PURPOSE: This study was designed to establish standard guidelines to meet the growing health care needs of adolescents by direct assessment of pediatricians' current practices, attitude and obstacles to the primary care of adolescents. MEHTODS: A questionnaire consisting of 9 questions, including personal characteristics of respondents, current health care practice of adolescents, attitude, obstacles to providing adolescent care, interest in further training, roles of Korean Pediatric Society for adolescent medicine, etc., was completed by 214 pediatricians. RESULTS: Among the respondents, 87.4% were in the 4th or 5th decade of age, and 88.8% of respondents were working for private clicins. More than 60% of respondents were managing patients without age limits. Most of the respondents were interested in adolescent medicine. However, approximately one half of all respondents answered that they could not currently provide satisfactory care to their adolescent patients. Obstacles to providing adolescent care include : their image as "baby doctors", lack of knowledge and skills in adolescent medicine, lack of separate hours for adolescents and concern that parents would object to certain types of care. Among respondents who wanted to further training, many were interested in Continuing Medical Education(CME) course, lecture series, introducing reading lists and publishing textbooks, while others expressed their interest in a newsletter and mini-fellowship. Respondents expected the Korean Pediatric Society to play a role in activating the adolescent medicine as a field for pediatric practice through educating adolescents, pediatricians and advertising via mass media. CONCLUSION: Future policy decisions and medical education must respond to these realities in pediatric practice.
Adolescent Medicine ; Adolescent* ; Surveys and Questionnaires ; Delivery of Health Care* ; Education, Medical ; Humans ; Mass Media ; Parents ; Periodicals as Topic ; Primary Health Care

BACKGROUND: Epidural pressure is reported to change in accordance with intracranial pressure (ICP). As ICP changes during general anesthesia, it is also possible that epidural pressure may change during general anesthesia. The aim of this study was to obtain trends of epidural pressure change during general anesthesia. METHODS: Eighteen patients scheduled for gastrectomy were allocated for this study after obtaining informed consent. Epidural catheter was inserted at T7-8, T8-9 interspace before induction. Catheter was connected to a pressure transducer after calibration. General anesthesia was induced with thiopental sodium (5 mg/kg), succinylcholine (1 mg/kg), followed by 3% enflurane. Anesthesia was maintained with 50% N2O in oxygen and 1-2% enflurane with vecuronium (0.1 mg/kg). Each patients was mechanically ventilated with tidal volume of 10 ml/kg at a rate of 10 bpm. Epidural pressure was measured before induction, at the time of injection of thiopental sodium, succinylcholine, laryngoscopy, intubation, surgical incision, and 30 minutes after surgical incision. Stastical analysis was done using repeated measures of ANOVA with Helmert option (p<0.05). RESULTS: Epidural pressure significantly changed dynamically during general anesthesia. Epidural pressures increased at intubation and at 30 minutes after surgical incision when compared with those at the time of laryngoscopy and incision, respectively (p<0.05). CONCLUSION: Our study indicates that epidural pressures changes dynamically during induction period of general anesthesia and also showed possibility that epidural pressure monitoring could be used instead of more invasive direct ICP monitoring.
Anesthesia* ; Anesthesia, General ; Calibration ; Catheters ; Enflurane ; Gastrectomy ; Humans ; Informed Consent ; Intracranial Pressure ; Intubation ; Laryngoscopy ; Oxygen ; Succinylcholine ; Thiopental ; Tidal Volume ; Transducers, Pressure ; Vecuronium Bromide

