Endoscopic variceal band ligation requires the incertion of over tube. Since adopting EVL, we encountered pharyngeal trauma and complaints of severe pain during over tube insertion. So We compared the safety and efficacy of EVL according to the method of scope insertion, as over tube and free hand method. We studied 49 patients who require EVL due to grade 3 esophageal varices. The group l consist of 26 patients who undergone EVL without over tube and group 2 consist of 23 patients who undergone EVL with over tube. There were no differences in basal arterial oxygen saturation by pulse oxymeter, basal heart rate and EKG by EKG monitor, hemoglobin concentration, and Child class between 2 groups. The changes of arterial oxygen saturation and EKG were not different between 2 groups during EVL. And the symptom score and speed of single band ligation were similar in over tube and free hand method of EVL. The complication induced by scope insertion methods is minor pharyngeal trauma only in over tube group. We suggest that over tube method of EVL can be replaced by free hand method in patients who complain of severe pain during over tube insertion, and with anatomical abnormality of oropharynx and urgent cases in which require good vision.
Child ; Electrocardiography ; Esophageal and Gastric Varices ; Hand ; Heart Rate ; Humans ; Ligation* ; Oropharynx ; Oxygen

No abstract available.
Child* ; Humans

The number of Internet users is rapidly increasing in Korea. Because of the busy modern life style, demands for the convenient medical services using the Internet are also increased. There are about 10,000 medical Internet sites in Korea. However, several surveys on the Internet medical information in Korea have shown disapointing results. As in other nations medical information is often inappropriate for the questions and some might be even harmful. Somewhat insufficient role of the Internet medical consultation do not satisfy the people' needs. There are eseveral movements for the improving medical Internet information system in Korea but are still at the beginning state. By using the Internet technology, telemedicne for the remote area, for the dementia patients, for the emergency care, and for the elderaly have been tried in Korea. But legal problems, insufficient evidence for its efficiency, and several other drawback make telemedicine be still remaining at the experimental state. However, increasing demands for the better medical services, developing inforamtion technology, expanding high-velocity network system, and fucure capacity mobile communication systems will obviate these problems in the near future.
Dementia ; Emergency Medical Services ; Humans ; Information Systems ; Internet* ; Korea ; Life Style ; Telemedicine*

Sweets syndrome has 4 cardinal features, that is, fever, neutrophil polymorphonuclear leukocytosis of the blood, raised painful plaques on the limbs, face and neck, histologically a dense dermal infiltration with mature neutrophil polymorphs. Hematologic malignancies are associated with 10-15% of cases, but gastric adenocarcinoma associated case is very rare. A 57-year-old male patient admitted to Korea University affiliated hospital because of fever and painful erythematous plaques of both limbs. No response to antibiotics and antihistamines for 1 week, so we referred to dermatologic department for skin biopsy. After then under the impression of Sweet's syndrome, oral prednisolone 60 mg/day prescribed and skin lesions were progressively regressed. For the purpose of screening of associated disease, we did abdominal CT scan and panendoscopy with biopsy which revealed adenocarcinoma of stomach. We couldn't find out any other etiologic agents.
Adenocarcinoma* ; Anti-Bacterial Agents ; Biopsy ; Extremities ; Fever ; Hematologic Neoplasms ; Histamine Antagonists ; Humans ; Korea ; Leukocytosis ; Male ; Mass Screening ; Middle Aged ; Neck ; Neutrophils ; Prednisolone ; Skin ; Stomach ; Sweet Syndrome* ; Tomography, X-Ray Computed

