Internet medical counseling is increasing through the recent diffusion of super-high speed network. It provides not only medical information but also substantial Internet counseling(home medical care or telemedicine) that may rander definite diagnosis and treatment on line. But Internet medical counseling is still prohibited since Korean medical law stipulates the principle of facing treatment. Soon if will be possible to deliver Internet medical counseling under the revised bill of Korean medical law on telemedicine and electronic medical record. Therefore, I would like to give some legal information and advice that merit attention when medical personnel deliver Internet medical counseling. First, in case of substantial Internet medical counseling, it would be desirable to allow Internet counseling as the second treatment with the trust between doctor and patient being the first. Internet counseling should replace facing treatment only when the latter is practically not possible. It should be initiated not by physicians??soliutation but by requests from patients themselves. Of course, full explanation about the practice, including any potential disadvantages to the patients, should be provided. Second, counseling contents should be recorded and the hard copies of the Q-and-A should be kept with signature on. Patients privacy should not be infringed. Third, in case of Internet medical counseling, medical personnel has the same responsibility as that in the facing treatment. And it is stipulated in the revised bill of Korean medical law that if there is no definite evidence that acknowledges remote doctor's fault, resident doctor has the responsibility. But this could make a resident doctor hesitate to practice telemedicine, and enough discussion should follow on this. Internet medical counseiling gives a big opportunity to provide highly developed medical techniques overcoming the geographic barrier of distance, but it also might be dangerous enough to threaten patient's life by providing wrong information and cause effluence of private inforamtion. Therefore, it is necessary to facilitate public opinion regarding the Internet medical counseling on its limit and regulation.
Counseling* ; Diagnosis ; Diffusion ; Electronic Health Records ; Humans ; Internet* ; Jurisprudence ; Privacy ; Public Opinion ; Telemedicine

No abstract available.
Estrogens, Conjugated (USP)* ; Heart Failure*

No abstract available.
Drug Therapy* ; Dyslipidemias*

No abstract available.
Cardiovascular Diseases* ; Female ; Hormone Replacement Therapy* ; Humans

No abstract available.
Critical Care* ; Jurisprudence*

The study comprises 127 inpatients with drug eruption, treated at the Department of Dermatology, Seoul National University Hospital, during a 10-year period. The results are summarized as follows: 1. Out of 1,434 dermatologic inpatients, 127(8. 9%) patients were diagnosed as drug eruption. 2. The cutaneous manifestations of drug eruptions in the order of frequency were as follows: exanthematous eruption, urticaria, erythema multiforme, Stevens Johnson syndrome, TEN, exfoliative dermatitis, fixed drug eruption and purpura. 3. Antibiotics and antimicrobials were the most common causative agents followed by antipyretics and analgesics, CNS depressant drugs and herb drugs. 4. The 5 most common drugs causing drug eruptions were ampicillin, acetyl salicylic acid, diphenylhydantoin, sulfonamide and phenacetin.
Ampicillin ; Analgesics ; Anti-Bacterial Agents ; Antipyretics ; Dermatitis, Exfoliative ; Dermatology ; Drug Eruptions* ; Erythema Multiforme ; Humans ; Inpatients ; Phenacetin ; Phenytoin ; Purpura ; Salicylic Acid ; Seoul ; Stevens-Johnson Syndrome ; Urticaria

A 36-year-old female patient with sarcoidosis is presented showing lupus pernio, papular skin lesions, cervical lymph node enlargement and lung lesions. Diagnosis was confirmed by characteristic histologic findings of noncaseating granulomas in skin and cervical lymph node, supported by compatible clinical and laboratory features. Methatrexate was administered orally, which resulted in considerable improvement of skin lesions.
Adult ; Diagnosis ; Female ; Granuloma ; Humans ; Lung ; Lymph Nodes ; Methotrexate ; Sarcoidosis ; Skin

BACKGROUND: The blunted tip of a reusable with multiple uses can cause problems with the passing procedure in arthroscopic Bankart repair. This study assessed the advantage of Scorpion with a 70° arthroscope in arthroscopic Bankart repair compared to hook typed suture passer. METHODS: Scorpion in 19 patients, the hook type suture passer (conventional group) in 18 patients were used. All patients underwent the same procedure except for the type of suture passer used. Another different point of the procedure were telescopes and the number of portals used; three arthroscopic portals (posterior, anterorsuperiorlateral, and mid-anterior) and a 30° arthroscope in the conventional group, but two portals and a 70° arthroscope as well as the 30° one in the Scorpion group. The surgery time and the surgical complications including an iatrogenic axillary nerve injury were recorded. RESULTS: The Scorpion group showed a significant decrease in surgery time compared to the conventional group. In contrast to the conventional group, Scorpion provided an easy estimation of the exit of suture passing, no iatrogenic labral injury during the passing procedure with straight movement and the sharp tip of the knife installed. Iatrogenic supraspinatus injuries could be avoided when making an accessory anteosuperiorlateral portal due to the 70° arthroscope. CONCLUSIONS: In arthroscopic Bankart repair, the use of the Scorpion suture passer and a 70° arthroscope can reduce the surgery time, avoid unnecessary supraspinatus injury, and avoid iatrogenic axillary nerve damage through the relatively easy and precise suture passing and saving of the anterosuperior portal.
Arthroscopes* ; Arthroscopy ; Humans ; Scorpions* ; Sutures* ; Telescopes

