This sutdy was performed to find out a LD isoenzyme pattern in neoplastic tissue of gastric carcinoma and in gastric mucosa with intestinal metaplasia, which has been known as premalignant lesion. The specimens used in this study were 18 stomachs with caarcinoma and 8 stomachs with peptic ulcer as control, and wer obtained by subtotal or total gastrectomy at Pusan National University Hsopital from Oct. 1987 to Sept. 1988. Total LD activity and its isoenzymes in body and antral mucosae and neoplastic tissue of stomach were assayed, and analysed statistically from several points of view. The results obtained were summarized as follows: 1) There was no significant difference in total LD activity between univolved body and antral mucosae of stomach with carcinoma, and between mucosa of stomach with peptic ulcer and univolved mucosa of stomach with carcinoma. 2) Total LD activity in the neoplastic tissue of gastric carcinoma was significantly higher than those of univolved body and antral mucosae of stomach with carcinoam or that of stomach with peptic ulcer, but no significant difference was observed among histological types of gastric carcinoma. 3) The uninvolved body mucosa of stomach with carcinoma or peptic ulcer showed a pattern of LD1 predominance and increas of H to M ratio, while the antral mucosa of stomach with carcinoma or peptic ulcer showed a pattern of LD3 predominance and decrease of H to M ratio. 4) The LD4 and LD5 fractions in antral mucosa with moderate to severe intestinal metaplasia were slightly increased than those of antral mucosa with nil to mild intestinal metaplasia, but did not show statistically significant difference. 5) Marked increase of LD5 fraction was found in neoplastic tissue of gastric carcinoma, and thus ratio of H to M subunit in neoplastic tissue was significantly lower, as compared with body or antral univolved mucosa of stomach. In conclusion, the neoplastic tissue of gastric carcinoma and gastric mucosa with intestinal metaplasia show substantially predominant "M" subunit as well as increased total LD activity.

It has been generally assum d that eccrine poroma arises from acrosyringium, the epidermal sweat duct unit. Eccrine poroma mainly involves the non hairy surfaces of the skin, but it has also been found on hair-bearing areas. One of the characteristics of this structure is absence of melanocytes and melanin granules arnong its cells. However a complete absence of melanocytes and melanin granules in eccrine poroma is not invariable and a few reports of such an occurrence have been presented. The authors report herein a case of unusual and rare eccrine poroma. The eccrine poroma had melanin pigment and melanocytes, was pedunculated and occurred on the parietal scalp which was the unusual site of involvement. The eccrine poroma was also combined with a pedunculated congenital melanocytic nevus on the supraauricular scalp.
Melanins ; Melanocytes ; Nevus, Pigmented* ; Poroma* ; Rabeprazole ; Scalp* ; Skin ; Sweat

Necrolytic migratory erythema is a rare, distinctive, necrotizing cutaneous eruption usually associated with glucagonoma, an alpha-cell tumor of the pancreas. Other clinical features include ane- mia, diabetes mellitus and weight loss. However, it also occurrs without the pancreatic glucagonoma. So this rare condition is called pseudoglucagonoma syndrome, and has been described in association with chronic hepatic diseases, malabsorption with villous atrophy, chronic pancreatitis, celiac sprue, hypoproteinemia and odontogenic infection. We report a case of pseudoglucagonoma syndrome induced by malnutrition without glucagonoma. A 28-year-old Korean female was referred to our department complaining of multiple erythematous, desquamative, crusted and erosive patches on the extremities, and diffuse scalp alopecia for 5 years. She also had perianal erosion, angular cheilitis without glossitis, amenorrhea, axillary and pubic hair loss, and weight loss. Six years previously she had had Whipples operation for a pancreatic solid and papillary neoplasm. The laboratory data showed hypoalbuminemia, essential fatty acid deficiency, diabetes mellitus and slightly high levels of zinc and glucagon. A skin biopsy showed irregular acanthosis, epidermal edema and pallor, dyskeratosis, areas of superficial epidermal necrosis and vascular dilatation of the papillary dermis. The patient improved dramatically after intravenous hyperalimentation and oral intake of mediurn chain triglyceride. For 2.5 years she has taken medium-chain triglycerides without any other treatment, and no side effects on recurrence has been observed.
Adult ; Alopecia ; Amenorrhea ; Atrophy ; Biopsy ; Celiac Disease ; Cheilitis ; Dermis ; Diabetes Mellitus ; Dilatation ; Edema ; Extremities ; Female ; Glossitis ; Glucagon ; Glucagonoma ; Hair ; Humans ; Hypoalbuminemia ; Hypoproteinemia ; Malnutrition ; Necrolytic Migratory Erythema* ; Necrosis ; Pallor ; Pancreas ; Pancreatitis, Chronic ; Parenteral Nutrition, Total ; Recurrence ; Scalp ; Skin ; Triglycerides* ; Weight Loss ; Zinc

