BACKGROUND: Chronic shoulder pain draws the attention of doctors since it is a very common and serious disease at primary care level. The patients with this pain usually have a tendency to see many doctors, to take an abundance of medication, and sometimes to even suffer from depression. The pain and the symp- toms thereof often disable the patients in their every day lives. This study aims to seek the most efficient way of treatment between two therapies, namely, the existing drug therapy based on NSAID and the intramuscular stimulation(herein after IMS) therapy, which has re- cently been introduced, by comparing them in accordance with the following method. METHODS: The two therapies were applied for 3 weeks to female patients aged between 50 and 70 who had visited a hospital over a period of more than 3 months due to this type of pain. The patients were randomly given each therapy although the treatment and monitoring was done by the same physiotherapist. The monitoring was performed four times, the day before the start of treatment, 1 week, 2 weeks and 3 weeks after respectively. It measured the following elements: (1) pain scale by VAS(Visual Analogue Scale), (2) Sleep hygiene scale by VAS, (3) ROM(Range of Motion), Repeated measure ANOVA was used for analysis. RESULTS: While both therapies reduced the pain significantly during the 3 weeks, the study showed that IMS was more effective than the drug therapy in every element monitored(p<0.05). IMS turned out to be more effective the 1st week in every measured element, however, the drug therapy was more effective the 3rd week if compared to the 2nd week in terms of Sleep VAS score. CONCLUSION: IMS is more effective in easing chro nic shoulder pain since it has better results than NSAID in pain VAS score, sleep VAS score and ROM.
Chronic Pain ; Depression ; Drug Therapy ; Female* ; Humans ; Hygiene ; Physical Therapists ; Primary Health Care ; Shoulder Pain* ; Shoulder*

PURPOSE: Complications and mortality rate of burn injuries are recently decreasing owing to development of systematic and special burn therapy. Whereas we are suffering from the lack of the medical manpower in burn center. In the future we might need more medical assistants to compensate these shortages. In this study we tried to search the path through these difficulties by considering the practical application of medical assistants. METHODS: We compared Korea's current situation of burn treatment with other countries in various references. Also we studied and compared recent situation of medical assistants in Korea and U.S.A. We took special considerations for Korean emergency medical technician, physical therapist and occupational therapist. RESULTS: Our study showed that we are practically using emergency medical technician, physical therapist and occupational therapist as medical assistants in various fields including burn centers. Emergency medical technician, physical therapist and occupational therapist as medical assistants can be excellent medical substitutes for shortage of manpower in our burn centers. Compared with U.S.A's current situation we are quite lacking of certain certified programs for such medical assistants. Burn therapists can be promoted from medical assistants through certain certified educational programs. CONCLUSION: We think that emergency medical technician, physical therapist and occupational therapist, who have certification concerning certain medical experience, should undergo certified educational program for burn therapy and should be used as a actual burn therapists to overcome the shortage of manpower in our burn centers.
Burn Units ; Burns ; Certification ; Emergency Medical Technicians ; Humans ; Korea ; Physical Therapists ; Stress, Psychological

Heterotopic pancreas, a developmental anomaly uncommonly noted both during operations and autopsies, is usually described in each instance as an incidental finding, Precise diagnosis can be made more often now by endoscopy. Rarely heterotopic pancreas can cause intra-abdominal hemorrhage or obstruction. We experienced a very rare case in which aberrant pancreas located at the Ampulla of Vater was found to be the cause of partial obstruction of the comon bile duct. Diagnosis was done by duodenoscopy and biopsy. So, we report a case of heterotopic pancreas at the Ampulla of Vater diagnosed by endoscopy with a review of relevant literatures.
Ampulla of Vater* ; Autopsy ; Bile Ducts ; Biopsy ; Diagnosis ; Duodenoscopy ; Endoscopy* ; Hemorrhage ; Incidental Findings ; Jaundice, Obstructive ; Pancreas*

