Criminal liability of medical professionals

The Medical Service Act and many other laws regulate the actions of medical professionals. Receiving rebates from pharmaceutical companies has been criticized as unethical but not punished until 2011. However, it is now strongly forbidden. Unlicensed acts of medical care, which include providing medical care beyond the scope of the license or giving directions to an unlicensed person to practice medical care, are strictly punished even in the case of licensed medical professionals. It recently became an issue whether a doctor who wrote prescriptions to patients after examining them over the telephone violated the Medical Service Act. In addition, it is necessary to pay special attention to the administration of propofol since it recently became a major controversy. Furthermore, public health doctors are legally forbidden to work outside of a public health institution. The number of regulations on the medical industry is increasing every day. New laws usually toughen up punishment for those violating regulations. There is a legal maxim that says, "Ignorance of law excuses no one." Therefore, it is necessary for medical professionals to steadily study and become familiar with applicable laws and related criminal cases to prevent themselves from becoming criminally liable.

The Effects of Extracorporeal Shock Wave Therapy on Spasticity in Chronic Stroke Patients

OBJECTIVE: To evaluate the immediate and short term effects of extracorporeal shock wave therapy (ESWT) on elbow flexor spasticity after stroke, to compare the treatment effects according to the ESWT applied site (muscle group and musculotendinous junction group) and to assess the factors affecting the treatment effect. METHOD: A total of 32 stroke patients were enrolled, 23 of them were ESWT group and 9 were control group. ESWT was applied 1 session/week, total 3 sessions and 12 patients were applied at biceps muscle belly and 11 patients were applied at biceps musculotendinosus junction. Patients were evaluated using modified Ashworth scale (MAS), modified Tardieu scale (MTS), Korean-modified Barthel index (K-MBI) at baseline, immediately, 1 week and 4 weeks after ESWT. RESULTS: MAS and MTS were significantly improved immediately after ESWT, but were not significantly changed at 1 week, 4 weeks in ESWT group. The scores of K-MBI improved but were not different between ESWT group and control group. The treatment effect was greater in musculotendinous junction group than muscle belly group in MTS and MAS immediately after ESWT. We could not find out any significant factors affecting the effects of ESWT. CONCLUSION: Spasticity after chronic stroke improved immediately after ESWT, but was not changed significantly at 1 week and 4 weeks after ESWT. Further studies about ESWT parameters for spasticity and factors affecting treatment effect are needed.

Comparison on Treatment Effects of Pharmaceutic Agents for Trigger Point Injection

OBJECTIVE: To compare the effect of pharmaceutic agents which were used in trigger point injection and to establish a relationship between ultrasonographic change in injected muscle and post-injection soreness by a double blinded study. METHOD: Twenty-seven patients who were diagnosed as myofascial pain syndrome with their trigger point in upper trapezius muscle were recruited. They were assigned to four groups by age and sex: lidocaine injection (n=8), normal saline injection (n=6), 20%dextrose injection (n=6), and BTX-A injection (n=7). One physiatrist palpated a trigger point at upper trapezius muscle and injected blinded agents with same volume (1 ml). Ultrasonography for injected muscle was done by 2 weeks after injection. Visual analog scale was evaluated up to twenty three weeks. RESULTS: Mean score of visual analog scale was decreased in all groups. Among the four agents, 0.5% lidocaine and BTX-A showed significant decrement in visual analog scale (p<0.05). Ultrasonographic depth of muscle was increased in BTX-A and 20% dextrose injected group at the end of injection (p<0.05). There were no significant different treatment effect in four pharmaceutic agents. CONCLUSION: In all four groups, trigger point injection showed therapeutic effect for myofascial pain syndrome. Among the four agents, 0.5% lidocaine and BTX-A could reduce pain significantly up to twenty three weeks. Mechanical pressure on muscle fiber was thought to be one of the causes of post-injection soreness.

