No abstract available.
Humans ; Risk Factors*

No abstract available.
Child* ; Hemagglutination* ; Humans ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pneumonia* ; Pneumonia, Mycoplasma*

Transient pancytopenia preceding acute lymphoblastic leukemia is an infrequent but well-known event, especially in childhood. We report a case of childhood acute leukemia preceded by transient pancytopenia and hepatitis. A seven-year-old boy presented with pancytopenia and hepatomegaly. He had suffered from fever, generalized rash, and jaundice for one week. His clinical symptoms and laboratory data normalized within two weeks. One and a half months later, however, he developed multiple lymphadenopathy and hepatomegaly, and follow-up bone marrow study revealed acute leukemia. The blasts were counted up to 92% of all nucleated cells in bone marrow, and showed lymphoid feature confirmed by the cytochemical reactions. Immunophenotypically, it was acute biphenotypic leukemia with positivity of CD13, CD33, CD19, CD10, CD34, HLA-DR, and terminal deoxynucleotidyl transferase. In conclusion, this is the first report of childhood leukemia preceded by pancytopenia in Korea, characteristically with the biphenotypic feature and the rare association with hepatitis.
Bone Marrow ; DNA Nucleotidylexotransferase ; Exanthema ; Fever ; Follow-Up Studies ; Hepatitis ; Hepatomegaly ; HLA-DR Antigens ; Humans ; Jaundice ; Korea ; Leukemia* ; Leukemia, Biphenotypic, Acute ; Lymphatic Diseases ; Male ; Pancytopenia* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma

This study introduces the Clinical practice guidelines (CPGs) appraisal system by the Korean Academy of Medical Sciences (KAMS). Quality management policies for CPGs vary among different countries, which have their own cultures and health care systems. However, supporting developers in guideline development and appraisals using standardized tools are common practices. KAMS, an organization representing the various medical societies of Korea, has been striving to establish a quality management system for CPGs, and has established a CPGs quality management system that reflects the characteristics of the Korean healthcare environment and the needs of its users. KAMS created a foundation for the development of CPGs, set up an independent appraisal organization, enacted regulations related to the appraisals, and trained appraisers. These efforts could enhance the ability of each individual medical society to develop CPGs, to increase the quality of the CPGs, and to ultimately improve the quality of the information available to decision-makers.
Guideline Adherence/*standards ; *Models, Organizational ; Practice Guidelines as Topic/*standards ; Quality Assurance, Health Care/*standards ; Republic of Korea

A 32-year-old female patient and her sister show high levels of high density lipoprotein (HDL) cholesterol in regular health checkups, since female patient was 11 years old. The patient's serum total cholesterol was 285 mg/dL and HDL cholesterol was 113 mg/dL. Her sister's total cholesterol was 240 mg/dL and the HDL cholesterol measured to be 90 mg/dL. Lipoprotein pattern and cholesteryl ester transfer activity gene analysis were examined in these patients. We found c.1321+1G>A (IVS14+1G/A) hetero mutation in cholesteryl ester transfer protein (CETP) genes. Generally, CETP mediates transfer and exchange of triglycerides and cholesteryl ester between plasma lipoproteins. Also we investigated a key role of HDL-CE and Apo A-1 metabolism. Patients with low levels of CETP have increased serum HDL levels. We hereby report two Korean cases of CETP deficiency in a family. Brief literature review ensues with the cases.
Adult ; Apolipoprotein A-I ; Cholesterol ; Cholesterol Ester Transfer Proteins ; Cholesterol, HDL ; Female ; Humans ; Hypercholesterolemia ; Lipid Metabolism, Inborn Errors ; Lipoproteins ; Plasma ; Protein Deficiency ; Siblings ; Triglycerides

Combination chemotherapy and radiation therapy have contributed to the successful treatment of various cancer patients. But the development of second malignancies is an inevitable complication of long-term cytotoxic treatment. The most serious and frequent of such complications is acute myelogenous leukemia (AML). Therapy-related leukemia is generally fatal. Since the number of patients exposed to chemotherapy is increasing each year, the clinical significance of this entity cannot be underestimated. There have been many investigations of therapy-related leukemia, but in Korea published reports are rare. We describe four such cases, involving one older female with lung cancer and three children with acute lymphoblastic leukemia (ALL) and malignant lymphoma. Alkylating agents were used for chemotherapy, and in one case, topoisomerase II inhibitor. Irrespective of the causative agents, the latency periods were relatively short, and despite induction chemotherapy in two, all survived for only a few months. During the follow-up of patients treated for primary malignancies, the possibility of therapy-related leukemia should always be borne in mind.
Adolescence ; Aged ; Antineoplastic Agents, Alkylating/therapeutic use* ; Antineoplastic Agents, Alkylating/adverse effects ; Carcinoma, Small Cell/radiotherapy ; Carcinoma, Small Cell/drug therapy ; Case Report ; Child ; DNA Topoisomerase (ATP-Hydrolysing)/antagonists & inhibitors ; Fatal Outcome ; Female ; Human ; Leukemia, Lymphocytic, Acute, L1/drug therapy ; Leukemia, Monocytic, Acute/etiology ; Leukemia, Myelocytic, Acute/etiology* ; Leukemia, Myelomonocytic, Acute/etiology* ; Lung Neoplasms/radiotherapy ; Lung Neoplasms/drug therapy ; Lymphoma, B-Cell/radiotherapy ; Lymphoma, B-Cell/drug therapy ; Male ; Neoplasms, Second Primary/etiology*

