Compliance of epileptic patients is one of the most important factors for adequate therapy. Recently, it had been shown that the variability of three serial measurement of the serum levels of antiepileptic drug(AED) may be used as an indication of the degree of compliance. Coefficient variation(CV) of serum drug levels calculated by only one AED had been used to determine the compliance in epileptic patients who took multiple AEDs. We attempted to evaluate the CV of AEDs and then find the objective clue of compliance and the compatible therapeutic planing according to CV. Ninety seven epileptic patients of outpatients department of the Gyengsang National University Hospital were entered to this study. All patients were taking medication at least for 6 months without any changes of drug regimen. Patient's information was acquired by reviewing the chart and interview with questionnaire. With these informations, we determined the compliance of the patients. Antiepileptic serum levels were measured three times at intervals of at least two to four weeks apart, and their CV was calculated. We compared the CV between the compliant and non-compliant group in each AED(phenytoin, carbamazepine , valproic acid) and three drugs in the compliant group. The mean CVs of phenytoin, carbamazepine and valproic acid in the compliant group were 18.3+/-13.0, 15.2+/-10.2 and 23.8+/-8.9, respectively(mean+/-SD). The mean of CV in the compliant and the non-compliant group were 17.9+/-10.9 and 38.8+/-27.2, respectively. The CVs of the compliant group were significantly lower than those of the non-compliant group(p<0.05). However, CVs had no significant difference between three antiepileptic drugs. This study showed that CVs of AEDs were not different between each AEDs, even though they possess different pharmacokinetic properties. Therefore, the CV of one AED can be used in determining the compliance of the epileptics who are taking multiple AEDs.
Anticonvulsants ; Carbamazepine* ; Compliance ; Humans ; Outpatients ; Phenytoin* ; Surveys and Questionnaires ; Valproic Acid*

OBJECTIVE: For the ubiquity of medical service, when user who has proper authority want to access medical data, user accessability should be assured. And the security of the disclosed medical data is important. This paper presents single user access interface on multiple patient reservoirs and elaborate access control using the Role-Based Access Control(RBAC) system. METHODS: Proposed system consists of 4-tier architecture that is client application, Access Control Central(ACC) agent, Local Access Control(LAC) agent and Hospital Information Systems(HIS). User requests medical data with client application. ACC notarizes user identity and controls access of user request and selectively encrypts medical data. LAC charges data conversion for communication between ACC and HIS. HIS has repositories of medical datum. System provides security service with digital certificate, X.509v3, of user. RESULTS: User requests medical data of several HIS approaching single ACC not by each HIS. Through conversion process of LAC, data that is described XML and is used for communication inter system enables information exchange with single common data format that is independent to several HIS. CONCLUSION: In the proposed system, user accesses medical datum of several HIS regardless of location and has consistent access interface. And using independent format against each HIS makes easy information exchange between several HIS. Transferred data maintains security about significant datum by selective encryption and increases encryption efficiency. Unified access control about multiple patient reservoirs that are scattered in other places provides unified and precise diagnosis of patient information. And it functions the portal of collaborate treatment in inter-HIS.
Computer Security ; Delivery of Health Care, Integrated ; Diagnosis ; Health Services Accessibility ; Hospital Information Systems ; Humans

No abstract available.
Alopecia* ; Minoxidil*

Tracheopathia osteoplastica (TO) is a rare clinical and pathologic benign condition that causes irregularity, narrowing and rigidity of the trachea and the main bronchi, characterized by multiple submucosal cartilaginous and osseous nodules of various sizes lining the upper respiratory tract. The treatment of TO diagnosed with CT and bronchoscopic biopsy is mostly supportive, and sometimes laser vaporization is used. We experienced a case of TO with severe obstructed airway that was treated by drilling.
Biopsy ; Bronchi ; Laser Therapy ; Respiratory System ; Trachea