OBJECTIVES: For Parkinsonian patients who had not reacted favorably on drug therapy are good candidate for ventroposterolateral pallidotomy, although not curative. We studied these patients after unilateral pallidotomy, to confirm the effectiveness and safety of this procedure. METHODS: We evaluated the 17 patients with idiopathic Parkinson's diesease who had undergone unilateral posteroventral pallidotomy. All patients responded to levodopa initially. Mean age was 55 years(38-75years), and mean duration of disease was 9.8 years(3-20years). Pre-and postoperative evaluation at 3 month intervals included Unified Parkinson's Disease Rating scale(UPDRS) scoring, Hoehn and Yahr(H and Y) staging, and neuropsychological examinations. RESULTS: Pallidotomy significantly improved parkinsonian symptom(tremor, rigidity, bradykinesia, dyskinesia, sensory symptom). Nine of 10 patients who showed dyskinesia preoperatively significant improvement. The mean dose of levodopa in 9 patients was lowered. The mean H and Y score and UPDRS score were improved in on and/or off time in 15 patients. Among patients who were not improved, one patient worsened, and the others showed no change. The mean overall UPDRS off score changed from 76 preoperatively to 44(33%) at 6 months and from 70 to 52(25%) at 1 year. Transient surgical morbidity was showen in four patients and included dysarthria, hypotonia and confusion. CONCLUSION: We conclude that pallidotomy is safe and effective in patients who have levodopa-reponsive parkinsonism with severe symptom fluctuation. Unilateral pallidotomy also considered helpful to ipsilateral symptom. Unilateral pallidotomy can improve all of parkinsonian's symptom and allow to reduce the levodopa medication. Most of patients show satisfactory results.
Drug Therapy ; Dysarthria ; Dyskinesias ; Humans ; Hypokinesia ; Levodopa ; Muscle Hypotonia ; Pallidotomy* ; Parkinson Disease ; Parkinsonian Disorders

OBJECTIVE: The objective of this study was to determine the photodynamic therapeutic response of U-87 human glioma cell in vitro as well as in the nude rat xenograft model using photofrin as photosensitizer. MATERIAL AND METHOD: U-87 cells were cultured on 96-well culture plates, photofrin(Quadralogic Technologies Inc., Vancouver, Canada) was added into the cell culture medium at concentration of 1ng/ml, 2.5ng/ml, 5ng/ml, 10ng/ml and 20ng/ml. 24 hour after drug treatment, cells were treated with optical(632nm) irradiation of 100mJ/cm2, 200mJ/cm2 and 400mJ/cm2. Photofrin(12.5mg/kg, i.p.) was administered to 28 nude rats containing intracerebral U-87 human glioma as well as 26 normal nude rats. 48 hours after administration, animals were treated with optical irradiation(632nm) of 35J/cm2, 140J/cm2 and 280J/cm2 to exposed tumor and normal brain. The photofrin concen-tration was measured in tumor and normal brain in a separate population of animals. RESULTS: By MTT assay, there was 100% cytotoxicity at any dose of photofrin with optical irradiation of 200mJ/cm2 and 400mJ/cm2. But at the optical irradiation of 100mJ/cm2 cells were killed in dose dependent manner 28.5%, 49.1%, 54.4%, 78.2%, and 84.6% at concentration of 1ng/ml, 2.5ng/ml, 5ng/ml, 10ng/ml and 20ng/ml, respectively. Dose dependent PDT lesions in both tumor and normal brain were observed. In the tumor lesion, only superficial tissue damage was found with optical irradiation of 35J/cm2. However, in the optical irradiation group of 140J/cm2 and 280J/cm2 the volume of lesions was measured of 7.2mm3 and 14.0mm3 for treatment at 140J/cm2 and 280J/cm2, respectively. The U-87 bearing rats showed a photofrin concentration in tumor tissue of 6.53+/-2.16ng/g, 23 times higher than that found in the contralateral hemisphere of 0.28+/-0.15ng/g. CONCLUSION: Our data indicate that the U-87 human glioma in vitro and in the xenografted rats is responsive to PDT. At these doses, a reproducible injury can be delivered to human glioma in this model. Strategies to spare the normal brain collateral damage are being studied.
Animals ; Brain ; Brain Neoplasms ; Cell Culture Techniques ; Dihematoporphyrin Ether* ; Glioma* ; Heterografts ; Humans* ; Photochemotherapy ; Rats ; Rats, Nude

