Carcinoid tumors are arisen from enterochromaffin cells, which are scattered throughout the body but occur primarily in the submucosa of the intestine and brpnchi. Carcinoid tumors synthesises numerous bioactive amines such as serotonin, and cause the carcinoid syndrome. Rectal carcinoids present as asymptomatic submucosal nodules less than 2cm in size. In contrast to other carcinoid tumors, distant metastasis are rare(less than 15%). Malignant potential is seen almost exclusively in patients with tumors larger than 2cm. Transanal local excision suffices for tumors less than 2cm, with radical surgery reserved only for larger tumors and those with histological evidence of invasion of the muscularis propria. I have experienced two cases of rectal carcinoid tumors less than 2cm, which do not invade the muscular wall of the rectum. These carcinoids were treated with endoscopic polypectomy.
Amines ; Carcinoid Tumor* ; Enterochromaffin Cells ; Humans ; Intestines ; Neoplasm Metastasis ; Rectum* ; Serotonin

BACKGROUND: It is expected that the demand for the information about the primary medical service in the forthcoming supersede age of communication will be on the increase. For that reason, family doctors who are in charge of the primary medical service have to play an important part in constructing a data-base for furnishing the medical information. This article presents a model which includes the roles of family doctors, constructing medical-related information site of family medicine in the communications net with PC to gat,her fundamental data in operating the system of medical information and elucidating the formation of medical-related information site and the effect of operating that system. METHODS: Since Aug. 20 in 1996, the site of family medicine, the program of medical information, has been set up in Unitel. The medical information of the site of family medicine is to be classified into two parts : for doctors and for the public. The former is composed of medicine documents, several kinds of medical data, a linkage with medicine site in Internet, movements of an academic society and information exchanges for friendship. The latter is mainly made up of some practical medical sense and medical counsel. RESULTS: From the opening the medical information site to Jul. 30 in 1997, 250 persons a day have connected with medical information site and this fact implied 15 hours connection a day in terms of the daily mean. The cases of health counsel averaged 6 cases connection a day and the annual statistics of those cases were about, 1980 cases. The major content of health counsel was related to common symptoms that could be settled in primary medical problem. According to the survey for connectors, most of connectors answered that the medical information through communications net was much more effective t.han that from other media in the educational aspects and very helpful in the prevention of diseases and in the medical expenditure. Above all, the medical information through communications net was very effective in correcting the mistaken practical medical sense. CONCLUSIONS: It is necessary for family doctors to give thought to the connection of both information communication and medicine and to have correct understanding of medical domain in the cyberspace. On the foundation of these necessities, all the family doctors have to make the best of their way to construct a database with rnedical data and to transfer these data into the computer sites.
Friends ; Health Expenditures ; Humans ; Internet

We experienced four cases of sporotrichosis including three lymphocutaneous type and one fixed cutaueous type. Case 1 was a 6-year old child, affected over the right chin. Case 2 was a 31-year old housewife, affected over the right forearm, Case 3 was a 53-year old housewife, affected over the right forearm and dorsum of right hand. Case 4 was a 19-year old student, affected over the left forearm. Histopathologically, chronic granulomatous inflammation with the neutrophilic ivfiltration and/or central suppuration were observed. Mycologically, typical colonies with moist, wrinkled and rnembraneous surface were cultured except in case 3. All patients were completly cured by oral administration of low dosage of potassium iodide(63. R-lllg) in a short period (50~86 days).
Administration, Oral ; Adult ; Child ; Chin ; Forearm ; Hand ; Humans ; Inflammation ; Middle Aged ; Neutrophils ; Potassium Iodide* ; Potassium* ; Sporotrichosis* ; Suppuration ; Young Adult

Clinically, the transformation of morphea to scleroderma is rare. We report a case suggested acroselerosis transformed from guttate morphea. Patient was 30-year old woman who had generalized bean-sized depigmented macules except face since early childhood. About one year ago, Raynauds phenomenon, edema and sclerotic change of the both hands and feet were developed. On the laboratory findings, there were positive reaction for rheumatoid factor and antinauclear antibody test and increase of erythrocyte sedimentation rate. Histopathologically, there were even increased collagen fibers, atherosclerotic change of the vessels and atrophic sweat glands.
Adult ; Blood Sedimentation ; Collagen ; Edema ; Female ; Foot ; Hand ; Humans ; Rheumatoid Factor ; Scleroderma, Localized* ; Sweat Glands