E-cadherin is one of intercellular adhesion molecules, and it has been demonstrated that E- cadhedrin acts as an invasion suppressor in vitro and loss of its expression is an important prognostic factor in human malignancies. However the prognostic value of loss of expression of E-cadhedrin in renal cell carcinoma (RCC) remains to be defined. We herein immunohistochemically examined the expression of E-cadhedrin in paraffin- embedded tissues of 43 patients with RCC to investigate the prognostic value of loss of expression of E-cadherin. Twenty three of 43 patients (54.5%) showed loss of expression of E- cadherin. There were significant correlations between loss of expression of E-cadherin and histopathologic grade, Robson stage, T stage, N stage and M stage (all p<0.05). Patients with loss of expression of E-cadherin showed significantly decreased 2 year disease free survival as compared with those with normal expression of E-cadherin (p<0.001). These results suggest that loss of expression of E-cadherin has a ominous prognostic value in patients with RCC.
Cadherins* ; Carcinoma, Renal Cell* ; Cell Adhesion Molecules ; Disease-Free Survival ; Humans ; Prognosis

PURPOSE: This study was conducted to identify job experiences of male hospital nurses. METHODS: Data were collected from 20 male nurses working at general hospitals, through semi-structured in-depth interviews. The interviews were recorded and subsequently transcribed verbatim. Using content analysis, data were coded and categorized. RESULTS: The analyzed domains were motivations for choosing nursing, occupational experiences (3 subdomains), and attitudes toward the future. A total of 85 significant statements were selected from the data and classified into 32 categories. The nurses' motivations for choosing nursing were advantages of employment, their aptitude, scarcity value of men, professionalism and job security, good promotion, stable income, and family influence. In occupational experiences, they were assigned to special fields and dissatisfied with vertical relationship, promotion system, their salary, and gaps in military service time; they had difficulties in adapting to female-dominated groups and encountered gender role stereotype and preconception; they were satisfied with their distinguished performance, but had damaged self-esteem, and were stressed and disappointed in their work. In their attitudes toward the future, they considered their career changes, but tried to make professional and personal advancement. CONCLUSION: These findings have implications for recruiting and retaining male nurses in clinical settings.
Aptitude ; Employment ; Gender Identity ; Hospitals, General ; Humans ; Male ; Military Personnel ; Motivation ; Nurses, Male ; Salaries and Fringe Benefits ; Statistics as Topic

Malignant acanthosis nigricans is very rare disease. The disease is related with internal malignancy, especially gastrointestinal tract malignancy. Reported occurrence rate of malignant acanthosis nigricans associated internal malignancies are 64% of stomach adenocarcinoma, 27% of other organs of abdomen (liver, gall bladder, small intestine, rectum, uterus, ovary), 9% of non-abdominal organs(breast, lung). We report a case of malignant acanthosis nigricans associated with stomach adenocarcinoma from 20-year-old female and discuss review of literature on a acanthosis nigricans briefly.
Female ; Humans ; Adenocarcinoma

Aortopulmonary septal defect is a rare congenital cardiac anomaly. A 15 year old boy was admitted to Department of Internal Medicine of Seoul National University Hospital because of exertional dyspnea. Aortopulmonary septal defect was confirmed by cardiac catheterization demonstrating severe pulmonary hypertension and patent foramen ovale, and retrograde aortogram showing contrast material passing from the ascending aorta just above the aortic valve into the pulmonary trunk. We present a case of aortopulmonary septal defect with a review of literatures.
Adolescent ; Aorta ; Aortic Valve ; Aortopulmonary Septal Defect* ; Cardiac Catheterization ; Cardiac Catheters ; Dyspnea ; Foramen Ovale, Patent ; Humans ; Hypertension, Pulmonary ; Internal Medicine ; Male ; Seoul

