BACKGROUND: The implementation of health care delivery system(HCDS) in 1989 affected the visit pattern of tertiary care hospital. In this study we analyzed the effect of implementation of HCDS in a university hospital. METHODS: We analyzed the yearbook of a university hospital from 1986 to 1992. The clinical departments were divided into three groups of medical departments, surgical departments with application of HCDS and clinical departments without application of HCDS. RESULTS: The total outpatient visits increased after implementation of HCDS. The new outpatient visits decreased after implementation in the medical departments and surgical departments but re-visit patients increased in all clinical departments. The number of emergent patients increased at year 1889, but decreased in 1990, then little changed. Admission rate via emergency room decreased in surgical departments and clinical departments without application of HCDS. The patient from Pusan in which hospital is located was little changed but patients that from other areas increased. So the proportion of patients from Pusan decreased, and from other regions increased. The visit of patients with self pay decreased, but patients with medical insurance increased. CONCLUSIONS: In spite of increased total outpatient visits, the new outpatient visits and patient visits from near place decreased through implementation of HCDS. The new outpatient visits decreased in the medical departments and surgical departments in clinical departments with application of HCDS, but the new outpatient visits increased in clinical departments without application of HCDS.
Busan ; Delivery of Health Care* ; Emergency Service, Hospital ; Humans ; Insurance ; Outpatients ; Tertiary Healthcare

The authors reviewed serial chest films of 113 patients of spontaneous pneumothorax which were treated byclosed tube thoracotomy during the period from May, 1979 till July, 1982 in CNUH. The resuls are as follows; 1.Male was more frequently affected than female, and the sex ratio was 3.5:1. 2. 71.1 per cent of patients were over31 years of age. 3. Of the 113 cases, 51.3 per cent were on the right, 48.7 per cent on the left. 4. The mostcommon underlying pulmonary disease was pulmonary tuberculosis(39.8), the next was belb or bullar (17.7%), and thelast was pneumonia(8.8%). 5. Pneumothorax was the most common type in pulmonary tuberculosis(66.7%), andpyopneumothorax in pneumonia(80.0%). 6. Among 103 cases in complete re-expansion of collapsed lung after closedthe thoracotomy, 39.5 per cent was expanded completely within 1 week in presence of visceral and/or parietalpleural thickening, and 86.2 per cent in none of it. According to the degree of pneumothorax, the more severedegree of pneumothorax, the more delay in re-expansion times. 7. Most common chest finding after re-expansion ofcollapsed lung was pleural thickening(51.4%).
Female ; Humans ; Lung ; Lung Diseases ; Pneumothorax ; Sex Ratio ; Thoracotomy ; Thorax

Endoscopic ACL reconstruction using bone-patellar tendon-bone has been considered the gold standard in the field of reconstructive ACL surgery. Technically, graft must be placed at isometric point. But it is difficult to evaluate the placement of graft postoperatively. The purpose of this study is to determine the radiological ideal position of graft by comparing postoperative results with the graft placement. Seventy cases of endoscopic ACL reconstruction were reviewed and classified according to the femoral and tibial graft position on radiologic imaging. The femoral graft position was classified in relation to angle of graft on anterior position view and distance from posterior margin of graft to the inner surface of posterior cortex on lateral view. The tibial graft position was classified in relation to intercondylar eminence on anterior posterior view and lateral view. Knee score (modified Marshall, Lysholum), manual anterior instability test (Lachman test, Pivot shift test) and arthrometer measurement were checked to evaluate postoperative results in each case. The results of this study implicate that knee joint in which femoral graft was oriented at direction of 11 o clock centring around 68 degree respect to tibial joint and placed within 3mm from posterior cortex showed higher knee score and lesser laxity. In cases of tibial side, the graft oriented to intercondylar eminence (AP view) and placed anterior to intercondylar eminence (lateral view) showed higher knee score and lesser laxity.
Joints ; Knee ; Knee Joint ; Patellar Ligament* ; Transplants

