A Social History of Carbon Monoxide Poisoning in Korea in 1960s: from an Accident due to Carelessness to a Social Disease / 의사학

This paper deals with social history of carbon monoxide poisoning in Korea in 1960s. From the mid 1950s, Korean society began to use coal briquettes (Yeontan) for fuel for cooking and heating in the winter, especially in urban area. As the use of coal briquettes replaced fire woods which had been used as fuel in traditional Korean society for centuries, incidence and deaths from carbon monoxide poisoning increased dramatically during the 1960s. The coal briquettes were used to heat the living rooms through "Ondol" arrangement. The coal briquettes at the kitchen place make the heated air and smoke, which pass through the horizontal space under a stone floor of the room and escape through chimney at the opposite site of the kitchen. This Ondol system could make leakage of carbon monoxide easily and thereby kill people who sleep in the room. In the 1960s, carbon monoxide poisoning by briquettes gas was a serious health problem to kill more people than all of the infectious diseases. It was a unique and very serious health hazard in 1960s Korea. No other place in the world has experienced such a high mortality and incidence from the briquettes gas as in Korea. Employing newspaper articles and epidemiological papers, this paper analyzes how the Korean society experienced and perceived carbon monoxide poisoning (CO poisoning) in 1960s. It also follows how the perception changed over time and how the changes affected social responses to CO poisoning. In the early 1960s, the CO poisoning was perceived as an accident due to carelessness of the people who did not fix the leakages of the Ondol system or that of the people who built the Ondol improperly. Mostly CO poisoning was the casualty caused by carelessness and ignorance of the poor class. The prevention measure was mainly education which would enlighten the ignorant so that they care about CO poisoning and their lives. It was the victims who were to be blamed, for they caused the their poisoning with their own carelessness. Since CO poisoning was perceived as preventable with a good care, people were optimistic about the prevention of the CO poisoning. In the late 1960s, however, the perception of CO poisoning changed as the epidemiological studies demonstrated meteorological, social, economical, and cultural factors were related to the poisoning. As CO poisoning was regarded not as an accident due to carelessness but as a social disease, the Korean government began to take various measures for its control including surveillance and punishment, education and certification of those who made Ondol, and funding research for detoxification of the poisoning. In spite of the state's intervention, the number of CO poisoning cases drastically increased every year. At the end of 1960s, in contrast to the optimism of the early 1960s, the outlook of CO poisoning control was grim. It was merely a beginning of huge epidemic of CO poisoning in 1970s and 1980s in Korea.

Cryoablation for Endophytic Renal Cell Carcinoma: Intermediate-Term Oncologic Efficacy and Safety

PURPOSE: To evaluate the efficacy and safety of laparoscopic renal cryoablation (LRC) of small endophytic renal cell carcinoma, for which surgical treatment is technically difficult. MATERIALS AND METHODS: We enrolled patients with endophytic tumors from a prospectively collected database of 45 renal tumors in 39 patients who had undergone LRC from June 2005 to May 2009. An endophytic tumor was defined as less than 40% of the lesion extending off the surface of the kidney. We evaluated surgical and oncological outcomes. RESULTS: Among the treated tumors, 17 tumors (37.8%) were defined as endophytic tumors and 15 tumors from 14 patients were confirmed as renal cell carcinoma (RCC) in the pathologic examination of the tissue biopsy that was conducted at the time of LRC. The mean American Society of Anesthesiologists (ASA) score of the whole patient group was 2.9 (range, 1-4), and 85.7% (12/14) of the patients had an ASA physical status score over 3. The mean tumor size was 2.8 cm (range, 1.7-3.7 cm). The layout of the cryoprobe was carefully planned preoperatively on the basis of radiologic evaluation in all tumors. Multiple cryoprobes (mean, 3.2; range, 2-5) were used. No major complications, including open surgical conversion and nephrectomy due to bleeding, occurred. No patient experienced clinical symptoms of collecting system injuries. During the mean follow-up of 32.6 months (range, 12-51 months), radiologic evidence of tumor recurrence was found in one patient (6.7% for RCC). With the exception of this patient, all other patients have remained free of recurrence or metastasis, as determined by periodic radiologic workups. CONCLUSIONS: In this series of patients with intermediate-term follow-up, LRC for endophytic renal cell carcinoma showed acceptable oncological and surgical outcomes without sequelae in the collecting system.

