The objectives of this study are (1) to examine the training and working conditions of residents after revision of the 'Regulations on Specialist Training and Accreditation,' (2) to determine the causes of problems with these training and working conditions, and (3) to seek improvement in these conditions. A questionnaire survey was conducted over two weeks. A total of 10,768 respondents and 1,793 valid responses were analyzed. Although revised regulations had been implemented, training conditions did not appear to have undergone any improvements. 52.9% of residents work over 80 hours per week and 27.1% respondents exceeded 100 hours per week. 76.9% of respondents indicated that they exceed the maximum continuous training time of 36 hours. 64.5% of respondents said their emergency room training time was over 12 hours. 25.4% of respondents' duty days exceeded three days a week. 34.7% of respondents said that they had less than three days off per month. The proportion of those with annual leave under 14 days is 70.2%. For substantive improvements in training and working conditions, new plans must consider practical factors in the implementation of improvements. This requires a governance structure based on participation, and an independent, objective training evaluation organization should be established to perform a reliable assessment. Above all, the government financial compensation plan must prepare for improving the training environment.
Compensation and Redress ; Education ; Emergency Service, Hospital ; Social Control, Formal ; Specialization ; Surveys and Questionnaires

OBJECTIVE: To evaluate the safety and efficacy of the laparoscopic incidental appendectomy during gynecologic laparoscopic operation. Methods: This study was evaluated for the clinical analysis of 118 patients who underwent laparoscopic assisted vaginal hysterectomy(LAVH group, 65 cases) and LAVH with laparoscopic incidental appendectomy(LAVH + IA group, 53 cases) at the Wallace Memorial Baptist Hospital from Oct. 1996 to Nov. 1998. RESULTS: The following results were obtained: 1) There was no significant difference between two groups in regard to age. The mean age was 45.7 years in LAVH group and 43.8 years in LAVH + IA group. 2) There was no significant difference between two groups in mean operative time. The mean operative time was 90.4 minutes in LAVH group and 97.5 minutes in LAVH + IA group. 3) The mean appendectomy time was 7.1 minutes. 4) The mean time recovering normal bowel activity was 46.2 hours in LAVH group and 45.8 hours in LAVH + IA group. There was no significant difference between two groups. 5) The mean hospital stay was 6.4 days in LAVH group and 5.7 days in LAVH + IA group. There was no significant difference between two groups. 6) The postoperative complications occurred in 11 cases(9.3 %). The serious complications of appendectomy was not found. 7) Of the 53 appendices removed, 5(9.4 %) were abnormal pathologic findings. CONCLUSION: Laparoscopic incidental appendectomy during laparoscopic operation was not found to influence the operation time, hospital stay, gas passing time, but there is one case of wound infection due to incidental appendectomy. Therefore, a large number of study should be performed to evaluate the safety and efficacy of laparoscopic incidental appendectomy during laparoscopic operation.
Appendectomy* ; Humans ; Length of Stay ; Operative Time ; Postoperative Complications ; Protestantism ; Wound Infection

Pancreatic metastases are found in up to 40% of patients with small cell lung cancer, but metastasis-induced acute pancreatitis is rare. Treatment of metastasis-induced acute pancreatitis is initially supportive, but failure of conservative management are common. There are few reports on aggressive treatment with chemotherapy which lead to rapid clinical improvement and prolongation of survival in patients with metastasis-induced acute pancreatitis. We experienced a case of metastasis-induced acute pancreatitis in a patient with small cell lung cancer. Despite conservative treatment with dietary restriction and intravenous fluid supply, serum amylase levels increased persistently with severe abdominal pain. After chemotherapy with irinotecan and carboplatin, abdominal pain and serum amylase levels resolved dramatically.
Acute Disease ; Aged ; Carcinoma, Small Cell/*secondary ; English Abstract ; Humans ; Lung Neoplasms/*pathology ; Male ; Pancreatic Neoplasms/complications/*secondary ; Pancreatitis/*etiology

Angiosarcoma arising from chronic lymphedema is referred to as Stewart-Treves Syndrome. It typically occurs as a complication of long-lasting lymphedema of the arm, after mastectomy and/or radiotherapy for breast cancer. Angiosarcoma associated with lymphedema of the lower extremity is rare. We report a case of angiosarcoma of the leg in a patient with a 15-year history of lymphedema due to cervical cancer operation and radiotherapy.
Arm ; Breast Neoplasms ; Hemangiosarcoma ; Humans ; Leg ; Lower Extremity ; Lymphedema ; Mastectomy ; Uterine Cervical Neoplasms

