METHODS: The subject was a 48-year-old male patient with a malignant lymphoma originating in the parotid gland, which had been slowly increasing in size over previous 6 months. The diagnosis was established by MRI and a superficial lobectomy. After diagnosis, the patient was referred to an oncologist for staging and medical treatment. RESULTS: The stage was IIIA. The patient was treated with chemotherapy following surgery with rituximab and CHOP (Cyclophosphamide, Adriamycin, Vincristine, Prednisolone). The tumor was controlled successfully by chemotherapy. The patient was followed up for 1 year with no relapse. CONCLUSION: A case of primary non-Hodgkin's lymphoma of the parotid gland was treated with a superficial parotidectomy and chemotherapy. The disease was well controlled after a 1 year follow-up.
Antibodies, Monoclonal, Murine-Derived ; Doxorubicin ; Follow-Up Studies ; Humans ; Lymphoma ; Lymphoma, Non-Hodgkin ; Male ; Middle Aged ; Parotid Gland ; Recurrence ; Salivary Glands ; Vincristine

PURPOSE: Graft-Versus-Host Disease (GVHD) is a rare (0.1~2%) but severe complication after liver transplantation (LT). It is the most lethal complication after LT and there are currently no effective preventive or therapeutic measures available. Approximately 90 such cases have been reported in the literature, but only one case has been reported in Korea. METHODS: We performed a retrospective analysis of 767 patients who underwent LT (living donor:deceased donor=554:213) at Seoul National University Hospital, Korea from 1998 to 2009. Four patients (4/767, 0.52%) with histologically proven GVHD were found. The diagnosis of GVHD was made according to observing macrochimerism in the peripheral blood and the affected tissue biopsy. RESULTS: Four patients underwent LT due to Hepatitis B virus-related liver cirrhosis and two of these patients had coexisting hepatocellular carcinoma. Three patients received livers from deceased donors and one received a liver from a live donor. All their blood matching were identical. The first diagnosed case underwent human leukocyte antigen (HLA) typing only after LT and it showed complete one-way donor-recipient HLA matching. The onset of GVHD occurred between 10 days and 55 days after LT. All the patients developed high-grade fever, skin rash, neutropenia, diarrhea and the main signs and symptoms related to GVHD. All the patients died because of sepsis despite intensive treatment. CONCLUSION: GVHD after LT is an extremely rare and fatal complication and it is difficult to diagnose. Therefore, we should perform pre-transplant HLA matching and try to establish an early diagnosis for patients who are clinical suspicious of having GVHD. Further study in this area is needed and physicians need to be alert to detect this malady.
Carcinoma, Hepatocellular ; Chimerism ; Diarrhea ; Early Diagnosis ; Exanthema ; Fever ; Graft vs Host Disease ; Hepatitis B ; Humans ; Korea ; Leukocytes ; Liver ; Liver Cirrhosis ; Liver Transplantation ; Neutropenia ; Retrospective Studies ; Sepsis ; Tissue Donors

PURPOSE: Split liver transplantation (SLT) offers an effective way of increasing the donor pool. However, it is often difficult to perform SLT under current allocation system. We retrospectively analyzed the outcome of the patients who had undergone SLT in Seoul National University Hospital. METHODS: From the first case of SLT in Korea on November 4, 1998, 8 patients underwent SLT in our center. Three adult patients received extended right liver graft and five child patients received left lateral section graft. All liver were split by in-situ method. RESULTS: All adult patients were alive. One adult patient developed hepatic artery thrombosis one month after SLT and underwent retransplantation due to graft failure. Another patient developed biliary leakage and had to undergo operative bile duct revision. Two of child patients were died of pneumonia and hepatic failure due to HBV hepatitis, respectively. One child patient suffered from hepatic venous stricture and persistent ascites and received interventional therapy. Overall 3-year patient survival rate was 87.5% and graft survival rate was 75.0%. No primary nonfunction developed and three patients (37.5%) suffered form vascular or biliary complications. CONCLUSION: The results of SLT were similar to that of conventional deceased donor liver transplantation. Although SLT is technically difficult and increase the risk of vascular or biliary complications just like living donor liver transplantation (LDLT), its result might be acceptable and it could be a successful method to expand the donor pool if it would be performed in the center experienced in LDLT.
Adult ; Ascites ; Bile Ducts ; Child ; Constriction, Pathologic ; Graft Survival ; Hepatic Artery ; Hepatitis ; Humans ; Korea ; Liver Failure ; Liver Transplantation* ; Liver* ; Living Donors ; Pneumonia ; Retrospective Studies ; Seoul ; Shiga Toxin 1 ; Survival Rate ; Thrombosis ; Tissue Donors ; Transplantation ; Transplants

