The number of undocumented migrant workers in Korea is increasing. They are not covered by national health insurance, and thus find it difficult to access medical services. A number of medical service teams from religious organizations and some hospitals provide targeted services to migrant workers through special programs, but they face many limitations of scope and resources. In a globalized world, undocumented migrant workers should not be treated as simply passing through. Health care for these guests to our country should be of the quality we would expect for our neighbors and families.
Delivery of Health Care ; Humans ; Korea ; National Health Programs ; Republic of Korea ; Transients and Migrants*

Most foreign bodies in the lower genitourinary tract are self-inserted through the urethra for masturbation. It can be diagnosed by clinical histories and physical examinations of the patient, endoscopy and radiologic evaluations. Extraction should be tailored as the surgery, endoscopic manipulation and dissolution according to the nature of the foreign body and should minimize bladder and urethral injury. We report a case of a long wire in the bladder and urethra with brief review of literatures.
Endoscopy ; Foreign Bodies* ; Humans ; Masturbation ; Physical Examination ; Urethra* ; Urinary Bladder

OBJECTIVE: To determine the dincal significance of placenta previa totalis. METHODS: Maternal and neonatal medical rerords were reviewed retrospectively. Between March 1990 and June 1997, sixty-nine pregnant women with placenta previa totalis delivered at Asan Medical Center. Diagnosis of placenta previa totalis was confirmed during cesarean section. RESULTS: Mean maternal age at diagnosis was 31.7+ 3.9 years and 3 patients(4.3%) were nullipara. Fifty two patients(75%) had the history of vaginal bleeding during their index pregnancy and seventeen of 52 patients were admitted more than once. Median gestational age at the time of initial bleeding episode was 33.2 weeks(range 23.5-41. 1) and median interval from the first admission to delivery was 11 days(range 1-63), Major placental implantation site was posterior uterine wall(64%, 44/69). Six cases(8%) were complicated with placenta accreta or increta and no case was combined with abruptio placentae. Estimated blood loss at the time of cesarean section was 1,510+/-952ml(mean+/-SD) and 43 patients(62%) were transfused. No case was complicated with disseminated intravascular coagulation. Eight patients(11.6%, 8/69) underwent cesarean hysterectomy because of uncontrollable bleeding. Thirty four patients(49.3%) delivered their babies before 37 weeks of gestation. The mean gestational age at delivery was 36.4+/-3.0 weeks(mean+/-SD). Major neonatal morbidity was respiratory distress syndrome(20.3%, 14/69). Perinatal death rate was 4.3%(3/70). CONCLUSION: Because pregnant women complicated with placenta previa totalis have high probability for transfusion and cesarean hysterectomy, these patients should be managed cautiously and thoroughly. The most frequent neonatal morbidity was respiratory distress syndrome due to preterm delivery.
Abruptio Placentae ; Cesarean Section ; Chungcheongnam-do ; Diagnosis ; Disseminated Intravascular Coagulation ; Female ; Gestational Age ; Hemorrhage ; Humans ; Hysterectomy ; Maternal Age ; Mortality ; Placenta Accreta ; Placenta Previa* ; Placenta* ; Pregnancy* ; Pregnant Women ; Retrospective Studies ; Uterine Hemorrhage

A paraffinoma is a type of inflammatory lipogranuloma that develops after the injection of an artificial mineral oil, such as paraffin or silicon, into the foreskin or the subcutaneous tissue of the penis for the purpose of penis enlargement, cosmetics, or prosthesis. The authors experienced a case of macro-paraffinoma associated with sexual dysfunction, voiding dysfunction, and pain caused by a buried glans penis after a paraffin injection for penis enlargement that had been performed 35 years previously. Herein, this case is presented with a literature review.
Foreskin ; Granuloma* ; Male ; Mineral Oil ; Oils ; Paraffin* ; Penis ; Prostheses and Implants ; Silicon ; Subcutaneous Tissue

