PURPOSE: There are so many causes of an altered mental status, including acute stroke and nonorganic causes. Making the differential diagnosis and the diagnostic approach for cases with an altered mental status represent a challenge to all emergency physicians. The serum S-100B protein concentration and the neuron-specific enolase (NSE) concentration have been used to evaluate brain damaged patients. We evaluated the usefulness of the serum S-100B protein concentration and the NSE concentration as screening tests for the patients with an altered mentality METHODS: Seventy-eight patients with an altered mentality were included in this prospective study. The patients were divided in two groups. One was the acute stroke group and the other was the non-organic cause group. We analyzed the serum S-100B protein and NSE concentrations of the two groups. We also assessed the correlation of the serum S-100B protein and NSE concentrations with the clinical and laboratory data of the two groups RESULTS: The serum concentration of S-100B was higher in the acute stroke group (median: 0.376, interquartile range: 0.18-1.05) than that in the nonorganic group (0.123, 0.087-0.307, p=0.000). The NSE level was also higher in the acute stroke group (median: 19.12, interquartile range: 14.42-27.19) than that in the non-organic group (13.71, 10.48-19.29, p=0.002). To differentiate the acute stroke group from the non-organic group, the sensitivity and specificity was 81.1% and 61.0%, respectively, at a cutoff value for the serum S-100B protein concentration of 0.14 microgram/L, and these were 81.1% and 51.2%, respectively, at a cutoff value for the serum NSE concentration of 13.71 microgram/L CONCLUSION: Our study suggests that the serum S-100B protein and NSE concentrations may be useful as screening markers for differentiating acute stroke from non-organic causes. However, further studies are needed to evaluate the relationship between the two proteins and the various diseases that have possibility to alter patients' mental status before these two proteins can be used clinically as screening tests.
Brain ; Diagnosis, Differential ; Emergencies ; Humans ; Mass Screening ; Mentally Ill Persons ; Nerve Growth Factors ; Phosphopyruvate Hydratase ; Prospective Studies ; Proteins ; S100 Proteins ; Sensitivity and Specificity ; Stroke

