Communicable diseases are a continuing menace to all people. Although some diseases have been conquered by antibiotics and vaccines, new ones are constantly emerging (such as HIV/AIDS, Legionnaires' disease), while others re-emerging (such as malaria, shigellosis). In 2000, the communicable disease control law had been amended to cope with emerging and re-emerging infectious diseases. The important amendatory contents are revision of statutory communicable diseases (3 class, 29 → 5 groups,63), shortening of the reporting time(group I,II,IV, immediately ; group III, V, within 7 days), and introduction of sentinel surveillance system, EDI reporting system, and reporting criteria.
Anti-Bacterial Agents ; Communicable Disease Control ; Communicable Diseases* ; Communicable Diseases, Emerging ; Jurisprudence ; Malaria ; Sentinel Surveillance ; Vaccines

Since bioterrorism has become reality after its occurrence in USA, our goverment is preparing and conducting strategic plans for preparedness and response to bioterrorism. The major plans consist of reinforcement of surveillance of notifiable communicable diseases, construction of supplementary surveillance systems, organization of emergency department and infection specialists networks, strengthening of laboratory capacity and network, and establishment of a stepwise response plan according to risk assessment. For the preparedness for bioterrorism, we are preparing a national pharamaceutical stockpile (antibiotics, smallpox vaccine, etc) and strengthening the organization, law, epidemiologic capacity, research, and management of critical infectious agents. It is very difficult to predict the risk of bioterrorism, which may be very low. Nevertheless, the complete preparedness is necessary to prevent social confusion by bioterrorism. Especially, phisician's role in response to bioterrorism such as case detection, report, management, and treatment is very important.
Bioterrorism* ; Communicable Diseases ; Emergency Service, Hospital ; Jurisprudence ; Risk Assessment ; Smallpox Vaccine ; Specialization

Microscopic polyangiitis is a systemic small-vessel vasculitis, which may involve multiple organs, but cardiac involvement is relatively rare. We report a case of microscopic polyangiitis with multiple organ involvement, in which myocardial infarction was the early manifestation of the disease. A 53-year-old man presented with sudden papulovesicular eruptions and swellings on the face, posterior neck, dorsa of both hands and fingers, and with diffuse erythematous patches on the back. He had suffered from renal dysfunction, arthralgia, and hypertension for more than 8 years. He had been admitted to the department of cardiology for acute myocardial infarction and had suffered from recurrent gastrointestinal bleeding, renal failure, acute pancreatitis and sepsis during the admission. Histopathologically, small-vessel leukocytoclastic vasculitis with out granuloma was seen. Direct immunofluorescence showed no immune deposite. A high serum level of P-ANCA was detected by ELISA.
Acute Kidney Injury ; Antibodies, Antineutrophil Cytoplasmic ; Arthralgia ; Cardiology ; Enzyme-Linked Immunosorbent Assay ; Fingers ; Fluorescent Antibody Technique, Direct ; Granuloma ; Hand ; Hemorrhage ; Humans ; Hypertension ; Microscopic Polyangiitis* ; Middle Aged ; Myocardial Infarction* ; Neck ; Pancreatitis ; Sepsis ; Vasculitis

Despite the increasing numbers of patients in need of organ transplantation following the increasing prevalence of chronic diseases such as CRF, chronic liver disease, disparities between the supply and demand of transplantable organs are getting increasingly widened. After the "Organ transplatation act" is enacted in 2000, brain death organ is equitably allocated by KONOS and illegal organ bargains are nearly eradicated. But unfortunately, brain death organ donation is not sufficiently activated, because of immature organ donation culture, absence of notification of potential brain death and active organ procurement system, and inflexibe organ donation processes. Ministry of Health and Welfare had made the comprehensive activation plan to solve the organ shortage problems, to increase organ procurments and transplantations at Oct. 2005. The major measures are strengthening the PR and education about organ donation, introduction of notification of potential brain death, and establishment of active organ procurement system through organ procurement organizations, strengthening of national responsibility and support.
Brain Death ; Chronic Disease ; Education ; Humans ; Liver Diseases ; Organ Transplantation* ; Prevalence ; Tissue and Organ Procurement ; Transplants*

The Korea national blood services has been established since 1970 when the "Blood management law" was enacted. National blood services grew fast through 1980~1990 and the voluntary non-remunerated blood donation system was introduced successfully. However, blood-transmissible infections such as HIV, HCV, and HBV were documented since 2000, which compromised the confidentiality of national blood services. In 2004, the Korean government established the? National Blood Safety Plan? for the provision of safe and adequate blood supply. The major measures include the expansion of blood collection centers, improvement of blood screening laboratories, introduction of an investigation and compensation system of blood transfusion-related adverse events, introduction of blood transfusion guidelines and hospital blood services commitment, evolution of a national blood services organization, and the strengthening of national responsibility and support.
Blood Donors ; Blood Safety ; Blood Transfusion ; Compensation and Redress ; Confidentiality ; HIV ; Humans ; Korea ; Mass Screening

