No abstract available.
Porphyria, Acute Intermittent* ; Pregnancy*

This study was performed in a rural community, Kanghwa county which was introduced to a regional medical insurance pilot program in 1982. The purposes of this study were, firstly, to observe the changes in ambulatory care utilization in the three years 1982, 1983 and 1987 ; secondly, to analyse factors which convert perceived medical care needs to effective medical care demand. During the three periods, a serial interview survey was performed to determine the changes in medical utilization before and after the regional medical insurance program implementation. The number of subjects was 3,356 persons in the year 1982, 3,705 in 1983 and 2,745 in 1987. The results of the study were as follows : 1. Total ambulatory care utilization rates per 100 persons during a 2-week period were 23.6 in the year 1982, 21.8 in 1983, and 29.3 in 1987 ; and physician visit rates were 6.1 in 1982, 11.7 in 1983, and 14.9 in 1987. Thus, compared to the total utilization rate there was a definite increase in physician visit, and during the study periods there was a decrease in drug stores visits whereas an increase in hospital or clinic visits was noticed. 2. The rates of effective demand for medical care need were 70.7% in 1982, 70.5% in 1983 and 75.9% in 1987 ; and the rates of patients who visited physicians were 20.2% in 1982, 42.8% in 1983 and 35.6% in 1987. Thus, physician visits increased sharply by introducing the medical insurance program, but after the latent medical care demands were fulfilled, there was a slight decrease in the physician visits. 3. The number of acute symptoms and the number of chronic symptoms were common determinants of total ambulatory care utilization and physician visits. Besides the medical care need factors, age in 1982, sex and accessibility in 1983, and accessibility in 1987 were statistically significant determinants of the total utilization ; sex and accessibility in 1983, and education in 1987 were also statistically significant determinants of the physician visit. 4. For persons with perceived acute symptoms during the 2-week periods, accessibility in total utilization and age in physician visits were common discriminating factors of ambulatory care utilization in the three years, and education and income were also statistically significant variables For persons with perceived chronic symptoms, occupation and income were statistically significant discriminating variables commonly observed in total utilization and physician visits.
Age Factors ; Ambulatory Care* ; Education ; Humans ; Insurance* ; Occupations ; Rural Population*

PURPOSE: Many articles have proposed that osteonecrosis of the femoral head (ONFH) is caused by fat embolism or intravascular coagulation linked to hyperlipidemia. To determine whether hyperlipidemia is an associated factor for ONFH, serum lipid levels were measured. MATERIALS AND METHODS: Nighty-eight patients presenting with ONFH and 110 controls were investigated. We compared the average value of serum lipid levels and the incidence of hyperlipidemia of the two groups. RESULTS: ONFH group showed generalized increase in lipid level and statistically significant difference in the average value of total cholesterol (P=0.0001), HDL-cholesterol (P=0.0261) and phospholipid (P=0.0465) compared with the control. The incidence of hyperlipidemia of the two groups showed statistically significant difference in HDL-cholesterol (P=0.019) and triglyceride (P=0.024). CONCLUSION: Hyperlipidemia seems to be associated with pathogenesis of ONFH. We speculated that hyperlipidemia might be a contributing factor of ONFH. Hyperlipidemia may play a role as a triggering factor in the pathogenetic process that results in osteonecrosis. However, it can not be ruled out that secondary hyperlipidemia might be a finding following ONFH.
Cholesterol ; Embolism, Fat ; Head* ; Humans ; Hyperlipidemias ; Incidence ; Osteonecrosis* ; Triglycerides

H2-receptor blockers are widely used for therapy of peptic ulcer disease and gastroesophageal reflux disease. H2-receptor blockers infrequently cause adverse hepatic effects, and when they occur they are usually asymptomatic. There are several previous reports of liver injury related to ranitidine. Until now, only two cases of acute hepatitis associated with the use of famotidine were reported in the world. We report three cases of clinical hepatitis that followed administration of famotidine (2 cases) and ranitidine (1 case). First, a 54-year-old woman received famotidine, 40mg, daily for treatment of erosive gastritis. After 6 weeks of treatment with famotidine, jaundice and itching sense developed. Second, a 45-year-old man was hospitalized for jaundice. He had a long history of duodenal ulcer and had been intermittently treated with famotidine. He had 6 weeks of treatment with famotidine prior to admission. Third, a 19-year-old woman was hospitalized for nausea, vomiting and urticaria. She had a history of acute hepatitis B virus infection and was discharged 4 weeks prior to readmission. She had been received ranitidine, 300 mg, daily for treatment of gastritis. After 17 days of drug ingestion, whenever she had taken her medication, she developed these symptoms of nausea, vomiting and urticaria. Other causes of hepatitis were ruled out and all patients recovered after discontinuation of drug ingestion.
Duodenal Ulcer ; Eating ; Famotidine* ; Female ; Gastritis ; Gastroesophageal Reflux ; Hepatitis B virus ; Hepatitis* ; Humans ; Jaundice ; Liver ; Middle Aged ; Nausea ; Peptic Ulcer ; Pruritus ; Ranitidine* ; Urticaria ; Vomiting ; Young Adult