AIMS: This study was done to develop an ethical guideline for organ transplatation, a life-saving treatment which helps improve the quality of life. METHODS: This study begins with a survey of the Korean current state of affairs concerning organ transplantation. This study used a survey questionnaire and received responses from 31 hospitals out of 45 hospitals where organ transplantation are being done. After this survey, followed by a discussion of ethical considerations in arranging organ transplants. Before proposing an ethical guideline, this study discusses a series of interesting ethical issues in transplanting(both living and cadaveric)organs including ethical foundations of organ transplantation, distributive justice and matters of donor's consent in organ transplatation. RESULTS: The foremost research for this study boils down to a survey paper titled, "An Analysis of the Current State of Affairs Concerning Organ Transplantation and Ethical Considerations in Domestic and International Hospitals." Based upon data collected from various hospitals, this work analyzes items, such as the frequency and types of organs transplanted in a hospital, the existence of organ transplant coordinator, the performance of the hospital ethics committee, and ethical considerations in obtaining consents from the living donor. Although thousands of organs are annually transplanted in domestic hospitals, virtually none of them are found to meet ethically proper standards. The paper points out the need to institutionalize a nationwide cadaveric organ distribution organization like UNOS(United Network for Organ Sharing) in the U.S., and proposes to stretch out the national health insurance to extensively cover transplanting expenses. "The Ethical Foundation of Organ Transplantation", the author counts three key ethical principles in organ transplantation: the principle of respect for autonomy; the principle of beneficence; and the principle of justice. He argues that in cases of living donor no principle should take precedence over the principle of respect for autonomy and thus it is very important for a hospital to obtain the donor's consent. As for cadaveric organ transplantation, he holds reservation because he is worried that serious shortage of organs for transplantation in conjunction with pure utilitarian considerations could change the definition of death so that the brain death gains more popularity than ever. In addition, the author claims that the proponent of organ transplantation must distinguish the moral dimension of the discussion from the legal one because otherwise she would hardly be able to defend herself from the slippery slope argument against organ transplantation. This paper concludes with a note that we must implement restrictions to avoid undesired effects if organ transplantation could ever be justified. "A Discussion of Distributive Justice in Organ Transplantation" comprises two parts. The first half delineates above mentioned ethical principles in the context of organ transplantation, while the second half goes generally over the UNOS Point System. This work is focused entirely upon cadaveric organ transplants, because the vast majority of organs available for transplants comes from cadavers and the number is still increasing. The UNOS allocates cadaveric organs based upon both medical and justice criteria. Following are summaries of the UNOS policy on organ distribution. Every potential recipient of organ transplants must be listed on the UNOS computer system waiting list. Allocation of cadaveric kidneys consider factors such as waiting time, six antigen match, panel reactive antibody, blood group and age. The UNOS Point System allocates livers to the local patients first, followed by regional and national patients respectively, in order to limit ischemic time. A recipient of liver transplant belongs to one of five(0~4) medical status levels where status 4 is the most medically urgent. At the regional and national levels pancreas are allocated first to patients with excellent HLA matches, while at the local level waiting time is the sole factor. The intestinal organ allocation system is based on two(1~2) patient status codes, ABO blood type identity and time waiting. In heart or lung tranplants ischemic time seriously matters. "A Biomedical Study of Informed Consent from the Organ Donor" investigates several topics: the relevance of the principle of respect for autonomy as the basic principle of informed consent; how the autonomy of the organ donor to be respected; and the role of the hospital ethics committee in obtaining informed consent from the donor. The author finds the principle of respect for patient's autonomy not sufficient for the basic principle of the living donor's informed consent because there is some danger in which the patient may be left uncared-for, and thus she suggests that the principle of nonmaleficence and the principle of care also be considered. That the principle of respect for autonomy turns out not sufficient even for cadaveric organ donation, and so judgment based upon the best interest of the deceased may seem appropriate for people from some special groups. A medical team must make efforts to identify the donor's competence and voluntariness, i.e., preconditions of informed consent. All the relevant medical information should be disclosed to the living donor. Once the donor makes a judgment, medical experts should respect the donor's decision. This article puts an emphasis on the role of the hospital ethics committee in such activities as identifying donor's voluntariness, confirming the disclosure, and evaluating the minority's benefit. The last work in this paper, "A Moral Theological Investigation of the Presumed Consent in Organ Transplantation" talk about Principium Riflexum(the principle of reflection) in an attempt to explain the possibility that we may harvest cadaveric organs from the deceased who while alive had never expressed their wishes concerning organ donation. To apply the principle in the context of presumed consent, the author, a Catholic priest, introduces two elements of the principle. Probabilismus allows us to feel free to choose when we face dubious matters(in dubio libetas), and by the rule of selection we are justified in choosing whatever our consciousness mandates. He takes both elements to support the presumed consent of the deceased because he believes the good that people may contribute to their neighbors by donating organs would obviously override opposing reasons. Although the author argues for the presumed consent from the deceased, he does not overlook the family grief in donating the cadaveric organs. He concludes with a suggestion that we should work to keep the public aware of cadaveric organ donation and to form public opinions education should play a key role. CONCLUSION: Researcher suggest an Ethical Guideline for Organ Transplantation as our study conclusion. 1) Body organs may be transplanted to protect the health and well-being of the patient, but not for the medical or scientific research. 2) Body organs may be taken for transplantation, only with the consent from the donor. In cases of cadaveric donors who have left no formal consent in the lifetime, they are to be presumed to refuse to donate body organs. 3) In principle, cadaveric transplantation is preferred. Living donors are limited to competent adults who have blood ties with the patient, e.g., parents, children, or siblings of the patient. However, reversible tissue like bone marrows donation may be an exception to this limitation. In particular, no living donors may be put under inappropriate pressure or influences. Body organs may be taken from the living donor only if based upon sufficient and easy-to-understand information provided, the donor voluntarily consents after (s)he deliberately balances benefits against harm. 4) Under no circumstances human bodies, organs, or tissues may be sold or purchased for transplantation. A physician should not participate in any transplanting operations if (s)he becomes to know that the transplant has been obtained through a transaction. 5) Recipients of organs for transplantation should be determined in accordance with the principle of justice on the allocation of limited medical resources. 6) When a vital, single organ is to be transplanted, the death of the donor shall have been determined by at least one physician other than the recipient's physician. 7) Transplant procedures of body organs should be undertaken (a) only by physicians who possess special medical knowledge and technical competence developed through special training, study, and laboratory experience and practice, and (b) in medical institutions with adequate facilities. 8) All decision procedures in transplanting body organs should be objective, open to parties involved, kept accurately on record, and maintained for a given period of time.
Adult ; Beneficence ; Bioethics* ; Bone Marrow ; Brain Death ; Cadaver ; Child ; Computer Systems ; Consciousness ; Disclosure ; Education ; Ethics ; Ethics Committees, Clinical ; Foundations ; Furunculosis ; Grief ; Heart ; Human Body ; Humans ; Informed Consent ; Judgment ; Kidney ; Liver ; Living Donors ; Lung ; Mental Competency ; National Health Programs ; Organ Transplantation* ; Pancreas ; Parents ; Presumed Consent ; Public Opinion ; Quality of Life ; Surveys and Questionnaires ; Siblings ; Social Justice ; Tissue and Organ Procurement ; Tissue Donors ; Transplants* ; Waiting Lists ; Wedge Argument

