Endoscopic variceal ligation(EVL) is newly developed method to manage esophageal variceal bleeding. This study asse initial control rate of active variceal bleeding, incidence of rebleeding and complications in EVL. From June in l992 to December in 1994, this study was performed on 70 patients who had visited to our medical center for melena or hematemesis by acute esophageal variceal bleeding. In all of 70 cases, eradication of esophageal varix was performed and variceal bleeding was controlled well. And first session was performed successfully with EVL. But rebleeding was occured in 12 cases(11 cases caused by esoyhageal varix and 1 case caused by esophageal ulcer) during follow-up period, so EVL therapy was performed repeatedly and 8 cases were eradicated and 4 cases were uncontrolled and died, and then 94% hemostatic effect was achieved during follow-up period. Complications of EVL therapy were mild(substernal discomfort in 12 cases, substernal pain in 4 cases, fever in 3 cases, mild dysphagia in 2 cases) and well controlled. Superficial esaphageal ulcer was shown in 18 cases by follow-up endoscopy after 1 week. These results show that EVL is a good therapeutic method to control active variceal bleeding and eradication of varix with repeat treatment. In conclusion, EVL is an effective and safe method of treatment and prevention for esophageal variceal bleeding.
Deglutition Disorders ; Endoscopy ; Equidae ; Esophageal and Gastric Varices* ; Fever ; Follow-Up Studies ; Hematemesis ; Humans ; Incidence ; Ligation* ; Melena ; Ulcer ; Varicose Veins

Acute fatty liver is rare but life threatening complication and usually manifests late in pregnancy. The mean gestational age onset of symptoms has been reported 35-37 weeks of gestation. Recently, several reports revealed acute fatty liver can develops in the second trimester of pregnancy. Recent reports suggest that early diagnosis and delivery decreased the mortality of fetus and mother. We have experienced a case of the second trimester onset acute fatty liver, in pregnancy so we report the case with brief review.
Early Diagnosis ; Fatty Liver* ; Female ; Fetus ; Gestational Age ; Humans ; Mortality ; Mothers ; Pregnancy ; Pregnancy Trimester, Second*

No abstract available.
Humans

OBJECTIVE: Post-marketing surveillance (PMS) is an adverse events monitoring practice of pharmaceutical drugs on the market. Traditional PMS methods are labor intensive and expensive to perform, because they are largely based on manual work including phone-calling, mailing, or direct visits to relevant subjects. The objective of this study was to develop and validate a PMS methodology based on the clinical data warehouse (CDW). METHODS: We constructed a archival DB using a hospital information system and a refined CDW from three different hospitals. Fluoxetine hydrochloride, an antidepressant, was selected as the target monitoring drug. Corrected QT prolongation on ECG was selected as the target adverse outcome. The Wilcoxon signed rank test was performed to analyze the difference in the corrected QT interval before and after the target drug administration. RESULTS: A refined CDW was successfully constructed from three different hospitals. Table specifications and an entity-relation diagram were developed and are presented. A total of 13 subjects were selected for monitoring. There was no statistically significant difference in the QT interval before and after target drug administration (p=0.727). CONCLUSION: The PMS method based on CDW was successfully performed on the target drug. This IT-based alternative surveillance method might be beneficial in the PMS environment of the future.
Electrocardiography ; Fluoxetine ; Hospital Information Systems ; Postal Service ; Retrospective Studies

PURPOSE: Lung cancer is now one of the most frequently diagnosed cancers in the world and its incidence has been increasing also in Korea. In several recent studies, the indidence of adenocarcinoma and female/male ratio have been reported to be increasing. The aim of this study is to investigate the changing trends in sex and age distribution, the histologic type and location (peripheral or central) of tumors in lung cancer. MATERIALS AND METHODS: We performed the retrospective review of histopathology and clinical information of 1409 patients diagnosed as baving primary lung cancer, except non-epithelial tumors and undetermined histologic types, at Kyungpook National University Hospital from January 1988 to December 1996. RESULTS: Male to female ratio was 4.6; 1. The peak incidence of age group was 7th decade (40.3%) with mean age of 61.5. Percentage of smokers in patients with lung cancer was 84.3%. Total number of patients with lung cancer has increased recently. However, the annual female/male ratio was nearly constant during the study period. Peripheral tumors, which were found in 20.6% of patients with lung cancer in 1988, increased to 33.5% in 1996 and this trend was more prominent in squamous cell carcinoma than in adenocarcinoma. Squamous cell carcinoma was the most common histologic type (62.0%), followed by adenocarcinoma (19.2%), small cell carcinoma (14.2%), large cell carcinoma (4.6%) in order. There was a predominance of squamous cell carcinoma (67.9%) in males and of adenocarcinoma (46.6%) in females. There has been a significant shift in the histology pattern with an increase in the percentage of adenocarcinoma. The incidence of adenocarcinoma was more than doubled from 7.5% in 1988 to 25.8% in 1996. CONCLUSION: These findings suggest that the epidemiology of lung cancer is changing.
Adenocarcinoma ; Age Distribution ; Carcinoma, Large Cell ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Epidemiology ; Female ; Gyeongsangbuk-do ; Humans ; Incidence ; Korea ; Lung Neoplasms* ; Lung* ; Male ; Retrospective Studies