High dose intravenous gammaglobuline (IVLG) therapy is effective in some of the autoimmune diseases. Although the exact mechanism of action of IVIG is uncertain, the action as a neutralizing antibody against unknown etiologic agents, the action of blocking of Fc receptors of effector cells, or the action as a antiidiotypic antibody are suggested. We report a case of 12 year old girl with systemic juvenile rheumatoid arthritis who was treated with high dose IVIG and got a remission. In August 1990 she was admitted to our hospital. because of intermittent fever, transient rash and multiple arthralgia. Under the diagnosis of systemic juvenile rheumatoid arthritis, aspirin (4.0g/day) had been given with symptom improvement. She was readmitted in October 1990 because of aspirin intoxication and acute fulminant hepatitis. She was discharged after recovery and any medicine was not prescribed. In November 1990 she was admitted because of epigastric pain, vomiting, intermittent fever, multiple arthritis, and mild hepatomegaly. Total parenteral alimentation had been given under the diagnosis of superior mesenteric artery syndrome and gold sodium thiomalate (Myochrysine, 5 and 10 mg, two weekly IM injection) was given in conjunction with prednisolone (30 mg/day) and naproxen (375 mg/day). She was admitted again in February 1991 due to the fever, coughing, rash, and hepatosplenomegaly. Pneumonia and leukopenia (2100/mm(3)) were found and gold sodium thiomalate injection was discontinued. Gammaglobulin 1 g/kg/day was given intravenously for 2 consecutive days with dramatic symptom improvement. Five more monthly IV gammaglobulin had been given and the side reaction of injection were nausia, fever, and headache which were controlled by the decrease of infusion rate. Four months after the last IVIG injection she had no symtom of arthritis and the hepatosplenomegaly was decreased. Hemoglobin level was increase to 12.2 mg/dL form 6.2mg/dL and ESR was decrease to 15mm/h. The oral prednisolne and ibuprofen were stopped one year after th last IVIG injection. All the laboratory parameters of arthritis and physical examinations had been normal for more than two year after the stop of all the medications until March of 1994. We suggest that high dose intravenous gammaglobulin can be one of treatments for severe systemic juvenile rheumatoid arthritis.
Antibodies, Neutralizing ; Arthralgia ; Arthritis ; Arthritis, Juvenile ; Aspirin ; Autoimmune Diseases ; Child ; Cough ; Diagnosis ; Exanthema ; Female ; Fever ; Gold Sodium Thiomalate ; Headache ; Hepatitis ; Hepatomegaly ; Humans ; Ibuprofen ; Immunoglobulins, Intravenous ; Leukopenia ; Naproxen ; Physical Examination ; Pneumonia ; Prednisolone ; Receptors, Fc ; Superior Mesenteric Artery Syndrome ; Vomiting

The goal of reduction mammaplasty is a breast with natural contour and volume, aesthetically situated scars, and a well-placed, sensate nipple and areola. The most successful techniques achieve this through the excision of tissue from the lower part of the breast based on some variation. However, the Mckissock's vertical bipedicle technique is the popular method for reduction mammaplasty. As an alternative modified Mckissock's method, we have found the use of only an inferior dermal flap with a keyhole pattern to be a simple and safe method for obtaining satisfactory aesthetic results. We have used inferior dermal flap for 4 patients recently and obtained the advantages as below compare to the Mckissock's method. 1. Rich blood supply to the broad based inferior flap. 2. More easy transposition of the nipple and areola. 3. More good operation field for resection of breast tissue. 4. Short operation time. 5. Can applied to the gigantomastia.
Breast ; Cicatrix ; Female ; Humans ; Mammaplasty* ; Methods ; Nipples

Regulation of respiration differs significantly between wakefulness and sleep. Respiration during wakefulness is influenced by not only automatic control but also voluntary and behavioral control. Sleep is associated with definite changes in respiratory function. With the onset of sleep, voluntary control of ventilation that overrides automatic control during wakefulness becomes terminated. Also ventilatory response to various stimuli including hypoxemia and hypercapnia is decreased. With these reasons respiration during sleep becomes fragile and unstable so that marked hypoxemia can be happened in patients with lung disease especially during REM sleep. Obstructive sleep apnea may also be developed if upper airway resistance is increased in addition to these blunted ventilatory responses.
Airway Resistance ; Anoxia ; Humans ; Hypercapnia ; Lung Diseases ; Respiration ; Sleep Apnea, Obstructive ; Sleep, REM ; Ventilation ; Wakefulness

