No abstract available.
Child* ; Heart* ; Humans

OBJECTIVES: The drug utilization review (DUR) system, which checks any conflict event of medications, contributes to improve patient safety. One of the important barriers in its adoption is doctors' resistance. This study aimed to analyze the impacts of doctors' resistance on the success of the DUR system. METHODS: This study adopted an augmented the DeLone and McLean Information System (D&M IS) Success Model (2003), which used doctors' resistance as a socio-technological measure. This study framework is the same as that of the D&M IS Success Model in that it is based on qualities, such as system, information, and services. The major difference is that this study excluded the variable 'use' because it was not statistically significant for mandatory systems. A survey of doctors who used computers to enter prescriptions was conducted at a Korean tertiary hospital in February 2012. RESULTS: This study is very meaningful in that it is the first study to explore the success factors of the DUR system associated with doctors' resistance. Doctors' resistance to the DUR system was not statistically associated with user usefulness, whereas it affected user satisfaction. CONCLUSIONS: The results indicate that doctors still complain of discomfort in using the DUR system in the outpatient clinical setting, even though they admit that it contributes to patient safety. To mitigate doctors' resistance and raise user satisfaction, more opinions from doctors regarding the DUR system have to be considered and have to be reflected in the system.
Drug Utilization Review* ; Humans ; Information Systems ; Medicare Assignment ; Outpatients ; Patient Safety ; Prescriptions ; Tertiary Care Centers

No abstract available.
Biopsy* ; Prostate*

OBJECTIVES: The clinical manifestations of gout in Korea would be changed lately according to the rapid economical development and the development of diagnostic methods. This study was done to reveal the late clinical features of gout in Korea. METHODS: A retrospective study was done for the 90 gout patients who had been treated in Seoul Paik Hospital from March 1974 to August 1994. Age of onset, sex, duration of disease, serum uric acid level, uric acid concentration of 24 hour urine, joint of first attack, recurrently involved joints, X-ray of involved joint, frequency of tophi, renal ultrasonography, and associated diseases were analyzed. The uric acid levels of the 808 civilians who visited our hospital for the periodic health examination were used as a control value. RESULTS: 1) The serum uric acid level in Korean adults was 5.2+/-1.1mg/dL in male, 3.8+/-0.7mg/dL in female, and 4.7mg/dL in general. The serum uric acid concentration of the gout patients was 8.6+/-2.2mg/dL in male, 6.1+/-2.1mg/dL in female, and 8.5+/-2.3mg/dL in general. The age of onset was 46.4+/-12.9 years old and male to female ratio was 44: 1 2) The renal excretion of uric acid was 470+/-173 mg/day in gout patients. 3) The sites of first attack were first MTP joint(76%), tarsal joint(13%), knee(5%), and other MTP joints(5%) 4) The involved joints during the repeated attacks were first MTP joint(84%), tarsal joint(23%), and fingers(23%), The duration of disease was significantly longer and the serum uric acid concentration was higher in the patients with tophi than they are in the patients without. 5) The 4l% of patients showed hone change in X-ray. 6) The renal ultrasound examinations were abnormal in 42% of the patients and the serum uric acid concentrations were significantly higher. 7) Obesity was found in 68% of patients, hypertension in 39%, hyperlipidemia in 16%, and chronic renal disease in 12%. CONCLUSION: The clinical features of gout in our study were similar to those of others done in and out of Korea, except that the frequency of hypertringlyceridemia was much lower than that of the foreign countries.
Adult ; Age of Onset ; Arthritis, Gouty ; Female ; Gout* ; Humans ; Hyperlipidemias ; Hypertension ; Hyperuricemia ; Joints ; Korea* ; Male ; Obesity ; Renal Insufficiency, Chronic ; Retrospective Studies ; Seoul ; Ultrasonography ; Uric Acid

Background: Melatonin receptors are present in the human skin and retina. These receptors can be stimulated by light emitting diodes (LEDs) at specific wavelengths, thereby inducing cutaneous photorejuvenation. However, the underlying mechanism remains unclear. Objective: To evaluate the influence of LEDs at specific wavelengths on melatonin membrane receptor (MT1) and cutaneous photorejuvenation via the MT1 pathway in vitro. Methods: Normal human dermal fibroblasts (HDFs) were irradiated using LEDs at different wavelengths (410~940 nm) at a dose of 1 J/cm 2 . MT1 activity was evaluated after melatonin stimulation and LED irradiation. Thereafter, the expressions of collagen (COL) and matrix metalloproteinases (MMPs), with and without luzindole (MT1/2 receptor antagonist), were investigated via semi-quantitative reverse transcription polymerase chain reaction (PCR), real-time PCR, western blotting, and enzyme-linked immunosorbent assay. Results: In HDFs, the MT1 mRNA and protein levels increased significantly in response to melatonin (dose, 50 nM) (p<0.01) and LED irradiation at 595, 630, 850, and 940 nm (p<0.01). LED irradiation up-regulated COL type I and down-regulated MMP-1. Compared to LED irradiation without luzindole, LED irradiation with luzindole produced no significant increase in COL type I mRNA and protein levels (p<0.01). Conclusion We found that LED irradiation induces collagen synthesis and MMP-1 inhibition in HDFs via MT1 activation. Additionally, multiple LED wavelengths (595, 630, 850, and 940 nm) stimulated MT1 in HDFs, unlike in the eyes, where only blue light induced plasma melatonin suppression. This suggests the possibility of the melatoninergic pathway in photorejuvenation.

