After medical insurance came into effect in Korea, health care system has undergone tremendous changes. Changing patterns of newly established clinics is one of them. To investigate changes and trends, a total of 10,184 clinics which were newly established from 1981 to 1990 were analysed. Data were obtained from the file of contracting medical facilities of the Federation of Medical Insurance Societies. The proportion of newly establishied clinics has increased gradually, so that they amount to 13% of the total medical facilities in Korea. Meanwhile, the number of newly established medium-size hospitals and general hospitals have decreased. The number of newly established clinics per 100, 000 populations has increased in the all areas, but the rate of increase has decreased in the cities except in 6 major cities in 1990. The rate of increase in newly established clinics surpasses that of population increase. This study has identified the trend of young physicians' early driving into their solo medical practice than before. This indicates chance of the medical specialty training nowadays toughen due to the limited openings in residency programs. However, the sex ratio of physicians at newly established clinics has not changed. The decreasing tendency to open medical practice without beds and the increasing size of clinics are found in this study(The size has been measured in terms of medical manpower, of beds, and of medical equipment in this study). Two thirds of general practitioners have opened their clinics without beds, although such trend has been less in the case of specialists. All three indicators show increasing size, especially in the case of rural clinics. However, among them, the number of medical equipments has increased most significantly from 8.9 items in 1981 to 12.9 in 1990.
Delivery of Health Care ; General Practitioners ; Hospitals, General ; Humans ; Insurance ; Internship and Residency ; Korea* ; Sex Ratio ; Specialization

No abstract available.
Disseminated Intravascular Coagulation* ; Heparin*

No abstract available.
Gastrin-Secreting Cells* ; Gastrins* ; Gastrointestinal Tract*

Recent advances in stent technology have allowed the introduction of more flexible stents that may be tracked more easily in the intracranial vessels. We present a patient with improved cerebral perfusion as assessed by single-photon emission computed tomographic(SPECT) scan after stent-assisted angioplasty for symptomatic middle cerebral artery stenosis. A 72-year-old man presented with multiple episodes of transient verbral disturbance and right-sided motor weakness for 5 months despite treatment with aspirin and clopedigrel. Angiography revealed a 50% to 60% stenosis of the left middle cerebral artery. 99m Tc-exametazime-SPECT scan demonstrated decreased cerebral blood flow in the left cerebral hemisphere, particularly in the left middle cerebral artery territory. The patient was recommended a stent-assisted angioplasty for middle cerebral artery stenosis. The patient underwent uncomplicated stenting with S-660 2.5- by 9-mm stent(Arterial Vascular Engineering, Santa Rosa, CA) of the left middle cerebral artery, with excellent angiographic results. Follow-up brain SPECT scan showed markedly improved perfusion. Stent-assisted percutaneous transluminal angioplasty can provide a favorable clinical course as well as improved cerebral perfusion for a patient with middle cerebral artery stenosis. Long-term follow-up data and additional clinical experience are required to assess the durability of this procedure.
Aged ; Angiography ; Angioplasty* ; Aspirin ; Brain ; Cerebrum ; Constriction, Pathologic* ; Follow-Up Studies ; Humans ; Middle Cerebral Artery* ; Perfusion* ; Rosa ; Stents ; Tomography, Emission-Computed, Single-Photon

Recent advances in stent technology have allowed the introduction of more flexible stents that may be tracked more easily in the intracranial vessels. We present a patient with improved cerebral perfusion as assessed by single-photon emission computed tomographic(SPECT) scan after stent-assisted angioplasty for symptomatic middle cerebral artery stenosis. A 72-year-old man presented with multiple episodes of transient verbral disturbance and right-sided motor weakness for 5 months despite treatment with aspirin and clopedigrel. Angiography revealed a 50% to 60% stenosis of the left middle cerebral artery. 99m Tc-exametazime-SPECT scan demonstrated decreased cerebral blood flow in the left cerebral hemisphere, particularly in the left middle cerebral artery territory. The patient was recommended a stent-assisted angioplasty for middle cerebral artery stenosis. The patient underwent uncomplicated stenting with S-660 2.5- by 9-mm stent(Arterial Vascular Engineering, Santa Rosa, CA) of the left middle cerebral artery, with excellent angiographic results. Follow-up brain SPECT scan showed markedly improved perfusion. Stent-assisted percutaneous transluminal angioplasty can provide a favorable clinical course as well as improved cerebral perfusion for a patient with middle cerebral artery stenosis. Long-term follow-up data and additional clinical experience are required to assess the durability of this procedure.
Aged ; Angiography ; Angioplasty* ; Aspirin ; Brain ; Cerebrum ; Constriction, Pathologic* ; Follow-Up Studies ; Humans ; Middle Cerebral Artery* ; Perfusion* ; Rosa ; Stents ; Tomography, Emission-Computed, Single-Photon

