Seborrheic dermatitis is a chronic recurrent inflammatory disorder presumed to be caused by increased sebaceous gland secretion, metabolic changes in the cutaneous microflora, and changes in the host immune function. Stellate ganglion block (SGB) is known to increase the blood flow rate without altering the blood pressure, heart rate, or cardiac output, to stabilize hypertonic conditions of the sympathetic nerves, and to affect the endocrine and immune systems. It is used in the differential diagnosis and treatment of autonomic nervous system disorders of the head, neck, and upper limbs. The authors report the first case of successful treatment of a patient with seborrheic dermatitis through repeated SGB trials.
Autonomic Nervous System Diseases ; Blood Pressure ; Cardiac Output ; Dermatitis, Seborrheic* ; Diagnosis, Differential ; Head ; Heart Rate ; Humans ; Immune System ; Neck ; Nerve Block ; Sebaceous Glands ; Stellate Ganglion* ; Upper Extremity

BACKGROUND: In an effort t enhance long term patency of coronary bypass grafts, utilization of arterial conduits have been on an icrease. With the same objective, we have been using the right gastroepiploic artery (RGEA) in coronary artery bypass procedures since 1998. The current paper has been undertaken with the aim of assessing the apropriateness, problems, and short term results of using the RGEA as an arterial graft conduit by studying the postoperative clinical results of 100 patients than received coronary artery bypass grafting (CARG) with this artery. MATERIAL AND METHOD: Between May of 1998 and May of 1999, an analysis of the mortality, postoperative myocardial infarction, and the need for IABP insertion as a result of low cardiac output were made between 100 consecutive patients undergoing CABG with the RGEA. There was one postoperative death due to cerebral infarction. Postoperative complications/morbidity comprised myocardial infarction in 2, cerebral infarct in 3, reoperation due to bleeding in 1, mediastinitis in 1, and low cardiac output syndrome necessitating IABP in 3 patients. Complicatons related to harvesting of the arterial grafts were not experienced in any of the patients. CONCLUSION: The results of the current data show that utilization of the RGEA in CABG is not associated with increased mortality/morbidity and demonstrates satisfactory short term results suggesting the usefulnessof this conduit as an arterial graft.
Arteries ; Cardiac Output, Low ; Cerebral Infarction ; Coronary Artery Bypass* ; Coronary Vessels* ; Gastroepiploic Artery* ; Hemorrhage ; Humans ; Mediastinitis ; Mortality ; Myocardial Infarction ; Reoperation ; Transplants

PURPOSE: Crowding causes dysfunction in the emergency department (ED) and is associated with poor quality of patient care, dissatisfaction of the physicians, and increased financial burden of medical care. Frequent use is often considered a major contributor to ED crowding. The present study sought to verify the relationship between the frequent ED users and ED crowding, and to ascertain the severity of the frequent ED users. METHODS: One-year ED visit data from a tertiary teaching hospital located in an urban area were analyzed. Frequent ED users were defined as four or more ED visits per year. Crowding indicators were defined as the length of stay and the percentage of patients staying over 6 hours. Severity indicators were defined as operation within 24 h, admission to intensive care unit, and expiry in the ED. RESULTS: The 2.7% of patients who had four or more ED visits were responsible for 11.9% of visits. The median length of stay of frequent users was significantly longer (6.18 h) than that of infrequent users (3.42 h). The percentage of patients who stayed more than 6 h was significantly larger in the frequent user group than infrequent user group (51.4% vs. 32.9%, respectively; OR=2.158; 95% CI, 2.041~2.281). However, the severity of frequent users was lower than that of infrequent users (3.0% vs. 5.3%, respectively; OR=0.553; 95% CI, 0.472~0.648). CONCLUSION: Frequent users presenting to an ED located in an urban area were more likely to stay longer in the ED, and were less likely to be severe. Active interventions to reduce ED crowding are required.
Crowding ; Emergencies ; Emergency Medical Services ; Health Services Misuse ; Hospitals, Teaching ; Humans ; Intensive Care Units ; Length of Stay ; Patient Care