OBJECTIVES: Our aims of this study is to analyze the clinical characteristics and the prognos is of the disease which develops in patient swith chronic liver disease as acutely exacerbated hepat it is accompanied by myosit is. Finally we try to identify and is olate the causative agent. METHODS: The patient swith chronic liver diseases, who developed muscle weakness and paralysis, were classified to group A or group B, according to the level of creatinine kinase ( CK) activity. The group A consists of patients with less than 3-fold increase of normal CK activity and the group B includes patients with over 3-fold increase of it. We evaluated clinical characteristics, blood chemistry, clinical course, and causes of deathin patients of study groups, compared with those of patients with chronic liver disease with normal CK activity as controls. The causative agent was suggested by conventional culture and RT-PCR analysis in two cases of group B. RESULTS: 1. There was no significant differences in age, sex, underlying disease, or liver function test bet ween control and study group ( control and group A or B) before entry. 2. The clinical symptoms and signs , such as drowsy mental state, generalized weakness/myalgia caused by hepatic encephalopathy and myositis , occurred frequently in the study group. 3. Significant elevation of aspartic acid transaminase (AST ) and alaninetr ans aminase ( ALT ) was noted in Group B. AST / ALT ratio is over 2 in group A or B. Synthetic function of the liver such as prothrombin time ( PT ) or serum albumin level is significantly decreased. Blood urea nitrogen ( BUN) and creatinine were increased as a result of impaired renal function. 4. Culture of coxs ackievirus was positive by immunofluor escence as say IFA) as a caus ative agent and also was positive in reverse transcription-polymerase chain reaction (RT-PCR) analys is using universal primer of enterovirus in two recent cases of group B. 5. Death rate increased significantly in study group, compared with that of control group ( 20.7% versus 5.6%). Major cause of death, 12 patients died of which, is hepatic failure. CONCLUSION: The patients with chronic liver disease abruptly developed a exacerbated hepaticdys function and muscle paralysis and/or weakness. This exacerbated hepatitis accompanied by myositis was suggested to be caused by coxsackie B viral infection. Furthermore, this infection increase deathrate and resulted in poor prognosis. Thus, further study should be continue to confirm the causative agent and classify the subtype.
Aspartic Acid ; Blood Urea Nitrogen ; Cause of Death ; Chemistry, Clinical ; Creatinine ; Enterovirus ; Hepatic Encephalopathy ; Hepatitis* ; Humans ; Liver Diseases* ; Liver Failure ; Liver Function Tests ; Liver* ; Mortality ; Muscle Weakness ; Myositis* ; Paralysis ; Phosphotransferases ; Prognosis ; Prothrombin Time ; Serum Albumin

Streptococcus agalactiae or group B streptococcus (GBS) is associated with infectionsin neonates and pregnant women. Herein, we describe a rare case of GBSrenal abscess with peritonitis and pleural effusion in a 17-year-old girl with type 1diabetes mellitus. The girl was admitted due to fever and right flank pain. Laboratoryfindings included leukocytosis and increased C-reactive protein level anderythrocyte sedimentation rate. Her serum glucose level was 484 mg/dL. Urinalysisshowed no pyuria. Renal sonography revealed parenchymal swelling in the rightkidney. The patient was administered intravenous cefotaxime. Urine and bloodcultures were negative. Fever seemed to improve, but the following day, she complainedof abdominal pain and fever. Antibiotic was switched to imipenem, andabdominal and pelvic CT revealed a ruptured right renal abscess, peritonitis, andbilateral pleural effusion with atelectasis. Pigtail catheter drainage of the abscesswas performed. Culture from the abscess was positive for GBS, and fever subsided2 days after the drainage. She was discharged with oral cefixime. The clinical courseof urinary tract infections (UTIs) can be atypical in patients with diabetes, and GBScan be a cause of UTIs. Prompt diagnosis and management are necessary to preventcomplications in patients showing atypical courses.