STUDY DESIGN: A case report. OBJECTIVES: To report a rare case of subacute delayed ascending myelopathy. SUMMARY OF LITERATURE REVIEW: After low spinal cord injury, the cord injury may proceed to a proximal level and lead to subacute delayed ascending myelopathy. The patient suffered from orthostatic hypotension, weakness and sensory loss in the upper extremities and dyspnea. MRI showed more proximal progression of the spinal cord injury. There is no prevention or treatment for this condition. MATERIALS AND METHODS: A 62-year-old man fell from heights and had 11th thoracic spine flexion-distraction injury. Upon arrival at the hospital, he was found to suffer from lower extremity weakness and sensory loss, but showed no neurologic symptom in his upper extremities. Two days later, we performed posterior instrumentation with fusion, and no postoperative neurologic symptom change was detected. One week after the fall, he suffered from dyspnea, upper extremity weakness and sensory loss. MRI was taken and we discovered that his spinal cord injury had proceeded to the 2nd cervical spine level. RESULTS: Three months later, he showed little improvement in his upper extremity motor power, but not to the extent of the previous low spinal injury. CONCLUSION: Physicians should pay attention to the upper extremity and respiratory function of the patient with low spinal cord injury, because the level of spinal cord injury may proceed to a proximal level.
Dyspnea ; Humans ; Hypotension, Orthostatic ; Lower Extremity ; Middle Aged ; Neurologic Manifestations ; Spinal Cord ; Spinal Cord Diseases ; Spinal Cord Injuries ; Spine ; Upper Extremity

OBJECTIVES: The aims of this study were to determine the benefits of short-term empirical proton pump inhibitor (PPI) medication on laryngopharyngeal reflux (LPR) and to determine whether scores on the reflux symptom index (RSI) and the reflux finding score (RFS) could be combined to identify subgroups of patients that will more likely to improve with this medication. METHODS: Fifty-one Korean Otolaryngology Board-certified specialists joined this prospective, multi-center, and open-label observational study. A total of 1,142 adult patients with LPR was enrolled for 12 weeks of rabeprazol medication. According to pre-treatment scores on RSI and RFS, patients were divided into 4 subgroups. RFS and RSI were measured repeatedly with a month interval along the treatment period. Changes of RSI and RFS were analyzed in an overall study cohort as well as in each subgroup. RESULTS: Approximately 40% (n=455) of enrolled patients were followed up until 12 weeks of PPI treatment. Significant improvement in RSI was obtained in 29%, 58%, and 75% of patients after 4, 8, and 12 weeks of PPI medication. RFS was improved in 16%, 42%, and 57% of the patients with 4, 8, and 12 weeks of PPI medication. All subgroups showed improvement regardless of their pre-treatment scores on the RSI and RFS. CONCLUSION: Even though RSI and RFS may be used as a general guideline for LPR management, pre-treatment RSI and RFS are not useful in predicting the patients' response to short-term PPI medication in the usual pattern of practice for LPR, which is mostly based on the physical evaluation and history taking.
2-Pyridinylmethylsulfinylbenzimidazoles ; Adult ; Cohort Studies ; Humans ; Laryngopharyngeal Reflux ; Otolaryngology ; Prospective Studies ; Proton Pump Inhibitors ; Proton Pumps ; Specialization

The use of a pneumatic torniquet to obtain a blood less field in the extremities is essential in the precise operations of present-day plastic and orthopedic surgery. There have been studies conducted regarding systemic and metabolic change in response to torniquet ischemia and complication, associated with torniquets have been reported such as injuries to nerves, muscles and blood vessel. The purpose of this investigation was to examine changes in the systemic circulation, blood gases serum potassium and base status on release of torniquet ischemia in adult. The results were as follows: 1) The mean blood pressure and heart rate did not change significantly after torniquet release. 2) The pH decreased significantly after the torniquet release. 3) The PaO2, and PaCO2, did not charge significantly after torniquet release. 4) The HCO3, and BE decreased significantly after torniquet release (P<0.05). 5) The serum potassium levels tended to increase after torniquet release but the changes was not significant. There-fore to minimize the predictable complications, the ventilatory control and rapid volume replacement are needed during the time immediately preceeding and following torniquet release.
Adult* ; Blood Circulation ; Blood Pressure ; Blood Vessels ; Extremities ; Gases ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Ischemia ; Lower Extremity* ; Muscles ; Orthopedics ; Plastics ; Potassium

OBJECTIVES: To understand the current status of the opening, closing and relocation of primary medical institutes in Korea and identify the underlying decision factors. METHODS: Sources of analyzed data included the medical institutional master file at the National Health Insurance Corporation (1998, 2000) and Regional Statistic Annual Bulletins. To investigate changes including the opening, closing and relocation, a total of primary medicalinstitutions (16,757 in 1998, 19,267 in 2000) were analysed. RESULTS: Between 1998 and 2000, there was a 15.0% (2,510) increase in the number of primary medical institutions and the rate of increase in the rural area was higher than the urban area, and higher for specialty clinics than primary practice. However, these findings did not suggestany improvement in the maldistribution of primary medical institutions. During the time period studied, newly opened and closed primary medical institutions numbered 4,085 and 1,573, respectively. Additionally, institutions thatrelocated numbered 2,729, or 16.3%of all primary medical institutions in operation in 1998. These openings and closings were more frequent among young doctors. As a result of our analysis on the underlying regional factors forrelocation, the factors that were statistically significant were local per capita tax burden and the number of schools per ten thousand persons. In the case of institutional factors, movements were significantly associated with gender and the location of primary medical institutions. CONCLUSIONS: In order to establish effective long-term intervention for primary medical institutions, further study and monitoring of primary medical institutions and the dentification of factors influencing opening location and relocation is necessary.
Academies and Institutes ; Humans ; Korea* ; National Health Programs ; Taxes