We have reviewed 251 children with urinary tract infection who were seen in our hospital during the last 5 years. Underlying abnormalities of the urinary tract were found in 154 patients(61 %). This figure is high because referred patients from other physicians for further treatment are included here. Of these 154 patients, surgical treatments were required in 85. The most frequent finding was vesicoureteral reflux(110 pts). Obstructive lesions were found in 44 pts ; UPJ obstruction in 9, megaureter in 6, obstruction associated with duplication in 6, urethral valve in 5, neurogenic bladder in 11, and others in 7. Abnormal findings without clinical significance were found in additional 17 pts. To evaluate the role of ultrasonography(US), we have compared findings of intravenous pyelography(IVP) and US. Of 58 pts who had both studies, 52 showed identical findings. US failed in detection of small renal scar and duplication of collecting system. US in combination with voiding cystourethrography(VCU) identified abnormal findings in most cases. It is our impression that US can replace IVP as a screening procedure which should be performed with VCU in every child with proven UTI. And as IVP is superior in imaging anatomical details than US, we recommend IVP before any surgical attempt.
Child* ; Cicatrix ; Humans ; Mass Screening ; Urinary Bladder, Neurogenic ; Urinary Tract Infections* ; Urinary Tract*

No abstract available.
Heart Defects, Congenital* ; Urinary Tract*

This study was conducted to investigate the association of the occurrence of pediatric disease with environmental, seasonal and atmospheric factors. The data were collected at 5 pediatric clinics in Seoul and the Department of Pediatrics of Yongin Severance Hospital from May 1986 to April 1987. The results were as follows: 1. Vacation periods had a great influence upon the occurrence of pediatric diseases. 2. The majority of pediatric diseases occurred mainly in spring and autumn, not in summer and winter. 3. The higher the average relative humidity was, the less diseases occurred; and the higher the maximum change of daily temperature, the more diseases occurred. 4. In summer, the pattern of diseases varied along with the environmental factors(eg., toilet).
Gyeonggi-do ; Humidity ; Pediatrics ; Seasons* ; Seoul

