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: 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

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

BACKGROUND: The efficacy of isotretinoin in the treatment of acne has been widely established. Recently oral isotretinoin has been used for any grades and any types of acne. There have been many articles on long-term follow up data with oral isotretinoin therapy. OBJECTIVE: To assess, after 1 year post-treatment with oral isotretinoin, the relapse rate, risk factor which influence the outcome, and the total cumulative dose of oral isotretinoin in mild to moderate acne patients in Korea, prospectively. MATERIAL AND METHODS: 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 outcomes were evaluated by telephone contact, with regard to relapse, further treatment in cases of relapse; subjective assessment of sebum secretion and patient satisfaction. A total of 230 patients were evaluated at the end of the preliminary report, and 124 out of the 230 were contacted in this 1 year follow up. RESULT: A relapse rate of 25% was obtained on our study. The patient's sex, seborrhea, acne grade prior to treatment, previous severest acne grade did not influence the relapse rate. It appeared that young age and the total cumulative dose (TCD) influenced the percentage of relapse. About 71.3% of patients were satisfied with the result after 1 year post-treatment with oral isotretinoin. CONCLUSION: The dose schedule, in particular the cumulative dose, was an important factor in determining the relapse rate. It is capable of producing a low relapse rate and long-term remission in mild to moderate acne patients in Korea, if given in a dose regimen of a cumulative dose of 80 mg/kg.
Acne Vulgaris* ; Appointments and Schedules ; Dermatitis, Seborrheic ; Dermatology ; Follow-Up Studies ; Hospitals, University ; Humans ; Isotretinoin* ; Korea ; Outpatients ; Patient Satisfaction ; Prospective Studies ; Recurrence* ; Risk Factors ; Sebum ; Telephone

PURPOSE: The mass cultivation of functional hepatocytes is a key factor of a bioartificial liver. Combining spheroid and microcarrier cultures has been applied for enhancing the cell viability and metabolic activities. Hence, the optimal number of hepatocytes per microcarrier was investigated. METHODS: Firstly, spheroid cultures were carried out with 1 g Cytodex 3 microcarrier plus 2 x 10(9), 4 x 10(8) and 8 x 10(7) viable hepatocytes per flask. The numbers of hepatocytes per microcarrier were approximately 666.7, 133.3 and 26.7, respectively. The control group consisted of a spheroid culture of 4 x 10(8) hepatocytes without any microcarrier. According to the primary experimental results, spheroid cultures with 1 x 10(8) of hepatocytes plus 1 g, 2 g and 3 g of the Cytodex 3 microcarrier were performed. The numbers of hepatocytes per microcarrier were approximately 33.3, 16.7 and 11.1, respectively. The control group consisted of a spheroid culture of 1 x 10(8) hepatocytes. The cell viabilities were assayed using a Cell Counting Kit-8; with the albumin production assayed using ELISA. RESULTS: According to the primary experiment, the group consisting of 26.7 hepatocytes per microcarrier showed the highest viability (P<0.01). However, there was no statistical difference in the albumin production between the groups (P=0.744). The second Experiment showed the groups consisting of 11.1 and 16.7 hepatocytes per microcarrier had higher viabilities than the other hepatocyte and control groups (P<0.01). The albumin production was similar for each group (P=0.187). CONCLUSION: With respect to their application to a bioartificial liver, about 130 hepatocytes per microcarrier was appeared to be good for the mass cultivation of a hepatocytes spheroid culture using the Cytodex 3 microcarrier.
Cell Count ; Cell Survival ; Enzyme-Linked Immunosorbent Assay ; Hepatocytes* ; Liver, Artificial

We have performed 3 cases of APOLT in one child and two adults. The child recipient had suffered from complement factor H deficiency since 3 months after birth and at the age of 30 months, APOLT was undertaken. Living donors of two adult recipients were affected by severe hepatic steatosis and the grafts were relatively small-for-size. After left hemihepatectomies, left lateral section and left hemilivers were transplanted orthotopically. The child recipient died of heart failure due to sepsis 7 months after transplantation, but factor H level remained nearly normal until his death. Although one adult suffered from hepatic venous stricture postoperatively, all adult recipients are alive with normal liver function for 11 and 8 months. In conclusion, although APOLT is technically demanding, APOLT may be a suitable surgical procedure in non-cirrhotic metabolic liver disease and a feasible solution for marked steatotic living donor grafts and small-for-size grafts.
Adult* ; Child ; Complement Factor H* ; Complement System Proteins* ; Constriction, Pathologic ; Heart Failure ; Humans ; Liver Diseases ; Liver Transplantation* ; Liver* ; Living Donors ; Parturition ; Sepsis ; Transplants

PURPOSE: In our experience, post-LT persistent isolated unconjugated hyperbilirubinemia (IUH) has been frequently observed even after liver transplantation (LT) from normal donors. The present study was performed to evaluate the incidence and clinical significance of post-LT IUH. METHODS: Eighty-five patients were enrolled, and they had undergone adult-to-adult living donor LT between Jan 1999 and Jun 2003 and they had been followed-up for more than 2 years. Persistent post-LT IUH was defined as the case that showed repeated IUH 3 times or more per year. We excluded those cases that had other liver function abnormality, biliary complication, active infection or hemolysis. The donor's condition and the long-term prognosis of the post-LT IUH patients were investigated. RESULTS: Sixteen patients (18.8%) showed post-LT IUH. Seven of them underwent LT from donors who had IUH preoperatively. Nine (10.6%) of them, however, underwent LT from normal donors, that is, there was newly developed IUH postoperatively. There was no clinical factor associated with post-LT IUH for those nine patients, yet they developed no graft failure and major complications. A gradual increasing tendency of the bilirubin level during follow-up duration was observed for 3 of these 9 patients. CONCLUSION: Although about 10% patients developed post-LT IUH from normal donors, they all showed a good prognosis. Therefore, post-LT IUH was likely to be benign. However, close observation may be required because a gradual increasing tendency of bilirubin level was observed in some patients.
Bilirubin ; Follow-Up Studies ; Gilbert Disease ; Hemolysis ; Humans ; Hyperbilirubinemia* ; Incidence ; Liver Transplantation* ; Liver* ; Living Donors ; Prognosis ; Tissue Donors ; Transplants