The Code of Medical Ethics for the Korean Academy of Child and Adolescent Psychiatry: Why Is It Important?

This article provides an overview of the developmental history and rationale of medical ethics to establish the code of ethics and professional conduct of the Korean Academy of Child and Adolescent Psychiatry (KACAP). Most medical professional organizations have their own codes of ethics and conduct because they have continuous responsibility to regulate professional activities and conducts for their members. The Ethics and Award Committee of the KACAP appointed a Task-Force to establish the code of ethics and conduct in 2012. Because bioethics has become global, the Ethics Task Force examined global standards. Global standards in medical ethics and professional conduct adopted by the World Medical Association and the World Psychiatric Association have provided the basic framework for our KACAP's code of ethics and professional conduct. The Code of Ethics of the Americal Academy of Child and Adolescent Psychiatry has provided us additional specific clarifications required for child and adolescent patients. The code of ethics and professional conduct of the KACAP will be helpful to us in ethical clinical practice and will ensure our competence in recognizing ethical violations.

The production of interferon gamma by natural killer (NK) cells and proportion of NK cells in peripheral blood mononuclear cells in patients with severe bronchial asthma / 천식및알레르기

BACKGROUND AND OBJECTIVE: The natural killer (NK) cells which play an important role in defense immune system are supposed to be involved in the pathogenesis of bronchial asthma. The goal of this study is to analyze the role of NK cells in the pathogenesis of bronchial asthma by examining the proportion of NK cells in peripheral blood mononucler cells (PBMCs) and production of interferon gamma (IFN-gamma) in NK cells between normal group and asthmatic group. METHODS: Ten patients with moderate to severe persistent asthma sensitive to house dust mite were enrolled as asthmatic group. PBMCs were activated by 12-0-tetracanoylphorbol-13-acetate (TPA) and calcium inonophore for 18 hours. Surface CD3 and CD56 antigens with intracytoplasmic IFN-gamma staining were performed simultaneously and the results were analyzed by three color flow cytometer. RESULTS: The percentage of CD56+ positive NK cells in PBMCs from asthma group was lower compared to control group (15.4+/-3.9% vs 19.8+/-4.5%). However, There was no signficant difference of IFN-gamma production in CD56+ NK cells between two groups (30.3+/-3.9% vs 25.9+/-5.8%, p>0.05). IFN-gammaproducing CD3+ T cells were significantly higher in asthma group compared with normal control group (36.3+/-1.8% vs 28.4+/-5.7%, p<0.05). The ratio of TNK cells expressing both CD56 and CD3 was not different between asthma group and control group (4.7+/-1.4 % vs 5.9+/-1.8%, p<0.05). CONCLUSION: The results suggest that aggravation of asthma symptoms in severe asthma may be caused partly by decrease in NK cells. The increased production of IFN-gamma in asthma patients suggest that IFN-gammamay function as inflammatory cytokine.

Pulmonary Cavitary Lesions Associated with High Fever / 결핵

No abstract available.

Gradual reperfusion lowers the incidence of reperfusion-induced ventricular fibrillation in a cat model of regional ischemia

Blood flow restoration to ischemic zone of the heart is essential to salvage of ischemic tissue. However, there is a large body of evidence documenting that the reperfusion can induce reperfusion injury like reperfusion-induced malignant arrhythmias. In the present study, employing a cat model of regional cardiac ischemia, we examined if reperfusion rendered in a gradual fashion could lower the incidence of reperfusion-induced ventricular fibrillation (VF), which usually precipitated within a few to several tens of seconds after abrupt reperfusion. The experiments were conducted with male mongrel cats (n=46, 2.5-5 kg). The animals in the control and 30 MIN groups were subjected to an episode of 20- and 30-min left anterior descending coronary artery occlusion, respectively, followed by abrupt reperfusion. The animals in 5 G and 10 G groups received gradual reperfusion over a 5- and 10-min period, respectively, following a 20-min occlusion. The proportion of animals that exhibited VF during the reperfusion phase was 11/15 in the control, 7/10 in the 30 MIN, 5/10 in the 5 G and 2/11 in the 10 G groups. The incidence of VF in the 10 G group was significantly lower than that in the control or 30 MIN group subjected to abrupt reperfusion. These results suggest that the gradual reperfusion is a useful procedure against reperfusion-induced VF.