A Case of Multifocal Pyomyositis by Staphylococcus aureus / 감염과화학요법

Pyomyositis, the suppurative infection of skeletal muscle, is rarely found in areas of temperate climates unless the patients have immune suppressing conditions such as diabetes, human immunodeficiency viral infection, or chemotherapy. Most reported pyomyositis cases in Korea showed localized involvement in only one or two muscles. Previously, no case of pyomyositis with multifocal metastatic dissemination has been reported in Korea. This case of pyomyositis in 51 year old man involved multiple muscles including the chest wall muscles, abdominal muscles and pelvic muscles. Pus culture results revealed Staphylococcus aureus as the causative organism. Delayed diagnosis and prior treatment of two months before visiting our hospital were considered as the causes for the metastatic dissemination of the organism. After 1 month of treatment with aggressive surgical drainage and intravenous cefazolin the patient fully recovered.

A Case of Multifocal Pyomyositis by Staphylococcus aureus / 감염과화학요법

Pyomyositis, the suppurative infection of skeletal muscle, is rarely found in areas of temperate climates unless the patients have immune suppressing conditions such as diabetes, human immunodeficiency viral infection, or chemotherapy. Most reported pyomyositis cases in Korea showed localized involvement in only one or two muscles. Previously, no case of pyomyositis with multifocal metastatic dissemination has been reported in Korea. This case of pyomyositis in 51 year old man involved multiple muscles including the chest wall muscles, abdominal muscles and pelvic muscles. Pus culture results revealed Staphylococcus aureus as the causative organism. Delayed diagnosis and prior treatment of two months before visiting our hospital were considered as the causes for the metastatic dissemination of the organism. After 1 month of treatment with aggressive surgical drainage and intravenous cefazolin the patient fully recovered.

A Case of Acute Ischemic Enteritis Caused by Polyarteritis Nodosa / 대한소화기내시경학회지

Polyarteritis nodosa is a systemic necrotizing vasculitis of the small- and medium-sized arteries with gastrointestinal involvement in more than 50% of cases at some time during the course of the disease. The gastrointestinal manifestations can be diverse and include abdominal pain, nausea and vomiting, ulceration, hemorrhage, occlusion and perforation. Gut involvement is a serious prognostic factor. A 65-year-old man was referred to our department suffering from epigastric pain. A push enteroscopy revealed ischemic enteritis at the proximal small bowel and the CT scan showed a large dilation of the small bowel. His condition deteriorated rapidly and an exploratory laparotomy and total resection of the small bowel was performed. We report a rare case in which the push enteroscopy revealed acute ischemic enteritis of the small bowel and where the pathology specimen showed transmural necrosis of the involved small bowel due to vessel occlusion caused by polyarteritis nodosa.

The Role of the Epidemiological Causality of the Association between Smoking and Lung Cancer / 한국역학회지

It is generally accepted that acknowledgment of the causality of the association between smoking and lung cancer plays a crucial role in imposing liability on tobacco manufacturers in tobacco-related cases. However, acknowledgment of the epidemiological causality of the association is merely a precondition to putting liability on tobacco manufacturers; it does not play a crucial role. Smokers smoke manufactured tobacco by their right to choose according to their self-decision; therefore, it is not reasonable to place all liability concerning lung cancer on tobacco manufacturers. This paper studies the dual structure of the causality of the association between tobacco manufacturing and smoking as well as smoking and lung cancer. It can be understood that tobacco manufacturers must be held liable for lung cancer caused by smoking when there was intentional concealment or insufficient provision of information on the harmfulness of tobacco and the addictiveness of nicotine. The epidemiological causality of the association is the minimum scientific and legal precondition to placing liability on tobacco manufacturers for lung cancer caused by smoking. However, striving for protection and promotion of national health by, for instance, promoting antismoking programs, the epidemiological causality of the association adequately plays a social role when viewed from a public health perspective.

Effect of Rhythmic Stimulation of Music on Hemiplegic Gait

OBJECTIVE: We used music as a rhythmic cue in gait training of patients with hemiplegia and analysed its effect on gait parameters. METHOD: Twenty hemiplegic patients were included in the study. Gait cycle, foot contact area, and center of pressure pathway were measured by F-scan with and without music. Four subjects were followed after 3 weeks of gait training using rhythmic cue with music. RESULTS: 1) In involved limb, stance phase was slightly increased from 65.8+/-9.9% to 67.8+/-7.9%, and single limb support was changed from 17.1+/-6.3% to 17.2+/-6.2%, without statistical significance. 2) Stance and swing symmetry was slightly increased from 0.77+/-0.13 and 0.52+/-0.21 to 0.83+/-0.09 and 0.54+/-0.16 respectively, without statistical significance. 3) Foot contact area and anteroposterior distance of center of pressure were not changed significantly. 4) All 4 subjects who were followed after 3 weeks showed increased single limb support of involved limb (from 14.5% to 18.8%) and swing symmetry (from 0.47 to 0.67). CONCLUSION: Though it was not proved to be effective for every hemiplegics, use of rhythmic cue with music in gait training may be helpful in some patients. Further study is needed to confirm these results.

