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

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

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*

No abstract available.
Rhinoplasty* ; Transplants*

Vasectomy is the most popular method of birth control in Korea. Because of changing views about family life, increasing prevalence of divorce and remarriage, desire for more children, and fear of child death. a large number of men now. are requesting reversal or vasectomy. Between March 1987 and September 1991 we performed vasovasostomy using modified one-layer technique with optical loupe magnification in 58 patients who had underwent vasectomy for family planning. Of these 58 patients, 46 patients could be followed up. Rates of patency and pregnancy varied depending on the interval from vasectomy until its reversal. Patients whose vasectomies had been performed less than 5 years had a 95.0% patency rate and a pregnancy rate of 72.0%. Patients who had an obstructive interval of 5 to 10 years had a 85.7% patency rate and a pregnancy rate of 50.0%. Beyond 10 years, there was a 33.3% patency rate and a pregnancy rate of 0.0%. The overall success rate was 86.5% for patency and 58.7% for pregnancy. Since the modified one-layer vasovasostomy is easier, faster, and less expensive, this technique deserves further clinical experience and evaluation.
Child ; Contraception ; Divorce ; Family Planning Services ; Humans ; Korea ; Male ; Marriage ; Pregnancy ; Pregnancy Rate ; Prevalence ; Vasectomy ; Vasovasostomy

Proliferative scarring in the form of keloids and hypertrophic scars continues to be a clinical problem for some patients. The lack of an animal model for such scarring has been an obstacle to studying the biology and effective therapy of these entities. Consequently we created an accurate reproductive animal model to systematically study them. Human proliferative scars were explanted into flaps based on isolated vascular pedicles in congenitally rats. We compared the procollagen type III peptide levels of proliferative scar tissue before and after explanting. The procollagen type III peptide levels of explanted proliferative scar tissue remained increased as before explanting. Histological analysis of the explanted proliferative scar tissue revealed that all explants retained their original histotypic character even after 1 year. We could also retain the volume of implanted proliferative scar for 1 year and studied in vitro cellular proliferation. Fibroblast cultures from explanted scars demonstrated less aggressive growth characteristic than those from original surgical specimens. The advantages of this animal model are as follows: 1. The explants retain their histotypical character for a long period. 2. Placement of the explants outside the dorsum of a nude rat makes serial observation and measurement easier. 3. Agents under test can be injected into the explants through a catheter inserted into a single pedicle of island flap without the possibility of spreading systematically.
Animals* ; Biology ; Catheters ; Cell Proliferation ; Cicatrix* ; Cicatrix, Hypertrophic ; Collagen Type III ; Fibroblasts ; Humans ; Keloid ; Models, Animal* ; Rats ; Rats, Nude

Papillophlebitis is a central retinal vein occlusion with papillitis and usually occurs in a young healthy adult. It is usually unilateral and symptoms include mild visual impairment, floaters of metamorphopsia. In contrast to central retinal vein occlusion in old age, there is usually no association with diabetes, hyopertension and cardiovascular disorder. Usually the retinal hemorrhage resolves spontaneousaly after several months and the papillitis decreases with good visual outcome. The authors experienced a papillophlebitis in 21-year-old male with sudden visual decrease of left eye. He had no systemic diseases. The patient recovered good vision with systemic steroid treatment. We report this case with review of previous reports.
Adult* ; Humans ; Male* ; Papilledema ; Retinal Hemorrhage ; Retinal Vein ; Vision Disorders ; Young Adult*

PURPOSE: The detection and removal of synchronous cancer and polyps in colorectal surgery is important to prevent the future development of metachronous cancer. However, it is occasionally impossible to evaluate the entire colon with colonoscopy preoperatively due to luminal obstruction by tumors. The aim of this study is to evaluate the incidence of synchronous colorectal tumors and to emphasize the importance of their peri-operative detection through vigorous application of colonoscopy. METHODS: Three hundreds two patients underwent a potentially curative resection for colorectal cancer in Ilsan Paik Hospital from January 2000 to March 2005. Colonoscopy was performed preoperatively or intraoperatively. All the synchronous polyps detected by colonoscopy and contained in the surgical specimen were included in the analysis. The data on synchronous cancer and polyps were collected through medical records and colonoscopic databases. The incidence, the risk factors, and the effects of synchronous polyps on surgery were analyzed. RESULTS: A total of 268 polyps were detected in 112 patients (37%) when all types of polyp were included whereas true adenomatous polyps were present in 78 patients (26%) among 302 patients. Synchronous cancers were found in 14 patients (4.6%). The detection of polyps on preoperative colonoscopy changed the surgical strategy in 30 out of the 223 patients (13.5%) who had completed preoperative colonoscopy. Neither the age and the gender of the patient, the location and the stage of the tumor, nor the family history were related with increased risk of synchronous polyps. Seventeen among 46 intraoperative colonoscopy cases had synchronous lesions which were not known on preoperative evaluation. Another bowel resection was needed to remove the lesions in nine of them. CONCLUSIONS: Synchronous colorectal polyps or cancer is frequent, and preoperative detection is important. Intraoperative colonoscopy can provide valid information if a preoperative colonoscopic evaluation is not available.
Adenomatous Polyps ; Colon ; Colonoscopy ; Colorectal Neoplasms* ; Colorectal Surgery ; Humans ; Incidence ; Medical Records ; Phenobarbital ; Polyps ; Risk Factors

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*

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