BACKGROUND: It is important for the health care provider, particularly primary care physicians as gatekeepers of health care, to understand the social interests and needs toward health care. This study was done to find ways to deal with public opinion by analyzing the contributions of health care in the newspapers. METHODS: Two hundred twenty four contributions about health care were sorted out in the three national newspapers during one calendar year from January to December, 1996. These contributions were coded by themes and subjects according the content analysis and qualitative text interpretation. RESULTS: The contributions were classified into three categories, medical insurance, and hospital services, and health care policies. Forty four contributions of medical insurance category were coded into 5 themes and 18 subject. Fifty eight contributions of hospital services category were coded into 3 themes and 31 subjects. One hundred twenty two contributions of medical insurance category were coded into 8 themes and 32 subjects. The themes and subjects were listed and findings were described qualitatively. The characteristics of public opinions about health care were diversity, conflicting interests, plentifulness of complaints and discontent, and finally, infrequency of alternative proposals for problem solving. How to deal with public opinions were discussed. CONCLUSIONS: We can recognize the public attitude of health care and complaints of patients and consumers of health care by analyzing the contributions in the newspapers. These data can be used to develop ways of primary care physicians to deal with patients' needs.
Delivery of Health Care* ; Health Personnel ; Humans ; Insurance ; Periodicals* ; Patient Education as Topic ; Physicians, Primary Care ; Problem Solving ; Public Opinion

The middle ear adenoma is a rare neoplasm originating from the lining epithelium of the middle ear mucosa. The first report of a middle ear glandular tumor was published in 1898 by Treitel and since then over 100 cases have been reported. At least 14 different descriptions have been given to these lesions, reflecting the controversies relating to their presumed histogenesis and differentiation. The middle ear adenoma has been often classified into mixed and papillary type by cellular morphology, growing pattern, prognosis, and clinical manifestations. The most common initial symptom was decreased hearing, followed by ear-fullness, otalgia, headache, and otorrhea. Radiologically, the most common finding is a soft tissue mass in the middle ear. In this study, we present a case of the middle ear adenoma of the patient complaining hearing difficulty and otorrhea, which was diagnosed by histopathologic finding, and then discuss the current approach to this tumor with a review of literature.
Adenoma* ; Ear, Middle* ; Earache ; Epithelium ; Headache ; Hearing ; Humans ; Mucous Membrane ; Prognosis

Metastatic tumors to the heart are far more frequent than primary tumors of the heart. Cardiac metastasis may be detected up to 30 percent of patients with fatal lung cancers. Metastatic cancer to the heart is difficult to suspect. Where cardiac metastasis is diagnosed ante-mortem, signs and symptoms of the primary cancer are usually the presenting features and the presence of cardiac involvement is often incidentally detected. We experienced a case of 35-year-old woman with metastatic lung cancer invading the left atrium via pulmonary vein, which was not proved pathologically. She presented with hemoptysis and chest pain. Transthoracic echocardiography demonstrated massive cardiac infiltration with tumor and decreased cardiac wall motion, correlating with the chest CT findings, which were also remarkable for the presence of intracardiac mass and direct invasion to adherent pericardium, pulmonary vein and left atrium. We suggest that careful examination of 2D echocardiography can be noninvasive and valuable tool for diagnosis of metastatic cancer to the heart.
Adult ; Carcinoma, Large Cell* ; Chest Pain ; Diagnosis ; Echocardiography ; Female ; Heart ; Heart Atria* ; Hemoptysis ; Humans ; Lung Neoplasms ; Lung* ; Neoplasm Metastasis* ; Pericardium ; Pulmonary Veins ; Tomography, X-Ray Computed