H2-receptor blockers are widely used for therapy of peptic ulcer disease and gastroesophageal reflux disease. H2-receptor blockers infrequently cause adverse hepatic effects, and when they occur they are usually asymptomatic. There are several previous reports of liver injury related to ranitidine. Until now, only two cases of acute hepatitis associated with the use of famotidine were reported in the world. We report three cases of clinical hepatitis that followed administration of famotidine (2 cases) and ranitidine (1 case). First, a 54-year-old woman received famotidine, 40mg, daily for treatment of erosive gastritis. After 6 weeks of treatment with famotidine, jaundice and itching sense developed. Second, a 45-year-old man was hospitalized for jaundice. He had a long history of duodenal ulcer and had been intermittently treated with famotidine. He had 6 weeks of treatment with famotidine prior to admission. Third, a 19-year-old woman was hospitalized for nausea, vomiting and urticaria. She had a history of acute hepatitis B virus infection and was discharged 4 weeks prior to readmission. She had been received ranitidine, 300 mg, daily for treatment of gastritis. After 17 days of drug ingestion, whenever she had taken her medication, she developed these symptoms of nausea, vomiting and urticaria. Other causes of hepatitis were ruled out and all patients recovered after discontinuation of drug ingestion.
Duodenal Ulcer ; Eating ; Famotidine* ; Female ; Gastritis ; Gastroesophageal Reflux ; Hepatitis B virus ; Hepatitis* ; Humans ; Jaundice ; Liver ; Middle Aged ; Nausea ; Peptic Ulcer ; Pruritus ; Ranitidine* ; Urticaria ; Vomiting ; Young Adult

BACKGROUND/AIMS: Liver biopsy has been used to evaluate the degree of hepatic fibrosis in patients with chronic liver diseases. It is important to assess liver fibrosis when following the course of chronic liver diseases. Histopathological examination of percutaneous biopsy specimens is invasive and is also of questionable value because of the heterogenous distribution of pathological changes in the liver. Therefore, non-nvasive methods to determine the progress of liver fibrosis are needed. Serum hyaluronic acid and type IV collagen are known to be related to hepatic fibrosis. This study was performed to evaluate the clinical usefulness of serum hyaluronic acid and type IV collagen measurement as a differential point in patients with chronic liver diseases and early cirrhosis. METHODS: This study included 109 patients with chronic liver diseases caused by various etiologies. Liver biopsy and histopathological classification were done in all patients. Serum hyaluronic acid and type IV collagen were measured by one-tep sandwich binding protein assay and one-tep sandwich enzyme immunoassay. RESULTS: The concentrations of hyaluronic acid and type IV collagen in the early cirrhosis group (208.5+/-186.4 ng/mL, 242.1+/-162.8 ng/mL) were significantly higher (p<0.01) than those in the normal and fatty liver group (26.3+/-21.7 ng/mL, 79.2+/-28.8 ng/mL), mild chronic hepatitis group (22.8+/-15.4 ng/mL, 125.5+/-79.7 ng/mL), moderate to severe hepatitis group (66.3+/-60.5 ng/mL, 148.5+/-78.7 ng/mL). At the cutoff value of 100 ng/mL for hyaluronic acid and 200 ng/mL for type IV collagen, the sensitivities were 66.7% and 55.6%, and specifities were 82.9% and 89%, and diagnostic efficiencies were 78.9% and 80.7% respectively for discriminating patients with cirrhosis (4 points) from the mild to severe fibrosis (0~3 points). CONCLUSIONS: The serum levels of hyaluronic acid and type IV collagen may be sensitive markers of fibrotic process in chronic liver diseases and useful biochemical markers in differentiation of the patients with early cirrhosis from those with chronic liver diseases.
Biomarkers ; Biopsy ; Carrier Proteins ; Classification ; Collagen Type IV* ; Fatty Liver ; Fibrosis ; Hepatitis ; Hepatitis, Chronic* ; Humans ; Hyaluronic Acid* ; Immunoenzyme Techniques ; Liver Cirrhosis* ; Liver Diseases ; Liver*