OBJECTIVE: To examine expression of survivin and Bcl-2 in eutopic endometrium with endometriosis and without endometriosis by immunohistochemical stain. METHODS: Expression of survivin and Bcl-2 was immunohistochemically investigated in eutopic endometrium with endometriosis (n=30, study group I; laparoscopy-proved endometriosis, study group II; adenomyosis) or without endometriosis (n=34, control group). The score of immunohistochemical staining was evaluated semi-quantitative method modified by Sinicrope and Lu. Statistical analyses was carried out using one-way ANOVA with Turkey test. RESULTS: Survivin expression was significantly higher in nucleus of glandular epithelium of eutopic endometrium with endomtriosis compared to that without endometriosis (p<0.05). Increased expression of Bcl-2 was found in glandular epithelium of eutopic endometrium with endometriosis than without endometriosis, but there was no significantly difference. CONCLUSION: Our findings suggest that increased survivin expression may contribute to survival of endometriosis. Moreover, survivin could play an important role in pathogenesis of endometriosis.
Endometriosis* ; Endometrium* ; Epithelium ; Female ; Turkey

PURPOSE: This study aimed to evaluate the value of serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels to detect gastric cancer recurrence. MATERIALS AND METHODS: We retrospectively reviewed 154 patients who developed recurrence within 2 years after curative gastric cancer surgery and analyzed the relationship between postoperative CEA and CA19-9 levels and recurrence. We readjusted the cut-off values to improve the detection of recurrence. Subgroup analysis according to clinicopathologic variables was performed to further investigate the relationship between recurrence and CEA and CA19-9 levels. RESULTS: The sensitivity and specificity for elevated CEA levels to detect recurrence were 40.6% and 89.5%, respectively, and those for CA19-9 were 34.2% and 93.6%, respectively. The sensitivity and specificity for elevation of either tumor marker were 54.3% and 84.0%, respectively; those for elevation of both tumor markers were 19.2% and 98.4%, respectively. By readjusting the cut-off values from 5.0 ng/ml to 5.2 ng/ml for CEA and from 37.00 U/ml to 30.0 U/ml for CA19-9, the sensitivity was increased from 34.2% to 40.2% for CA19-9, while there was no increase in sensitivity for CEA. In subgroup analysis, the sensitivity of CEA was higher in patients with elevated preoperative CEA levels than in patients with normal preoperative CEA levels (86.7% versus 33.7%; P<0.001). Furthermore, the sensitivity of CA19-9 was higher in patients with elevated preoperative CA19-9 levels than in patients with normal preoperative CA19-9 levels (82.61% versus 26.83%; P<0.001). CONCLUSIONS: CEA and/or CA19-9 measurement with the readjusted cut-off values allows for more effective detection of gastric cancer recurrence.
Carcinoembryonic Antigen* ; Humans ; Recurrence* ; Retrospective Studies ; Sensitivity and Specificity ; Stomach Neoplasms* ; Biomarkers, Tumor

PURPOSE: Liver regeneration is crucial following major liver resection or partial liver transplantation. The inhibition mechanism of regeneration is portal hypertension caused by excessive portal flow to the small liver. Portal hypertension can be controlled with terlipressin, an effective splanchnic vasoconstrictor. The purpose of this study was to investigate the effect of terlipressin on the portal pressure and liver regeneration in 90% hepatectomized rats. METHODS: Forty-eight male Sprague-Dawley (250 gm) rats were divided into three groups; Group N (n=16) underwent Sham operation, Group C (n=16) was injected with 0.1 mL saline after 90% hepatectomy, and Group T (n=16) was injected with 50microgram/kg terlipressin after 90% hepatectomy. To assess the liver regeneration response, the changes in proliferating cell nuclear antigen (PCNA) and tumor necrosis factor-alpha (TNFalpha) were monitored for 48 hours. RESULTS: The baseline portal pressures in Groups N, C, and T were 4.9, 12.4, and 14.1 mmHg (P<0.05). In Group T, the injection of terlipressin induced a significant reduction of the portal pressure (-30.2%, P<0.05). There was no difference in PCNA between Groups C and T. However, serum TNFalpha levels were significantly higher in Group T (248.4 pg/ mL) than Group C (52.3 pg/mL) 48 hours postoperatively (P<0.05). CONCLUSION: The control of portal pressure with the use of terlipressin was correlated with serum TNFalpha. These data provide evidence that the administration of terlipressin during the early postoperative period following major liver resection may have an attenuating effect on portal hypertension, which may also stimulate the initiation of the regenerative process.
Animals ; Hepatectomy ; Humans ; Hypertension, Portal ; Liver Regeneration* ; Liver Transplantation ; Liver* ; Male ; Portal Pressure* ; Postoperative Period ; Proliferating Cell Nuclear Antigen ; Rats* ; Rats, Sprague-Dawley ; Regeneration ; Tumor Necrosis Factor-alpha