The Lambert-Eaton myasthenic syndrome (LEMS) is a rare disorder of neuromuscular transmission that is frequently associated with malignancy, particulary small cell carcinoma of the lung. To our knowledge, there was no report of LEMS in Korean listeratures and this might be the first case in this country. The patient is a 55 year old man with muscle weakness and fatigability of proximal lower limbs for 2 months. Bronchogenic carcinoma is confirmed radiologically and pathologically. The electrophysiological studies suppert the clinical diagnosis of LEMS with (1) low amplitude of evoked compound muscle potential to a single supramaximal stimulus on nerve, (2) significant decremental response at low rates of stimulation and (3) marked incremental response at high rates of stimulation.
Carcinoma, Bronchogenic ; Carcinoma, Small Cell ; Diagnosis ; Humans ; Lambert-Eaton Myasthenic Syndrome* ; Lower Extremity ; Lung ; Middle Aged ; Muscle Weakness

PURPOSE: The purpose of this study was to analyze the role performance and related factors of the Clinical Research Coordinator (CRC). METHODS: A quantitative, cross-sectional design was used. Data were collected using a structured questionnaire from 134 Clinical Research Coordinators in 4 hospitals and analyzed using descriptive statistics, t-test, ANOVA, and Pearson correlation coefficient. RESULTS: The scores for role performance of CRC were high (average 336.51 points of a possible 420 points, mean average 5.74+/-0.67 of a possible 7) and the degree of role performance in the management task sub dimension (mean average 6.12+/-0.77 of a possible 7) was higher than any other sub dimension. Role performance of the CRC was also related to job satisfaction (r=.198, p=.023). CONCLUSION: The study results indicate that most CRC are nurses and perceive their role as very important. Further the CRC performance of activities of management task and the Coordination/Advocacy task sub dimension were high and higher levels of job satisfaction were related to higher levels of role performance of CRC was. Therefore, strategies related to improvement in the fringe benefit system and work environment should be developed to increase job satisfaction and thus increase job performance.
Job Satisfaction ; Surveys and Questionnaires ; Salaries and Fringe Benefits

Using a monoclonal antibody OKT 6, we nvestigated Langerhans cells by indirect immunoperoxidase technique in 60 skin specimens of fetuses from 3 months of gestation period to 10 months and 21 skin specimens of adults for the study of their development and the comparison of their density in fetus with adult. The results were as follows: 1. Langerhans cell population density of fetus was 52/mm in 4 months of gestation period, l07/mm in 5 months,136/mm in 6 months, l97/mm in 7 months, 235/mm in 8 months, and 311/mm in 10 months and there was a tendency to increase from 4 months to 1Q months. The earliest fetal skin specimen showing OKTg(+) Langerhans cell was that of 13 weeks and 2 days of gestation period. 3. Langerhans cell population density of back skin in fetus was 12.6% in 5 months, 16.0%, in 6 months, 20.8% in 7 months, 26.4% in 8 months and 36, 2% in 10 months of 900/mm in adult back skin. 4, Langerhans cell population density in adult was 432/mm in the skin of shin, 363/mm in prepuce, and 90Q/mm in back skin and there was statistically significant in difference between prepuce and back skin(p<0.00l).
Adult ; Fetus* ; Humans ; Immunoenzyme Techniques ; Langerhans Cells* ; Population Density ; Pregnancy ; Skin

Dendritic cells (DCs) are the most potent antigen presenting cells that can activate naive T cells. Mature DCs exress high levels of MHC and costimulatory molecules on their surface and have capacity to produce IL-12, a 75 kDa heterodimeric cytokine composed of p35 and p40 subunit. IL-12 is currently thought to be one of most critical determinants for skewing the immune response towards Th1. Expression of IL-12 in dendritic cells seems to be regulated by various stimuli including CD40L. In the present study we investigated expression of IL-12 in mature DCs, which were cultured from bone marrow cells in the presence of GM-CSF. Maturity of the DCs was confirmed by morphologic characteristics, immunophenotypes, and allostimulatory activities. Exprssion levels of IL-12 p40 in the DCs were measured by semi-quantitative RT-PCR. Increases in IL-12 p40 expression were observed after treatment with lipopolysaccharide (LPS), an anti-MHC class II monoclonal antibody, or an anti-CD40 monoclonal antibody. The most remarkable increases, however, were observed in the DCs treated with an anti-CD40 monoclonal antibody. These results support a previous notion that signals through CD40/CD40L interaction may be important for the production of IL-12 by DCs. Moreover, results of this study show a possibility of using monoclonal antibodies against CD40 molecules for preparing DCs producing high amount of IL-12, which can be used for anti-tumor or anti-viral immunotherapy.
Animals ; Antibodies, Monoclonal ; Antigen-Presenting Cells ; Bone Marrow Cells ; CD40 Ligand ; Dendritic Cells* ; Granulocyte-Macrophage Colony-Stimulating Factor ; Immunotherapy ; Interleukin-12* ; Mice* ; T-Lymphocytes