PURPOSE: The clinical significance of Y. pseudotuberculosis infection has recently recognizd in various part of the world, because it can cause a wide range of clinical problems such as mesenteric lymphadenitis, septicemia, reactive arthritis, terminal ileitis, erythema nodosum, and a cute renal failure. We have experienced 19 children with Y. pseudotuberculosis infection confirmed by stool culture. Our aim in this study was to evaluate clinical charactieristics, age and sex distribution, and source of infection. METHODS: Stools were inoculated on CIN(Cefsulodin-Irgasan-Novobiosin) agar (Difco, USA) and incubated for 48hr at 22 degrees C for isolation of Y. pseudotuberculosis. API 20E and VITEC were used for identification of the isolates. The antimicrobial sensitivity tests were performed by GN S(gram negative sensitive) card. Clinical characteristics were analyzed retrospectively. RESULTS: Retrospective analysis of 19 children with Y. pseudotuberculosis infection who visited our hospital between Jun.1993 and Dec.1993 was performed. The most prevalent age group was 6 to 8 years(42%) and monthly distribution showed November, December, June, and July in order of frequency, respectively. The common symptoms and signs were fever(100%), abdominal pain(100%), rash(74%), s trawberry tongue(53%), vomiting(53%), diarrhea(37%), and desquamation(32%), respectively. Four cases among 9 cases showed multiple mesenteric lymph node enlargements on the abdominal ultrasonogaphy. Serogroups of the isolates from stool specimens were type 5(15/19, 79%), and type 4(4/19, 21%), respectively. Y. pseudotuberculosis was also isolated from 3 samples of untreated drinking water which was thought to be the source of infection. There were no resistance strains against Amikacin, Carbenidlin, Gentamicin, and Trimethoprim/Sulfamethoxazole in the antibiotic susceptibility tests. CONCLUSIONS: In this study, the antibiotic susceptibility against Y. pseudotuberculosis was excellent, although the clinical characteristics were various. We have found that untreated drinking water was an important source of this infection. Further epidemiologic study for this infection should be needed.
Agar ; Amikacin ; Arthritis, Reactive ; Child* ; Crohn Disease ; Drinking Water ; Epidemiologic Studies ; Erythema Nodosum ; Gentamicins ; Humans ; Lymph Nodes ; Mesenteric Lymphadenitis ; Renal Insufficiency ; Retrospective Studies ; Sepsis ; Sex Distribution ; Yersinia pseudotuberculosis* ; Yersinia*

BACKGROUND: From January 1989 to December 1996, we analyzed 22 cases of ventricular septal defect associated(VSD) with aortic valvular prolapse. MATERIAL AND METHOD: The mean age of the patients was 7 years with a range of 6 months to 22 years . Thirteen patients were male and 9 were female. The types of VSD were Kirklin type I in 13 , Kirklin type II in 8 and Kirklin type I+II in one. RESULT: The preoperative echocardiographic findings were aortic valvular prolapse in 10 patients, aortic valvular prolapse associated with aortic regurgitation in 6, and only aortic regurgitation in 2. Aortic valvular prolapse were found in operation field in 4 that was not be in preoperative echcardiography. Preoperative mean Qp/Qs, systolic PAP, systolic RVP were 1.48+/-0.42, 27.9+/-9.87, 32.9+/-10.87 mmHg, respectively. Twenty patients underwent patch closure of VSD, and two patients with moderate aortic regurgitation and prolapsed of the aortic valve underwent patch closure of VSD and aortic valvuloplasty. Short and long term echocardiographic follow-up in 8 patients who had preoperative aortic regurgitation were found to have improved or not aggravated by performing VSD patch closure only and patch closure with valvuloplasty in 2. Twelve patients who had only preoperative aortic valvular prolapse had no change in prolapsed valve in postoperative echocardiography. CONCLUSION: Early closure of VSD with patch is necessary in VSD with aortic valvular prolapse even in associated with mild regurgitation. But in moderate regurgitation, VSD closure with valvuloplasty is recommended.
Aortic Valve ; Aortic Valve Insufficiency ; Echocardiography ; Female ; Follow-Up Studies ; Heart Septal Defects, Ventricular* ; Humans ; Male ; Prolapse*

BACKGROUND: It is well-known that migraineurs frequently have abnormal findings on transcranial Doppler ultra-sound (TCD), but their clinical implications are not clear. We investigated the clinical significance of TCD findings in migraineurs. METHODS: One hundred thirty-seven consecutive migraineurs were prospectively gathered. The following clinical parameters were investigated : 1) age and sex, 2) time from onset of headache to visiting hospital, 3) frequency, duration, laterality, pulsating quality, and severity of headache, 4) presence of nausea, vomiting, photophobia, and phonophobia, 5) aura, and 6) aggravation of headache by routine physical activity. TCD was performed during a headache-free period to measure the mean flow velocities (MFVs) and other parameters of 13 intracranial and 2 extracranial vessels. If MFV of any artery or its side-to-side difference in each migraineur was beyond 2 standard deviations of corresponding age and sex-matched reference subgroups, the TCD result was regarded as abnormal. Correlations between abnormal TCD and clinical parameters were examined by univariate and multivariate analyses. RESULTS: Results of TCD were abnormal in 84 patients (61.3%). Pulsatility of headache and absence of aura were significantly correlated with abnormal TCD on univariate analyses (p=0.003 and 0.049 respectively). On multivariate analysis, pulsatility of headache was the only statistically significant predictor of abnormal TCD (p=0.015). Headache attacks tended to be less frequent in patients with abnormal TCD with marginal significance (p=0.050). CONCLUSIONS: Our study shows that abnormal results on TCD are more frequent in migraineurs with pulsatile headache. An association between abnormal TCD and frequency of headache attacks is suggested.
Arteries ; Epilepsy ; Headache ; Humans ; Hyperacusis ; Migraine Disorders ; Motor Activity ; Multivariate Analysis ; Nausea ; Photophobia ; Prospective Studies ; Vomiting