BACKGROUND: The goal of this study is to assess the usefulness of immediate-cytospin Wright stain cytology with bladder tumor markers such as BTA and NMP22 in the screening and monitoring of bladder cancer. METHODS: We evaluated immediate-cytospin (cytospin 3, Shandon, UK) Wright stain and Papanicolau stain urinary cytology with the BTA stat (Bion Diagnostic Sciences, Inc., Redmond, WA, USA) and the NMP22 (Matritech, Newton, MA, USA) in 143 urine specimens for screening and monitoring of bladder cancer from September 2001 to May 2002. The cut-off decision level of NMP22 was determined by the receiver-operating characteristics (ROC) curve and those above the cut-off were classified as positive. The Wright and PAP stained urinary cytology results were reviewed by two experts. Negative and atypia cytology results were classified as negative, and suspicions of malignancy and malignancy results were classified as positive. RESULTS: The ROC curve analysis for NMP22 demonstrated optimal sensitivity and specificity (81.8% and 83.8%, respectively) with the cut-off decision level 11.0 IU/mL. Sensitivity, specificity, false positive rate, and false negative rate for the BTA stat were 62.5%, 92.9%, 47.4%, and 4.8%, respectively, and 81.8%, 83.8%, 55.0%, and 3.4%, respectively for the NMP22. Whereas, those values for immediate-cytospin Wright stain cytology were 90.9%, 98.4%, 16.7%, and 0.8%, respectively, showing a 100% concordance rate with Papanicolau stained cytology. The area under the ROC curve of the BTA stat, the NMP, and the immediate-cytospin Wright stain cytology was 0.78, 0.81, and 0.95, respectively. CONCLUSIONS: Immediate-cytospin Wright stain cytology was useful for the decrease in false positivity and false negativity for tumor markers such as the BTA stat and the NMP22 in screening and monitoring for bladder cancer.
Mass Screening* ; ROC Curve ; Sensitivity and Specificity ; Biomarkers, Tumor ; Urinary Bladder Neoplasms*

A 38-year-old male-to-female transgender patient who had undergone a transsexual operation 20 years earlier presented with right flank pain and chills. Abdominal CT scan and gastrografin colon enema revealed a right psoas abscess and an abnormal communication between the large bowel and this psoas abscess. She underwent a right hemicolectomy and was finally diagnosed as having a Klebsiella psoas abscess due to perforated diverticulitis and intestinal tuberculosis. Additional antibiotics and antituberculous medication were required. A secondary psoas abscess due to diverticulitis is rare, and to our knowledge, no case combined with intestinal tuberculosis has previously been reported. We present the case with a brief review of related reports.
Adult ; Anti-Bacterial Agents ; Chills ; Colon ; Diatrizoate Meglumine ; Diverticulitis ; Enema ; Flank Pain ; Humans ; Klebsiella ; Psoas Abscess ; Tuberculosis

A 38-year-old male-to-female transgender patient who had undergone a transsexual operation 20 years earlier presented with right flank pain and chills. Abdominal CT scan and gastrografin colon enema revealed a right psoas abscess and an abnormal communication between the large bowel and this psoas abscess. She underwent a right hemicolectomy and was finally diagnosed as having a Klebsiella psoas abscess due to perforated diverticulitis and intestinal tuberculosis. Additional antibiotics and antituberculous medication were required. A secondary psoas abscess due to diverticulitis is rare, and to our knowledge, no case combined with intestinal tuberculosis has previously been reported. We present the case with a brief review of related reports.
Adult ; Anti-Bacterial Agents ; Chills ; Colon ; Diatrizoate Meglumine ; Diverticulitis ; Enema ; Flank Pain ; Humans ; Klebsiella ; Psoas Abscess ; Tuberculosis