A study on the expression of glycosaminoglycans in the experimental tooth movement of rat and in cultured periodontal ligament cells / 대한치과교정학회지

The purpose of this study was to evaluate 1) in vivo, the expression of chondroitin 4-sulfate (CH-4S), a structural element of glycosaminoglycans(GAGs), in periodontal tissue during the experimental movement of rat incisors, by labelled streptavidine biotin immunohistochemical staining for CH-4S, 2) In vitro, the expression of CH-4S in cultured human periodontal ligament(PDL) cells supplemented with 10ng/ml of TGF-beta1, 20ng/ml of PDGF-BB, 1ng/ml TNF-alpha, or 1microgram/ml LPS by western blot analysis. The results of this study were as follows : 1. The expression of CH-4S was stronger in pulp, PDL, osteoblasts, osteoclasts and osteocytes in experimental group than in control group, but was rare in dentin, and cementum of experimental groups, regardless of the duration of force application, which was not different from that of control group. 2. In experimental group, the expression of CH-4S in pulp began to increase at 1 day after force application and got to the highest degree at 7 days. After 14 days, the expression in CH-4S immunoreactivity was decreased, and became similar to that of control group at 28 days. 3. The expression of CH-4S in PDL was noted in adjacent to alveolar bone. PDL showed higher intensity of immunolabelling after 1 day of orthodontic tooth movement. And the expression was more stronger in the tension side than that of pressure side of PDL at 1 day, but more stronger in the pressure side than that of tension side of PDL at 4 days. After 7 days, a decrease in CH-4S expression was observed. 4. The expression of CH-4S in alveolar bone got to the highest degree at 4 days, and At 7 days, a decrease in CH-4S expression was observed. 5. PDGF-BB notably raised the expression of CH-4S in the PDL cells at 3 days of cultivation 6. The expression of CH-4S of PDL cells was decreased with the application of TNF-alpha at 1 day. 7. Admixture of TGF-beta1 and PDGF-BB got more expression of CH-4S in PDL as compared to only TGF-beta1 or PDGF-BB. A similar decrease of the expression of CH-4S was observed in the case of application of LPS or TNF-alpha.

MR Cholangiography: Usefulness in Obstructive Jaundice

PURPOSE: Three-dimensional(3D) magnetic resonance(MR) projection imaging was evaluated as a noninvasive alternative to direct cholangiography for the assessment of its reliability in patients with obsructive jaundice. METHODS AND MATERIALS: A heavily T2-weighted gradient-echo sequence(PSIF) was used for 3D MR projecion imaging of the biliary system in five healthy volunteers and 25 patients with obstructive jaundice. The 3D images of the bile ducts were formed by stacking consecutive coronal MR images obtained with a fast imaging method to a maximum-intensity projection algorithm. RESULTS: In the volunteers, MR cholangiography could demonstrate the anatomy of the biliary tract in only two subjects. The extrahepatic and intraheparic bile ducts were well visualized in 23 patients with obstructive jaundice. The leve of obstruction and the grade of dilatation were dipicted with MR cholangiography in all cases. And the cause of obstruction could be determined with MR cholangiography in 18 cases, MR cholangiography was successful in two patients in whom ERCP failed. The gallbladder or dilated pancreatic duct not demonstrated by means of direct cholangiography was demonstrated with MR cholangiography in six cases.