The treatment of pathologic aerophagia has rarely been discussed in the literature. In this retrospective study, the authors investigated the effects of clonazepam on the management of pathologic childhood aerophagia (PCA) with psychological stresses (PS), but not with mental retardation. Data from 22 consecutive PCA patients with PS (aged 2 to 10 yr), who had been followed up for over 1 yr, were reviewed. On the basis of videolaryngoscopic views, the authors observed that the pathology of aerophagia was the result of reflex-induced swallowing with paroxysmal openings of the upper esophageal sphincter due to unknown factors and also observed that these reflex-induced openings were subsided after intravenous low dose benzodiazepine administration. Hence, clonazepam was administered to treat paroxysmal openings in these PCA patients with PS. Remission positivity was defined as symptom-free for a consecutive 1 month within 6 months of treatment. The results of treatment in 22 PCA patients with PS were analyzed. A remission positive state was documented in 14.3% of PCA patients managed by reassurance, and in 66.7% of PCA patients treated with clonazepam (p=0.032). Thus, clonazepam may produce positive results in PCA with PS. Future studies by randomized and placebo-controlled trials are needed to confirm the favorable effect of clonazepam in PCA.
Treatment Outcome ; Stress, Psychological/*complications/*drug therapy ; Retrospective Studies ; Male ; Injections, Intravenous ; Humans ; Female ; Clonazepam/*administration & dosage ; Child, Preschool ; Child ; Anticonvulsants/administration & dosage ; Aerophagy/*complications/*prevention & control

BACKGROUND: Accurate staging is important to determine treatment modalities and to predict prognosis for the patients with lung cancer. The simple two-stage system of the Veteran's Administration Lung Cancer study Group has been used for staging of small cell lung cancer(SCLC) because treatment usually consists of chemotherapy with or without radiotherapy. However, this system does not accurately reflect segregation of patients into homogenous prognostic groups. Therefore, a variety of new staging system have been proposed as more intensive treatments including either intensive radiotherapy or surgery enter clinical trials. We evaluate the prognostic importance of TNM staging, which has the advantage of providing a uniform detailed classification of tumor spread, in patients with SCLC. METHODS: The medical records of 166 patients diagnosed with SCLC between January 1989 and December 1996 were reviewed retrospectively. The influence of TNM stage on survival was analyzed in 147 patients, among 166 patients, who had complete TNM staging data. RESULTS: Three patients were classified in stage l /ll, 15 in stage llla, 78 in stage lllb and 48 in stage lV. Survival rate at 1 and 2 years for these patients were as follows stage l/ll, 75% and 37.5% ; stage llla, 46.7% and 25.0% ; stage lllb, 34.3% and 11.3% ; and stage lV, 2.6% and 0%. The 2-year survival rates for 84 patients who received chemotherapy(more than 2 cycles) with or without radiotherapy were as follows stage l/ll, 37.5% ; stage lll, 31.3% ; stage lllb 13.5% ; and stage lV 0%. Overall outcome according to TNM staging was significantly different whether or not received treatment. However, there was no significant difference between stage llla and stage lllb though median survival and 2-year survial rate were higher in stage llla than stage lllb. CONCLUSION: These results suggest that the TNM staging system may be helpful for predicting the prognosis of patients with SCLC.
Classification ; Drug Therapy ; Humans ; Lung ; Lung Neoplasms ; Medical Records ; Neoplasm Staging* ; Prognosis ; Radiotherapy ; Retrospective Studies ; Small Cell Lung Carcinoma* ; Survival Rate