PURPOSE: Nocturnal enuresis is one of the most common disorders of childhood, occurring in 15% of 5 year-old children. Although usually self-limiting, justification for early treatment has been founded in psyc hological impact on the child. Many investigators have reported upon the effectiveness of prospectively studied to compare the therapeutic effect between imipramine (Tofranil) and desmopressin (Minirin/1-Desamino-8-D-Arginine Vasopressin: DDAVP) on the monosymptomatic enuretic patients. MATERIALS AND METHODS: 83 enuretic patients (primary enuresis 64 cases, secondary enuresis 19 cases) were randomized th one of two groups: imipramine group(44 cases) or desmopressin group (39 cases). They were free of other abnormalities in the screening tests. In addition to drug therapy, all of cases were performed motivational counselling, reduction of fluid in take prior to bedtime and voiding diary. The efficacy of drug was measured in reduction of the number of wet nights per week. During the treatment period, 83 cases were classified as excellent (0 to 1 wet night per week), good (over 59% reduction of wet night)and failed responder(less than 50% reduction of wet night). RESULTS: Average age of imipramine group and desmopressin group was 9.3 years (range 5-17) and 9.6 years (range 5-17), respectively. The number of wet nights per week decreased respectively from a mean of 6.1 to 3.4 in imipramine group are from a mean of 6.4 to 2.3 in desmopressin group. Average therapeutic duration and overall response rate in the imipeamine group and desmopressin group was 9.1 weeks, 6.7 weeks (p<0.05) and 90.9%, 95.9%, respectively (p<0.05). The overall relapse rate of imipramine group and desmopressin group was 40.0% and 40.8% during the follow-up period of 3 months after cessation of medication in excellent responders. There was no difference in the therapeutic effects between primary and secondary enuresis on each drug therapy. There was also on no difference in the therapeutic response according to constipation. No serious side effects were observed in both groups. CONCLUSIONS: These data suggest that the overall effects of imipramine and desmopressin are excellent. But desmopressin has more effective therapeutic response and more shorter therapeutic duration as compared with imipramine.
Child ; Child, Preschool ; Constipation ; Deamino Arginine Vasopressin* ; Drug Therapy ; Enuresis ; Follow-Up Studies ; Humans ; Imipramine* ; Mass Screening ; Nocturnal Enuresis ; Prospective Studies ; Recurrence ; Research Personnel ; Vasopressins

In order to observe the complement fixation test and immuno-diffusion test of paragonimiasis, the sera taken at 10 days intervals up to 150 days from cats infected with Paragonimus westermani were examined by the above two immunological methods. The resultant findings were as follows: The complement fixation test showed positive reaction 20 days after the infection with 20 metacercariae, and 40-50 days after the infection with 10 metacercariae. The highest titer was observed 110 days later following the acceleration at 80 days later. In immuno-diffusion test, one are appeared 30 days after the infection with 20 metacercariae, but 60 days after the infection with 10 metacercariae. However, more than two arcs were observed since 70 days after infection. A relatively wide band appeared by the antigens of Fresh worm material and Somatic material. But relatively clear precipitin lines were observed in the diffusion test with V.B.S. antigen, increasing to 3-4 arcs after 110days. In general, complement fixation test showed earlier and higher sensitive reaction than immuno-diffusion test, and was considered to be more valuable method forr immunological diagnosis.
parasitology-helminth-trematoda ; Paragonimus westermani ; immunology ; cat ; complement fixation test ; immuno-diffusion test

Sleep disturbances are commonly encountered problems in cancer patients. Sleep has a role in maintenance of immunity, metabolism, and quality of life but little has been known about the prevalence, risk factors, and effects on prognosis of sleep disturbances in patients with cancer. Also little attention has been made on proper assessment and management of sleep disorders in these patients. Recently, there have been some reports that sleep disorders are related with development of many cancers such as breast, colorectal, prostate, and endometrial cancers. An intermittent hypoxia and a disruption of circadian rhythm are considered as one of the possible mechanisms of cancer developments. More aggressive evaluation and meticulous management of sleep disturbances in cancer patients are essential to improve quality of life as well as prognosis.
Anoxia ; Breast ; Circadian Rhythm ; Endometrial Neoplasms ; Female ; Humans ; Prevalence ; Prognosis ; Prostate ; Quality of Life ; Risk Factors ; Sleep Wake Disorders