BACKGROUND: The induced hypotension was used to decrease blood loss, thereby decreasing the need for blood transfusion and/or improving operating conditions at the surgical site. It was hypothesized that SNP-induced hypotension with fixed concomitant esmolol infusion(75 ug/kg/min) might prevent side effects such as reflex tachycardia and reduce SNP dose requirement during SNP-induced hypotension. METHOD: The concomitant infusion of 75 ug/kg/min esmolol was used to potentiate hypotension(30% reduction of mean arterial blood pressure) induced with sodium nitroprusside in six dog during halothane(lvo1%)-N2O(50%)-O2(50%) anesthesia. Mean arterial blood pressure, heart rate, cardiac output, mean pulmonary arterial blood pressure, central venous pressure, arterial blood gas analysis, and mixed venous oxygen saturation were measured and systemic vascular resistance was calculated in the each periods. RESULT: The results run as follows; 1) Compared to SNP-induced hypotension, there was significant reduction in SNP dose requirement to maintain a 30% reduction of mean arterial pressure at the concomitant infusion of 75 ug/kg/min esmolol. 2) There were significant reduction in heart rate, mixed venous oxygen saturation and cardiac output, but significant increase in systemic vascular resistance and mean pulmonary arterial pressure at the coneomitant infusion of 75 ug/kg/min esmolol. 3) No rebound hypertension was observed at 30 minute after SNP and esmolol infusions were simultaneously discontinued. CONCLUSION: The result of present study suggests that esmolol infusion is a safe and effective pharmacologic means of potentiating SNP-induced hypotension during halothane-N2O-O2 anesthesia. Probably esmolol may act by counteracting side effects such as acute tolerance during SNP-induced hypotension.
Anesthesia* ; Animals ; Arterial Pressure ; Blood Gas Analysis ; Blood Transfusion ; Cardiac Output ; Central Venous Pressure ; Dogs* ; Halothane* ; Heart Rate ; Hemodynamics* ; Hypertension ; Hypotension* ; Nitroprusside* ; Oxygen ; Reflex ; Sodium* ; Tachycardia ; Vascular Resistance

OBJECTIVE: The presence of the various cytokines in human peritoneal fluid has been evaluated incompletely. Changes in cytokine lefels may be related to activation of peritoneal macrophage and T-lymphocyte, development of endometriosis, and infertility. This study assesses peritoneal fluid levels of interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10) and tumor necrosis factor-alpha (TNF-alpha) in infertile women with endometriosis and normal women without endometriosis. Design : Prospective and case-control study in university hospital. MATERIALS AND METHODS: Cytokine levels in peritoneal fluid obtained during laparotomy or laparoscopy from 21 patients in infertile patients in infertile patients with endometriosis and 24 controls undergoing laparotomy or laparoscopy with no evidence of pelvic endometriosis were determined by enzymelinked immunosorbent assay. RESULTS: The mean levels of interleukin-6 in infertile patients with endometriosis and controls were 72.7+/-23.7 pg/ml and 18.5+/-9.7 pg/ml respectively (p=0.02). Similarly, the mean levels of interleukin-8 in infertile patients with endometriosis was significantly higher than that of controls (445.0+/-89.6, vs 45.1+/-48.4, p=0.04). The mean concentration of interleukin-10 in infertile patients with endometriosis was significantly lower than that of controls (1.09+/-0.04 vs 2.19+/-0.03, p=0.03). The level of tumor necrosis factor-alpha was not significantly different between the two study groups. CONCLUSIONS: Increased IL-6 and IL-8 and decreased IL-10 levels in the peritoneal fluid may be related to pathogenesis in the endometriosis and infertility, suggesting that partially contribute to the disturbed immune regulation observed in infertili women with endometriosis.
Ascitic Fluid* ; Case-Control Studies ; Cytokines ; Endometriosis* ; Female ; Humans ; Infertility ; Interleukin-10 ; Interleukin-6 ; Interleukin-8 ; Laparoscopy ; Laparotomy ; Macrophages, Peritoneal ; Prospective Studies ; T-Lymphocytes ; Tumor Necrosis Factor-alpha

Tuberculosis affecting only the appendix is exceedingly rare, and tuberculous involvement of the appendix in the presence of tuberculosis elsewhere in the body, e.g., the lung or the gastrointestinal tract, is not common. Tuberculosis of the appendix is not associated with any specific clinical features, and diagnosis is revealed only after histopathological examination. Recently, we clinically experienced a case of tubercular appendicitis on histopathologic examination after an appendectomy for acute appendicitis. This case of tubercular appendicitis is presented with a brief review of the literature.
Appendectomy ; Appendicitis ; Appendix* ; Diagnosis ; Gastrointestinal Tract ; Lung ; Tuberculosis*

No abstract available.