The prevalence of PPNG among pretreatment isolates at a VD Clinic in Seoul has been studied and reported annually since 1981. In 1987, 649 strains of N. gonorrhoeae were isolated, among which 339(52.2%) were PPNGs. The prevalence of PPNG in Seoul is still increasing.
Korea* ; Prevalence* ; Seoul*

OBJECTIVE: To compare an isotonic lumbar extension exercise program utilizing lumbar extension exercise machines with modified combination program of isotonic lumbar extension exercises, including dynamic stabilization exercise, to improve and maintain trunk stability in the patient with microscopic lumbar discectomy. METHOD: We studied 41 male workers who underwent microscopic lumbar discectomy. Group 1 (n=24) was treated with the isotonic lumbar extension exercise program. Group 2 (n=17) was treated with the modified combination program of dynamic lumbar stabilization exercise and isotonic lumbar extension exercise. The categories that were evaluated and measured were trunk stability, isometric peak torque of lumbar extensor, weight distribution rate of both leg and trunk muscle balance, and Oswestry low back pain (LBP) disability index. RESULTS: After 3 months, group 1 revealed higher isometric peak torque, weight distribution rate of both leg and trunk muscle balance compared with that of group 2. At the end of 6 months, group 2 revealed higher isometric peak torque compared with that of group 1. CONCLUSION: We suggested that combined exercise program, that included the dynamic lumbar stabilization exercise and the isotonic lumbar extension exercise, was a valuable treatment for postoperative lumbar rehabilitation.
Diskectomy* ; Exercise ; Humans ; Leg ; Low Back Pain ; Male ; Rehabilitation ; Torque

Essential thrombocythemia (ET) is a chronic myeloproliferative disease characterized by a markedly elevated platelet count in the peripheral blood due to excessive proliferation of bone marrow megakaryocytes. When the disease affects women during pregnancy, an adverse obstetric outcome is possible: miscarriages, intrauterine growth restriction, preterm delivery, intrauterine fetal death, preeclampsia. Maternal complications, both thrombotic and hemorrhagic, were reported relatively infrequently. Various treatments as acetylsalicylic acid, hydroxyurea, anagrelide, heparin, interferon-alpha and plateletpheresis have been proposed to improve the pregnancy. Our case was a 38 years old multiparous women at 37 weeks of gestation with preeclampsia, intrauterine growth restriction. Under the impression of oligohydramnios and fetal distress, an emergency cesarean section was performed under epidural anesthesia. During cesarean section, sudden cardiac arrest with unknown cause was developed, and successful resuscitation was done. After cesarean section, patient continued to elevate platelet count. So bone marrow aspiration and biopsy were performed and showed essential thrombocythemia. We report a case of essential thrombocythemia diagnosed during pregnancy with brief review of the literature.
Abortion, Spontaneous ; Adult ; Anesthesia, Epidural ; Aspirin ; Biopsy ; Bone Marrow ; Cesarean Section ; Death, Sudden, Cardiac ; Emergencies ; Female ; Fetal Death ; Fetal Distress ; Fetal Growth Retardation ; Heparin ; Humans ; Hydroxyurea ; Interferon-alpha ; Megakaryocytes ; Oligohydramnios ; Platelet Count ; Plateletpheresis ; Pre-Eclampsia ; Pregnancy* ; Resuscitation ; Thrombocythemia, Essential*

PURPOSE: There has been controversy over an adequate operative method for peptic ulcer perforation, but currently there is general agreement in the surgical literature that perforated duodenal ulcers in patients who constitute excessive surgical risk should be managed by the simplest possible procedure and in the absence of surgical risk, definitive operations are advocated. However, an accurate description of the degree of severity of concurrent medical disease and surgical risk factor is not available and the question as to whether the postoperative mortality is influenced by the magnitude of the procedure or determined only by the patient's risk remains unanswered. METHODS: This retrospective study reviewed the case histories of all patients who underwent operations for perforated duodenal ulcer at Gil Medical Center from January 1993 through 1998 and evaluates the influences of prognostic factors, APACHE II, SAPS, age, duration of peritonitis, concurrent major medical disease and ulcer size, and operative procedures on postoperative mortality in high risk and low risk groups. RESULTS: Large APACHE II score (> or =15) and SPSS (> or =10), delayed operation, large ulcer (> or =2 cm), age (> or =60), and major medical illness that severely compromised cardiorespiratory, hepatic, renal, and immunologic function were associated significantly with mortality in patients with a perforated peptic ulcer. CONCLUSION: Age, duration of peritonitis, major medical disease, APACHE II score, and ulcer size should be pre-sumed to be important prognostic factors. Although further study is necessary in a larger number of patients, it appears that operative procedures have no influence on postoperative mortality.
APACHE ; Duodenal Ulcer* ; Humans ; Mortality ; Peptic Ulcer ; Peptic Ulcer Perforation ; Peritonitis ; Retrospective Studies ; Risk Factors ; Surgical Procedures, Operative ; Ulcer