PURPOSE: Crowding causes dysfunction in the emergency department (ED) and is associated with poor quality of patient care, dissatisfaction of the physicians, and increased financial burden of medical care. Frequent use is often considered a major contributor to ED crowding. The present study sought to verify the relationship between the frequent ED users and ED crowding, and to ascertain the severity of the frequent ED users. METHODS: One-year ED visit data from a tertiary teaching hospital located in an urban area were analyzed. Frequent ED users were defined as four or more ED visits per year. Crowding indicators were defined as the length of stay and the percentage of patients staying over 6 hours. Severity indicators were defined as operation within 24 h, admission to intensive care unit, and expiry in the ED. RESULTS: The 2.7% of patients who had four or more ED visits were responsible for 11.9% of visits. The median length of stay of frequent users was significantly longer (6.18 h) than that of infrequent users (3.42 h). The percentage of patients who stayed more than 6 h was significantly larger in the frequent user group than infrequent user group (51.4% vs. 32.9%, respectively; OR=2.158; 95% CI, 2.041~2.281). However, the severity of frequent users was lower than that of infrequent users (3.0% vs. 5.3%, respectively; OR=0.553; 95% CI, 0.472~0.648). CONCLUSION: Frequent users presenting to an ED located in an urban area were more likely to stay longer in the ED, and were less likely to be severe. Active interventions to reduce ED crowding are required.
Crowding ; Emergencies ; Emergency Medical Services ; Health Services Misuse ; Hospitals, Teaching ; Humans ; Intensive Care Units ; Length of Stay ; Patient Care

OBJECTIVE: The purpose of this study was to describe a surgical technique of axillary approach of percutaneous endoscopic interlaminar discectomy for L5-S1 disc herniation and its preliminary results. METHODS: From July 2002 to September 2003, 101 patients with lumbar radiculopathy due to L5-S1 disc herniation, who were treated by percutaneous interlaminar endoscopic discectomy, were retrospectively reviewed. There were 57 males and 44 females with a mean age of 44.8 years (range, 18 to 62 years). The surgery consisted of needle insertion into the epidural space via the interlaminar space, sequential dilatation, and endoscopic discectomy through the axillary area of the S1 root. RESULTS: The mean follow-up period was 14.5 months and the average surgical time was 41 min. According to the modified Macnab criteria, 44 patients (43.6%) had excellent outcomes, 49 (48.5%) had good results and only 8 (7.8%) had fair or poor outcomes. Four patients had a revision microdiscectomy due to incomplete removal of disc fragment. There were no major complications related to this surgical approach. CONCLUSION: Axillary approach of percutaneous endoscopic interlaminar discectomy is safe and effective procedure for the treatment of L5-S1 disc herniation. It combines the advantages of MED and conventional percutaneous endoscopic discectomy.
Dilatation ; Diskectomy* ; Epidural Space ; Female ; Follow-Up Studies ; Humans ; Male ; Needles ; Operative Time ; Radiculopathy ; Retrospective Studies

BACKGROUND: Alopecia areata(AA) is believed to be an autoimmune disease in which a mononuclear cell infiltrate develops in and around anagen hair follicles. There is no clearly superior therapy in the treatment of AA, especially AA with atopic dermatitis and alopecia universalis. The theory of autoimmune pathogenesis of alopecia areata suggests a potential therapeutic effect of cyclosporin-A(CsA). OBJECTIVE: The purpose of this study is to evaluate the effectiveness of CsA in the treatment of AA. METHOD: 12 patients with severe or refractory AA were treated with DPCP for at least 12 months. They showed resistance to treatment using DPCP. CsA was made up as a 0.01M, 0.005M solution in an ethanol preparation. 1cc of 0.01M CsA solution was applied on the Lt. side scalp and 1cc of 0.005M CsA solution was applied on the Rt. side scalp. The drug was applied once per week. Response to treatment was evaluated as follows: complete recovery, more than a 80% extent of hair regrowth; marked recovery, hair regrowth of 60% to 80%, moderate recovery, hair regrowth of 40% to 60%; slight recovery, hair regrowth of 20% to 40%; no response, hair regrowth of 0% to 20%. RESULT: The Six patients with focal type AA showed a moderate recovery. Of the six patients with alopecia totalis, 4 patients showed a moderate recovery, two patients showed no response. CONCLUSION: Topical CsA therapy is recommended in severe and refractory AA.
Alopecia Areata* ; Alopecia* ; Autoimmune Diseases ; Dermatitis, Atopic ; Ethanol ; Hair ; Hair Follicle ; Humans ; Scalp