The T cell responses to hepatitis B surface antigen (HBsAg) were analyzed in acute hepatitis patients, chronic active hepatitis (CAH) patients and asymptomatic carriers. Neither proliferative responses nor substantial cytokine production of peripheral blood mononuclear cells (PBMC) in response to HBsAg was detected. For further studies, HBsAg- reactive T cell lines were prepared from PBMC of the hepatitis patients and asymptomatic carriers. No proliferative response of the T cell lines was observed. Interestingly, however, T cell lines obtained from acute hepatitis patients were found to produce IFN-r, but not IL- 4, in response to HBsAg stimulation, whereas T cell lines obtained from CAH patients and carriers were not. Results of this study suggest that HBsAg-reactive T cells producing Thl type cytokines may play an important role in the viral clearance during acute infections, while defects in those T cells may be responsible for the viral persistency.
Cell Line ; Cytokines ; Hepatitis ; Hepatitis B Surface Antigens* ; Hepatitis, Chronic ; Humans ; T-Lymphocytes*

Neurofibromatosis is a syndrome of multiple neurofibromas, abnormal skin pigmentation and certain bony abnormalities. Sometimes the growth of plexiform neurofibromatosis on the face or trunk is centripetal and usually involves the mediastinum and skull base. However, it is very rare that neurofibromatosis involves the trigeminal ganglion. Its encroachment around the foramina of the skull base may induce facial palsy or conductive hearing loss. The guiding principle in the treatment of generalized neurofibromatosis is a radical excision with preservation of vital structures and an immediate reconstruction of the bony skeleton and soft tissue defect. The authors experienced 4 cases of neurofibromatosis involving the trigeminal ganglion. All had trigeminal symptoms for 3 to 4 years. These were severe headache and intractable trigeminal neuralgia. Tumors in all 4 cases were spread in the centripetal type from extracranial neurofibromatosis. The facial nerve was affected in 4 cases. Malignat Schwannoma occurred in 1 case. Accurate diagnosis and assessments were necessary with CT, MRI art oomputer-aided simulation design. Intraoperative bleeding was minimal with hypotensive anesthesia. Surgical approach to the middle cranial fossa involved temporary removal of the zygomatic arch and TMJ disarticulation with downward traction of the mandible. Satisfactory results have been obtained far 3 to 7 years(mean 5 years) follow-up.
Anesthesia ; Cranial Fossa, Middle ; Diagnosis ; Disarticulation ; Facial Nerve ; Facial Paralysis ; Follow-Up Studies ; Headache ; Hearing Loss, Conductive ; Hemorrhage ; Magnetic Resonance Imaging ; Mandible ; Mediastinum ; Neurilemmoma ; Neurofibromatoses* ; Neurofibromatosis 1 ; Skeleton ; Skin Pigmentation ; Skull Base ; Temporomandibular Joint ; Traction ; Trigeminal Ganglion* ; Trigeminal Neuralgia ; Zygoma

BACKGROUND: Many clinicians tend to assume that psoriasis rarely involves the face, and therefore have little interest in facial psoriasis. However, the face is the most important area of cosmetic concern and social activity, and facial involvement of psoriasis is more common than we think. A few reports have even suggested that facial psoriasis could be a marker of severe psoriasis. OBJECTIVE: To investigate the epidemiological and clinical characteristics of facial psoriasis. METHODS: A total of 235 patients with facial psoriasis were enrolled in this retrospective study at the psoriasis clinic, Department of Dermatology, Seoul National University. Epidemiological and clinical data from patient records was collected and analyzed. RESULTS: The most frequent age of onset for facial psoriasis was in the 3rd decade of life. The peak age of onset of facial psoriasis in male patients was in the 3rd and 4th decade of life, whilst for female patients it was in the 3rd decade. Most patients had presented with facial psoriasis before they were 40. The sites of the face most often affected were the upper (73.9%) and lower (46.2%) aspects of the forehead and periauricular area (45.7%). The eyelid, perioral area and nasolabial fold were relatively unaffected. Patients who had scalp-unrelated facial psoriasis presented with a more severe condition than patients who only had scalp-related facial psoriasis. With reference to the extent of psoriasis, 43.8% of patients were moderate cases, whereas 29.6% were mild and 26.6% were severe. With reference to the activity, 40.3% of patients were mild, while 38.5% were moderate and 21.2% were severe. Family history was observed in 39.9% of patients and nail involvement was observed in 27.7% of patients. Only 38.2% of patients had no pruritus, while 16.3% of patients experienced moderate or severe pruritus. CONCLUSION: The present retrospective analysis contributes to our understanding of the clinical characteristics of facial psoriasis.
Age of Onset ; Dermatology ; Eyelids ; Female ; Forehead ; Humans ; Male ; Nasolabial Fold ; Pruritus ; Psoriasis* ; Retrospective Studies ; Seoul