BACKGROUND/AIMS: It is recommended that duodenal ulcer patients who are infected with H. pylori should be treated with eradication therapy, whether the ulcer is active or in remission. However, there has been no report on the effect of eradication treatment in patients with incidentally found S-2 stage duodenal ulcer scar. METHODS: We prospectively enrolled 80 H. pylori-positive patients with S-2 stage duodenal ulcer scar who have no past history of ulcer treatment. Treatment group received triple therapy consisted of omeprazole, amoxicillin, and clarithromycin for 2 weeks, whereas control group received no treatment. The follow-up endoscopy was performed every 1 year and when the patients have symptoms of ulcer disease. Fifty-three patients were followed up for more than 1 year. RESULTS: The eradication rate of the treatment group was 92.9%. During the follow-up period of 14.7 months, 20% (5/25) of patients in the control group (2 gastric ulcers and 3 duodenal ulcers) and 3.6% (1/28) of patients in the treatment group (1 duodenal ulcer) developed active or healing stage peptic ulcers (p=0.089). CONCLUSIONS: Our results suggest that H. pylori eradication may he effective in preventing peptic ulcers in patients with S-2 stage duodenal ulcer scar.
Amoxicillin ; Cicatrix* ; Clarithromycin ; Duodenal Ulcer* ; Endoscopy ; Follow-Up Studies ; Helicobacter pylori* ; Helicobacter* ; Humans ; Omeprazole ; Peptic Ulcer ; Prospective Studies ; Stomach Ulcer ; Ulcer

Hereditary hemorrhagic telangiectasia, also knawn as Rendu-Osler-Weber disease, is a rare autosomal dominant condition characterized by telangiectases, arteriovenous fistulas, and aneurysms involving the skin and mucosa, as well as blood vessels of the lung, liver, and central nervous system. The most common clinical manifestations are epistaxis and gastrointestinal bleeding. Arteriovenous shunting leads to hepatic congestion, and congestive heart failure may occur. We report a casie of Rendu-Osler-Weber disease which revealed typical clinical symptoms and radiologic findings with a review of relevant literatures.
Aneurysm ; Arteriovenous Fistula ; Blood Vessels ; Central Nervous System ; Epistaxis ; Estrogens, Conjugated (USP) ; Heart Failure ; Hemorrhage ; Liver ; Lung ; Mucous Membrane ; Skin ; Telangiectasia, Hereditary Hemorrhagic* ; Telangiectasis

BACKGROUND/AIMS: Carcinogenesis is characterized by the abnormal regulation of cell cycle. The abnormal expression of the regulators of cell cycle may be related to the prognosis. Since the clinical significance of the expression of the three proteins in colorectal carcinomas is still controversial, we evaluated the prognostic value of the expression of cyclin E, p27 and mutant p53 in stage II colorectal cancer. METHODS: The expression levels of cyclin E, p27 and mutant p53 proteins in 41 patients with stage II colorectal carcinomas were analyzed by immunohistochemistry. RESULTS: In the univariate analysis, the level of CEA at diagnosis was associated with disease relapse. In the multivariate analysis, the clinicopathological variables such as age, gender, site of primary tumor, tumor size, state of tumor differentiation and preoperative plasma CEA level were not associated with disease relapse. When Kaplan-Meier survival curves were constructed to determine the prognosis, cyclin E, p27 and mutant p53 expressions did not predict poor prognosis. CONCLUSIONS: Our results suggested that the expression of cyclin E, p27 and mutant p53 proteins did not predict the clinical outcome in the stage II colorectal carcinomas.
Adenocarcinoma/chemistry/*diagnosis/mortality/pathology ; Adult ; Aged ; Aged, 80 and over ; Cell Cycle Proteins/*analysis ; Colorectal Neoplasms/chemistry/*diagnosis/mortality/pathology ; Cyclin E/*analysis ; Disease-Free Survival ; Female ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Mutation ; Prognosis ; Protein p53/*analysis/genetics ; Survival Rate ; Tumor Markers, Biological/analysis ; Tumor Suppressor Proteins/*analysis