OBJECTIVE: Percutaneous vertebroplasty is often complicated by the presence of multiple fractures or non-localizing pain in the patients with osteoporotic vertebral fractures. The purpose of this study is to estimate the value of preoperative radiologic studies in the localization of symptomatic vertebrae and to determine the factors which can influence on the clinical results. MATERIALS AND METHODS: We retrospectively reviewed the clinical and radiologic data of 57 vertebrae in 30 patients underwent percutaneous vertebroplasty for osteoporotic vertebral compression fractures. Inclusion criteria was severe pain(McGill-Melzack score 3, 4 or 5) associated with the acute vertebral fractures and absence of spinal nerve root or cord compression sign. Acute symptomatic vertebral fracture was determined by the presence of signal change on MR images or increased uptake on whole body bone scan. RESULTS: Pain improvement was obtained immediately in all patients and favorable result was sustained in 26 patients(86.7%) during the mean follow-up duration of 4.7 months(5 complete pain relief, 21 marked pain relief). Those who underwent vertebroplasty for all acute symptomatic vertebrae had significantly better clinical result than those who did not. Further vertebral collapse and eventual bursting fracture occurred in 1 vertebra which showed intradiskal leakage of bone cement and disruption of cortical endplate on postoperative CT scan. CONCLUSION: Preoperative MR imaging and whole body bone scan are very useful in determining the symptomatic vertebrae, especially in the patients with multiple osteoporotic vertebral fractures. To obtain favorable clinical result, the careful radiologic evaluation as well as clinical assessment is required. Control of PMMA volume seems to be the most critical point for avoiding complications.
Follow-Up Studies ; Fractures, Compression* ; Humans ; Magnetic Resonance Imaging* ; Polymethyl Methacrylate ; Retrospective Studies ; Spinal Nerve Roots ; Spine ; Tomography, X-Ray Computed ; Vertebroplasty*

PURPOSE: We investigated compounds from food sources given to children that may induce the differentiation of small intestinal epithelial cells in order to signal pathways that induce the prolif eration and differentiation of small intestinal epithelial cells. METHODS: We analyzed small intestinal epithelial cell differentiation using in vitro IEC-6 cells model. The growth curve of IEC-6 cells was obtained by standard MTT assay. Alkaline phospha tase(ALP) activities were determined using the paranitrophenol colorimetric assay for the differ entiation of IEC-6 cells. We did ALP and Brdu double-staining of cultured IEC-6 cells to distin guish between differentiation and proliferation, and investigated compounds' potential for inducing differentiation of small intestinal epithelial cells and protein kinase signal pathway. RESULTS: The calcium ion was essential for the differentiation of IEC-6 cells. Retinol and retinoic acid induced the differentiation of IEC-6 cells. beta-LG stabilized and increased cell permeation of retinoic acid. IEC-6 cells showed 3 or 4 times more ALP activity with co-treatment of retinoic acid and beta-LG. BSA and OVA accelerated differentiation of IEC-6 cells in a similiar fashion to beta -LG. But, pepton and casein didn't. Heat destruction of beta-LG, BSA and OVA lead to loss in the ability of these compounds to induce cellular differentiation. The PKA signal pathway involved differentiation of IEC-6 cells. IEC-6 cells proliferation increased by the activation of PKC signal pathway and decreased differentiation by PKC signal pathway. CONCLUSION: Our results confirm that signal pathways are related to the proliferation and differ entiation of small intestinal epithelial cells and various compounds from food sources of childhood, such as beta-LG, BSA, OVA, and retinoic acid. These compounds appear to induce differentiation of small intestinal epithelial cells and may play a role in stimulating regeneration of epithelial cells after small intestinal mucosal injury.
Bromodeoxyuridine ; Calcium ; Caseins ; Child ; Epithelial Cells* ; Hot Temperature ; Humans ; Ovum ; Protein Kinases ; Regeneration ; Signal Transduction ; Tretinoin ; Vitamin A

