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.

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

We report a case of spontaneous uretreral rupture cured by conservative management. The patient(65-year-old man) who had left flank pain for 6 days was presented to our hospital. He had no history of trauma and previous urologic problems. Diagnosis was made by IVP and abdominal CT scan, which showed extravasation from left upper ureter and accumulation of a large amount of contrast media in the retroperitoneal space. On ureteroscopy, partial obstruction of left lower ureter was found and the upper ureteral mucosa showed diffuse erythematous changes. The rupture site with erythematous edema and some necrotic tissues was identified in lateral wall near ureteropelvic junction. A guide wire was passed upward the rupture site under direct vision of ureteroscope and then 6 Fr. double J stent was successfully palced. The stent was removed 4 weeks after the placement. Followup IVP showed good urinary drainange without evidence of extravasation.
Contrast Media ; Diagnosis ; Edema ; Flank Pain ; Follow-Up Studies ; Mucous Membrane ; Retroperitoneal Space ; Rupture* ; Rupture, Spontaneous ; Stents ; Tomography, X-Ray Computed ; Ureter* ; Ureteroscopes ; Ureteroscopy

The goal of this study was to examine the characteristics of the histo- immunological changes following induction of autoimmune prostatic inflammation achieved by subcutaneous allograft injection of the tissue homogenate of mouse ventral prostate. We also investigated the effect of the administration of androgen upon the development of mouse autoimmune prostatitis. Eight week old male C57BL/6 mice were selected and the presence, location and the degree of inflammation were identified after injection. The extent of infiltrations of the inflammatory cells in the prostate following the administration of the exogenous testosterone, the variation of the CD4/CD8 ratio of splenic lymphocyte and the variations of the interleukin-2 and tumor necrosis factor-alpha secreted by the splenic cells were also examined. The autoimmune prostatitis of the mouse induced by subcutaneous allograft injection of the mouse ventral prostate showed histological findings similar to that of human. The degree of induction was in proportion to the amount of tissues injected and showed organ-specificity. Exogenous administration of testosterone resulted in partial inhibitory effect on the induction of inflammation which was thought to be related to the decrease in the CD8+ T lymphocyte count and the functional inhibitory effect of the splenic T lymphocyte on the production of Interleukin- 2. However, tumor necrosis factor-alpha is presumed to be not closely related to the inhibitory effect of the administration of testosterone. In the future, further studies on the variation of cytokine levels and the value of sex hormones within the prostate and, moreover investigations in related to the humoral immune mechanism should be encouraged.
Allografts ; Animals ; Gonadal Steroid Hormones ; Humans ; Inflammation ; Interleukin-2 ; Lymphocyte Count ; Lymphocytes ; Male ; Mice* ; Prostate ; Prostatitis* ; Testosterone* ; Tumor Necrosis Factor-alpha

PURPOSE: The purpose of this study was to determine the safety and efficacy of the percutaneous transluminal angioplasty(PTA) in patients with chronic arterial occlusive disease below the knee joint. MATERIALS AND METHODS: We retrospectively analyzed the results of 36 procedures in 16 patients. There were 15 men and one woman, aged 57-75 years(mean, 62 years). Indications were disabling claudication(SVS/ISCVS grade 1, category 3) in five cases, rest pain(grade 2, category 4) in three cases, and non-healing ulceration or gangrene(grade 3, category 5) ineight cases. PTA was performed by using small vessel balloon catheter of 2-4 mm and 3 mm monorail balloon catheterin tibioperoneal vessels and 5-6 mm balloon catheter in distal popliteal artery and tibioperoneal trunk. Combined thrombolytic therapy with Urokinase was performed in 14 patients. RESULTS: Involved infrapopliteal vessels werefour distal popliteal arteries, 15 tibioperoneal trunks, six anterior tibial arteries, five posterior tibialarteries, and seven peroneal arteries. Technical success was determined when post-PTA angiogram showed less than 30% of residual stenosis. Clinical success was defined as improvement of clinical symptoms, such as disappearance of claudication or rest pain, and healing of ulceration. Technical success was achieved in 30 of 36 arteries(83%). Clinical success was achieved in 12 of 16 patients(75%) at an average follow-up of 13.3 months(range, 2-46 months). Clinical success rate was 100% in grade 1 category 3 patients, 67% in grade 2 category 4 patients, and 63% in grade 3 category 5 patients. Complication included two distal emboli, one vessel rupture, one vessel thrombosis, and one occluding intimal flap. CONCLUSION: PTA was an effective method for treatment of chronicarterial occlusive disease below the knee joint and considered as the procedure of first choice. Severe claudicant(grade 1) should be included in the indication of the tibioperoneal PTA.
Angioplasty* ; Arterial Occlusive Diseases* ; Arteries ; Catheters ; Constriction, Pathologic ; Female ; Follow-Up Studies ; Humans ; Knee Joint* ; Knee* ; Male ; Popliteal Artery ; Retrospective Studies ; Rupture ; Tibial Arteries ; Ulcer ; Urokinase-Type Plasminogen Activator

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