BACKGROUND/AIMS: The predictory factors of the response to initial steroid therapy in active Crohn's disease has been controversial in numerous literature reviews. We evaluated any predictory factor of the response to initial steroid therapy in active Crohn's disease patients. METHODS: The medical records of 32 patients with active Crohn's disease who clinically responded to oral steroid therapy were retrospectively reviewed. The steroid responsive group was defined as the one showing maintenance of response for more than one month from steroid withdrawal and the steroid dependent group as the one showing relapse or exacerbation during steroid tapering or within 30 days from steroid withdrawal. The clinical, biochemical, and pathologic factors were evaluated. RESULTS: There were 22 male and 10 female patients. The mean age was 28.9 years. The number of steroid responsive and dependent group was 22 (68.8%) and 10 (31.2%), respectively. There were no significant differences between these two groups in age, sex, time to diagnosis, perianal lesion, extent of disease, extraintestinal manifestations, presence of granuloma, presenting features, hemoglobin, ESR, and CRP, except serum albumin level. CONCLUSIONS: Serum albumin level was significantly lower in steroid dependent group than steroid responsive group, reflecting severe inflammation in steroid dependent group.
Crohn Disease* ; Diagnosis ; Female ; Granuloma ; Humans ; Inflammation ; Male ; Medical Records ; Recurrence ; Retrospective Studies ; Serum Albumin

BACKGROUND/AIMS: Safety of endoscopic procedures has been a major issue over the last 10 years. Most endoscopy units use 2% glutaraldehyde and automated endoscope reprocessors (AERs) for disinfecting gastrointestinal endoscopes. We attempted an in-use evaluation of the current reprocessing procedures. METHODS: Thirty flexible endoscopes were randomly collected just after upper endoscopic examinations and were disinfected using 2% glutaraldehyde in an AER. Cultures were taken from biopsy channels (S-1), tip of the insertion tubes (S-2), umbilical cords (S-3), and angulation knobs (S-4). RESULTS: In 63.3% (19/30) of endoscopes, there was no microbial contamination after disinfection procedures. The culture positive rates of S-1, S-2, S-3, and S-4 samples were 20.0%, 0.0%, 3.3%, and 20.0%, respectively. Microorganisms of 13 species were identified, but there was no pathogen related with reported infectious complications after endoscopic procedures. CONCLUSIONS: Current disinfection procedure using 2% glutaraldehyde and an AER appears to be very effective in decontaminating patient-used endoscopes. Low level microbial contamination of endoscopes after conventional reprocessing methods may not impose great risk on patients.
Biopsy ; Disinfection* ; Endoscopes* ; Endoscopes, Gastrointestinal ; Endoscopy ; Glutaral* ; Humans ; Umbilical Cord

BACKGROUND: Obesity induced by high-fat diet (HFD) is one of the most widespread metabolic disorders in current society. However, there has been little research regarding the effects of HFD-induced obesity in the septa of animal models of cerebral ischemia. Therefore, in the present study, we investigated septal effects of HFD on neuronal damage and gliosis induced by transient cerebral ischemia. METHODS: Body weight, blood glucose levels and serum lipid profiles levels were measured both in the normal diet (ND) and HFD-group. We also investigated the effects of ND and HFD on neuronal damage and gliosis in the septum after transient cerebral ischemia using immunohistochemistry. RESULTS: The levels of blood glucose, serum triglyceride, and total cholesterol were significantly increased in the HFD-fed gerbils compared with the ND-fed gerbils, although body weight was not significantly changed after HFD feeding. In the ND-fed gerbils, ischemia-induced neuronal damage was found in the septohippocampal nucleus (SHN) of the septum 7 days after ischemia. In the HFD-fed gerbils, ischemia-induced neuronal damage in the SHN was much more severe compared with that of the ND-fed gerbils 4 and 7 days after ischemia. In addition, we found that ischemia-induced glial activation including astrocytes and microglia was accelerated and exacerbated in the HFD-fed gerbils compared with that in the ND-fed gerbils. CONCLUSION: These results indicate that HFD can lead to much more severe effects in ischemia-induced neuronal damage/death in the septum after ischemia-reperfusion, and that it may be associated with accelerated change in glial activation.
Astrocytes ; Blood Glucose ; Body Weight ; Brain Ischemia ; Cholesterol ; Diet ; Diet, High-Fat ; Dietary Fats* ; Gerbillinae* ; Gliosis ; Immunohistochemistry ; Ischemia ; Ischemic Attack, Transient* ; Microglia ; Models, Animal ; Neurons* ; Obesity ; Triglycerides