BACKGROUND: In Korea, the problem of physician workforce imbalances has been a debated issue for a long time. This study aimed to draw key lessons and policy implications to Korea by analyzing projection models of physician demand/supply among five countries. METHODS: We adopted theoretical framework and analyzed detail indicators used in projection models of demand/supply comparatively among countries. A systematic literature search was conducted using PubMed and Google Scholar with key search terms and it was complimented with hand searching of grey literature in Korean or English. RESULTS: As a results, Korea has been used a supply-based traditional approach without taking various variables or environmental factors influencing on demand/supply into consideration. The projection models of USA and Netherlands which considered the diversity of variables and political issues is the most closest integrated approach. Based on the consensus of stakeholder, the evolved integrated forecasting approach which best suits our nation is needed to minimize a wasteful debate related to physician demand/supply. Also it is necessary to establish the national level statistics indices and database about physician workforce. In addition, physician workforce planning will be discussed periodically. CONCLUSION: We expect that this study will pave the way to seek reasonable and developmental strategies of physician workforce planning.
Consensus ; Forecasting ; Hand ; Korea ; Netherlands

Traumatic bronchial injury (TBI) is rare and often fatal, usually a result of blunt or penetrating chest trauma. Clinical manifestations of TBI include pneumothorax, pneumomediastinum, subcutaneous emphysema and continuous air leakage despite thoracostomy with negative pressure. However, TBI is initially difficult to diagnose because its signs are similar to other chest traumas. Delayed diagnosis of TBI can result in sepsis, bronchial stenosis, hypoxic injury, and eventually can cause death. We experienced two patients with TBI, possibly a result of blunt chest trauma. We did not diagnose TBI in the emergency room because we did not suspect it. During surgery, we discovered right bronchial rupture, so performed end to end anastomosis of bronchus in two patients. This report discusses the rare occurrence of TBIs due to chest trauma; our aim is to increase awareness of this diagnosis in the trauma center.
Bronchi ; Constriction, Pathologic ; Delayed Diagnosis ; Diagnosis ; Emergency Service, Hospital ; Humans ; Mediastinal Emphysema ; Pneumothorax ; Rupture ; Sepsis ; Subcutaneous Emphysema ; Thoracic Injuries ; Thoracostomy ; Thorax* ; Trauma Centers

OBJECTIVE: To evaluate the effect of short coasting, by withdrawing both gonadotropins and GnRH agonist (GnRHa), on the prevention in severe ovarian hyperstimulation syndrome (OHSS) without compromising pregnancy outcome. METHOD: Thirty-seven women who had been coasted during COH for IVF were coasted when > or =20 follicles > 15 mm with serum E2 level of 4,000 pg/ml were detected. Coasting was initiated for one or two days depending on the status of follicle on ultrasound and serum E2 level. Both gonadotropin and GnRHa were withheld for coasting. Retrospective study was carried and changes of serum E2 levels, number of oocytes retrieved, fertilization rate, pregnancy rate were compared and analyzed. RESULTS: The mean serum E2 level fell from 6,993 pg/ml on the onset of coasting to 3,396 pg/ml on the day of hCG administration. The mean number of oocytes retrieved and fertilization rate were 15.7 and 70.0%, respectively. Fifteen patients were pregnant (40.6%) and implantation rate was 15.2%. Twenty-six (70.3%) patients were coasted for one day and 11 (29.7%) were coasted for two days. The mean decrease rate of serum E2 level was 43% in one day coasting group and 15% (1st day) and 81% (2nd day) in two day coasting group. The pregnancy outcome was similar between the two groups. After coasting, no severe or moderate OHSS occurred in any patients and mild OHSS occurred in 3 (8.1%) patients. CONCLUSIONS: Coasting for one or two days can be used successfully in the prevention of OHSS without compromising IVF cycle outcome.
Female ; Fertilization ; Gonadotropin-Releasing Hormone* ; Gonadotropins* ; Humans ; Oocytes ; Ovarian Hyperstimulation Syndrome* ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate ; Retrospective Studies ; Ultrasonography