BACKGROUND: Medical skin care is essential for the treatment of skin diseases all over the world. Medical skin care is also part of medical practice and this must be differentiated from the simple skin care that is given for normal healthy skin. OBJECTIVE: We wanted to discuss medical skin care and the related medical devices and legal issues. METHODS: We reviewed the related laws and regulations, we consulted experts and associations and we analyzed the result of the survey. RESULTS: Legally, medical skin care and simple skin care are well classified. However, many illegal procedures are still performed by non-medical personnel and many adverse effects have been reported as a result. Furthermore, there are no legal restrictions for the performer based on the grade of each medical skin care procedure. CONCLUSION: For the best results and safe procedures, medical skin care must be performed by approved medical equipment under the supervision of a physician or medical personnel. Continuous control and guidance by the government is strongly needed.
Jurisprudence ; Organization and Administration ; Skin ; Skin Care ; Skin Diseases ; Social Control, Formal

Pyoderma gangrenosum (PG) is a vasculitic process, often associated with systemic diseases, including Takayasu's arteritis (TA), rheumatoid arthritis, and inflammatory bowel disease. Most cases of PG associated with TA have been observed in Japan. However, this association is not commonly observed in North American and European patients. PG is often refractory to therapy, requiring high dosages of glucocorticoids. Here, we describe a case of recalcitrant PG that was associated with TA and successfully treated with methotrexate.
Arthritis, Rheumatoid ; Glucocorticoids ; Humans ; Inflammatory Bowel Diseases ; Japan ; Methotrexate* ; Pyoderma Gangrenosum* ; Pyoderma* ; Takayasu Arteritis*

Sweet's syndrome is an uncommon reactive dermatosis characterized by fever, polymorphonuclear leukocytosis, painful erythematous cutaneous plaques and dense dermal infiltrate of neutrophils at the skin lesions. Unlike Sweet's syndrome associated with patients with malignancies, autoimmune diseases, antecedent infectons-most commonly the upper respiratory infections, it is reported to be rarely associated with systemic lupus erythematosus (SLE). Here we report a rare case of young female with Sweet's syndrome and SLE presenting with high fever.
Autoimmune Diseases ; Female ; Fever ; Humans ; Leukocytosis ; Lupus Erythematosus, Systemic* ; Neutrophils ; Respiratory Tract Infections ; Skin ; Skin Diseases ; Sweet Syndrome*

Psoriatic arthritis and avascular necrosis of the femoral head each are relatively common diseases. However, avascular necrosis of the femoral head in psoriatic arthritisis extremely rare disease and a few cases have been reported to date. It is suggested that the use of steroids or chemotherapeutic agents, hyperuricemia, alcohol abuse, immunologic disorders, coagulopathies are risk factors of the development of avascular necrosis of the femoral head in psoriatic arthritis. This report describes a 58-year-old female patient without any of forementioned risk factors who underwent total hip replacement for femoral head avascular necrosis associated with psoriatic arthritis.
Alcoholism ; Arthritis, Psoriatic* ; Arthroplasty, Replacement, Hip ; Female ; Head* ; Humans ; Hyperuricemia ; Middle Aged ; Necrosis* ; Rare Diseases ; Risk Factors ; Steroids

PURPOSE: We wanted to determine the incidence of HGC (hereditary gastric cancer) in Korean under the minimal criteria of ICG-HGC (International Collaborative Group on Hereditary Gastric Cancer). MATERIALS AND METHODS: Tumor registry abstracts of 1752 patients who underwent operations for gastric cancer during the time period 1996 to 1998 in the Department of Surgery at Seoul National University College of Medicine were examined. Based on their family histories, candidate HGCs were identified. Their detailed family histories including diagnosis of cancer, age at diagnosis, and dates of birth and death were obtained from interviews by phone. Another study was performed on 195 patients with gastric cancer who admitted for operations in the same department during the time period April, 1999 to June, 1999. Their detailed family histories were also obtained from probands or nearest relatives during admission. Pedigree studies of documented families were conducted. Minimal Criteria of ICG-HGC we used for present study are as followings: At least three relatives with histologically verified gastric cancer; one of them should be a first-degree relative to the other two. At least two successive generations should be affected. In one of the relatives, gastric cancer should be diagnosed under 45 years of age. Suspected HGC fullfills only two of the above three criteria. HNPCC, FAP and Li-Fraumeni syndromes should be excluded. RESULTS: A total of 12 HGCs were identified in this study. In recent 3 years, during the time period 1996 to 1998, the incidence of true and suspected HGC accounted for 6 (0.3%) and 44 probands (2.5%) among 1752 patients (in 1996, 0.4% and 3.2%; in 1997, 0.3% and 1.8%; in 1998, 0.3% and 2.8%) respectively. In contrast, during the time period April, 1999 to June, 1999, the incidence of true and suspected HGC increased up to 3.1% (6 probands) and 11.3% (22 probands), respectively, out of 195 patients (in April, 1999, 0% and 11.7%; in May, 1999, 4% and 14.7%; in June, 1999, 5% and 6.7%). There was no difference in terms of the incidence even if the third criterion of age at diagnosis among Minimal Criteria of ICG-HGC was modified from 'under 45 years of age' to 50. Mean ages of 12 probands (46.3 8.8) were statistically younger than those of control gastric cancer patients (54.2 11.5) retrieved from database of Department of Surgery at Seoul National University College of Medicine. CONCLUSION: In the present study, the incidences of HGC were remarkably altered in accordance with study methods. Retrospective reviews of medical records revealed to be ineffective for this kind of study since their informations were often incomplete and some suspected patients were lost during follow-up. According to the Minimal Criteria of ICG-HGC, the incidence of true and suspected HGC was 3.1% (6 probands) and 11.3% (22 probands), respectively, out of 195 gastric cancer patients. We propose that families who meet the Minimal Criteria of ICG-HGC should be prospectively found in order to determine the exact incidence of HGC in Korean.
Diagnosis ; Family Characteristics ; Follow-Up Studies ; Humans ; Incidence* ; Korea ; Medical Records ; Parturition ; Pedigree ; Retrospective Studies ; Seoul ; Stomach Neoplasms*