Reduction of Intussusception by Air Insufflation in Children: Recent Three-year Experience

PURPOSE: This study was conducted to evaluate success and perforation rates of pneumatic reduction and to find the predictors of reduction failure. METHODS AND MATERIALS: We reviewed 224 cases of pediatric intussusception diagnosed by air-enema between July, 1989 and June, 1992. The mean age was 9.8 months(range, 1 month to 3 years). Logistic regression analysis was used to find predictors of reduction failure. RESULTS: Successful reduction was achieved in 197 cases(87.9% of success rate). Bowel perforation occurred in two cases(0.9% of perforation rate). There were two statistically significant predictors of failure;(1) ileoileocolic intussusception(p<.001), (2) long duration of symptom(p<.001). Surgery was performed in 26 cases (11.6%), of which seven required bowel resection. CONCLUSION: Pneumatic reduction is a useful means in the management of pediatric intussusception with a high success rate and no mortality.

Image-Guided Percutaneous Biopsies with a Biopsy Gun

PURPOSE:We report the results of image-guided percutaneous biopsies with a biopsy gun and evaluate the clinical usefullness. MATERIALS AND METHODS: One hundred and five biopsies under ultrasonographic or fiuoroscopic guidance were performed. Various anatomic sites were targeted (liver;50, chest;22, kidney;12, pancreas;8, intraperitoneum;7, retroperitoneum; ). RESULTS:Obtained tissue was diagnostic in 98 of the 105 biopsies(93%). In each instance, representative core tissue specimens were obtained. Evaluation of the core tissue by pathologist revealed consistent, uniform specimens that contained significant crush artifact in no case. Five biopsies yielded inadeguate tissues which were too small for histopathologic interpretation or were composed of necrotic debris. Two biopsies yielded adequate tissues, but tissues were not of the target. The diagnoses were malignancy in 77 biopsies and benign disease in 21 biopsies. No complications other than mild, localized discomfort were encountered except a transient hemoptysis and pneumothorax which was observed in two patients. CONCLUSION:Cutting biopsy with a biopsy gun provided sufficient amount of target tissue for an accurate diagnosis of malignant and benign disease. It was a safe and useful procedure for percutaneous biopsy.

Radiological evaluation of vasculo-Behcet's disease

In order to study the vascular manifestation of Behcet's disease, authors analized retrospectively the radiological and clinical features of 22 patients who were diagnosed as vasculo-Behcet's disease. The angiographic findings were aneurysm formation and occlusion of artery and vein, Aneurysm formations were found at common carotid artery (3 cases), abdominal aorta (2 cases), aortic arch (2 cases), innominate artery (2 cases) etc. Arterial occlusions were found at pulmonary artery (2 cases), subclavian artery (1 cases), brachial artery (1 case), common femoral artery (1 case) etc. Venous occlusions were found at the veins of the lower extremities including superficial femoral vein (18 cases), IVC (2 cases), SVC (1 case), and lateral sinus (1 case). The clinical features were similar to that of Behcet's disease without vascular involvement, but incidence of vascular involvement was more common in men and interval between the onset of the disease and vascular symptoms was 1-16 years(77%) and common associated symptoms were oral ulcers(59%) and skin lesions(55%). Angiographically the morphological featured of vasculo-Behcet's disease are not specific, but vascular radiologist must be aware of vascular involvement by Behcet's disease in differential diagnosis when occlusive changes in the venous or arterial tree, or aneurysm formation are seen in young patients.

MR angiography of the renal arteries

We reviewed MR angiograms to evaluate its efficacy for visualizing the renal arteries and detecting renovascular disease. 41 renal arteries in 19 patients were examined by MR angiography. 3-D time-of-flight technique was used as routine examination method for MR angiography and 2-D time-of-flight technique was added in some particular cases to visualize venous flow. Within two weeks after MR angiography was performed, 23 renal arteries in 10 patients were additionally examined by conventional angiography or intraarterial DSA. The success rates of vessel visualization on MR angiography in normal renal arteries were 100% in main 67.7% in segmental, and 11.8% in intrarenal arteries. As a result of comparative study in normal main renal arteries with MR angiograms and conventional angiograms, overall correspondence in the number and the shape was noted and the caliber discrepancy between two examination did not exceed 3.0 mm. one arteriovenous fistula with aneurysm, one stenotic artery and two occluded arteries were well evaluated One arteriovenous fistula with aneurysm, and two occluded arteries were well evaluated by MR angiography. However three stenotic lesions were misdiagnosed as occlusions on MR angiography. and the overall accuracy was 87%. We conclude that MR angiography has the potential to be a noninvasive and useful screening method for determining the number of renal arteries and for detection of abnormalities of main renal arteries.