PURPOSE: Growth inhibitory effects of lipid soluble components of the Korean red ginseng and the antineoplastic mechanism against human melanoma cell lines were investigated. To examine molecular mechanism of growth inhibitory effects of GX-PE, we analyzed the effect of GX-PE on cell cycle progression and expression of cell cycle regulatory factors such as retinoblastoma gene product (Rb), p27 (Kip1), p21 (WAF1), cdk2, cdk4 and cyclin D1 which are known to regulate cell cycle progression. MATERIALS AND METHODS: Petroleum ether extract of the Korean red ginseng (GX-PE) was added to cultures of three human melanoma cell lines, SK-MEL-1, SK-MEL-2, and SK-MEL-5. Proliferation was measured by 3H-thymidine incorporation assay. Cell cycle and expression of cell cycle regulatory factors were analyzed by flow cytometry and Western blotting, respectively. RESULTS: Growth of melanoma cells was inhibited by GX-PE in proportion to the concentration. GX-PE significantly inhibited cell cycle progression at G1 phase. GX-PE increased expression of negative cell cycle regulators, i.e., p27 (Kip1) in SK-MEL-2 and p21 (WAF1) and Rb in SK-MEL-1. CONCLUSION: These results suggest that GX-PE inhibits proliferation of melanoma cells at a G1-S transition point of the cell cycle. The effect of GX-PE is most likely due to induction of negative cell cycle regulatory factors.
Blotting, Western ; Cell Cycle* ; Cell Line* ; Cyclin D1 ; Ether ; Flow Cytometry ; G1 Phase ; Genes, Retinoblastoma ; Humans* ; Melanoma* ; Panax* ; Petroleum

BACKGROUND AND OBJECTIVES: Dacryocystorhinostomy is commonly performed through an external incision. Several transnasal approach were described earlier in this century but they failed to gain popularity probably because of difficult exposure. Whether the endoscopic laser dacryocystorhinostomy improved intranasal visualization and decreased intraoperative complications than external incision. MATERIALS AND METHODS: During recent 3 years, we performed endoscopic laser dacryocytorhinostomy about 10 cases at Joong Ang Gil Hospital. RESULTS: Success rate of revision groups (3 cases) was very good. CONCLUSION: Small-diameter endoscope with angled field of view provides excellent intranasal visualization. Endoscopic laser dacryocystorhinostomy avoids the possibility of pathologic scar formation and injury to the medial canthus. Endoscopic laser dacryocystorhinostomy appears to be the safe treatment especially for revision procedure.
Cicatrix ; Dacryocystorhinostomy* ; Endoscopes ; Endoscopy ; Intraoperative Complications

BACKGROUND AND OBJECTIVES: Deep neck space infections, which affect soft tissues and fascial components of the head and neck, were frequently encountered in the preantibiotic era, but their frequency has been remarkably reduced after the development of chemotherapeutic agents and antibiotics. However, they may still result in significant morbidity and mortality despite the use of chemotherapeutic agents and antibiotics. The purposes of this study has been to assess clinical findings and the effectiveness of the treatment of deep neck infection through statistical analysis. MATERIALS AND METHODS: A retrospective study was performed on 86 cases of deep neck space infections in patients admitted for diagnosis and treatment during a 9-year period from January 1988 to December 1996. RESULTS: All cases were treated with either conservative treatment only as in 47 cases (55%), or surgical drainage and antibiotics as in 33 cases (33%), or surgical drainage with tracheostomy and antibiotics as in 6 cases (7%). At the end of the treatment, 83 cases were cured of the disease and 3 cases were reported to have complications. CONCLUSION: We concluded that treatment of deep neck infection requires knowledge of the natural history of the disease and a detailed understanding of anatomy. Management guidelines include (1) hospitalization, (2) culture and sensitivity tests, (3) antibiotic therapy, (4) diagnostic radiographic procedures, and (5) surgical intervention.
Anti-Bacterial Agents ; Diagnosis ; Drainage ; Head ; Hospitalization ; Humans ; Mortality ; Natural History ; Neck* ; Retrospective Studies ; Tracheostomy