PURPOSE: We analyzed the gene status of p16INK4A, p15INK4B and MTAP (methylthio adenosine phophorylase) in Korean hepatdegrees Cellular carcinoma (HCC) to investigate whether the inactivation of these genes participated in hepatdegrees Carcinogenesis, and evaluated MTAP-targeted chemotherapy in MTAP-deficient cell lines. MATERIAL AND METHODS: We examined eleven primary HCC and 8 SNU cell lines using PCR, Southern blot analysis, PCR-SSCP, DNA sequencing, methylation-specific PCR, Western blot analysis, MTT assay, and crystal violet staining. RESULTS: Mutations or deletion of the p16INK4A, 15INK4B, and MTAP genes were rare, but methylation of the p16INK4A promoter region was common in HCC. The base alterations of 3' untranslated region of p16INK4A exon 3 were also detected in 3 samples. In SNU cells, p16INK4A was not detectable, when treated with demethylating agent, high levels of re-expressed p16INK4A protein were detected. In MTAP-targeted chemotherapy experiment, methylthioadeno sine (MTA) was able to rescue MTAP positive cell lines but not MTAP negative cell lines from growth inhibition by depletion of methionine and MTX treatment. CONCLUSION: These results suggest that de novo methylation of the p16INK4A promoter region seems to play an important role in the pathogenesis of HCC. And treatment of MTX, combined with methionine depletion in the presence of MTA, may be a high selective treatment for MTAP negative HCC.
3' Untranslated Regions ; Adenosine ; Blotting, Southern ; Blotting, Western ; Carcinogenesis ; Cell Line ; Cyclin-Dependent Kinase Inhibitor p16 ; Drug Therapy ; Exons ; Gentian Violet ; Methionine ; Methylation ; Polymerase Chain Reaction ; Promoter Regions, Genetic ; Sequence Analysis, DNA ; Pemetrexed

BACKGROUND: This study was designed to analyze chronological changes of the clinicopathologic features in patients with gastric cancer who had undergone gastric operations at Seoul National University Hospital. METHODS: A retrospective review of the clinicopathologic features of a total of 2,217 gastric cancer patients was made for four different years: 407 patients in 1986, 507 patients in 1990, 646 patients in 1994, and 657 patients in 1997. RESULTS: The overall male-to-female ratio was 2.4:1, and there was no significant differences among the year groups. The mean ages were 53.2, 53.4, 54.5, and 55.9 years for each year group, respectively. The most common presenting symptoms were epigastic pain (44.5%), epigastric discomfort (19.5%), and indigestion (11.6%). The duration from onset of symptoms to operation has been shortened in recent years, and the proportions of operations delayed over 6 months were 43.0%, 40.2%, 38.0%, and 27.4% in each year group, respectively. The main cause of delayed diagnosis was neglect of symptoms by the patients (60.7%). The ratio of gastric cancer detected by routine health check-up without symptoms has increased significantly (p<0.01), being 1.2%, 3.4%, 5.1%, and 7.5% in each year group, respectively. Poorly differentiated carcinomas were the most common histopathologic type overall (57.6%), and there was no significant change in the distribution of histologic differentiation over time. The proportion of earlier stages has increased over time (p<0.01), and the ratios of early gastric cancers were 19.7%, 23.1%, 30.3%, and 35.3% in each year group, respectively. The postoperative survival rate of the 1994 year group was improved significantly when compared to that of the 1986 or the 1990 year group (p=0.01); however, there were no significant differences among these year groups with the same stage of the disease. CONCLUSIONS: These results suggest that the shortened duration of diagnostic delay and, partly, the early detection of the cancer by routine health check-ups have resulted in stage shifting (increased proportion of earlier stages) and improved survival.
Delayed Diagnosis ; Dyspepsia ; Humans ; Retrospective Studies ; Seoul ; Stomach Neoplasms* ; Survival Rate