PURPOSE: In recent years there has been a considerable increase in the use of chemotherapy as an adjuvant to surgery, radical radiotherapy and in addition to best supportive care. However, the value of chemotherapy in improving survival is still unclear, despite more than 50 randomised trials addressing this question in the different stages of disease. This study was done to evaluate Korean doctors' personal management preference and their beliefs about prognosis in non-small celllung cancer(NSCLC). MATERIALS AND METHODS: A mail survey of Korean respirologists, thoracic surgeons, radiation oncologists, and medical oncologists was performed. Four cases of NSCLC were described and respondents were asked to give their treatment recommendations and to estimate the prognosis in each case. RESULTS: After a complete resection for stage II NSCLC, 27% recommended no adjuvant treatment, 36% recommended radiotherapy, 18% recommended chemotherapy, and 19% recommended both radiotherapy and chemotherapy. After a complete resection for stage IIIA(N2) NSCLC, the vast majority of respondents recommended adjuvant therapy. For an asymptomatic patient with stage IIIB NSCLC, 5% recommended supportive care, 24% recommended radiotherapy, 16% recommended chemotherapy, and 54% recommended chemotherapy combined with radiotherapy. For a patient with stage IV NSCLC, 76% recommended chemotherapy with or without palliative radiotherapy. Doctors' treatment preference was significantly different by their speciliaty in a case with stage II, IIIA(N2), or IV NSCLC. Most respondents believed that chemotherapy would increase survival in NSCLC. Doctors' beliefs about the efficacy of treatment were strongly associated with their treatment recommendations. CONCLUSION: Korean doctors generally preferred relatively aggressive management although their personal preferences varied widely. Team approach is important in deciding the treatment modality because doctors' treatment preference is different by their speciality.
Carcinoma, Non-Small-Cell Lung* ; Surveys and Questionnaires ; Drug Therapy ; Humans ; Postal Service ; Prognosis ; Radiotherapy

Primary tumors of the heart are uncommon and their incidence in autopsy series ranges from 0.0017 to 0.28 per cent. About 75 per cent of all cardiac tumors are histologically benign and the remainder are malignant. The majority of benign cardiac tumors are myxoma, comprising 30 to 50 per cent of the total cases in most pathological series and the majority of malignant cardiac tumors are sarcoma. But tumors metastatic to the heart are far more common than primary cardiac tumors and actually appear to be increasing in incidence because of prolonged survival of cancer patients. We experienced six cases of cardiac tumors which were diagnosed with echocardiography : 2 hepatocellular carcinoma, 1 malignant melanoma, 1 malignant fibros histiocytoma, 1 lipoma, and 1 myxoma. The mean age of the 3 men and 3 women was 50(range 28 to 71). Two patients with right atrial metastasis from hepatocellular carcinoma and one patient with metastasis from malignant melanoma expired during conservative management. Two benign cardiac tumors(1 lipoma and 1 myxoma) were successfully excised and later follow-up echocardiography showed no signs of tumor recurrence. One patient with biatrial recurrence of malignant histiocytoma was treated medically and expired 4 months later.
Autopsy ; Carcinoma, Hepatocellular ; Echocardiography ; Female ; Follow-Up Studies ; Heart ; Heart Neoplasms ; Histiocytoma ; Humans ; Incidence ; Lipoma ; Male ; Melanoma ; Myxoma ; Neoplasm Metastasis ; Recurrence ; Sarcoma

OBJECTIVES: The purpose of this research was to evaluate the ability of completing death certificates among medical students. METHODS: The self-administered questionnaires were completed, during May to August 2007, by 380 medical students in senior. The questionnaire was composed of 10 cases to write the death certificate. The cause-of-deaths written by students were compared with the gold standards and their errors in the certificates also evaluated. RESULTS: Mean agreement score for 10 underlying cause-of-deaths completed on the lowest line of part I in the death certificate (UC1) was 4.8+/-1.7, and for underlying cause-of-death selected by a coder of the death certificates (UC2) was 5.6+/-1.5. The UC1 and UC2 were significantly higher among the students having the case-oriented education for death certificate than others. For the major errors in the certificates completed by students, the students having the error with no antecedent cause were highest, the error with two or more conditions secondly highest. Mean number of errors was significantly lower in the case-oriented education group than others. CONCLUSIONS: Errors are common in the death certificates completed by medical students in senior. The accuracy of death certification may be more improved with the case-oriented education than the traditional method.
Certification ; Death Certificates ; Education, Medical ; Humans ; Students, Medical ; Surveys and Questionnaires