BACKGROUND: Korea is one of the endemic areas of viral hepatitis B, and 6-8% of general population are hepatitis B virus carriers. Although there have been little reduction in morbidity and infectivity of viral hepatitis B owlng to newer vaccines and the effects of immunizations, there are some differences among physicians in managing hepatitis B virus infection, and guidelines have not been established. Therefore in this study, we investigated general practitioners' concept and the practical management of viral hepatitis B in comparison with the hepatologists'. METHODS: Information was obtained through questionnaires sent to 67 hepatologists and 400 general practitioners(general internists, general surgeons, family physicians, general physicians, and public health center managers) in Pusan during the 5 months from April to August, 1997. Overall respondents were 142(116 General practitioners, 26 Hepatologists), and the response rate was 32.9%. RESULTS: In general practitioners, the most commonly used serologic test for viral hepatitis was HBsAg/MBsAb(71.0%). 51.9% of subjects underwent anti-HBs test 3-5 months later after vaccination. The most common revaccination method for healthy non-responders of initial vaccination was 3 series of immunizations with the same vaccine of equal dosage (36.9% ). 65.7% of subjects were tested for LFT every 6 months for chronic carriers, and 41.5% of them were advised - interferon treatment for chronic active hepatitis patients only if the patients requested it. In comparison with general practitioners, hepatologists had a tendency to add anti-HCV test for the serologic evaluation of hepatitis(56.6% vs 26.2%), to limit age for vaccination(82.6% vs 54.1% ), and to delay prescribing hepatotonics until the AST and ALT levels increased up to 2 folds normal(53.8% vs 39.1%). 38.5% of hepatologists did not recommend giving booster injection of hepatitis. CONCLUSIONS: Practioal guidelines is necessary to manage viral hepatitis B patients.
Busan ; Surveys and Questionnaires ; General Practitioners* ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Hepatitis, Chronic ; Humans ; Immunization ; Immunization, Secondary ; Interferons ; Korea ; Physicians, Family ; Public Health ; Serologic Tests ; Vaccination ; Vaccines

A clinical observation was made on 52 cases of hypospadias which were treated at the department of Urology, Kyung Hee University Hospital during the period of January, 1972 through December, 1985 and the following results were obtained. 1. The patients` age were between 2 to 28 years. Only 22 patients(41.6%) were found in the age group under 6 years. 2. Of 52 cases of hypospadias, 27 cases(50.9%) were penoscrotal, 11 cases(22.7%) were penile, 6 cases(11.3%) were perineal, 4 case(7.5%) were scrotal, 3 cases were glandular and 1 case(1.9%) was chordee without hypospadias in type. 3. Cryptorchidism was the most common among the associated anomalies and it occupied 25% of all patients. 4. Of the 52 cases of hypospadias, one stage operation was done in 12 cases, two stage operation in 32 cases and their success rate was 58.5%, 40.6% in respectively. 5. The most common complication was fistula formation and it occurred in 20 cases(54.5%)of hypospadias repair.
Cryptorchidism ; Female ; Fistula ; Humans ; Hypospadias* ; Male ; Urology

XO/XY mosaicism is frequently observed in the most patients with mixed gonadal dysgenesis. Mixed gonadal dysgenesis is a condition of Intersexuality characterized by asymmetric gonads or ambiguous genitalia or both. The external genitalia are always masculinized to some extent, on occasion represent a hypospadias as a common genetic form of a mixed gonadal dysgenesis. The disorder probably results from a cytogenic error that occurs early in embryogenesis. Phenotypic males with mixed gonadal dysgenesis have a high risk of developing gonadal tumors. We describe a case of hypospadias with a unilateral testis and XO/XY chromosome complement that is considered as a mixed gonadal dysgenesis.
Chromosome Aberrations* ; Complement System Proteins ; Disorders of Sex Development ; Embryonic Development ; Female ; Genitalia ; Gonadal Dysgenesis, Mixed ; Gonads ; Humans ; Hypospadias* ; Male ; Mosaicism ; Pregnancy ; Testis

