BACKGROUND: In family practice residency program, education of common health problems in community primary care is the most important. This study was performed to evaluate whether the trainees of current tertiary hospital family practice residency programs could sufficiently experience common health problems in community primary care. METHODS: Each of three conveniently chosen tertiary hospital family practice centers in seoul was matched with one family practice clinic by its location. Whole patients visited the three family practice clinics on one specific day of June, 2001(primary care group) and the patients seen by the trainees of tertiary hospital family practice residency programs(tertiary care group), whose number was the same as that in matched family practice clinic, were included in this study. Demographic and clinical characteristics were obtained. RESULTS: In primary care group, the proportions of patients younger than 15-year(31.62%) or older than 65-year(21.79%) were significantly higher than those in tertiary care group. Laboratory tests(34.24%:2.99%) and referral(11.79%:0.85%) were significantly more common in tertiary care group. The most common health problem assessed by physician and chief complaint of patients in primary care group was respiratory illness, while digestive illness was the most common in tertiary care group. CONCLUSION: Age distribution, performance rate of laboratory tests and referral, chief complaints, and the health problems in primary care group were significantly different from those in tertiary care group. Trainees in family practice residency program needs to be provided more chances experiencing common health problems in community primary care.
Age Distribution ; Ambulatory Care* ; Education ; Family Practice* ; Humans ; Internship and Residency* ; Primary Health Care ; Referral and Consultation ; Seoul ; Tertiary Care Centers* ; Tertiary Healthcare

The orbital wall resection with removal of tumor in patient who has malignant tumor in paranasal sinuses or nasal cavity causes enophthalmos, dystopia, or severe facial deformities. The methods of reconstruction of orbital wall have been used skin graft, muscular sling, parietotemporal fascial calvarial bone flap, and free flaps. The parietotemporal fascial calvarial bone flap has been used as a pedicle flap, but it can not be used in reconstruction of medial wall of the orbit because it has a short vascular pedicle. Therefore we designed the galeal-frontalis- pericranial-calvarial bone flap which is a new pedicled bone flap for reconstruction of orbital wall. We used this flap in 2 patients who have orbital wall defect following resection of malignant tumor arising from the nasal cavity or maxilla. The outcome was gratifying in all two patients. We think that this flap is a new useful method in reconstruction of the orbit.
Congenital Abnormalities ; Enophthalmos ; Free Tissue Flaps ; Humans ; Maxilla ; Nasal Cavity ; Orbit* ; Paranasal Sinuses ; Skin ; Transplants

A 59-year-old female patient with rheumatoid arthritis showed hypokalemic metabolic alkalosis, normotensive hyperreninemic hyperaldosteronism and high urinary prostaglandin level. She was thought to have Bartter's syndrome. But, her kidney biopsy specimen showed chronic interstitial nephritis. She have used acetaminophen containing analgesics for recent three years. So we thought her disease was caused by drug. But, in this case, clinical manifestations are correspond with Bartter's syndrome and we have witnessed a successful respond to kalium replacement, angiotensin converting enzyme inhibitor, prostaglandin inhibitor and spironolactone administration.
Acetaminophen ; Alkalosis ; Analgesics ; Arthritis, Rheumatoid* ; Bartter Syndrome ; Biopsy ; Female ; Glycogen Storage Disease Type VI ; Humans ; Hyperaldosteronism ; Kidney ; Middle Aged ; Nephritis, Interstitial* ; Peptidyl-Dipeptidase A ; Prostaglandin Antagonists ; Spironolactone

We report a successful pregnancy in a woman who at the age of 31years received chemotherapy for mucinous cystadenocarcinoma of the right ovary. She was treated with multiple chemotherapy including cis-platinum, cyclophosphamide, adriamycin, and oral melphalan. She had microscopic residual cancer at the opposite ovary at second-look laparotomy. She developed secondary amenorrhea with symptoms of menopause after commencing treatment which persisted on its completion. Biochemical investigations were consistent with ovarian failure, which was assumed to be chemotherapy-induced. She was given hormonal replacement therapy with a conjugated equine estrogen/medroxyprogesterone acetate combination, resulting in regular withdrawal bleeding. The patient conceived 5 years after completing chemotherapy and gave birth a normal infant at term.
Amenorrhea ; Cisplatin ; Cyclophosphamide ; Cystadenocarcinoma, Mucinous ; Doxorubicin ; Drug Therapy* ; Female ; Hemorrhage ; Humans ; Infant ; Laparotomy ; Melphalan ; Menopause ; Neoplasm, Residual ; Ovarian Neoplasms ; Ovary ; Parturition ; Pregnancy*

PURPOSE: To evaluate the efficacy of two-phase dynamic helical CT, including the gastric mucosal phase, for the detection of atypical non-hyperattenuating early gastric carcinoma (EGC). MATERIALS AND METHODS: In 32 patients, we evaluated the two-phase helical CT findings of endoscopically suspected EGC for changes of the inner hyperattenuating mucosal layer, the hypoattenuating outer layer and the serosal surface. Two gastrointestinal radiologists working together reached their conclusions before pathologic diagnosis had been made. The first, so-called gastric mucosal, phase was obtained 38 -45 sec after the start of IV injection of 150 ml/sec contrast material at a rate of 4 ml/sec to obtain maximum enhancement of the mucosal layer. RESULTS: Among 32 patients, EGC was confirmed in 30 and AGC (T2) in two. Using two-phase helical CT, the detection rate for typical hyperattenuating EGC was 27 % (8/30). Lesions showing focal interruption of the mucosal layer without abnormal enhancement of the outer layer (EGC atypical enhancement pattern type 1) were detected in five patients during the mucosal phase, and were pathologically confirmed as 3 EGC IIc+III, 1IIc+IIa, and I IIb+IIc. Lesions showing a locally protuding lesion of the inner and preserved outer layers, with a smooth serosal surface (EGC atypical enhancement pattern type 2) and which could be distinguished from normal folds, were detected in six patients during the mucosal phase, and were pathologically confirmed as 2 EGC IIb+IIc, 1 IIc+IIa, and 3 IIc+IIb. Lesions were less distinct during the equilibrium phase, and there was no change in the enhancement pattern. The overall detection rate for EGC in which an atypical enhancement pattern was added to the typical one showed improvement (19/30, 63 % ). CONCLUSION: Helical CT using a two-phasic scan technique including the mucosal phase was efficient for various combinations of EGC II and/or III, including IIc. The findings were atypical and non-hyperattenvating, but reliable, and improved the overall detection rate.
Diagnosis ; Humans ; Stomach Neoplasms* ; Tomography, Spiral Computed*