PURPOSE: Endoscopic incision of ureterocele is considered a simple and safe method for decompression of urinary tract obstruction above ureterocele. The purpose of this study was to evaluate the radiological findings after endoscopic incision of ureterocele. MATERIALS AND METHODS: We retrospectively reviewed the radiological findings ultrasonography (US), intravenous urography, and voiding cystourethrography(VCU)] in 16 patients with ureterocele who underwent endoscopic incision (mean age at surgery, 15 months; M: F=3:13; 18 ureteroceles). According to the postoperative results, treatment was classified as successful when urinary tract obstruction improved without additional treatment, partially successful when medical treatment was still required, and second operation when additional surgical treatment was required. RESULTS: Postoperative US (n=10) showed that in all patients, urinary tract obstruction was relieved: the kidney parenchyma was thicker and the ureterocele was smaller. Intravenous urography (n=8), demonstrated that in all patients, urinary tract obstruction and the excretory function of the kidney had improved. Postoperative VCU indicated that in 92% of patients (12 of 13), endoscopic incision of the ureterocele led to vesicoureteral reflux(VUR). Of these twelve, seven (58%) showed VUR of more than grade 3, while newly developed VUR was seen in five of eight patients (63%) who had preoperative VCU. Surgery was successful in four patients (25%), partially successful in three (19%), and a second operation-on account of recurrent urinary tract infection and VUR of more than grade 3 during the follow-up period was required by nine (56%). CONCLUSION: Although endoscopic incision of a ureterocele is a useful way of relieving urinary tract obstruction, an ensuing complication may be VUR. Postoperative US and intravenous urography should be used to evaluate parenchymal change in the kidney and improvement of urinary tract obstruction, while to assess the extent of VUR during the follow-up period, postoperative VCU is required.
Decompression ; Endoscopy ; Follow-Up Studies ; Humans ; Kidney ; Postoperative Period ; Retrospective Studies ; Ultrasonography ; Ureterocele* ; Urinary Tract ; Urinary Tract Infections ; Urography

PURPOSE: Authors analyzed the clinico-pathologic parameters of 34 remnant gastric cancers to know the general behavior and prognosis of remnant gastric cancer. MATERIALS AND METHODS: Medical records of 34 patients were reviewed retrospectively, who were diagnosed as remnant gastric adenocarcinoma and underwent operation in Korea Cancer Center Hospital from February of 1988 to March of 1998. RESULTS: The incidence of remnant gastric cancer was 0.7% (34/4,904 cases). Sex ratio, male to female, was 2.8: 1. Mean age was 55 years of age. Diagnoses of primary lesion were 10 cases of benign lesion, 24 cases of malignant lesion. The operation for the remnant gastric cancer is total gastrectomy or extended total gastrectomy. The most common extended-resected organ was spleen (21 cases). The morbidity following operation of remnant gastric cancer were quite rare and treated conservatively. The overall five year survival rate was 11.3%. CONCLUSION: Authors concluded that aggressive operation of remnant gastric cancer is warranted, as it is proved relatively safe and is the only option to lengthen patients survival and to alleviate their QOL (quality of life).
Adenocarcinoma ; Diagnosis ; Female ; Gastrectomy ; Humans ; Incidence ; Korea ; Male ; Medical Records ; Prognosis ; Retrospective Studies ; Sex Ratio ; Spleen ; Stomach Neoplasms* ; Survival Rate

