No abstract available.
Catheters*

Gastrointestinal stromal tumor (GIST) is known as considerable controversal tumor about it's histogenesis, differentiation and biologic behavior. It is traditionally regarded as smooth muscle tumor. To evaluate and clarify the origin of tumor, we performed immunohistochemical study of 23 cases of GIST on CD34 antigen, alpha-smooth muscle actin, S-100 protein, and compared the result with 4 cases of typical leiomyoma of GI tract. The results were as follows. CD34 antigen expression was noted in 21 cases (91.3%) of GIST, while typical leiomyoma was all negative. There were no difference of CD34 expression according to the biologic behavior. However, it's staining pattern was significantly different (p<0.05). Focal or multifocal expression was dominant in benign GIST (58.3%), while diffuse expression was dominant in malignant GIST (80%). Actin was expressed in 5 cases of benign GIST (38.5%) and 1 of malignant GIST (16.7%) focally. All typical leiomyoma showed diffuse strong positivity on alpha-smooth muscle actin. S-100 protein was expressed in 2 cases of benign GIST (16.7%) only. The pattern of CD34 expression was focal in the actin or S-100 protein positive cases. In conclusion CD34 antigen is useful marker in the separation of GIST, from typical smooth muscle tumor. Also it suggest that most GISTs are histogenetically primitive mesenchymal cell origin. However, CD34 expression was unrelated with biologic behavior of GIST.
Actins ; Antigens, CD34* ; Gastrointestinal Stromal Tumors* ; Gastrointestinal Tract ; Leiomyoma ; S100 Proteins ; Smooth Muscle Tumor

Service diversification is recognized as an important strategy against turbulent environmental change. This study is designed to find out the trend of service diversification in Korean health care organizations and also to identify factors associated with the degree of service diversification. Data were collected from 69 hospitals out of 71 hospitals with over 300 beds. Important findings are summarized below. 1. Types of diversification are closely related to hospital size. Large hospitals have a tendency to provide sophisticated service requiring specialized skills and equipment, while small hospital have concentrated their efforts on health screening programs. 2. The more competitive and bigger hospitals are, the greater number of services that provide. Also, hospitals operating rational management information systems provide more services. Contrary to the expectation, hospitals with a low performance during last 3 years showed more service diversification. 3. A trend of more diversification was observed in hospitals whose chief executive officer used a prospector strategy. 4. A multiple regression analysis revealed that bed size, competitive environment, degree of rational management, and the growth pattern were significantly associated with teh service diversification.
Delivery of Health Care ; Health Facility Size ; Hospital Bed Capacity ; Management Information Systems ; Mass Screening

There are increasing interest and need for information on health care consumer with the significance of hospital marketing and strategic planning being increasingly emphasized. This study was conducted to investigate the criteria for selection of medical facilities according to the characteristics of health care consumer by the types of medical services on a sample of 1,500 population aged 20 years and above. Major findings are as follows; 1. When considering the criteria for selection of medical facilities into two factors, namely, quality or convenience factors, convenience factor was the major contributor for outpatient and dental services whereas it was quality factor for inpatient services. 2. Females and those residing in large cities selected medical facilities based on convenience factor in the outpatient services. In the case of inpatient service, persons who considered their present health status to be good and whose ages were 50 years old and above choose medical facilities based on quality factor. 3. Persons who considered medical facilities to be profit-making tended to choose medical facilities based on convenience factor for outpatient services. There were no differences in the cases of inpatient and dental services. 4. There was no significant difference on the criteria for selection of medical facilities according to the decision maker for selection or trust on medical facilities. On the use of health service information, selection of medical facilities was based on qPality factor for those who made more use of the information in the cases of outpatient and dental services. 5. Analysis using the logistic regression model on the criteria for the selection of medical facilities with the characteristics of health care consumer as independent variables was performed. The selection of medical facilities was significantly related with residential area, sex, and use of information on medical facilities for outpatient services and with age, average monthly income, and perception of health status for inpatient services. For dental services significant association with residential area and use of information on medical facilities was seen. The results of this study, despite some limitations, can be used as baseline data for marketing and strategic planning of hospital management.
Delivery of Health Care ; Female ; Health Services ; Humans ; Inpatients ; Logistic Models ; Marketing ; Middle Aged ; Outpatients ; Patient Selection

