No abstract available.

No abstract available.
Hepatitis B, Chronic* ; Hepatitis, Chronic*

No abstract available.

No abstract available.

The recent development of microsurgical tissue transfer has enabled any defect in any area to be reconstructed with free flaps. However, the need for a more functional and thinner flap has been raised due to bullkiness of the flap and donorsite morbidity. For better functional and aesthetic results, various perforator flaps excluding muscles or adjacent subcutaneous tissue have been recently reported. We report 44 cases of perforating artery pedicled flaps from April 1995 to August 1998, including 21 cases of anterolateral thigh flap, 12 cases of gluteal artery perforator flap, 4 cases of posterior interosseous flap, and 7 cases of paraumbilical perforator flap for various soft tissue defects. Even though marginal necrosis of flap occurred in 9 cases, complete healing without significant problem was possible. The advantages of perforator flaps are as follows: 1. It is possible to obtain a relatively thin fasciocutaneous flap, but still with sufficient volume 2. Donor site morbidity was reduced without damage of main artery. 3. In spite of diverse vascular pattern of the perforator, the location of perforating arteries can be Detected with relative ease and mapped preoperatively with an ultrasound Doppler. The need of meticulous and tedious dissection could be a sole disadvantage of these flaps. This report describes the clinical experience with a perforator-based flap, anticpating applications of many other types of perforator flap in the future.
Arteries* ; Free Tissue Flaps ; Humans ; Muscles ; Necrosis ; Perforator Flap ; Subcutaneous Tissue ; Surgical Flaps* ; Thigh ; Tissue Donors ; Ultrasonography

No abstract available.
Electric Stimulation* ; Epilepsy* ; Evoked Potentials*

Viral hepatitis is one of major causes of liver diseases in Korea. Acute hepatitis that is characterized by symptoms of fatigue, nausea, anorexia, malaise, and jaundice is caused by various hepatitis viruses such as hepatitis A, B, and C virus. Viral hepatitis has 4 clinical phases, incubation period, preicteric phase, icteric phase, and convalescence period. Hepatitis A is spread by the fecal-oral route, and is associated with poor sanitary conditions. Sometimes acute hepatitis A shows prolonged cholestatic hepatitis or recurrent hepatitis after a convalescence period; however, acute hepatitis A is usually self-imited and does not progress to chronic hepatitis. Hepatitis B virus can cause both acute and chronic hepatitis. Acute hepatitis B shows similar clinical manifestations as in hepatitis A, however, chronic hepatitis can develop in about 5% of acute hepatitis B. Chronic hepatitis B is the major cause of chronic liver diseases such as liver cirrhosis and hepatocellular carcinoma in Korea. The route of chronic infection correlates with vertical infection and sexual contact because hepatitis B virus is spread by the parenteral route. Recently hepatitis B vaccine can protect the transmission of hepatitis B virus effectively from mother to neonate, so the incidence of carrier state in child ages is very low. Hepatitis C virus can also cause both acute and chronic hepatitis. Acute hepatitis C shows similar clinical manifestations as in hepatitis A; however, chronic hepatitis can develop in about 80~90% of acute hepatitis C. Chronic hepatitis C is also one of the major causes of chronic liver diseases in Korea.
Anorexia ; Carcinoma, Hepatocellular ; Carrier State ; Child ; Convalescence ; Fatigue ; Hepacivirus ; Hepatitis A* ; Hepatitis B ; Hepatitis B Vaccines ; Hepatitis B virus ; Hepatitis B, Chronic ; Hepatitis C ; Hepatitis C, Chronic ; Hepatitis Viruses ; Hepatitis* ; Hepatitis, Chronic ; Humans ; Incidence ; Infant, Newborn ; Jaundice ; Korea ; Liver Cirrhosis ; Liver Diseases ; Mothers ; Nausea