BACKGOUND: Narrow-band ultraviolet B (NBUVB) phototherapy has appeared to be effective in clearing psoriatic lesions. Calcipotriol has been combined with a number of the systemic antipsoriatic treatments, improving efficacy or reducing the systemic treatment required. OBJECTIVE: We performed calcipotriol-NBUVB combination therapy to evaluate the clinical efficacy and the safety in Korean psoriasis patients. METHOD: In the psoriasis clinic at Seoul National University Hospital, 69 psoriasis patients were treated with calcipotriol-NBUVB. Phototherapy was given once daily, three times a week, and the dose was gradually increased. Calcipotriol ointment was applied twice a day. The PASI score was used to evaluate the effects of the treatment and the patients were classified according to clearance, improvement, or failure. RESULTS: The therapeutic results showed 53.6% for clearance, 31.9% for improvement and 14.5% for failure. The total number, duration, final and cumulative doses to achieve grade IV were 16.1, 41.8days, 1487.3mJ/cm2, and 15234.5mJ/cm(2) respectively. Of 69 patients, 44 patients experienced variable adverse effects, but there was no significant adverse effect to discontinue the therapy. CONCLUSION: Our results demonstrated that using calcipotriol ointment with NBUVB phototherapy is an effective therapeutic method for psoriatic patients.
Humans ; Phototherapy* ; Psoriasis ; Seoul

OBJECTIVE: To analyze the factors affecting the participation rate in the health screening program of medical insurance. METHOD: We investigated the factors associated with the participation rate in the health screening program in Korea. Data were collected at the aggregate level from 145 employee health insurance societies and 227 self-employed health insurance societies from 1995 to 1997. Data were also collected at the individual level from four health insurance societies. This study hypothesized that the participation rate of the health screening program was related to 1) the characteristics of its members and the size of the health insurance society; 2) the specifications of the health screening program; 3) the venue of the health screening institution and the interests of individuals in the health screening program; and 4) the activities of the health insurance society. We used bivariate and multiple regression models to examine the factors on the participation rate of the health screening program. RESULTS: First, in the case of dependents of on employee health insurance society, the ratio of dependents 40 years old and over, the average monthly contribution per household, the interest and satisfaction level of individuals in health screening, and the level of refunds for over-payment were all associated with the participation rate in the health screening program, accounting for 54.4% of the participation rate. Second, in case of those insured by the self-employed health insurance society, the interest and satisfaction level of individuals in health screening, the level of refunds for over-payment, and the performance level of on-the-spot health screening were statistically significant, accounting for 40.1% of the participation rate. CONCLUSION: The factors concerning the participation rate in the health screening program of medical insurance, in both a health insurance society and for individuals, were closely related to the age and gender of individuals and household contributions.
Adult ; Family Characteristics ; Humans ; Insurance* ; Insurance, Health ; Korea ; Mass Screening* ; Occupational Health

BACKGROUND: Facial involvement of psoriasis requires a different approach than that used for typical plaque psoriasis on other skin areas. Calcitriol ointment may improve lesions on the face without atrophy or other local side effects associated with the use of topical corticosteroids. OBJECTIVE: Our purpose was to determine the efficacy and tolerability of calcitriol 3 microgram/g ointment for the treatment of facial psoriasis. METHODS: In the psoriasis clinic of Seoul National University Hospital, a total of 53 patients were treated with calcitriol 3 microgram/g for 8 weeks. Efficacy was evaluated by an investigator's assessment of the area and a severity index score of facial psoriasis at the 2nd, 4th, and 8th week. Global assessment was also determined at the 8th week. RESULTS: A total of 10 patients discontinued prematurely from the study, due to disappearing during follow-up treatment (n=9) and combined use of topical corticosteroids (n=1). The remaining patients showed the following response to treatment; excellent (n=10), good (n=14), fair (n=11), and poor (n=8). After 8 weeks of treatment with calcitriol ointment, clinical improvement was achieved in 81.4% of the patients. Among them, 55.8% showed excellent (23.3%) or good effect (32.5%) with calcitriol ointment. Five patients (11.6%) showed a local adverse reaction such as erythema, exfoliation, or an itching sensation, and 2 patients discontinued treatment due to adverse reactions. However, no patient showed telangiectasia, skin atrophy, or systemic side effects. CONCLUSION: Our results suggest that calcitriol ointment is an effective and tolerable agent for treatment of psoriasis on the face.
Adrenal Cortex Hormones ; Atrophy ; Calcitriol* ; Erythema ; Follow-Up Studies ; Humans ; Pruritus ; Psoriasis* ; Sensation ; Seoul ; Skin ; Telangiectasis