OBJECTIVE: The object of this study was to assess the accuracy of dipyridamole stress intravenous (IV) myocardial contrast echocardiography (MCE) using pulse inversion harmonic imaging and PESDA in the detection of perfusion defect in the patients with coronary artery disease in comparison with dipyridamole stress Tc-99m sestamibi SPECT. METHODS: Total 46 patients (29 males, mean age 64 years old) were consecutively enrolled. Patients with prior myocardial infarction were excluded. MCE and Tc-99m sestamibi SPECT were performed at the same day during rest and after 0.56 or 0.84mg/Kg dipyridamole infusion. Continuous IV infusion of PESDA (2-5 mL/min) was administered while obtaining triggered (1:1) end-systolic apical 2, 4 chamber and long axis views. Tc-99m sestamibi was injected 3 minutes after dipyridamole. Tc-99m sestamibi SPECT images were obtained one hour later. Coronary angiography was followed within two days in all patients. Tc-99m sestamibi SPECT images were matched to the sixteen segments of left ventricle according to American Society of Echocardiography for segmental comparison. Both images were analyzed visually. Results Using coronary angiography as the standard, MCE showed overall sensitivity of 70.7%, specificity of 95.8%, positive predictive value (PPV) of 87.8% and negative predictive value (NPV) of 88.5% in the detection of coronary atherosclerosis (70% stenosis). Tc-99m sestamibi SPECT showed sensitivity of 75.6%, specificity of 98.9%, PPV of 96.8% and NPV of 90.6%. The overall concordance rate between MCE and Tc-99m sestamibi SPECT for the detection of perfusion defects was 86.9% (Cohen's kappa value 0.63) according to the coronary territory and 86.8% (Cohen's kappa value 0.55) according to segmental analysis. CONCLUSION: Dipyridamole stress IV MCE using pulse inversion harmonic imaging and PESDA is feasible and comparable to Tc-99m sestamibi SPECT in identifying significant coronary stenosis and inducible myocardial perfusion defects in the patients with coronary artery disease. MCE using pulse inversion harmonic imaging seems to be a promising modality for assessing myocardial perfusion in the patients with suspected coronary artery disease.
Axis, Cervical Vertebra ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Dipyridamole ; Echocardiography* ; Heart Ventricles ; Humans* ; Male ; Myocardial Infarction ; Perfusion* ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon*

Background/Aims: To assess the effectiveness and feasibility of a brief session of hypnosis to reduce distress in children with functional constipationundergoing anorectal manometry (ARM). Methods: A partially-blinded randomized controlled pilot trial was conducted in children 4-18 years old scheduled for ARM. Children were randomized to receive a brief session of hypnosis prior to ARM or standard care. Non-blinded and blinded observers rated the child’s level of distress using the Observation Scale of Behavioral Distress and a 4-point-Likert scale, respectively. Differences between groupswere analyzed using Fisher’s exact test or Mann-Whitney U test as appropriate. Results: Data from 32 children (15 hypnosis and 17 standard care) were analyzed. Prior to insertion of the catheter, the observed mean levels of distress were lower in the hypnosis group according to both the non-blinded observer (median 0.0 [interquartile range {IQR} 0.0-0.3] vs 1.4 [IQR 0.3-2.4]; P = 0.009) and the blinded observer (median 0.0 [IQR 0.0-0.0] vs 0.5 [IQR 0.0-1.0]; P = 0.044). During ARM, observed and reported levels of distress did not differ significantly. In the hypnosis group, 92.9% of parents and childrenreported that hypnosis helped the child to relax. There were no significant differences in resting pressure, squeeze pressure, or duration of the procedure between both groups. Conclusion A brief session of hypnosis for children before ARM is an easily incorporable intervention that lowers distress levels prior to theprocedure and is positively perceived by children and parents.

Purinergic P2Y Receptor Antagonists ; Consensus ; Cardiovascular System ; Cardiology ; Asia