No abstract available.
Heart* ; Pericardial Effusion*

This study was conducted to reduce sodium (Na) intake and to establish healthy dietary lifestyles of children. To achieve these goals, we searched, collected, and analyzed the materials related to the Na education, based on which the research personnel-professors and graduate students in nutrition and child education and elementary school teachers discussed to figure out major topics, objectives, and detailed contents and activities appropriate for Na intake reduction. Also a survey was done on the sodium intake and nutrition knowledge of the elementary students. We also organized an advisory committee composed of 15 professionals in related fields to discuss the adequacy and validity of the specific contents. Finally, we systematically organized the contents and developed children's textbooks and teacher's guidebooks. Considering the different cognitive development stages of junior and senior elementary students, we developed two different textbooks for each of them which are easy to read and understand, fun to play with lots of activities, and designed to practice into daily life. The contents cover three major topics-the concept of Na, Na in food, Na in life and are composed of 6 units in total. To help teachers understand and instruct, teacher's guidebook contains an overview of the education, specific information and practical guidelines for each class. We developed these education materials with the aim of lowering children's Na consumption and eventually promoting their health welfare; hopefully we expect these materials would be useful for children's nutritional education in the field.
Advisory Committees ; Child ; Humans ; Life Style ; Sodium

BACKGROUND: The t (8;21) (q22;q22), which produces the fusion gene AML1/ETO, is associated with relatively good prognosis and, in particular, with a good response to cytosine arabinoside. Analysis of t (8;21) positive leukemic blasts has shown characteristic morphological and immunological features. We performed this study to investigate the incidence of AML1/ETO rearrangement in adult AML, especially in M2 subtype, to make a comparison of morphologic, immunophenotypic and clinical characteristics between AML1/ETO rearrangement positive and negative group in patient with AML and to analyze the correlation with other biological parameters. METHODS: From May 1995 to Sep. 2000, fifty-nine patients with AML including twenty-nine AML-M2 were studied. RNAs were extracted from leukemic cells and reverse transcriptase mediated polymerase chain reaction (RT-PCR) for AML1/ETO fusion transcript was done. Chromosome study, immunophenotypic, and clinical characteristics were analysed and statistical analysis was done. RESULTS: The male to female ratio was 32:27 in AML and 17:12 in AML-M2. The median age was 43 years (range 14-86) in AML and 43 years (range 14-77) in AML-M2. The incidence of AML1/ETO fusion transcripts was 22.0% in AML and 44.8% in AML-M2. The morphologic finding of bone marrow in AML-M2 showed higher incidence of Auer rods, large blast with prominent golgi and abnormal granules in AML1/ETO positive patients. There was no significant difference of immunophenotype. AML patients with AML1/ETO rearrangement had a tendency of higher complete remission rate (81.8% vs 56.6%, p=0.13). The overall survival (median 82.2 weeks vs 34.4 weeks, p=0.02) and progression free survival (median 50.9 weeks vs 20.4 weeks, p=0.02) of AML1/ETO positive group were longer than those of negative group in AML. AML-M2 patients with AML1/ETO rearrangement had also a tendency of longer overall survival and progression free survival, although there was no significant difference between both group (median OS 82.4 weeks vs 15.6 weeks, p=0.07, median PFS 50.9 weeks vs 16.0 weeks, p=0.09). CONCLUSION: Our data suggest that AML1/ETO rearrangement is detected frequently in AML, especially M2, and is a favorable prognostic factor. Thus, molecular diagnostic approaches should be used routinely to identify patients with this genetic subtype of AML.
Adult ; Bone Marrow ; Cytarabine ; Disease-Free Survival ; Female ; Humans ; Incidence ; Leukemia, Myeloid, Acute* ; Male ; Pathology, Molecular ; Polymerase Chain Reaction ; Prognosis ; RNA ; RNA-Directed DNA Polymerase