BACKGROUND: Telemedicine can be useful in dermatology in which there is a physical barrier between the dermatologist and patient or primary care giver. OBJECTIVE: Our purpose of this study is to examine a usefulness of teledermatology system in Korean situation. METHODS: We made store-and forward teledermatology system on world wide web for it's usefulness. We examined the difference of diagnostic accuracy, level of certainty, and quality of images of photographs and still digital images. RESULTS: The merits of our teledermatology system are summarized as follows1. It has more diagnostic accuracy than classic store-and forward system. 2. The real-time additional history taking and request of laboratory examinations are possible by chatting system between dermatologist and primary care giver. 3. Patient follow-up is easier than store-and forward system. The difference of diagnostic accuracy, level of certainty, and quality of images of photographs and still digital images are summarized as follows. 1. There is no difference of diagnostic accuracy between photographic readers and digital image readers. 2. There is no difference of level of certainty between photographic readers and digital image readers. 3. In assesment of quality of photographs, no difference was founded between photographic readers and digital image readers 4. The satisfaction of quality of photographs is very high in all groups. The average is 97.5%. CONCLUSION: This study provides evidence that our teledermatology system is useful in korean situation and still digital image can substitute historic photographs in teledermatology.
Dermatology* ; Equidae ; Follow-Up Studies ; Humans ; Internet ; Primary Health Care ; Telemedicine*

OBJECTIVE: The introduction of new psychiatric medications with better efficacy and tolerance seems to increase the frequencies of co-prescriptions of various psychotropic agents. We investigated the frequencies of the combined treatments of atypical antipsychotics and selective serotonin reuptake inhibitors (SSRIs) that are supposed to be common in clinical practice. METHODS: Data on 2783 outpatients from March 1, 2002 through June 31, 2002 in Seoul National University Hospital were collected. The number of cases with a co-prescription of atypical antipsychotics with SSRIs were counted and compared by diagnoses. The relations of diagnosis and age to the combined treatment were explored. RESULTS: 499 (17.4%) patients took co-prescriptions of antipsychotics with antidepressants, and 393 (13.7%) patients those of atypical antipschotics with SSRIs. Patients with obsessive compulsive disorder and schizophrenia took the combinations of atypical antipsychotics and SSRIs more frequently than patients with other diagnoses, as 41.6% and 20.8%, respectively. Controlling for diagnostic categories, age was significantly correlated with the presence of those co-prescriptions. CONCLUSION: The findings of the current study reflect evidence-based prescriptions in an educating hospital and provide basic data for further pharmaco-epidemiological studies. The co-prescription of atypical antipsychotic agents with SSRIs seems to occur only in proper indications, under the consideration of the risk of drug-drug interactions and adverse effects.
Antidepressive Agents ; Antipsychotic Agents* ; Diagnosis ; Humans ; Obsessive-Compulsive Disorder ; Outpatients* ; Prescriptions ; Schizophrenia ; Seoul ; Serotonin Uptake Inhibitors*

OBJECTIVE: The introduction of new psychiatric medications with better efficacy and tolerance seems to increase the frequencies of co-prescriptions of various psychotropic agents. We investigated the frequencies of the combined treatments of atypical antipsychotics and selective serotonin reuptake inhibitors (SSRIs) that are supposed to be common in clinical practice. METHODS: Data on 2783 outpatients from March 1, 2002 through June 31, 2002 in Seoul National University Hospital were collected. The number of cases with a co-prescription of atypical antipsychotics with SSRIs were counted and compared by diagnoses. The relations of diagnosis and age to the combined treatment were explored. RESULTS: 499 (17.4%) patients took co-prescriptions of antipsychotics with antidepressants, and 393 (13.7%) patients those of atypical antipschotics with SSRIs. Patients with obsessive compulsive disorder and schizophrenia took the combinations of atypical antipsychotics and SSRIs more frequently than patients with other diagnoses, as 41.6% and 20.8%, respectively. Controlling for diagnostic categories, age was significantly correlated with the presence of those co-prescriptions. CONCLUSION: The findings of the current study reflect evidence-based prescriptions in an educating hospital and provide basic data for further pharmaco-epidemiological studies. The co-prescription of atypical antipsychotic agents with SSRIs seems to occur only in proper indications, under the consideration of the risk of drug-drug interactions and adverse effects.
Antidepressive Agents ; Antipsychotic Agents* ; Diagnosis ; Humans ; Obsessive-Compulsive Disorder ; Outpatients* ; Prescriptions ; Schizophrenia ; Seoul ; Serotonin Uptake Inhibitors*