Coronary artery aneurysm is an uncommon disease. The optimal medical or surgical treatment for this disease remains obscure. The causes of coronary artery aneurysms include atherosclerosis, Kawasaki disease, infectious vascular disease, connective tissue disorder and congenital malformation. A 50 year old man visit our institution for chest pain that had started 3 days previously. After coronary angiography, multiple coronary aneurysms were diagnosed and successful surgical intervention was performed.
Aneurysm ; Angina, Unstable ; Atherosclerosis ; Chest Pain ; Connective Tissue ; Coronary Aneurysm ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Vessels ; Mucocutaneous Lymph Node Syndrome ; Vascular Diseases

No abstract available.
Acinar Cells* ; Arthritis* ; Carcinoma, Acinar Cell* ; Humans ; Panniculitis*

BACKGROUND/AIMS: Hypoxemia is often associated with liver cirrhosis without cardiopulmonary diseases. Pulmonary vascular impairments including intrapulmonary shunt have been considered as a major mechanism of hypoxemia. The aim of this study was to determine the incidence and pathophysiologic basis of hypoxemia in cirrhotic patients without respiratory symptoms. METHODS: In fourty three cirrhotic patients without heart and lung diseases, we performed the arterial blood gas analysis and calculated alveolar arterial oxygen gradient (A-aO2). According to the A-aO2, the patients were divided into hypoxemic and normoxemic groups. In each group, a Tc-99m-macroaggregated albumin (Tc-99m-MAA) scan, a contrast-enhanced echocardiography and a pulmonary function test were performed. RESULTS: Twenty-eight of 43 patients (65%) showed hypoxemia. Hypoxemic patients showed significantly more increased shunt fraction of 3.1 1.4% than normoxemic one of 2.1 1.1% in the Tc-99m-MAA scan (p<0.05). However, only two of hypoxemic patients had shunt fraction above physiologic shunt range. By contrast-enhanced echocardiography, an intrapulmonary shunt was confirmed in one patient. There was no significant correlation between the shunt fraction and the hepatic reserve based on the Child-Pugh classification in hypoxemic patients. In the results of pulmonary function test, only DLco decreased more significantly in hypoxemic group than in normoxemic group (58.4 14.2 % vs 75.3 16.5% of predicted, p<0.05). CONCLUSIONS: Hypoxemia is not infrequently observed in cirrhosis, but incidence of significant intrapulmonary shunt is low. Therefore, other mechanism such as diffusion defect may be suggested to play a role in the development of hypoxemia in cirrhotic patients without respiratory symptoms.
Anoxia ; Blood Gas Analysis ; Classification ; Diffusion ; Echocardiography ; Fibrosis ; Heart ; Humans ; Incidence ; Liver Cirrhosis* ; Liver* ; Lung Diseases ; Oxygen ; Respiratory Function Tests ; Technetium Tc 99m Aggregated Albumin

BACKGROUND: Hepatitis B virus (HBV) is major source of chronic liver disease in Korea. However this virus might have different nucleotide sequence according to races, different region, etc. Recently the novel method that allows sensitive amplification with dramatically decreased mis-incorporation has developed. We determined to get the major form of HBV nucleotide sequence from whole sequencing data of 26 Korean HBV carriers. METHODS: HBV DNA were collected from 26 Korean chronic HBV carriers. We used the novel PCR with pfu for the amplification of HBV DNA, and specific primers were made with combination sequence bases of non-HBV part and HBV parts which were located head and tail in the virion. Then whole length of HBV were directly sequenced and analysed. RESULT: HBV DNA was consisted of 3215 bases in 20 cases of 26 Korean chronic HBV carriers. And the remainder had smaller or larger number due to deletion, insertion or both in pre-S2 and S gene. They were 99.03% homology of their nucleotide sequence and belong to genotype C. The variability of nucleotide sequence was significantly higher in the singly coding region (SCR) than doubly coding region (DCR), and also high in pre-S1 and pre-S2 gene among the DCR. Hot-spots were more frequently found in the SCR, pre-S1 and pre-S2 gene. CONCLUSION: In Korean chronic HBV carriers, HBV is consisted of 3215 nucleotides, and belongs to genotype C. And it might exist one genotype with the variability in Korea.
Base Sequence* ; Clinical Coding ; Continental Population Groups ; DNA ; Genome* ; Genotype* ; Head ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Humans ; Korea ; Liver Diseases ; Nucleotides ; Polymerase Chain Reaction ; Polymerization* ; Polymers* ; Virion