Kawasaki disease is described by fever lasting five days or more, bilateral conjunctival injection, changes of lips and oral cavity, polymorphous exanthema, acute non-purulent cervical lymphadenopathy, and changes of extremities. Atypical Kawasaki disease is defined as fewer than 4 of 6 criteria described above including coronary artery abnormalities. Especially, atypical clinical manifestations of Kawasaki disease appear in infants younger than 6 months old of age. Thus we recommend echocardiography in early infancy who has prolonged fever in order to diagnose atypical Kawasaki disease and treat early. We have experienced three cases of atypical Kawasaki disease with coronary aneurysm who were admitted because of fever and revealed coronary aneurysm on echocardiography.
Coronary Aneurysm* ; Coronary Vessels ; Echocardiography ; Exanthema ; Extremities ; Fever ; Humans ; Infant ; Lip ; Lymphatic Diseases ; Mouth ; Mucocutaneous Lymph Node Syndrome*

Pulmonary vascular hypertension is characterized by migration and proliferation of smooth muscle cells accompanying abnormal synthesis and accumulation of extracellular proteins in vascular wall. The aim of this study is to define the role of endogneous TGF-betas and PDGF in the process of remodeling vessels through determining the temporal and spatial distribution of these growth factors in hypertensive pulmonary vessels in monocrotaline-induced pulmonary hypertension in rat. Sprague-Dawley rats were sacrificed 12 hours, 1, 2, 4, 7, 10, 14, 21, 28, and 56 days after treatment. The morphometric analysis of medial thickening and immunohistochemical study using antibodies to TGF-beta1, TGF-beta2, TGF-beta3, and PDGF were performed. Immunoreactivities for TGF-beta1 and TGF-beta3 were increased from the 14th day in the medial smooth muscle cells and PDGF showed increased expression from the 21st day in the medial smooth muscle cells. No difference in TGF-beta2 immunoreactivity was found between control and experimental groups. The expression of TGF-beta1, TGF-beta3 and PDGF increased in medial layers with the progressive thickening of pulmonary arteries which was considered to have close relation to medial hypertrophy of pulmonary arterioles. In the case of PDGF, however, the morphologic change occurred before increase in immunoreactivity was observed in the medial layer of pulmonary arterioles. Moreover, the function of isoforms of TGF-beta has yet to be completely elucidated; the different affinity to receptors and the degree of expression of these receptors that are supposed to affect the function of growth factors. Thus, further studies are needed.
Animals ; Antibodies ; Arterioles ; Hypertension ; Hypertension, Pulmonary* ; Hypertrophy ; Immunohistochemistry ; Intercellular Signaling Peptides and Proteins ; Monocrotaline ; Myocytes, Smooth Muscle ; Protein Isoforms ; Pulmonary Artery ; Rats* ; Rats, Sprague-Dawley ; Transforming Growth Factor beta* ; Transforming Growth Factor beta1 ; Transforming Growth Factor beta2 ; Transforming Growth Factor beta3

Between August 1994 and June 1995, seventeen patients diagnosed as having partial or complete ruptures of the anterior cruciate ligament on MRI were managed by non-operative methods. Among them four patients were excluded due to operation during follow-up and the results were evaluated at a one year follow-up. We selected the patients prospectively for non-operative care using the selection criteria of age, degree of instability, activity level and patient compliance. The average age of them was 37.7 years. Initially knee stress test and MRI were checked, and Cybex study and Lysholm knee scoring were done at post-trauma one year follow-up. They were managed conservatively by ROM and muscle strengthening exercises and a brace fitting schedule for three months. Among them, six cases had partial tears and seven had a complete tear initially. At the one year follow-up, five of six cases who had shown partial ruptures, and two of seven cases with complete tears, recovered continuity of the ruptured ACL on MRI. Their Lysholm knee score was 84.4, and the Cybex test showed no difference in muscle power between the injured and uninjuried side. Those patients who had loss of continuity on follow-up MRI showed Lysholm score of 57.4 and decreased muscle power on Cybex study. Although there are still controversies about the adequate management of ACL injuries, our study suggests that conservative management is a viable alternative to surgery as long as the patients are selected prudently. For more concrete results, however, careful analysis based on a longer follow up period is necessary.
Anterior Cruciate Ligament* ; Appointments and Schedules ; Braces ; Exercise ; Exercise Test ; Follow-Up Studies ; Humans ; Knee ; Magnetic Resonance Imaging ; Patient Compliance ; Patient Selection ; Prospective Studies ; Rupture*