OBJECTIVES: This study is designed to develop a large group phychodrama for light delin-quent adolescents (hereinafter called as "Psychodrama") thereby determining therapeutic factors for dealing with them. METHODS: The study was conducted in the program of Seoul Metropolitan Youth Centre called "the class of love" during the period of July through December, 1998. The subjects consisted of a total of 827 young delinquents (759 boys and 68 girls, with the average age of 15.9 years old). To develop "this psychodrama", after we composed of therapeutic team centered by psychiatrists, we prepared from January to June, 1998 by practicing psychodrama with delinquent adolescents and by analyzing the results. "This psychodrama" has three basic steps: (1) warming-up (small group me-eting), (2) action (situation drama and main drama), (3) sharing. A survey of treatments, from a pool of participating adolescents, based on evaluation sheets and 13 therapeutic factors scale followed every session of this psychodrama. RESULTS: "This psychodrama" was helpful for 47.4%, interesting for 49.2%, not helpful for 12.1% and not interesting for 16%. In the whole group of subjects, the important therapeutic factors were existential factor, universality, identification with the therapist and the instillation of hope in the order of rank. When categorized in four different groups (audience, participants in situation drama, auxiliary egos, participants in sharing) the 4 groups displayed different results to one another. First, the therapeutic factors of audience were similar to that of the whole group. Second, participants in situation drama showed a higher catharsis than others. Third, auxiliary egos were leading in the guidance of members and therapists. Fourth, participants in sharing displayed higher group cohesiveness. CONCLUSION: As it is getting harder to find program's suitable for the treatment of increasing number of delinquents due to limited budget and experts, this psychodrama could be more cost-effective than any other measures.
Adolescent* ; Budgets ; Catharsis ; Drama ; Ego ; Female ; Hope ; Humans ; Psychiatry ; Psychodrama* ; Seoul

Duodenal diaphragm is a rare congenital anomaly among the congenital duodenal obstructions. Its symptom and sign usually appear since birth if obstruction is complete. The clinical manifestations of incompletely obstructive duodenal diaphragm are intermittent vomiting, abdominal pain and poor weight gain. Diagnosis may be delayed in this case. Authors experienced a case of incomplete duodenal diaphragm with a central hole. A 29 months old girl presented failure to thrive, intermittent episodes of bloating, abdominal discomfort and occasional vomiting. The patient vomited every 10-14 days, then the abdominal pain and distention were relieved. She overate for about 10 days until the next projectile vomiting. The vomitus frequently contained food ingested several days previously. Plain x-ray films of abdomen showed marked gastric distention. Upper gastrointestinal series revealed marked distention of the duodenum with windsock configuration and radiolucent line at the third portion of the duodenum. On gastroscopic examination, gastric bezoar impacting the pyloric canal and antrum was noted. At operation, we found mucosal membrane in the third portion of the duodenum and bezoar(Chinese cabbage) above the membrane. Side-to-side duodeno-jejunostomy was performed and bezoar was removed. She was discharged on the 13th postoperative day without any complication.
Abdomen ; Abdominal Pain ; Bezoars ; Bulimia* ; Child, Preschool ; Diagnosis ; Diaphragm* ; Duodenal Obstruction ; Duodenum ; Failure to Thrive ; Female ; Humans ; Membranes ; Parturition ; Vomiting ; Weight Gain ; X-Ray Film

Purpose of this study was to compare nutrient intakes of disabled children and non-disabled children. Subjects consisted of 86 disabled children from a special education school and 127 non-disabled children from an elementary school in Seoul. Nutrient intakes were assessed by modified 24-hr recall method, with the help of children's parents and teachers. Almost all nutrient intakes (energy, protein, fat, carbohydrates, vitamin B1 and niacin) of children with cerebral palsy were significantly lower than those of other groups. But nutrient intakes per body weight of children with cerebral palsy were not significantly different with those of other groups. There was no significant difference between disabled and non-disabled children in almost % RDA (rate of actual intake to RDA) except of energy %RDA in children with cerebral palsy. NARs (nutrient adequacy ratio) for energy and vitamin B1 of children with cerebral palsy were significantly lower than those of children with autism and mental retardation, and non-disabled children. The proportions of energy, carbohydrate and protein intakes from lunch were significantly higher than those from breakfast and dinner in children with mental retardation and autism. The nutrient intakes of disabled children were different between other groups according to the type of handicap. For example, children with cerebral palsy had the risk of undernutrition. On the other hand, autistic children had the tendency of overnutrition. These results suggest that nutrition educational programs and educational materials for disabled children, their teachers and their parents should be developed considering the type of handicap.
Autistic Disorder* ; Body Weight ; Breakfast ; Carbohydrates ; Cerebral Palsy ; Child* ; Disabled Children ; Education, Special ; Hand ; Humans ; Intellectual Disability ; Lunch ; Malnutrition ; Meals ; Overnutrition ; Parents ; Seoul ; Thiamine