Acute mesenteric ischemia remains to cause high mortality in spite of the marked development of diagnostic tools and surgical techniques in the area of vascular surgery. The reason why the disease has a high mortality is mainly the delayed diagnosis. If diagnosis and treatment are established early enough to prevent irreversible change of bowel, the prognosis might be favorable. Twenty patients with a disease of acute mesenteric ischemia who received surgical or interventional treatment were studied by retrospective manner. There were 12 men and 8 women. The mean age was 57.3 years (22~81 years). Underlying cardiovascular disease including valvular lesion and arrhythmia was the most commonly associated disease. The etiologies of ischemia were embolism of superior mesenteric artery in 9 cases, thrombosis of superior mesenteric artery in 1, thrombosis of superior mesenteric vein in 5, one non-occlusive (vasoconstrictive) mesenteric ischemia and unknown in 4 cases. Two patients received radiological interventional treatment with urokinase and papaverine respectively. Eighteen patients were undergone surgical treatment including revascularization and bowel resection. Second-look procedures for bowel resection were performed in 4 cases. Complications occured in 10 cases, wound infection in 5, sepsis in 3, short bowel syndrome in 2 and anastomotic site leakage in 2. Early postoperative mortality occured in 3 cases and late mortality in 2. The cornerstone in the management of the disease is early diagnosis and prompt interventional (radiologic or surgical) treatments before irreversible change was established. Therefore, with a high index of suspicion, early and aggressive angiographic diagnosis and interventional procedures should be carried out.
Arrhythmias, Cardiac ; Cardiovascular Diseases ; Delayed Diagnosis ; Diagnosis ; Early Diagnosis ; Embolism ; Female ; Humans ; Ischemia ; Male ; Mesenteric Artery, Superior ; Mesenteric Veins ; Mortality ; Papaverine ; Prognosis ; Retrospective Studies ; Sepsis ; Short Bowel Syndrome ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Wound Infection

Prolymphocytic leukemia (PL) is usually derived from B cells and shares some features with chronic lymphocytic leukemia (CLL), but it is clearly a distinct entity and defined to have more than 55% prolymphocytes. Chronic lymphocytic leukemia/prolymphocytic leukemia (CLL/PL) is a mixed type of CLL and is defined to have 11~55% prolymphocytes with intermediate features between CLL and PL. We experienced two different cases of leukemia PL and CLL/PL. On physical examination, PL (stage II, B) patient showed multiple cervical lymph node enlargement and 5cm sized splenomegaly and hepatomegaly. But CLL/PL (stage III, C) patient showed 10cm sized splenomegaly and no lymph node enlargement. On immunological phenotyping, surface markers showed 72% CD5 (+), 85% CD19 (+), and 40% SmIg (+) in PL patient and 3% CD5 (+), 90% CD19 (+) and SmIg (-) in CLL/PL patient. PL patient was refractory to chlorambucil and prednisolone chemotherapy and showed poor prognosis. CLL/PL patient did not show remarkable response to chlorambucil and prednisolone therapy.
B-Lymphocytes ; Chlorambucil ; Drug Therapy ; Hepatomegaly ; Humans ; Leukemia* ; Leukemia, Lymphocytic, Chronic, B-Cell ; Leukemia, Prolymphocytic ; Lymph Nodes ; Physical Examination ; Prednisolone ; Prognosis ; Splenomegaly

Purpose : Early colorectal cancer is defined as the depth of tumor invasion limited to mucosa or submucosa regardless of the presence or absence of lymph node metastasis. We performed a retrospective study to determine the chronological changes in frequencies of early colorectal cancer and clinicopathologic differences between early colorectal cancer (ECC) and advanced colorectal cancer (ACC). Methods : We reviewed hospital records of the patients with colorectal cancer operated between January 1990 and December 1995. We classified the patients into two groups, ECC and ACC, according to the depth of tumor invasion and compared the clinicopathologic characteristics. Results : Fifty eight patients (5.2%) were diagnosed with early colorectal cancer among 1113 colorectal cancer patients operated at the same period. The frequency of ECC has increased from 1.9% in 1970~1989 to 5.2% in 1990~1995. The average age of patients with ECC at the time of surgery was 55.8 compared to 56.5 for patients with ACC group (p>0.05). Most patients (72.4%) with ECC had bleeding symptoms and majority of the ECCs were located in the rectum (72.4%). The mean size of tumors was 2.6 cm in its greatest diameter and was significantly smaller than that of ACC (5.7 cm). Compared to ACC, ECC had better histologic differentiation and fewer lymph node metastases (p<0.05). Thirty six of the ECC patients underwent bowel resection and remaining 22 underwent local excision. After a mean follow up period of 39.1 months (range 2~81months), recurrence was detected in one case. There was no death during the follow up period. Conclusion : The frequency of ECC has increased recently. Compared to patients with ACC, patients with ECC had more favorable clinicopathologic characteristics and better outcome. In selected patients, minimal operation can be applied without compromising the clinical outcome.
Colorectal Neoplasms* ; Follow-Up Studies ; Hemorrhage ; Hospital Records ; Humans ; Lymph Nodes ; Mucous Membrane ; Neoplasm Metastasis ; Rectum ; Recurrence ; Retrospective Studies