The purpose of the study was to investigate two areas as a basis for providing an educational program for pulmonary rehabilitation. A) the learning needs about chronic obstructive pulmonary disease in patients with chronic obstructive pulmonary disease and B) the perception of nurses of the same learning needs. The subjects consisted of 57 patients, with chronic obstructive pulmonary disease, at the general hospital in Seoul and 71 nurses, who were working in the medical ward. Data was obtained from a "learning need" questionnaire between October 29 and November 19, '99. Data was analyzed using SAS program for t-test, ANOVA, Scheff test. The result were as follows: 1. The learning needs of the nurses(mean 4.36 +/- .38) were higher than those of the patients (mean 3.56 +/- .83). (t=6.78, P=.001) 2. The highest ranked patient education needs were as follows ; a)"how to control dyspnea", b)"cause for activating dyspnea", and c)"how to minimize the necessity of oxygen in daily living": and nurses' learning needs were ; a)"how to cope with the risk situation", b)"management after discharge", and c)"how to control dyspnea". 3. In the patient group, those who had a college degree or higher education and paid their own hospital expenses were higher in the learning needs. According to the above results, we should consider an educational program which is realistic and effective for patients by evaluating the items the patients really want to learn about and how much they know about the evaluated items.
Education ; Hospitals, General ; Humans ; Learning* ; Oxygen ; Patient Education as Topic ; Pulmonary Disease, Chronic Obstructive* ; Rehabilitation ; Seoul ; Surveys and Questionnaires

Viral myocarditis is considered an important cause of dilated cardiomyopathy. At preseent, two mechanisms are known to be involved in the pathogenesis of viral myocarditis and subse-quent cardiomyopathy: viral direct toxicity and immune mediated toxicity. Some authors have reported that IL-6 influences the immunologic mechanism and the virus-induced tissue damage in myocarditis. We injected encephalomyocarditis(EMC) virus to induce viral myocarditis in ICR mice. In order to study the lymphocyte subset and IL-6 expression to clarify the immune mechanism and to demonstrate the role of IL-6 in viral induced myocardial damage. The following results were obtained: 1) In virus inoculated mice, inflammation was severest at 10 days, and some serious complications developed, indicating a possible transition to dilated cardiomyopathy. 2) On analysis of the lymphocyte subset, CD4 cells were most prevalent at 5 days and CD8 cells were most prevalent at 10 and 20 days. 3) IL-6 was significantly increased and expression of IL-6 was constant, but its intensity was strongest at 5 days. In conclusion, IL-6, produced by inflammatory cells, fibroblasts, and endothelial cells, might play an important role in myocardial damage in experimentally induced EMC viral myocarditis by its direct cytotoxicity or cytokine mediated activation of cytotoxic cells.
Mice ; Animals

It is well documented that cardiac myxomas are associated with immunologic features that can simulate systemic autoimmune diseases. Recently, it was reported that cardiac myxomas produce IL-6 constitutively, which could partly explain the immunologic features observed in these patients. However, only a few investigators have studied cytokines in regards to symptoms they may cause in patients with cardiac myxoma. Also there is very little information in the literature on the immunohistochmical localization of IL-6. We performed immunobistochemical stains for IL-4, TNF, and IL-6 on paraffm embbeded tissue of cardiac myxoma tissue. A bioassay of IL-6 activity in patient's serum and in cultured cells from fresh myxoma tissue was performed to ascertain the role of these cytokines in myxomas. In this study, we demonstrated inununohistochemically that there was a local overproduction of IL-4, TNF, and IL-6 in cytoplasm of the tumor cells in about half cases. Bioassays of the serum and cultured tumor cells revealed elevated IL-6 activities. Also these findings correlate to production of patient's constitutional symptoms with statistical significance (P<0.05). In conclusion, these results are of considerable importance in understanding the role of IL-4, TNF, and IL-6 in cardiac myxoma patient with constitutional symptoms, and have an impact on strategies for diagnosis and therapy of cardiac myxoma.