No abstract available.
Hemolytic-Uremic Syndrome*

BACKGROUND AND OBJECTIVES: Tonsillectomy is one of the most common surgical procedures in otolaryngologic field and it can be carried out under general anesthesia or local anesthesia. The author compared tonsillectomy under local anesthesia to general anesthesia with respect to operation, anesthesia and recovery time as well as satisfaction of the patients. SUBJECTS AND METHOD: Fifty patients who underwent tonsillectomy were divided into a local anesthesia group (25 patients) and a general anesthesia group (25 patients). Parameters such as time spent for anesthesia, operation, recovery time, episodes of cautery, initiation of normal daily life including normal diet, pain, and complication were compared between the two groups. Paired student t-tests were used for statistical analysis. RESULTS: Among other parameters, local tonsillectomy was superior in terms of saving time during anesthesia, operation, recovery as well as hospital course compared to tonsillectomy under general anesthesia. However, ease on the initiation of normal daily life including normal diet, pain, and complication did not differ between the two groups. CONCLUSION: The author feels that local tonsillectomy should be advocated not only for time saving during operation, anesthesia and recovery but also for the satisfaction or compliance of the patients. In these respects, it is suggested that more active training should be provided to surgeons during their residency on tonsillectomy under local anesthesia.
Anesthesia ; Anesthesia, General* ; Anesthesia, Local* ; Cautery ; Compliance ; Diet ; Humans ; Internship and Residency ; Tonsillectomy*

Lingual osseous lesion can be classified as one of three types: osteoma, chondroma and osteochondroma. Osteoma is a benign neoplasms consisting of mature normal osseous tissue. Osseous growths within the oral cavity, but it is especially rare to find it in the tongue. The majority of the lesions occur in the posterior third of the tongue at or in close proximity to the foramen cecum and the circumvallate papillae. Clinically, tongue osteomas are benign, slow- growing tumors made up of densely sclerotic, well-formed bone. Symptoms include foreign body sensation, dysphagia, nausea, and choking. However, most patients tend to be asymptomatic, and histologic studies can confirm the diagnosis. Treatment of the oral osteoma is by surgical excision, preferably by a transoral approach. This should give complete resolution and there were rare recurrences with good prognosis. Recently, we experienced a 25 year old woman with asymptomatic hard mass on the base of the tongue. A surgical resection was performed and pathologic analysis confirmed tongue osteoma for the patient. Now we report this case with a review of literature.
Adult ; Airway Obstruction ; Cecum ; Chondroma ; Deglutition Disorders ; Diagnosis ; Female ; Foreign Bodies ; Humans ; Mouth ; Nausea ; Osteochondroma ; Osteoma* ; Prognosis ; Recurrence ; Sensation ; Tongue*

BACKGROUND AND OBJECTIVES: The precise mechanism of salicylic acid induced tinnitus has not been clearly identified as yet in spite of wide range of studies undertaken. We looked for the electrophysiologic evidence that salicylic acid has effect on the Locus Coeruleus (LC) neurons in vitro. MATERIALS AND METHOD: In LC, we measured the neuronal firing rate and cell membrane property according to the concentration of salicylic acid with extracellular single unit recording and whole cell current clamp recording. RESULTS: The basal firing activity was increased in 15 of the 20 LC nuclei, which were treated with 0.3 mM salicylic acid. Both 1mM and 2 mM salicylic acid increased the basal firing rate of all except for one LC neuron (n=20). These neurons also showed recovery after washing. However, 5 mM salicylic acid induced cell death after the bursting response in all of the LC neurons (n=10)(Fig. 2). There were no specific changes in the whole cell current-clamp recording of the LC neurons during the period of drug treatment (Fig. 3). CONCLUSION: The dose dependent response pattern observed in the extracellular single unit recording and the fact that there were no specific changes in the whole-cell current-clamp recording following the salicylic acid treatment suggest that the salicylic acid induced intracellular change in the LC neuron is caused not by the direct ligand-receptor reaction but by the indirect 2nd messenger system.
Animals ; Cell Death ; Cell Membrane ; Fires ; Locus Coeruleus ; Neurons ; Patch-Clamp Techniques ; Rats* ; Salicylic Acid* ; Tinnitus