No abstract available.
Humans*

PURPOSE: Gene therapy (ex vivo) has recently been used as a means of delivering bone morphogenetic proteins (BMPs) to sites of tissue regeneration. In the present study, we investigated the effect of co-transduction of adenoviruses expressing BMP-2 and BMP-7 on osteogenesisof C2C12 cells in vitro. METHODS: A replication-defective human adenovirus 5 (Ad5) containing a cDNA for BMPs in the E1 region of the virus (Ad5BMP-2 and Ad5BMP-7) was constructed by in vivo homologous recombination. Functional activity of Ad5BMP-2 and Ad5BMP-7 were evaluated in mouse stromal cells (W20-17cells). C2C12 cells are transduced with various MOI (multiplicity of infection) of Ad5BMP-2 and Ad5BMP-7 to assess most effective and stable titer. Based on this result, C2C12 cells were transduced with Ad5BMP-2 and Ad5BMP-7 alone or by combination. BMPs expression, alkaline phosphatase (ALPase) activity, cell proliferation, and mineralization were assessed. RESULTS: Ad5BMP-2 and Ad5BMP-7 are successfully transduced to W20-17 cells, and secreted BMPs stimulated cell differentiation. Also, C2C12 cells transduced with Ad5BMPs showed expression of BMPs and increased ALPaseactivity. In all groups, cell proliferation was observed over times. At 7days, cells co-transduced with Ad5BMP-2 and Ad5BMP-7 showed lower proliferation than the others. C2C12 cells co-transduced with Ad5BMP-2 and Ad5BMP-7 had greater ALPaseactivity than that would be predicted if effect of individual Ad5BMPs were additive. Little mineralized nodule formation was detected in cells transduced with individual Ad5BMPs. In contrast, Ad5BMP-2 and Ad5BMP-7 combination stimulated mineralization after culturing for 10 days in mineralizing medium. CONCLUSIONS: Present study demonstrated that adenoviruses expressing BMPs gene successfully produced BMPs protein and these BMPs stimulated cells to be differentiated into osteoblastic cells. In addition, the osteogenic activity of Ad5BMPs can be synergistically increased by co-transduction of cells with Ad5BMP-2 and Ad5BMP-7.
Adenoviridae ; Adenoviruses, Human ; Alkaline Phosphatase ; Animals ; Bone Morphogenetic Protein 2 ; Bone Morphogenetic Protein 7 ; Bone Morphogenetic Proteins ; Cell Differentiation ; Cell Proliferation ; DNA, Complementary ; Durapatite ; Genetic Therapy ; Homologous Recombination ; Mice ; Osteoblasts ; Osteogenesis ; Regeneration ; Stromal Cells ; Viruses

Eruptive vellus hair cysts (EVHC) are characterized by multiple, small, discrete red or brown colored papules that usually occur on the chest and extremities. Their etiology is unknown. A variant form of EVHC that occur exclusively on the face is rare and it is very characteristic for its location and color. We report here on a facial variant of EVHC that occurred on the face of 23-year-old woman with asymptomatic, skin-colored to bluish tiny papules. The lesions first appeared at the age of 22-years.
Extremities ; Female ; Hair ; Humans ; Thorax ; Young Adult

Allergic asthma is associated with persistent functional and structural changes in the airways and involves many different cell types. Many proteins involved in allergic asthma have been identified individually, but complete protein profiles (proteome) have not yet been reported. Here we have used a differential proteome mapping strategy to identify tissue proteins that are differentially expressed in mice with allergic asthma and in normal mice. Mouse lung tissue proteins were separated using two-dimensional gel electrophoresis over a pH range between 4 and 7, digested, and then analyzed by matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MS). The proteins were identified using automated MS data acquisition. The resulting data were searched against a protein database using an internal Mascot search routine. This approach identified 15 proteins that were differentially expressed in the lungs of mice with allergic asthma and normal mice. All 15 proteins were identified by MS, and 9 could be linked to asthma-related symptoms, oxidation, or tissue remodeling. Our data suggest that these proteins may prove useful as surrogate biomarkers for quantitatively monitoring disease state progression or response to therapy.
Animals ; Asthma/genetics/immunology/*metabolism ; Comparative Study ; Disease Models, Animal ; Electrophoresis, Gel, Two-Dimensional ; Gene Expression/immunology ; Gene Expression Profiling ; Lung/immunology/metabolism/pathology ; Male ; Mice ; Mice, Inbred BALB C ; Ovalbumin/immunology ; Proteome/*analysis/genetics/immunology ; Proteomics/methods ; RNA, Messenger/genetics/metabolism ; Research Support, Non-U.S. Gov't ; Reverse Transcriptase Polymerase Chain Reaction ; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization