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의약분업 시행 후 피부과 외래 환자의 의료이용 행태에 관한 후향적 임상역학 연구
김재왕 ( Jae Wang Kim ),이일환 ( Il Hwan Lee ),김순택 ( Soon Taek Kim ),김충철 ( Choong Chul Kim ),송동훈 ( Dong Hoon Song ),김경진 ( Kyung Jin Kim ),전인기 ( Inn Ki Chun ),김준협 ( Jun Hyeob Kim ),양준성 ( Joon Seong Yang ),이민 대한피부과학회 2003 대한피부과학회지 Vol.41 No.6
N/A Background : Despite 2 years` separation of dispensary from medical prartice since year of 2000, many outpatients in Korea have a lack of understanding this separation. In addition, the illegalpractices of pharmacists such as medical examination have contributed to the recent problematic situation. Objective : We performed this study to evaluate the actual situation of the separation of dispensary from medical practice in the dermatologic field. Methods : The clinico-epidemiologic analysis of 17 months` data of 18,230 outpatients was conducted through the available medical records and serial questionnaires. Results : 1. The medical or non-medical institutions that 18,230 outpatients with skin diseases had chosen at first, were as follows by the order of frequency; pharmacy(78.5%), folk remedies or self-medication(9.8%), dermatologic institutions(5.5%), non-dermatologic medical clinics(3.4%), herb clinics(2.8%). Accordingly, most(94.5%, 17,223) of the new patients did not select a dermatologic institution for the care of their skin diseases. 2. The patterns of health care utilization of the patients mostly(72.9%) showed a fixed tendency to visit the one particular institution or formula continuously prior to final visit to the research hospitals. Most of the patients(62.8%) firstly visited a pharmacy for their disease care and did not revisit another institution. 3. Since the first visit to a pharmacy, 9.6% of the patients repetitively utilized one or more herb clinic(s) or folk remedies in addition to one or more medical institution(s). 4. The patients utilizing non-dermatology measures for skin disease care at first, were mostly in their fifties(25.3%). The patients seeking herb medicine or non-dermatologic medical clinics, were in their teens(27.3% and 24.3% , respectively). 5. Of the cases misdiagnosed as another disease or aggravated in the patients choosing non-dermatologic care, fungal infections are most common(24.0%). 6. In front of 97.1% of the patients seeking pharmacy at first, the pharmacists practiced medicine like a physician in a wrong way instead of dispensing a prescription. Conclusion : In Korea, the majority of dermatologic clinics has been deprived of a position as an institution for primary care of skin diseases. It is imperative that dermatologists should be granted independent and unconstrained authority in the medical profession for the benefit of their patients. (Korean J Dermatol 2003;41(6) : 740~753)
Merkel 세포암양 조직 소견을 동반한 전이성 소형 신경내분비 세포암
김재왕 ( Jae Wang Kim ),김순택 ( Soon Taek Kim ),김상석 ( Sang Seok Kim ),이종주 ( Chong Ju Lee ) 대한피부과학회 2003 대한피부과학회지 Vol.41 No.6
Metastatic small cell neuroendocrine carcinomas(MSCNC) from distant sites, such as the lung, are high grade tumors with poor prognosis. Histopathologically, it is difficult to distinguish between MSCNC and Merkel cell carcinoma solely on the basis of histologic morphology, electron microscopy, and immunohistochemistry. In recent years, differential expression of cytokeratin(CK) 20 and thyroid transcription factor(TTF)-1 has been proposed as useful distinguishing features. It must be emphasized that clinical correlation(e.g. symptomatology, chest X-ray) and a combination of CK 20 and TTF-1 markers, are essential to differentiate these two disease entities. We herein present a case of MSCNC of the lung that might be misdiagnosed as Merkel cell carcinoma. (Korean J Dermatol 2003;41(6) : 714~779)
Dapsone에 의해 유발된 Stevens-Johnson 증후군
김재왕 ( Jae Wang Kim ) 대한피부과학회 2011 대한피부과학회지 Vol.49 No.3
Dapsone (4,4`-diaminodiphenylsulfone) has been widely used in the treatment of leprosy and for a variety of dermatoses. It rarely may result in unpredictable fatal effects such as agranulocytosis, dapsone syndrome, fulminant hepatitis or Stevens-Johnson syndrome (SJS). SJS is a life-threatening, acute hypersensitivity reaction to drugs characterized by atypical targetoid lesions, confluent erythematous purpuric macules and mucocutaneous blisterings. More than 100 medications have been implicated in the pathogenesis of SJS. To the best of our knowledge, there have been only a few reports in the literature of SJS caused by dapsone. Herein we present two cases of SJS that were likely induced by administration of dapsone. (Korean J Dermatol 2011;49(3):255∼259)
김재왕 ( Jae Wang Kim ),남상호 ( Kwang Joong Kim ),김광중 ( Chong Joo Lee ),이종주 대한피부과학회 1998 대한피부과학회지 Vol.36 No.5
Herein we report a case of subungual osteochondroma in a male patient. Although there have been several reports about cases of subungual exostosis in Korea, a case of subungual osteochondroma had not been reported until now. Osteochcndromas are clearly different disease entities from exastosis in that they have diagnostic hyaline cartilaginous caps instead of the fibrocartilages in subungual exostosis. Additioaally, subungual osteochondroma is a very rare type having an incidence rate of less than 1% among all osteochondromas. Our patient was an 18-year-old male with a solitary woody mass on his right great toe that was painfuL A surgical excisional biopsy following a nail plate avulsion showed the characteristic hyaline cattilaginous caps enclosing bony trabecula connected with the inferior cortical bone. (Korean J Dermatol 1998;36(5): 906-909)
김재왕 ( Jae Wang Kim ),김광중 ( Kwang Joong Kim ),이종주 ( Chong Ju Lee ) 대한피부과학회 1998 대한피부과학회지 Vol.36 No.3
We herein report a case of Spitz nevus which occurred in a 6-year-old girl with acute lymphocytic leukemia. The lesion was a well delimited, symmetric, 1.0 * 1.0cm sized, dome-shaped light pinkish nodule with a shiny surface on her forehead. The histopathological findings of the excisional biopsy specimen revealed mild epidermal hyperplasia ; numerous uniform nests of spindle cells and epitheloid cells with sparce pigmentation along the dermoepidermal junction; colloid body-like eosinophilic globules ; multinucleated giant nevus cells in the epidermis and edema in the upper dermis. Since the complete excision of her lesion was accomplished, there have been no new lesions over the past year. (Korean J Dermatol 1998;36(3) - 487-492)
김재왕 ( Jae Wang Kim ),김광중 ( Kwang Joong Kim ),김종민 ( Chong Min Kim ) 대한피부과학회 1998 대한피부과학회지 Vol.36 No.1
We report herein two cases of leukemia cutis. One case is a 54-year-old woman who came to our department with complaints of a solitary ulcerating nodule on her left leg that had been present for 2 months since prior to her visit. Through histopathological studies, the diagnosis of myelocytic leukemia cutis was made before the final diagnosis of acute myelocytic leukemia was made by hematological studies. When combined chemotherapy was finished, she was in a partial remission state and the nodule disappeared after 1 month of chemotherapy. The other case is a 77-year-old man having multiple infiltrative nodules on the right forearm and right thigh for 1 month prior his visit. He was diagnosed as having leukemia cutis for his skin lesions histopathologically. This was redefined as chronic myelomonocytic leukemia of the myelodysplastic syndrome with blastic transfor- mation by hematological examination. He developed septicemia and died 3 weeks after the dermato- logical diagnosis. (Korean J Dermatol '1998;36(1): 133-138)