AIMTo help clarifying the possibility of connective-tissue diseases in men with penile or testicular prostheses.

METHODSEight patients underwent inflatable penile prostheses and 15, testicular prostheses consented to the study. Their medical records were reviewed and a follow-up interview and physical and serological examinations were performed.

RESULTSIn patients with penile prostheses, there was no abnormal antinuclear antibody (ANA) or IgM elevation. The serum levels of the rheumatoid factor (RF), C4, IgA and IgG were abnormal in one patient, and the levels of erythrocyte sedimentation rate (ESR) and C3, abnormal in two. Four had elevated IgE. In patients with testicular prostheses, there was no abnormal RF, ANA or IgM. The serum levels of ESR and IgA were abnormal in two, and three had abnormal C4, ten abnormal C3, and eleven decreased IgG. All had increased IgE. Men with penile prostheses had higher serum levels of IgG and IgM than those with testicular prostheses (P=0.001, P=0.016, respectively). The rates of abnormal values of IgE and IgG were higher in men with testicular prostheses than in men with penile prostheses (P=0.008, P=0.009, respectively). Physical examination was normal in all patients and nobody had documented symptoms pertinent to connective-tissue diseases.

CONCLUSIONOur findings suggest that the risk of connective-tissue diseases is not higher in patients wearing prostheses as the ANA is negative and there is no apparent manifestation suggestive of connective-tissue diseases.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Blood Sedimentation ; Complement C3 ; metabolism ; Complement C4 ; metabolism ; Connective Tissue Diseases ; epidemiology ; etiology ; immunology ; Humans ; Immunoglobulin A ; blood ; Immunoglobulin E ; blood ; Immunoglobulin G ; blood ; Immunoglobulin M ; blood ; Male ; Middle Aged ; Penile Prosthesis ; adverse effects ; Pilot Projects ; Risk Factors ; Silicon ; adverse effects ; immunology

PURPOSE: Although numerous etiological models of premenstrual syndrome(PMS) such as the biochemical, hormonal, psychosocial models have been proposed, there is no consistent conclusion. Especially, in psychosocial model, state-dependent changes in the perception of stressors according to menstrual cycle phases was suggested for PMS. In this study, we investigated relationship between menstrual cycle and daily minor stressors in young women, and vulnerability to minor stressors in young women with PMS. METHODS: 46 female college students completed modified daily rating form(DRF) of premenstrual symptoms which based on DSM-IV criteria for PMDD, and daily stress inventory(DSI) during at least one menstrual cycle. If the mean score of at least one DRF item during premenstrual phase were more than 3 on 6 point scale and 30% increase in symptom severity during premenstrual phase compared with during postmenstrual phase, they were referred as PMS group(N=20), and the others as non-PMS group(N=26). The event, impact, and impact/event ratio scores of DSI were compared in two groups. Data were analyzed by analysis of variance with repeated measure ANOVA. And post hoc simple; repeated contrast test were performed when indicated by significant repeated measure ANOVA. RESULTS: In all subjects, the event and the impact scores in premenstrual and menstrual phases were significantly higher than in postmenstrual phase. Among the DSI categories, the impact scores of interpersonal problem and cognitive stressors in premenstrual and menstrual phases were significantly higher than in postmenstrual phase. In PMS group, there was a significant difference between premenstrual and postmenstrual phase in the impact score but not in the event score, and the event and the impact scores were significantly increased in menstrual phase than postmenstrual phase. In non-PMS group, the event and the impact scores in premenstrual and menstrual phases were significantly higher than in postmenstrual phase. There was no significant difference in the impact/event ratio scores in both groups. Between the PMS and non-PMS group, there was significant difference in the impact/event ratio scores in premenstrual phase, but not in the event score and the impact scores at any phase. CONCLUSION: Young women may experience more daily minor stressors and may be impacted more severely in premenstrual and menstrual phases than in postmenstrual phase. In premenstrual phase, the young women with PMS are likely to have more vulnerability to daily minor stressors than controls. Further studies using larger sample size with varied age are required.
Diagnostic and Statistical Manual of Mental Disorders ; Female ; Humans ; Life Change Events* ; Menstrual Cycle ; Premenstrual Syndrome* ; Sample Size

In accidental or suicidal methanol ingestion, bilateral necrosis of the putamen and hemispheric white matter lesions are the most common findings on CT and MRI. There are a few reports that have demonstrated abnormal CT findings in methanol intoxication, however, to our knowledge, contrast enhancement of these lesions have not been reported in Korea. We report the case of a 36-year-old male who had a brain MRI performed 3 weeks after accidental methanol intoxication. T2 weighted MRI showed bilateral symmetrical high signal lesions in the frontal lobe and basal ganglia with hemorrhaegic necrosis. A postcontrast MRI demonstrated multifocal enhancing lesions in both frontal lobes, right temporal lobe, both basal ganglias and both cerebellar hemispheres. We suggest that the characteristic brain MRI finding and careful history taking are helpful in diagnosis of methanol intoxication.
Adult ; Basal Ganglia ; Brain* ; Diagnosis ; Eating ; Frontal Lobe ; Humans ; Korea ; Magnetic Resonance Imaging* ; Male ; Methanol* ; Necrosis ; Putamen ; Temporal Lobe

PURPOSE: In the management of acute poisoning, the anion gap and the osmol gap are easily derived from serum laboratory findings and arterial blood gas analysis. The anion gap is known to be increased by the effects of the toxic material itself and secondary complications or by an exacerbation of an underlying illness. The osmol gap can be increased by the presence of osmotically active materials in the body, such as alcohol, glycols and mannitol. This study was proposed to investigate the significance of an increased anion gap in acutely poisoned patients and the effect of alcohol ingestion in increasing the osmol gap, which might help to understand the significance of an increased osmol gap in acutely poisoned patients. METHODS: A retrospective chart review of poisoned patients who had visited the emergency departments of the Anam and the Ansan hospitals of Korea University was used in this study. Serum laboratory findings and arterial blood gas analysis were used to measure the anion gap and the osmol gap. Patients were categorized into a non anion-gap group versus a high anion-gap group and a normal osmolgap group versus a high osmol-gap group. Frequency of toxidrome, blood pH and drinking history were included to evaluate the relations between the groups. RESULTS: Of 204 patients, 195 patients who completed the tests were included in the study. In the 99 patients with a high anion-gap, 38 (38.38%) patients showed development of toxidrome. In the 96 patients with a non anion-gap, only 15 (15.62%) patients showed toxidrome. Forty-six (80.7%) of the 57 patients with a high osmol-gap and 20 (22.2%) of the 90 patients with a normal osmol-gap had a history of drinking. CONCLUSION: In poisoned patients, the group with a higher anion gap showed a higher frequency of toxidrome. This suggests that in the management of a poisoning victim with an uncertain history, should a high anion gap be found, an intense observation and evaluation is necessary to identify the cause. An increase in the osmol gap in poisoned patients is generally considered to be from alcohol ingestion. Thus, for a patient with an increased osmol gap, measurement of the serum ethanol level should be done to exclude the effect of alcohol.
Acid-Base Equilibrium* ; Blood Gas Analysis ; Drinking ; Eating ; Emergency Service, Hospital ; Ethanol ; Glycols ; Gyeonggi-do ; Humans ; Hydrogen-Ion Concentration ; Korea ; Mannitol ; Poisoning* ; Retrospective Studies

Neuroimaging of the brain is useful diagnostic evaluation of patients with hepatic encephalopathy msofar as it is able to exclude other causes of abno rmal mental status. Recently, changes of basal ganglia on MRI characteriwd by increased signal mtensity on Tl-weighted images were reported m patients with liver cirrhosis. Signal abnormality involves mainly the globus pallidus and seems to be specific for patients with chronic liver disease. Its pathogenesis and significance are obscure, and no pathological reports have been made. We experienced 3 cases of Chronic acquired hepatic failure whose MRI showed increased signal in-tensity in the basal ganglia on Tl-weighted imaging. Our findings su-ggest that basal ganglia signal abnormality could arise as a marker of brain impairment related to deposition of an unidentified paramagnetic substance or altered intracellular water relaxation.
Basal Ganglia ; Brain ; Globus Pallidus ; Hepatic Encephalopathy ; Humans ; Liver Cirrhosis ; Liver Diseases ; Liver Failure* ; Magnetic Resonance Imaging ; Neuroimaging ; Relaxation