PURPOSE: We evaluated the feasibility of non-invasive imaging of estrogen receptors (ER) in primary breast cancer with iodine-123-labeled ER specific ligand (17alpha,20E)-21-[123I] iodo-19-nonpregna-1,3,5-(10), 20-tetraene-3, 17-diol using conventional nuclear medicine technique. METHODS: Before they underwent surgical management, planar scintigraphy and single-photon emission computed tomography (SPECT) were performed in 18 patients with proven primary breast cancer, after single IV injection of 5~10 mCi I-123-estradiol. The results were compared with those of immunohistochemical staining against ER of the surgical specimens. RESULTS: Planar and SPECT imaging showed hot uptake in nine of eighteen (50%) breast cancer patients. The results of ER immunohistochemistry were all positive in these patients. In the 9 cases of negative scintigraphy, 8 showed negative staining results but one showed positive staining results. Therefore, the overall concordance rate of ER scintigraphy and ER immunohistochemistry was 94.4% (17/18). CONCLUSION: ER scintigraphy using I-123-estradiol is a highly predictable in vivo technique to detect ER-positive breast cancer preoperatively. It has potential application as a re-liable diagnostic modality and indicator of hormone therapy for breast cancer patients.
Breast Neoplasms* ; Breast* ; Estradiol* ; Estrogens* ; Humans ; Immunohistochemistry ; Negative Staining ; Nuclear Medicine ; Radionuclide Imaging ; Receptors, Estrogen* ; Tomography, Emission-Computed ; Tomography, Emission-Computed, Single-Photon

PURPOSE: We evaluated the feasibility of non-invasive imaging of estrogen receptors (ER) in primary breast cancer with iodine-123-labeled ER specific ligand (17alpha,20E)-21-[123I] iodo-19-nonpregna-1,3,5-(10), 20-tetraene-3, 17-diol using conventional nuclear medicine technique. METHODS: Before they underwent surgical management, planar scintigraphy and single-photon emission computed tomography (SPECT) were performed in 18 patients with proven primary breast cancer, after single IV injection of 5~10 mCi I-123-estradiol. The results were compared with those of immunohistochemical staining against ER of the surgical specimens. RESULTS: Planar and SPECT imaging showed hot uptake in nine of eighteen (50%) breast cancer patients. The results of ER immunohistochemistry were all positive in these patients. In the 9 cases of negative scintigraphy, 8 showed negative staining results but one showed positive staining results. Therefore, the overall concordance rate of ER scintigraphy and ER immunohistochemistry was 94.4% (17/18). CONCLUSION: ER scintigraphy using I-123-estradiol is a highly predictable in vivo technique to detect ER-positive breast cancer preoperatively. It has potential application as a reliable diagnostic modality and indicator of hormone therapy for breast cancer patients.
Breast Neoplasms* ; Breast* ; Estradiol* ; Estrogens* ; Humans ; Immunohistochemistry ; Negative Staining ; Nuclear Medicine ; Radionuclide Imaging ; Receptors, Estrogen* ; Tomography, Emission-Computed ; Tomography, Emission-Computed, Single-Photon

Epstein-Barr virus (EBV)-associated disease is known to be one of the major complication after transplantation. Early identification and diagnosis is crucial. The objectives of this study are to evaluate the incidence and to analyze the risk factors of EBV-associated disease. Twenty-five children with liver transplantation from Oct. 1994 to Oct. 1997 had been surveyed. Laboratory data of EBV infection such as anti-viral capsid antigen (VCA) IgM and IgG, EBV PCR, EBV encoded small RNA (EBER) in situ hybridization had been obtained at pre op, and post op 1, 2, 3, 4, 12, 24 weeks, then annually or when EBV infection was suspected. We classified these cases as asymptomatic infection, EBV syndrome, posttransplant lymphoproliferative disease (PTLD). And we analyzed the incidence of EBV infection according to age, type of immunosuppression, and CMV disease. Incidence of EBV infection in this study was 48% (12 out of 25), among them, 5 children were symptomatic and PTLD developed in 2 children. The significant risk factors were age at transplantation and CMV infection. One of PTLD cases resulting from EBV infection showed fatal outcome, the other was improved. We suggested that physicians especially in the care of the children after the liver transplantation should recognize the risk factors of the development of the EBV infection to avoid the progression into the potentially fatal PTLD.
Asymptomatic Infections ; Capsid ; Child ; Diagnosis ; Epstein-Barr Virus Infections ; Fatal Outcome ; Herpesvirus 4, Human* ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Immunosuppression ; In Situ Hybridization ; Incidence* ; Liver Transplantation* ; Liver* ; Polymerase Chain Reaction ; Risk Factors ; RNA