Hypothermic preconditioning lowers the incidence of hypothermic arrest in neonatal rat

This study was performed to examine 1) Whether hypothermic cardiac arrest produces myocardial HSP72 expression; 2) And if, whether it serves to protect the heart against the subsequent hypothermic arrest. In the present study, neonatal rats were placed in an icebath to induce hypothermia. To determine whether hypothermic cardiac arrest produces myocardial HSP72, experimental animals were subjected to 10-min hypothermic insult before the extraction of the heart. The intervals between the insult and extraction were 1 (1 HR), 4 (4 HR), 8 (8 HR), 24 (24 HR) or 72 (72HR) hours. A minimal amount of HSP72 was detected in control, 1 HR and 72 HR groups. In contrast, 8 HR and 24 HR groups showed a significant level of HSP72 expressions. To assess the cardioprotective effect of HSP72 against hypothermic cardiac arrest, we compared the proportion of recovery from the arrest between control and preconditioned (PREC) animals. Control animals were subjected to 20-min hypothermic insult, while PREC group was preconditioned by 10-min hypothermic insult 8 hours before the 20-min test hypothermic insult. Resuscitation rate from cardiac arrest induced by the 20-min hypothermic insult in PREC group was significantly higher than that in controls. These results suggest that the cardioprotective effect of hypothermic preconditioning is associated with an increase in HSP72 expression.

Airway remodelling of severe bronchial asthma patients according to disease duration / 천식및알레르기

BACKGROUND: Bronchial asthma is classically defined as a reversible obstruction and hypsrresponsiveness of the airway attributed to an inflammatory process. However, some individuals with asthma show an irreversible component of airflow obstruction. It may be associated with structural changes in the airway resulting from severe or long standing air- way inflammation and remodelling. OBJECTIVE: The study was undertaken to compare the clinical characteristics of patient and airway remodelling as shown in bronchial wall thickness in HRCT according to the duration of asthma. MATERIALS AND METHODS: A retrospective clinical study was done on 119 patients with bronchial asthma, who had been admitted to Ewha Womans University Mokdong Hospital. Patients were divided to three groups according to disease duration and, clinical characteristics, pulmonary function test and HRCT were done. RESULTS: Basal FEV, and FVC was significantly lower in patient with longer duration. (p<0. 05) However pulmonary function was improved regardless of disease duration after 2 weeks steroid and bronchodilator therapy, and there was no significant difference in level changes according to the disease duration. The inner diameter of the bronchi and thickness of the bronchial wall at segmental and subsegmental bronchi increased significantly in patient with longer duration of asthma(p<0.05). Conclusion: These findings showed that airway remodelling was more extensive in patients with longer duration of disease resulting in decreased pulmonary function. These facts suggested that early anti-inflammatory therapy would be helpful for prevention of airway remodelling.

Cloning of the hyphantrica cunea nuclear polyhedrosis virus partial EcoRI genome DNA fragments in plasmid vectors pUC8 and pBR322

No abstract available.

Continuous Transsacral Epidural Block in a Patient with Diffuse Idiopathic Skeletal Hyperostosis / 대한마취과학회지

A 79-year-old male patient presented with a continuous transsacral epidural block for the treatment of herpes zoster pain on the right Tll-12 and Ll dermatome levels. However, it was impossible to introduce the Tuohy needle below the subcutaneous tissue. By the C-arm image intensifier, flowing calcifications of the lumbar paravertebral ligaments, except L5-Sl interspace, were observed. Thus, an epidural approach was tried at the L5-Sl interspace, but the Tuohy needle was introduced in the subarachnoid space instead of the epidural space. After an X-ray of the whole spine, diffuse idiopathetic skeletal hyperostosis was diagnosed. The Tuohy needle was introduced into the sacral canal through the second posterior sacral foramen and the epidural catheter was inserted about 15cm in length cephalad through the needle. The pain was controlled by the injection of 1% lidocaine and 0.5% bupivacaine every 3-4 hours continuously After 3 weeks this patient was discharged from hospital without any postherpetic sequelae.