In acute injury, liver recovers completely without any scarring change or complication. However, large portion of liver is changed into fibrotic state by excessive production of extracellular matrix (ECM) under chronic injury. Excessive production of ECM results in hepatic fibrosis and repeated process of hepatic fibrosis progress into liver cirrhosis. Liver cirrhosis is an irreversible and terminal state of chronic liver disease and one of the major causes of death in Korea. To block the progression to liver cirrhosis, various studies in the field of virology and immunology have been proceeded. Recently, studies on the hepatic fibrogenesis have progressed with the development of molecular biology. Hepatic stellate cells (HSC) play a key role in the pathogenesis of hepatic fibrosis by producing ECM. The degree of hepatic fibrosis depends on the proliferation and activation of HSC and increased net production of collagen. Therefore, inhibition of HSC activation is one of the main ways to block the progression of hepatic fibrosis. Many kinds of factors such as oxidative stress, acetaldehyde, ascorbic acid, transforming growth factor-beta (TGF-beta) and carbon tetrachloride (CCl4) have been reported to activate HSC and stimulate collagen gene expression. Although there are no definite and effective antifibrogenic agents, possible candidates are antioxidants, interferon, retinoids such as beta-carotene, flavonoids, renin-angiotensin system inhibitors and peroxisome proliferator activated receptor-gamma (PPAR-gamma) agonists. We tried to evaluate the charateristics of HSC in order to develop agents that inhibit hepatic fibrogenesis.
Extracellular Matrix/*metabolism ; Fibrosis ; Humans ; Liver/blood supply/metabolism/*pathology ; Liver Cirrhosis/etiology/genetics/*metabolism

Chronic hepatitis B infection is the most common cause of chronic liver diseases in Korea and can induce chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma. If patients have significant viral replication and persistent abnormal liver function and/or significant liver pathology, antiviral agents can be administered to prevent progression of the disease. Each antiviral agent shows different antiviral efficacy, resistance rate, and adverse events. Interferon alpha and pegylated interferon alpha have the advantage of relative short duration of treatment, however show high incidence of adverse events. Lamivudine has significant long-term data indicating the prevention of disease progression, but shows high resistance rate. Clevudine, entecavir, telbivudine, and tenofovir show high antiviral efficacy, however clevudine shows only short-term data, entecavir shows carcinogenesis in mouse, telbivudine shows relatively high resistance rate. In addition, clevudine and telbivudine show myopathy, and adefovir and tenofovir show renal toxicity as adverse events. AASLD and EASL guideline advise pegylated interferon alpha, entecavir, and tenofovir as first line treatment, which show high antiviral efficacy and low resistance rate. KASL and APASL guideline permits the use of all antiviral agents because of their respective advantage and problems as mentioned above. If resistance occurs during first line therapy, add-on therapy should be performed to prevent resistance of to second line antiviral agents. Ideal antiviral agents have to show high antiviral efficacy, low resistance rate, no significant adverse events and their effect on prevention of disease progression must be supported with a long-term data.
Adenine ; Animals ; Antiviral Agents ; Arabinofuranosyluracil ; Carcinoma, Hepatocellular ; Disease Progression ; Guanine ; Hepatitis B ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Humans ; Imidazoles ; Incidence ; Interferon-alpha ; Korea ; Lamivudine ; Liver ; Liver Cirrhosis ; Liver Diseases ; Mice ; Muscular Diseases ; Nitro Compounds ; Organophosphonates ; Tenofovir ; Thymidine

PURPOSE: In order to provide a systematic and standardized treatment course for MVD patients, a critical pathway (CP) program was developed and the results of its long term application were analyzed. METHODS: This was a methodological study. The CP was established and applied to 75 (step I) and 1,216 (step II). Another group of 56 with similar features was used as a control group. RESULTS: The application of CP turned out to be useful in many regards: the rate of hearing loss was reduced from 1.8% to 0% (step I) and 0.5% (step II), and low cranial nerve palsy was reduced from 1.8% to 1.3% and 0.7%, respectively. The length of hospitalization decreased by 2.56 days (25.2%) for step I and 3.05 days (30.0%) for step II. Days of ICU stay were reduced by 7.9% and 1.8%. The total cost per patient was reduced by 14.8% (step I). The cost per day was increased by 13.7% and 52.4%. An increase in the patient satisfaction index was noted, as shown in the ICU information guide (p=.002). CONCLUSION: The development and application of CP was found to improve the quality of medical treatment and the efficacy of hospital management in MVD patients. Well organized and efficient system and multidisciplinary teamwork are the key component of the successful application of CP.
Cranial Nerve Diseases ; Critical Pathways* ; Hearing Loss ; Hospitalization ; Humans ; Methods ; Microvascular Decompression Surgery* ; Patient Satisfaction ; Quality Control