Microvilli are outer membrane organelles that contain cross-linked filamentous actin.Unlike well-characterized epithelial microvilli, T-cell microvilli are dynamic similar to those of filopodia, which grow and shrink intermittently via the alternate actin-assembly and -disassembly. T-cell microvilli are specialized for sensing Ags on the surface of Ag-presenting cells (APCs). Thus, these finger-shaped microprotrusions contain many signaling-related proteins and can serve as a signaling platforms that induce intracellular signals. However, they are not limited to sensing external information but can provide sites for parts of the cell-body to tear away from the cell. Cells are known to produce many types of extracellular vesicles (EVs), such as exosomes, microvesicles, and membrane particles. T cells also produce EVs, but little is known about under what conditions T cells generate EVs and which types of EVs are released. We discovered that T cells produce few exosomes but release large amounsts of microvilli-derived particles during physical interaction with APCs. Although much is unanswered as to why T cells use the same organelles to sense Ags or to produce EVs, these events can significantly affect T cell fate, including clonal expansion and death. Since TCRs are localized at microvilli tips, this membrane event also raises a new question regarding long-standing paradigm in T cell biology; i.e., surface TCR downmodulation following T cell activation. Since T-cell microvilli particles carry T-cell message to their cognate partner, these particles are termed T-cell immunological synaptosomes (TISs). We discuss the potential physiological role of TISs and their application to immunotherapies.

BACKGROUND: Olmesartan medoxomil is an angiotensin II receptor blocker commonly used in hypertension. First objective of this study was to evaluate the bioequivalence of two olmesartan formulations, Olmesartan 20 mg and 40 mg tablet (Yuhan, Pharmaceutical Corp. Seoul, Korea) as test drugs and Olmetec(R) 20 mg and 40 mg tablet (Daewoong, Pharmaceutical Corp. Seoul, Korea) as reference drugs. Second objective of this study was to evaluate the dose-proportionality of two formulations. METHODS: Two studies (20 mg, 40 mg) were conducted as a randomized, open-label, 2-period, crossover design. Each subject received one 20 mg or 40 mg tablet of the reference or test formulation of olmesartan medoxomil in each study. Blood samples were obtained during the 48-hour period after the dose in each treatment period. Wash-out period was 1 week in each study. Concentrations of olmesartan medoxomil in plasma were analyzed using a liquid chromatography system with tandem mass-spectrometric detection (LC/MS/MS). The primary pharmacokinetic parameters were Cmax (maximum concentration) and AUCt (area under the concentration-time curve from time 0 to the last sampling time). RESULTS: A total number of 40 healthy male volunteers participated in the study and 37 volunteers completed both treatment periods in 20 mg trial. All 40 participants completed both treatment periods in 40 mg trial. The 90 % CIs for the geometric mean ratios of the pharmacokinetic parameters (test:reference drug) were 0.93 ~ 1.04 for AUCt and 0.97 ~ 1.08 for Cmax in 20 mg trial. The 90 CIs were 0.94 ~ 1.02 for AUCt and 1.00 ~ 1.11 for Cmax in 40 mg trial. All parameters of two studies satisfy the range of bioequivalence criterion. CONCLUSION: The obtained results indicated that pharmacokinetic exposure to Olmesartan 20 mg and 40 mg tablet was bioequivalent to that of Olmetec(R) 20 mg and 40 mg tablet, respectively.
Chromatography, Liquid ; Cross-Over Studies ; Humans ; Hypertension ; Imidazoles ; Male ; Plasma ; Receptors, Angiotensin ; Tetrazoles ; Therapeutic Equivalency

OBJECTIVE: Our purpose was to determine the effect of epidural analgesia on the first phase of labor and mode of delivery of nulliparous women. METHODS: We studied 170 nulliparous women at near-term who underwent spontaneous and induced labor at the Department of Obstetrics and Gynecology, Hanyang University Hospital from January 1999 to May 2000 prospectively. Eighty women who were received epidural analgesia for pain relief were compared to ninety women as control group. Cesarean delivery was performed when indicated. RESULTS: The demographic characteristics of the two groups were similar with respect to age, height, weight, gestational weeks, and gravida. The two groups had the same cervical dilatation at the time of analgesia. There were no statistically significant difference between two groups. The length of the first phase of labor was same between two groups(558.4+/-50.4 min. vs 452.1+/-46.7 min.). There were statistically significant differences in the instrument delivery and cesarean section rate between two groups(43 vs. 32, 8 vs. 16 respectively). CONCLUSIONS: Epidural analgesia provides safe and effective intrapartum pain control and may be administered without undesirable effects on the first phase of labor and delivery.
Analgesia ; Analgesia, Epidural* ; Cesarean Section ; Female ; Gynecology ; Humans ; Labor Stage, First ; Labor, Induced ; Obstetrics ; Pregnancy ; Prospective Studies