Observations of Arrhythmias by 24 Hour Ambulatory ECG Monitoring in Early Convalescent Phase of Acute Myocardial Infarction

In order to observe the arrhythmia which occured in early convalescent phase of acute myocardial infarction, a 24 hour ambulartory ECG monitiring was performed in 15 patients who is admitted at dept of Int Medicine, Ewha Womans University hospital from Aug. 1985 to Sept. 1986. during 7.5+/-3.4 days after admission. In all cases one or more of the following arrhythmias were observed;atrial premature beat, ventricular premature beat(VPB), transient paroxysmal ventricular thchycardia, atrial fibrillation, sinus arrest and junctional beat. Of 15 cases, 11(77.3%) had VPB's:Simple VPB's in 4 cases(26.7%) and complex VPB's(6.52+/-2.52)(P0.1). In addition, we compaired the arrhythmias in CCU with those of early convalescent phase of acute myocardial infarction. But there was no correlation between them.

Peptic ulcer in childhood

Peptic ulcer disease in children presents an interesting and sometimes difficult problem to the clinicians. Since the incidence is quite small in children, only small collected series have been reported in the literature. With the improvement of diagnostic aids (particularly radiologic equipments and greater attention paid by clinicians, peptic ulcers have been detected with increasing frequency. However, there is a paucity of information available concerning this disease in infancy and childhood in Korea. The symptoms and signs of peptic ulcer disease in childhood are obscure and have many differences from those of tihe adult, which too often go unrecogntzed until complications set in. The authors made on clinical observation on 14 patients with peptic ulcer under the age of 15 years, who had been admitted to the department of pediatrics of National Medical Center from Aug, 1972 to July 1978. The age, sex and seasonal incidences, type and location of ulcer, symptom curation, clinical and laboratory findings, complications and prognosis were analyzed and the data are summerized as follows. 1) The incidence of peptic ulcer in childhood was 0.33% of a total 4221 admissions, and the average number of patients of peptic ulcer per year was 2.3. 2) Among 14 patients, 9 cases (68%) were between 12 and 15 years of age, 4 patients (28%) between 7 and 11, and the majority (93%) were between the ages of 7 and 15. The youngest patients wea 4 year old male. 3) Sex incidence showed that males predominated in a proportion of 13:1. 4) Seasonal incidence was relatively high (inspring) (28.6%) and autumn (42.9%). 5) Three cases (21.5%) had gastric ulcer and 11 cases (78.5%) had duodenal (ulcer, 12 cases were diagnosed as primary type and 2 cases were) thought to be secondary type due to steroid therapy. 6) Duration of symptoms were variable, with the range between 1 week and 3 years. 7) The majority have abdominal pain (100%), vomiting (85.6%) and epigstric tenderness (71.4%), Other symptoms and signs were anemia (42.9%), indigestion (38.5%), melena (38.5%), epigastric pain (28.6%), general weakness (21.5%), weight loss (14.3%) and abdominal rigidity (14.3%). 8) Gastric analysis was performed in 5 patients, 2 of these patients had slight hyperchlorhydria, but 3 cases showed normal results. 9) Complications were found in 4 patients (28.6%). These were perforation (2 cases, 14.3%) and obstruction (2 cases 14.3%). Postoperative condition during hospitalization was excellent. 10) Among the chronic primary ulcer patients (12 cases), ulcer symptoms disappeared in 10 cases with medical treatment such as antacids, tranquilizers and other conservative treatments and within one month after treatments were discharged with improvement.