MR findings of failed back surgery syndrome

Recurrent disc herniation and postoperative fibrosis are the main disease entities causing failed back surgery syndrome (FBSS) and magnetic resonance (MR) imaging has become a major diagnostic modality in differentiating the two. To observe the variable entities of FBSS and their MR findings, we retrospectively analyzed 15 MR images in 12 patients. The causes of FBSS were as follows; normal (no organic cause), fibrosis, new or recurrent disc herniation, discitis, osteomyelitis, inflammation at operation site, epidural abscess, arachnoiditis, and hematoma. Except a case of hematoma, gadolinium enhancement scan was necessary and informative in the diagnosis of FBSS and MR imaging only was not enough in the diagnosis of arachnoiditis.

Diagnosis and follow-up of a case of nutcracker syndrome with MR angiography

A case of nutcracker syndrome which was initially diagnosed by magnetic resonance angiography (MRA) is reported. On preoperative MRA in an 18-year-old male patient with gross hematuria, left renal vein was obliterated at the level of superior mesenteric artery and there was no connection with inferior vena cava. The follow-up MRA after surgical correction with external prosthesis demonstrated entire course of left renal vein without evidence of obstruction which might suggest a possible usage of MRA for a non-invasive diagnosis of nutcracker syndrome.

Diagnosis and follow-up of a case of nutcracker syndrome with MR angiography

A case of nutcracker syndrome which was initially diagnosed by magnetic resonance angiography (MRA) is reported. On preoperative MRA in an 18-year-old male patient with gross hematuria, left renal vein was obliterated at the level of superior mesenteric artery and there was no connection with inferior vena cava. The follow-up MRA after surgical correction with external prosthesis demonstrated entire course of left renal vein without evidence of obstruction which might suggest a possible usage of MRA for a non-invasive diagnosis of nutcracker syndrome.

Sonographic characterization of tenosynovitis

Tenosynovitis of the extremities is not uncommon but its diagnosis is not easy owing to its non-specific clinical manifestation. Thus it was beyond the field of imaging diagnosis so far. Recently the development of high resolution ultrasonogram has aided preoperative imaging diagnosis of tenosynovitis. The authors performed a retrospective review of 27 patients who had ultrasonography due to tendon pathology(including 18 tenosynovites) by oserving sonographic finding and evaluation the diagnostic value of each finding. The overall diagnostic accuracy was 81.1% and common sonographic findings were focal swelling of the tendon. well-defined margin of the lesion, preserved fibrillar pattern, echo change of the lesion site and fluid collection. Above al,. fluid collection was the only statistically significant criterion for diagnosis of tenosynovitis (p<0.05). But its sensitivity was as low as 50%. In conclusion the ultrasonography is useful in diagnosis of tenosynovitis and fluid collection is of diagnostic value, but the differentiation between nodular tenosynovitis without fluid collection and other benign tumor is still beyond the scope of ultrasonographic diagnosis.

Intratemporal facial nerve neuromas and their mimics; CT and MR findings

CT and MR findings of nine cases with intratemporal facial nerve nouromas were described and compared with CT findings of 3 cases with facial nerve palsy and facial nerve canal erosion which may mimic facial nerve neuroma. The tympanic segment of the facial nerve was involved in 8 cases, mastoid segment in 7 cases and labyrinthine segment in 5 cases. The lesions were easily diagnosed with high resolution CT with bone algorythms by showing the expansion of bony structures along the course of the facial nerves. In 4 cases with large vertical segment tumors. Extensive destruction of mastoid air cells and external auditory canals posed difficulty in making a diagnosis. Two out of 5 cases with labyrinthine segment imvolvement were presented as middle cranial fossa masses. MRI with enhancement was performed in 4 cases and was useful in characterizing the lesion as a tumor with its superior sensitivity to enhancement. Three cases of facial neuroma-mimicking lesion including post-inflammatory perineural thickening. Perineural extension from parotid adenoidcystic carcinoma, and congenita: cholesteatoma showed irrgular erosion or mild expansion of the facial nerve canal which may be helpful for differential diagnosis from neuromas.

CT findings of bronchioloalveolar carcinoma: correlation with pathology

No abstract available in English.