Nearly 100% of monochorionic twin pregnancies have vascular anastomoses and a fourth of those has clinical features of twin-to-twin transfusion syndrome. Cerebral palsy, microcephaly, porencephaly, and multicystic periventricular leukomalacia are serious antenatal neurologic complications associated with vascular communications in monochorionic twin gestation. It is most likely that such neurological damage is caused by intrauterine cerebral ischemic necrosis. The intermittent blood flow reversal or sudden hypotension in one twin, or emboli of thromboplastic material originating in the dead fetus could cause in utero cerebral damage in the other twin. In this report, we present a case of antenatal periventricular leukomalacia in monochorionic twin pregnancy complicated with twin-to-twin transfusion syndrome.
Cerebral Palsy ; Female ; Fetofetal Transfusion* ; Fetus ; Humans ; Hypotension ; Infant, Newborn ; Leukomalacia, Periventricular* ; Microcephaly ; Necrosis ; Pregnancy ; Pregnancy, Twin*

An ultrasonographic examination revealed increased fetal bladder size and decreased AFI as well as fetal bilateral hydronephrosis at 173weeks' gestation. Diagnosis of the fetal posterior urethral valve syndrome was made. Percutaneous fetal bladder puncture with aspiration and amniocentesis was performed. The fetus was normal male karyotype and with a predicted good renal function(sodium concentration, chloride concentration, and osmolarity at 74 mEq/L, 60 mEq/L, and 148 mOsm, respectively). So, the fetus underwent amnioinfusion and vesico-amniotic shunting procedure (VASP) using a double-basket catheter at 194weeks' gestation in order to prevent development of dysplastic kidneys and hypoplastic lungs. The healthy male baby was delivered at 384weeks' gestation and had normally functioning kidney. Cutaneous vesicostomy was performed for the newborn since the urethral orifice was small. The one year old infant is now well and waiting for urethroscopic valve ablation procedure.
Amniocentesis ; Catheters ; Cystostomy ; Diagnosis ; Fetus ; Humans ; Hydronephrosis ; Infant ; Infant, Newborn ; Karyotype ; Kidney ; Lung ; Male ; Osmolar Concentration ; Pregnancy* ; Punctures ; Urinary Bladder

BACKGROUND AND OBJECTIVES: Myocardial infarction (MI) elicits nerve sprouting. However, the time course and spatial distribution of this nerve sprouting and its relationship to the expression of neurotrophic factors is unclear. The aim of this study was to identify the association of nerve sprouting with the expression of neurotrophic factors. MATERIALS AND METHODS: We induced MI in FVB mice by ligating the left coronary artery. The hearts were removed at 3 hours to 13 months after MI for growth associated protein 43 (GAP-43) immunostaining. The nerve density (micrometer2/mm2) was determined by ImagePro software. In another group of mice, their myocardial tissues were processed and analyzed with using an Affymetrix RG U74V2 array. RESULTS: The density of the nerve fibers that were immunopositive for GAP-43 was the highest 3 hours after MI in both the peri-infarct areas and the remote areas. The outer loop of the ventricle had a higher nerve density than that in the inner loop of the ventricle. The differences were at a peak 3 hours after MI, but they persisted for 2 months afterwards. The expressions of nerve growth factor, insulin-like growth factor, leukemia inhibitory factor, transforming growth factor-beta3 and interleukin-1alpha were increased for up to 2 months after MI as compared to the normal control. qRT PCR analyses showed increased mRNA for tyrosine hydroxylase, synaptophysin, nerve growth factor and leukemia inhibiting factor in the peri-infarct areas for up to 2 months after MI, but this occurred only for roughly 3 days after MI in the remote areas. CONCLUSION: We conclude that MI resulted in immediate upregulation of nerve growth factor, insulin-like growth factor, leukemia inhibitory factor, transforming growth factor-beta3 and interleukin-1alpha in the peri-infarct areas and this all occurred to a lesser extent in the remote areas. These changes persisted for at least 2 months, and they were associated with increased nerve sprouting activity, which was most active in the outer loop of the heart.
Animals ; Coronary Vessels ; DNA ; Electrophysiology ; GAP-43 Protein ; Heart ; Interleukin-1alpha ; Leukemia ; Leukemia Inhibitory Factor ; Mice* ; Myocardial Infarction* ; Nerve Fibers ; Nerve Growth Factor ; Nerve Growth Factors ; Polymerase Chain Reaction ; Regeneration ; RNA, Messenger ; Synaptophysin ; Tyrosine 3-Monooxygenase ; Up-Regulation ; Ventricular Remodeling