We aimed to investigate the effect of in vitro allergen challenge on activation of eosinophils and expression of intercellular adhesion molecule-1(ICAM-1) in the epithelial and endothelial cells of the nasal mucosa of allergic rhinitics. MATERIALS AND METHODS: Inferior turbinate mucosal specimens which were obtained from 16 perennial allergic rhinitics and sensitized to D. farinae during conchotomy operations were used. Each mucosal specimen was divided into six pieces. The first two pieces were used as basic control group without culture, the second two pieces as culture-control group which was cultured with diluent only, and the last two pieces as antigen-challenge group cultured with D. farinae solution for 24 hours. Specimens were immunohistochemically stained using monoclonal antibody against eosinophil cationic protein(EG1 for all eosinophils and EG2 for activated forms) and ICAM-1. RESULTS: Average counts of EG1 cells and EG2+ cells within 1 mm of lamina propria of nasal mucosa were 14 and 11 respectively in the basic control group, 17 and 19 in culture control group, and 16 and 16 in the antigen-challenge group. ICAM-1 expression on vessels was observed more than half of t,he vessels in the nasal mucosa and there was no significant difference between groups, however, its expression on the epithelial cells was most prominent in the antigen-challenge group (2.1 in basic control group, 3.3 in culture control group, and 6.2 in antigen-challenge group). CONCLUSION: Most of the eosinophils infiltrating into the nasal mucosae out of vessels in allergic rhinitics are activated forms. Significant up-regulation of epithelial ICAM-1 expression by antigen-challenge suggests that ICAM-1 contributes to the transmigration of eosinophils from the subepithelial tissue into the epithelial cell layer and then finally into the nasal secretion.
Endothelial Cells ; Eosinophils* ; Epithelial Cells ; Intercellular Adhesion Molecule-1* ; Mucous Membrane ; Nasal Mucosa* ; Turbinates ; Up-Regulation

BACKGROUND: Eosinophils are suggested to play a deleterious role in the inflammatory disease of the respiratory mucosa by releasing granule substances such as major basic prorein and eosinophil cationic protein. To investigate the contribution of eosinophils in the pathogenesis of nasal polyps and the mechanism of their accumulation and activation, we observed the eosinophil inhllration and expression of endotjelial and epithelial cell adhesion molecules in the nasal polyp tissues. MATERIALS AND METHODS: Polyp and inferior turbinate mueosal specimens (polyp group) taken out of 20 patients and 10 inferior turbinate mucosa specimens of non-allergic and non-infectious controls (control group) were immunohistochemically stained using EG1, EG2, and mAb for the ICAM-1, VCAM-1 and E-seleetin. The number of EG1 (+) and EG2 (+) cells within lmm2 of tissue and the expression of ICAM-1, VCAM-1 and E-seleetin on the vessels (% of total vessel) and epithelial eelis (area x intensity) were compared among three groups. RESULTS:The inferior turbinate mucosae of nasal polyp patients .were infiltrated by signifieantly higher number of eosinophils (EG1:17, EG2:16/mm2) compared with those of controls (EGi:0, EG2:0/mm2) (p<0.05), and the polyp tissue revealed much more eosinophils (EG1: 213, EG2:154/mm2) than inferior turbinates of same patients and those of controls (p<0.001). ICAM-1 expression in the vessels was frequenly observed both in polyps and in the turbinate mucosae with significant difference (median:85% vs. 67%, p<0.05), and ICAM-1 expression in the epithelial ceils was significantly different between the polyp and turbinate groups (median:9 vs. 2.5, p<0. 01). VCAM-1 was moderately expressed on the vessels of both polyps and turbinate mucosac (median:37%, 14%, respectively) and their expressions were significantly different (p<0.01). E-selectin expression was moderate to low both in the polyps and in the turbinate mucosae (median:18%, 10% respectively) and their expressions were not significantly different (p>0.05). CONCLUSION: Most of the eosinophils infiltrated into nasal tissue as well as nasal polyps were activated forms and they were significantly increased in the nasal polyps compared to the inferior turbinate mueosae of the same patients and control subjects. Significantly increased expression of ICAM-1 and VCAM-1 on the vessels and increased epithelial ICAM-1 expression in the nasal polyps indicate that interactions of eosinophils with ICAM-1 and VCAM-1 participate in the pathogenesis of nasal polyps.
E-Selectin ; Eosinophil Cationic Protein ; Eosinophils* ; Epithelial Cells ; Humans ; Intercellular Adhesion Molecule-1 ; Mucous Membrane ; Nasal Polyps* ; Polyps ; Respiratory Mucosa ; Turbinates ; Vascular Cell Adhesion Molecule-1