The Life of Dr. RO Kishun, a Reflection of Modern Korean Medical History of the Borders / 의사학

RO Kishun was born on February 2, 1893 in Ongjin County, Hwanghae Province of Joseon Korea. He graduated from the Medical Training Center, a campus associated with the Joseon Government-General Hospital, in 1915, and from Kyushu Imperial University School of Medicine in 1917. He continued his medical study at the university in 1929, majoring in biochemistry, and earned a doctorate in medicine in 1932. Dr. RO, one of the earliest pioneers in Korean biochemistry, was active in his research, publishing four studies in the Japanese Journal of Biochemistry between 1931 and 1932. After returning from Japan in 1932, Dr. RO opened a medical practice in Mokpo and Busan, port cities situated on the southern tip of Korea. Later in 1936, he moved north to Manchuria (northeast China) to practice medicine at the International Hospital in Mukden (present-day Shenyang). He also served as president of Tumen Public Hospital between 1942 and 1946. When Japan signed unconditional surrender bringing World War II to an end, Dr. RO relocated to Yanbian and began providing medical training to ethnic Koreans. In October 1946, he was appointed dean of the First Branch School of China Medical University in Longjing, and in October 1948 the first dean of Yanbian Medical School, the predecessor of Yanbian University College of Medicine. Dr. RO dedicated his life to medical practice, teaching and training students, and mentoring younger faculty. A brilliant clinician, he also inspired and helped his colleagues with his outstanding ability to diagnose and treat patients. He was one of the founding members of Yanbian University College of Medicine. RO Kishun died on June 7, 1957 at age 64. Ethnic Koreans hailed him as Sinui (literally, the physician of God), and a bronze statue of himself was erected in front of the medical college in 1988. Dr. RO's life brings modern historians' attention to the issue of determining geographical territories and nationality, in that his life unfolded at the borderlands or frontiers of Joseon Korea, China, and Japan, where the history of the three nations met and intermingled with one another. He was a biochemist and researcher, practicing physician and medical professor of the era under Japanese Rule and the one following it. In modern Korean medicine, his life is viewed as a history of the borders, or a transnational legacy going beyond individual history of Korea, China, and Japan.

A Comparison of Outcomes between Transurethral Resection of the Prostate and High Power Potassium-titanyl-phosphate Laser Vaporization of the Prostate / 대한남성과학회지

PURPOSE: Transurethral resection of the prostate (TURP) is the gold standard for the surgical treatment for benign prostatic hyperplasia (BPH), but the procedure's limitations are its invasiveness and the high prevalence of complications. Photoselective vaporization of the prostate (PVP) using an 80w high power potassium-titanyl-phosphate (KTP) laser has recently been developed as a less invasive treatment. We assessed the efficacy of PVP as an alternative to TURP for the treatment of BPH. MATERIALS AND METHODS: The medical records of 324 patients who were surgically treated for BPH from July 2005 to December 2007 were retrospectively reviewed. Among the 324 patients, 190 patients of Group I were treated by TURP and 134 patients of Group II were treated by PVP. Before treatment, assessing the serum PSA level transrectal ultrasound and urodynamic study were done. The primary efficacy parameters were the postoperative international prostatic symptom score and the uroflow parametersat 6 months after the operation. The secondary efficacy parameters were perioperative factors such as the duration of the hospital stay, the operative time and the catheter-indwelling period. Any adverse reactions were monitored. RESULTS: There was no significant difference in the basal characteristics of the study subjects between both the groups. The primary efficacy parameters, the IPSS, the Qmax and thepostvoid residual urine volume were significantly improved in both groups, but there were no significant differences between both the groups. In group II, the perioperative parameters such as the operation time, the hospitalization day and the catheter-indwelling periodwere significantly shorter than those of group I (p<0.05). But the urethral complications such as urethral stricture, dysuria and bladder neck contracture were more common in group II. CONCLUSIONS: These results suggest that PVP using an 80w high power KTP could be an alternative for TURP in terms of efficacy. For the general, safe use of PVP, PVP should be carefully done until the causes of the urethral complications of PVP are determined.