BACKGROUND: The purpose of this study was to evaluate the association between social support and health status for the elderly in a rural area where social network has been decreased. METHODS: One hundred and 58 elderly patients who visited free medical services participated in the survey that contained items about social support, heath status, socioeconomic status, health behaviors, and depression. Subjects were divided into three groups according to their social support index scores and two groups according to their health status. The health behaviors, socioeconomic status, and depression were considered as confounders. The associations between social support and confounders were analyzed by oneway analysis of variance, Cochran Mantel-Haenszel test, x2-test, and t-test. Then, multiple logistic regression analyses were done to find the adjusted association between social support and health status. RESULTS: Social support was related to education (P=0.012), economic level (P=0.007), smoking status (P=0.028), depression score (P<0.001), and health status (P<0.001). Health status was related to age (P=0.02), economic level (P<0.001), and depression score (P<0.001). The unadjusted prevalence odds ratios (POR) for poor health status were 7.3 (95% CI: 2.8-19.2) in the poorly supported group and 1.3 (95% CI: 0.5-3.5) in moderately supported group compared with the highly supported group. The corresponding adjusted POR increased to 14.3 (95% CI: 2.8-73.3) in poorly supported group and 6.2 (95% CI: 1.2-31.9) in moderately supported group. CONCLUSION: The poor social support was associated with poor health status and the relationship increased more with adjustment of confounders. Several methods to improve social support is necessary to maintain and enhance health status in the rural elderly.
Aged* ; Depression ; Education ; Health Behavior ; Humans ; Logistic Models ; Odds Ratio ; Prevalence ; Smoke ; Smoking ; Social Class

To investigate the effects of prostaglandin E1(PGX1) in prevention of proliferative scar formation, we cultured fibroblasts of normal skin (NS), hypertrophic scar (HS) and keloid (KL) tissues obtained from patients. We have compared type I collagenase production of cultured fibroblasts from normal skin, hypertrophic scar, and keloid tissues under various concentrations of PGE1. Our results demonstrate that type I collagenase production was significantly increased after addition of PGE1 in HS and KL, but not NS. Type I collagenase production of HS and KL fibroblasts were increased similarly in 10M and 10M of PGE1 and maximally increased in the concentration of 10M. This promotive effects of PGE1 on the production of type I collagenase was larger in KL than in HS. These results also suggest that PGE1 may play the promotive effects on type I collagenase production in dose-dependent manner. PGE1 may have a role in the prevention of hypertrophic scar and keloid by enhancing the production of type I collagenase of HS and KL fibroblasts. The promotive effects of PGE1 on type I collagenase production was variable depending on its concentration, and its effects was maximum in certain optimal condition. The maximally effective concentration of PGE1 in the prevention of proliferative scar formation should be searched in further investigations for clinical use.
Alprostadil ; Cicatrix ; Cicatrix, Hypertrophic* ; Collagenases* ; Fibroblasts* ; Humans ; Keloid* ; RNA, Messenger* ; Skin

No abstract available.
Rhinoplasty* ; Transplants*

Nevus sebaceus of Jadassohn is a hamartoma of the skin with the potential to develop benign and malignant neoplasms. This case was characterixed by multiple basal cell epitheliomas, clinically one reddish nodule and multiple pigmented papules, arising in the nevus sebaceus. Histologically, epithelial papillomatous hyperplasia and high-positioned hyperplastic sebaceous glands were found, and tumor nests consisting of basaloid cells with peripheral palisading arrangements were mainly situated in the upper dermis without significant infiltrative growth. We report a rare case of nevus sebaceus with multiple basal cell epitheliomas in the right cheek of a 49-year-old woman.
Carcinoma, Basal Cell* ; Cheek ; Dermis ; Female ; Hamartoma ; Humans ; Hyperplasia ; Middle Aged ; Nevus* ; Nevus, Sebaceous of Jadassohn* ; Sebaceous Glands ; Skin