ERCP may provide more definite diagnosis, preoperative guidance, and endoscopic therapy in many children with known and suspected disorders of the pancreas or biliary tract. To our knowledge, there has been rare case of ERCP in children and no reported case of ERCP performed in inf~int less than 2 years old in Korea. We report a case of KRCP performed in 26 month old girl who was admitted to evaluate jaundice. We diagnosed CBD stones and choledochal cyst, Todani type III containiaig stones by ERCP. After endoscopic sphincterotomy(EST), removal of stones, and endoscopic nasobiliary drainage(END) her bilirubin level normalized about 2 months later.
Biliary Tract ; Bilirubin ; Child ; Child, Preschool ; Cholangiopancreatography, Endoscopic Retrograde* ; Choledochal Cyst* ; Diagnosis ; Female ; Humans ; Infant* ; Jaundice ; Korea ; Pancreas ; Sphincterotomy, Endoscopic*

Central venous catheterization through subclavian vein has been used for central venous pressure monitoring, hyperalimentation, and fluid therapy. Its complications are air embolism, infection, vascular injury, pneumothorax, hemothorax and thrombosis that is the most serious complication. At the department of Thoracic and Cardiovascular surgery Chonbuk University Hospital, authors experienced superior vena cava syndrome due to thrombosis of the superior vena cava, internal jugular (left), subclavian(left), and innominate vein. Patients was a 21 years old female who had central venous catheterization through subclavian vein for hyperalimentation and fluid therapy because of enterocutaneous fistula. Thrombectomy on superior vena cava was performed, and pre and postoperative anticoagulation therapy was given. Symptoms were relieved after operation. From the venography, performed 6 weeks after the operation, restenosis was seen at the thrombectomy site of the superior vena cava. S anticoagulant and conservative treatment were done that symptoms relieved by the development of collateral venous channel.
Brachiocephalic Veins ; Catheterization, Central Venous ; Central Venous Catheters* ; Central Venous Pressure ; Embolism, Air ; Female ; Fluid Therapy ; Hemothorax ; Humans ; Intestinal Fistula ; Jeollabuk-do ; Phlebography ; Pneumothorax ; Subclavian Vein ; Superior Vena Cava Syndrome ; Thrombectomy ; Thrombosis ; Vascular System Injuries ; Vena Cava, Superior* ; Young Adult

Ophthalmoplegia, ataxia, and areflexia are a classical triad of Miller Fisher syndrome (MFS). The experience of dizziness secondary to ophthalmoplegia is also not uncommon. However, nystagmus is rare and vertigo, a symptom of vestibulocerebellar dysfunction, has not been reported yet. A 56-year-old woman visited our hospital due to sudden vertigo. Initial examination revealed nystagmus evoked by a bilateral horizontal gaze with left side dysmetria. The next day, her symptoms rapidly aggravated to ophthalmoplegia, severe ataxia, areflexia, and quadriplegia. She was diag-nosed with MFS and was treated with intravenous immunoglobulin. On the fourth day, she developed respiratory fail-ure and a ventilator was applied. Twenty-eight days after her admission, she recovered to the point of walking without any aid and was discharged with minimal disability. There are still controversies surrounding the nosology of MFS and many investigators have reported evidence for brainstem involvement. Vertigo can be additional evidence for the involvement of the central nervous system in MFS.
Ataxia ; Brain Stem ; Central Nervous System ; Cerebellar Ataxia ; Dizziness ; Female ; Humans ; Immunoglobulins ; Middle Aged ; Miller Fisher Syndrome* ; Ophthalmoplegia ; Quadriplegia ; Research Personnel ; Ventilators, Mechanical ; Vertigo* ; Walking