A 11-month-old male with severe combined immune deficiency (SCID) received allogeneic bone marrow transplantation (BMT). He had suffered from recurrent infection and chronic diarrhea. Two older brother died of pneumonia 2 months after birth, but his HLA identical sister was healthy. He had very low number of T lymphocyte and NK cell. Although number of B lymphocyte was normal, level of immunoglobulin was extremely low. First BMT was done when he was 11 months old. Eighteen milliliter of bone marrow was simply infused without conditioning or GVHD prophylaxis. T lymphocyte appeared and fever which persisted despite use of antibiotics disappeared at day 7. Grade II GVHD developed, but was well controlled with corticosteroid. T lymphocyte subpopulation became normal at day 42. But pancytopenia developed and persisted despite use of G-CSF. Second BMT was done 4 months after 1st BMT. The conditioning regimen included busulfan (8 mg/kg) and cyclophosphamide (200 mg/kg), and ATG, cyclosporine and short-course MTX were used for GVHD prophylaxis. He achieved ANC> 500/uL at day 20 and platelet> 20,000/uL at day 29. BM examination on day 45 showed that 100% of marrow cells were donor origin. Acute and chronic GVHD did not develop. Since T lymphocyte was observed on day 21, various immunological parameters were normalized sooner or later. Immunological reconstitution was complete on day 280. Vaccination was given after 1 year of BMT and he is healthy now.
Anti-Bacterial Agents ; Bone Marrow ; Bone Marrow Transplantation ; Busulfan ; Cyclophosphamide ; Cyclosporine ; Diarrhea ; Fever ; Granulocyte Colony-Stimulating Factor ; Humans ; Immunoglobulins ; Infant ; Killer Cells, Natural ; Lymphocyte Subsets ; Lymphocytes ; Male ; Pancytopenia ; Parturition ; Pneumonia ; Siblings ; Tissue Donors ; Vaccination

BACKGROUND: Donor leukocyte infusion (DLI) is an effective therapy for patients who relapse with leukemia after allogeneic bone marrow transplantation (BMT). This is due to the fact that the immune reactivity of infused allogeneic lymphocytes on relapsed leukemia cells plays a major role in the control of leukemia. However, severe graft-versus-host disease (GVHD) and pancytopenia compromise the success of this treatment in a substantial number of patients. METHODS: To evaluate the effect of DLI, we surveyed 6 BMT centers regarding their use of DLI for relapsed leukemia after BMT. Detailed forms were used to gather data regarding the original BMT, relapse, response to DLI, complication and survival. Reports of 11 patients were consequently available for analysis. RESULTS: Five (83.3%) of 6 patients with chronic myeloid leukemia (CML) achieved complete remission (CR) [time-to-CR; 116 (27~180) days after DLI], and currently 4 are alive in CR (49~436 days). Five patients (83.3%) developed GVHD, and 2 developed pancytopenia which was related to DLI. In acute leukemia, all patients received salvage chemotherapy prior to DLI. Only 1 of 3 patients with acute lymphoblastic leukemia (ALL) who had early relapse achieved CR, but durable remission was not yet confirmed (62+ days). Both 2 patients with acute myeloid leukemia (AML) achieved CR, and their CR durations were 242+ and 326 days after DLI, respectively. CONCLUSION: This study demonstrates that DLI can exert considerable effects against myeloid forms of leukemia, especially in CML. Further investigations of separating GVHD from the graft- versus-leukemia effect and finding more effective anti-leukemia approaches on acute leukemiaare necessary to improve the current DLI limitations.
Bone Marrow Transplantation* ; Bone Marrow* ; Drug Therapy ; Graft vs Host Disease ; Humans ; Leukemia* ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Leukemia, Myeloid, Acute ; Leukocytes* ; Lymphocytes ; Pancytopenia ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Recurrence ; Tissue Donors*