A 53-year-old woman developed a psinful erythematous papular skin eruption around the biting site by a tick on the left lower abdomen. A excision biopsy specimen from the skin lesion showed perivsscular infiltration of inflammatory cells composed mainly of neutrophiles, lymphocytes, and a few eosinophiles and histiocytes throughout the dermis. Some of the vessels were dilated with protruding and proliferated endothelial cells. The tick was identified as an adult female of Ixodes nipponensis by the scanning electron microscopic examination.
Abdomen ; Adult ; Biopsy ; Dermis ; Endothelial Cells ; Eosinophils ; Female ; Histiocytes ; Humans ; Ixodes* ; Lymphocytes ; Middle Aged ; Neutrophils ; Skin ; Tick Bites* ; Ticks*

Healing is an intricate, interdependent process that involves complex interactions between cells, the microcellular environment, biochemical mediators and extracellular matrix molecules. The goals of wound healing are to minimize bloods loss, to replace any defect with new tissue, and to restore an intact epithelial barrier as rapidly as possible. The rate of wound healing is limited by the available vascular supply and the rate of formation of new capillaries and matrix molecules, which are heavily influenced by locally-acting growth factors that affect proliferation, angiogenesis, chemotaxis, gene expression, proteinases, and protein production. We present a new method for wound control and treatment, the V.A.C (vacuum-assisted closure) technique. It places open-cell foam dressing into the wound cavity and applies subatmospheric pressure. The application of subatmospheric pressure accelerates the rate of wound healing by the foollowing two mechanisms: 1. Removal of excessive interstitial fluids, which decrease localized edema, reduce concentration of inhibitory factors, and increase local blood flow. 2. Transmission of mechanical forces to surrounding tissues with resultant deformation of the extracellular matrix and cells, which then increase protein and matrix synthesis as well as cell proliferation. We applied it to 17 patients: 1 Livedo vasculitis, 1 burned by flame 3 pressure sores, 1 extravasation injury, 1 wound infection, 2 wound disruption, and 8 diabetes mellitus feet. In the end, most of the remaining wounds were treated with a simple split-thickness skin graft and the results were encouraging. We concluded that the V.A.C technique may be an effective substitute to help promote wound healing. It could be especially helpful in chronic complicated wounds in aging or debilitated patients who can not tolerate aggressive surgical procedures.
Aging ; Bandages ; Burns ; Capillaries ; Cell Proliferation ; Chemotaxis ; Diabetes Mellitus ; Edema ; Extracellular Fluid ; Extracellular Matrix ; Foot ; Gene Expression ; Humans ; Intercellular Signaling Peptides and Proteins ; Peptide Hydrolases ; Pressure Ulcer ; Skin ; Transplants ; Vasculitis ; Wound Healing* ; Wound Infection ; Wounds and Injuries*

Although sacrococcygeal mass is rare and usually found in infants or children, adolescent or adult patients with protruding mass in sacrococcygeal region occasionally come to us simply for a cosmetic problem. In this situation, even though there is no definite neurological deficit, it should be evaluated whether or not the underlying bony pathology or dural defect exists. Few cases about the sacrococcygeal mass have been reported in adults. We reviewed our cases including preoperative evaluation methods and postoperative diagnosis. From March, 1993 to February, 1997, we experienced 6 adult patients with sacrococcygeal mass and no neurological abnormality. Preoperative evaluation were made by plain X-ray, myelogram, computed tomography(CT), and magnetic resonance imaging (MRI), as needed. Postoperative diagnoses were 2 meningoceles, 2 lipomyelomeningoceles, 1 desmoid tumor, and 1 teratoma. From our experiences, CT or MRI is essential to evaluate the sacrococcygeal mass preoperatively. These methods can visualize the precise anatomic location and extent of the mass, its relation to the spinal cord, and associated bony abnormalities. MRI is superior to CT, especially in defining the nature of the mass and involvement of the spinal cord. Conclusively, even a simple mass in the sacrococcygeal region in adults needs MRI or CT evaluation, and MRI is the most valuable method of evaluating the mass preoperatively and provides important information to establish a treatment plan.
Adolescent ; Adult* ; Child ; Diagnosis ; Fibromatosis, Aggressive ; Humans ; Infant ; Magnetic Resonance Imaging ; Meningocele ; Pathology ; Sacrococcygeal Region* ; Spinal Cord ; Teratoma