Autoimmune insulin syndrome is characterized by insulin autoantibody, hyperinsulinemia, and fasting hypoglycemia without previous insulin immunization. This syndrome shows discordant levels between immunoreactive insulin and C-peptide. Negative results of an anatomic study of the pancreas and an inability to reproduce hypoglycemia during a prolonged fast may be helpful in excluding insulinoma. Symptomatic hypoglycemia usually develops during an oral glucose tolerance test. This syndrome is a self-limited disorder. Recently, we experienced one case that developed symptomatic hypoglycemia during both the fasting & oral glucose tolerance test, and another that developed symptomatic hypoglycemia during the oral glucose tolerance test but not the fasting test. Hereby, we present these cases with a review of the literature.
C-Peptide ; Fasting ; Glucose Tolerance Test ; Hyperinsulinism ; Hypoglycemia* ; Immunization ; Insulin* ; Insulinoma ; Pancreas

BACKGROUND AND OBJECTIVES: Cardiovascular disease is a leading cause of death in patients on long-term dialysis and cardiac mortality decreases after renal transplantation. The aim of this study was to investigate the effects of successful renal transplantation on cardiac structure and function assessed by echocardiography. MATERIAL AND METHOD: Eighteen adult chronic renal failure patients who were taken renal transplantation in our hospital were included. They were submitted to two echocardiographic evaluations at preoperative time and postoperative time (mean: 23months). RESULTS: At the time of transplantation, 18 patients had undergone hemodialysis through a fistula (mean: 44months). At postoperative follow up, blood urea nitrogen/creatinine were decreased and mean hemoglobin level was increased. And systolic/diastolic blood pressure were decreased. Left ventricular mass index, left ventricular posterior wall thickness and septal wall thickness were decreased and ejection fraction was increased by echocardiography. Diastolic function did not improve. Hemodialysis duration and preoperative blood urea nitrogen/creatinine level affected ejection fraction change. CONCLUSION: We observed significantly decreased left ventricular mass index, increased ejection fraction after renal transplantation. We found that the patients who had been onlonger hemodialysis and higher preoperative blood urea nitrogen/creatinine level showed marked improvement of ejection fraction buy echocardiography.
Adult ; Blood Pressure ; Cardiovascular Diseases ; Cause of Death ; Dialysis ; Echocardiography* ; Fistula ; Follow-Up Studies ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation* ; Mortality ; Renal Dialysis ; Urea

BACKGROUND: Congenital nephrogenic diabetes insipidus (NDI) is a rare inherited disorder, in which two different hereditary forms, X-linked and autosomal recessive traits, have been identified. The X-linked recessive form, mostly (>90%) congenital NDI, has been known to be caused by mutation of the arginine-vasopressin receptor 2 (AVPR2) gene. AVPR2 mutation sites are different in ethnic groups and recently 72 different mutation sites have been reported among AVPR2 gene. This study aimed to analyze AVPR2 gene in selected members in a Korean family with NDI and provided a report of the existence of a new mutation site in AVPR2 gene. METHODS: Three-generation maternal pedigree of the index patient (21-year old male, patient I) and his younger brother (19-year old male, patient II) with NDI was collected. Genomic DNA was obtained from patient I, II, III (index patient's male maternal cousin with NDI), index patient's mother, three maternal aunts, one female maternal cousin and, for control, one healthy male volunteer. Three coding exons of AVPR2 gene were amplified by PCR using 4 pairs of oligonucleotide primers. After direct sequencing of amplified PCR products, the sequence was compared with whole squence of normal AVPR2 gene and identification of a new site of mutation in this gene was done. RESULTS: 1) all three male patients had transversion of G to C at position 1033 of the AVPR2 gene, resulting in a subsequent change of amino acid from glycine to cysteine in codon 201. 2) Two small peaks of G and T, the result of direct sequencing in five female members in this family, would suggest that they are carriers of G to N transversion. CONCLUSION: These results can demonstrate the significant functional correlation of the mutation in AVPR2 gene sequence with clinical NDI, and suggest the clinical utility of direct mutation testing for congenital NDI in family.
Clinical Coding ; Codon ; Cysteine ; Diabetes Insipidus, Nephrogenic ; DNA ; DNA Primers ; Ethnic Groups ; Exons ; Female ; Glycine ; Humans ; Male ; Mothers ; Pedigree ; Polymerase Chain Reaction ; Receptors, Vasopressin* ; Siblings ; Vasopressins* ; Volunteers