The Efficacy of a Combination of Phosphodiesterase Type 5 Inhibitor and Testosterone Replacement Therapy in Nonresponders to Phosphodiesterase Type 5 Inhibitor Mono-therapy / 대한남성과학회지

PURPOSE: The aim of this study was to evaluate the efficacy of a combination therapy with PDE5 inhibitor and testosterone replacement therapy in erectile dysfunction patients with testosterone deficiency syndrome (TDS) after failure of PDE5 inhibitor mono-therapy. MATERIALS AND METHODS: From March 2004 to July 2008, we evaluated 38 men (aged 38 to 69 years) who showed no response to PDE5 inhibitor therapy at the maximal recommended dose and they had testosterone levels less than 350ng/dL. Testosterone replacement therapy (TRT) was subsequently started with injectable testosterone undecanoate (NEBIDO(R)) or transdermal testosterone (Testogel(R)) in those patients. They received TRT during an 18-week period. After 14 weeks of TRT alone, PDE5 inhibitor was added to the TRT for an additional 4 weeks. After treatment, we evaluated the patients' sexual function, which was primarily based on the International Index of Erectile Function (IIEF), and the serum testosterone levels. RESULTS: All patients showed elevated serum testosterone levels after TRT (range: 212 to 662ng/dl, mean level: 362.19 ng/dl). At week 18, almost all of the men reported improved potency with combination therapy. After treatment, the mean total IIEF score and each sub-domain score were increased significantly compared to the baseline score. CONCLUSIONS: Testosterone replacement therapy combined with PDE5 inhibitor may be beneficial in improving the erectile function in testosterone deficiency syndrome patients with erectile dysfunction and who are unresponsive to PDE5 inhibitor alone.

A Case of Herpes Zoster with Generalized Varicella like Eruption / 대한피부과학회지

Generalized varicella-like eruption occurs in 2 to 10 percent of unselected patients with localized zoster, the majority of whom are patients with immunologic defects due to underlying malignanies (particularly rnalignancy of hematopoietic system) or immunosuppressive therapy. A 25-year old male noted onset of pain and burning sensation on the right side of cheet nine days prior to admission. The following day multiple vesicles were noted on right side of the chest. Three day before the admisson erythernatous maculopapules were noted on the abdomen. One day prior to admission vesicular lesions appeared over the entire hody. The patient was treated with topical application of calamin lotion, and with kanamycin and Cephalexin to prevent secondary infection. The secondary vesicles had disappeared by the fifth hospital day, but the initial lesion had not improved. On the fifteenth hosptital day the initia1 lesions has disappeared.

Hyperkeratosis of the Nipples Developed during Pregnancy: report of a case / 대한피부과학회지

Hyperkeratosis of the nipple and areola is rare dermatosis that may be divided into three categories: a type of epidermal nevus, a type associated with ichthyosis and a type of nevoid form seen in voung women. A 23-year-old woman was seen for skin lesion involving both nipples. These changes were first noted when the patient was in the sixth month of gestation. Physical examinations revealed papillomatous thickening of both nipples with brownish black discoloration. Histopathological changes were mild hyperkeratosis, keratotic plugging and telangiectasia. It was interesting to note that the skin lesions disappeared spontaneously 7 days after parturition without treatment. A possible correlation between pregnancy and acquired form of this rare skin disorder is suggested.