The radiologic findings of lumbosacral spine and measurement of lumbosacral angle were analysed in 238 with backache and 102 without backache which were visited at Chungnam National University from March 1980 to July 1981.The measurement of lumbosacral angle was based on a method of Fergson. The results obtained were as follows; 1. The age group of 18 to 29 years was most common in backache group and the male was affected more frequently than the female with the ratio of 1.9 to 1. 2. In patients with backache, the overall mean lumbosacral angles were 44.2±2.6 degrees in male and 35.8±2.0 degrees in female. In patients without backache, in control group, the overall mean lumbosacral angles were 32.6±0.7 degrees in male and 33.4±1.4degrees in female. 3. In control group, difference of means between male and female was about 1degrees in patients with backache, the overall mean lumbosacral angles were increased about 12degrees in male and 2degrees in female than control group. In patients with and without backache, no significant difference of lumbosacral angle between the 4 age groups was present. 4. In backache group, increased lordosis was more common and increased lumbosacral angle than the decreased lordosis. 5. In backache group, lumbosacral angle of abnormal radiologic findings in lumbosacral spine was significantly increased than control group. 6. In patients with backache, radiologic findings and its lumboscral angles were alumbosacral anomaly 56 cases (23.5%): 46.9 degrees, increased lumbar lordosis 46 cases (19.2%): 48.1 degrees, osteoarthritis 44 cases(18.5%) : 40.8 degrees, decreased lumbar lordosis 30 cases (12.6%): 29.9 degrees, in order, And these radiologic findings were similar with many other authors.
Animals ; Back Pain ; Chungcheongnam-do ; Female ; Humans ; Lordosis ; Male ; Methods ; Osteoarthritis ; Spine

No abstract available.
Constriction, Pathologic ; Stents

No abstract available.
Factor V Deficiency* ; Factor V*

No Abstract Available.
Humans ; Kidney Failure, Chronic* ; Rupture* ; Tendons*

A relationship between preceding acute paralytic poliomyelitis and the later development of motor neuron disease has only occasionally been suggested since it was first postulated by Charcot in 1875. The authors recently experienced a 20-year-old male who was considered to have postpoliomyelitis muscular atrophy. We report this case in view of its rarity and necessity of differential diagnosis from other neuromuscular disorders. Clinical presentation included slowly progressive muscle wasting of left thigh for 4 years, mild weakness of left arm and both thigh, intermittent fasciculation, and previous history of acute paralytic poliomyelitis. Electromyographic findings showed fibrillation potentials, positive sharp waves, fasciculations, giant motor unit potentials and reduced interference patterns. Muscle biopsy revealed scattered small angulated fibers, individual myofiber degeneration and mild inflammatory cell infiltration.
Arm ; Biopsy ; Diagnosis, Differential ; Fasciculation ; Humans ; Male ; Motor Neuron Disease ; Poliomyelitis ; Postpoliomyelitis Syndrome* ; Thigh ; Young Adult

No abstract available.
Antibodies, Neutralizing* ; Feces* ; Rotavirus*

A new method of urinary diversion via Skinner`s modification of Koch continent ileal reservoir was tried. With this method continence with storage of urine under low pressure is well maintained so that no external applicances are necessary. Ileorenal reflux is also prevented with this nipple forming technique. From May l986 to September l986, 4 patients underwent urinary diversion that included creation of a modified Koch pouch by Skinner. Previous urinary diversion was by ureterocutaneous diversion in 1 patient. A total of 3 patients underwent radical cystectomies for bladder cancer In 1 patient, simultaneous urethrectomy was done because of carcinoma in situ in the urethra. There were no operative mortalities. All patients are continent and without reflux to the upper urinary tract. The volume capacity of pouch is more than 400ml. The pouch is emptied by self-catheterization every 4 to 6 hours during the day and once at night. Postoperative follow-up presently is short and it is impossible to check late complications. Although preliminary, this clinical trial suggests that the quality of life for patients can be improved markedly by the modified Koch continent ileal reservoir.
Carcinoma in Situ ; Colonic Pouches* ; Cystectomy ; Follow-Up Studies ; Humans ; Mortality ; Nipples ; Quality of Life ; Urethra ; Urinary Bladder Neoplasms ; Urinary Diversion ; Urinary Tract