Hereditary motor and sensory neuropathy (HMSN), or Charcot-Marie-Tooth (CMT) disease, was described by Charcot and Marie in France and, independently, by Tooth in England in 1886. CMT is the most common form of inherited motor and sensory neuropathy, and is a genetically heterogeneous group of disorders in the peripheral nervous system. Traditionally, CMT has been subclassified into autosomal dominant inherited demyelinating (CMT1) and axonal (CMT2) neuropathies, X-linked neuropathy (CMTX), and autosomal recessive inherited neuropathy (CMT4). There are several related peripheral neuropathies, such as Dejerine-Sottas neuropathy (DSN), congenital hypomyelination neuropathy (CHN), hereditary neuropathy with liability to pressure palsies (HNPP), and giant axonal neuropathy (GAN). A large amount of new information on the genetic causes of CMT has become available, and mutations causing the disease have been associated with more than 20 different genes and 40 chromosomal loci. Advances in our understanding of the molecular basis of CMT have revealed an enormous diversity in genetic mechanisms, despite the clinical entity that is relatively uniform at presentation. Recent studies have shown therapeutic effects of certain chemicals in animal models of CMT1A, which suggests potential therapies for the most common form of CMT, CMT1A. This review focuses on the subgroups of inherited motor and sensory neuropathy on which there has been an explosion of new molecular genetic information over the past decade.
Axons ; Charcot-Marie-Tooth Disease* ; England ; Explosions ; France ; Giant Axonal Neuropathy ; Hereditary Sensory and Motor Neuropathy ; Models, Animal ; Molecular Biology ; Paralysis ; Peripheral Nervous System ; Peripheral Nervous System Diseases ; Tooth

Hereditary peripheral neuropathies can be categorized as hereditary motor and sensory neuropathies (HMSN), hereditary motor neuropathies (HMN), and hereditary sensory neuropathies (HSN). HMSN, HMN, and HSN are further subdivided into several subtypes. Here, we review the most recent findings in the molecular diagnosis and therapeutic strategy for hereditary peripheral neuropathies. The products of genes associated with hereditary peripheral neuropathy phenotypes are important for neuronal structure maintenance, axonal transport, nerve signal transduction, and functions related to the cellular integrity. Identifying the molecular basis of hereditary peripheral neuropathy and studying the relevant genes and their functions is important to understand the pathophysiological mechanisms of these neurodegenerative disorders, as well as the processes involved in the normal development and function of the peripheral nervous system. These advances and the better understanding of the pathogenesis of peripheral neuropathies represent a challenge for the diagnoses and managements of hereditary peripheral neuropathy patients in developing future supportive and curative therapies.
Axonal Transport ; Hereditary Sensory and Autonomic Neuropathies ; Hereditary Sensory and Motor Neuropathy ; Humans ; Neurodegenerative Diseases ; Neurons ; Peripheral Nervous System ; Peripheral Nervous System Diseases ; Phenotype ; Signal Transduction ; Wills

BACKGROUND: A genetic aberration in the MTHFR gene has been shown to result in reduced MTHFR enzyme activity and induced hyperhomocysteinemia. Recently, a second genetic polymorphism in MTHFR at position 1298 was reported. However, the association between the A1298C MTHFR polymorphism and ischemic stroke has not been reported. Therefore, we attempted to determine whether the MTHFR C677T and A1298C gene polymorphisms were associated with ischemic stroke. METHODS: We enrolled 220 ischemic stroke patients and 203 healthy individuals and compared their fasting plasma homocysteine levels and analyzed the MTHFR C677T and A1298C polymorphisms. RESULTS: Plasma homocysteine levels were significantly higher (p<0.05) in ischemic stroke patients (10.86 +/- 5.07 micro mol/L) than in control subjects (9.39 +/- 2.98 micro mol/L). Despite a clear association between 677TT genotype and elevated homocysteine level, there was no association between MTHFR C677T polymorphism and ischemic stroke. On the other hand, the odds ratio and 95% CI adjusted for other risk factors were 1.80 (1.08 to 3.00) for the 1298AC genotype, and 8.98 (1.00 to 80.42) for the 1298CC genotype. The adjusted odds ratio (AOR) for the 1298AC/CC genotypes were also significantly higher than that in the controls (AOR, 1.96; 95% CI, 1.19 to 3.24). However, in the analysis of combined genotypes with C677T and A1298C polymorphism, the AOR was not statistically significant. CONCLUSIONS: MTHFR A1298C gene polymorphism may be an independent risk factor for ischemic stroke. Our findings suggest that prediction of ischemic stroke may be possible by analyzing genetic defects.
Fasting ; Genotype ; Hand ; Homocysteine ; Humans ; Hyperhomocysteinemia ; Odds Ratio ; Plasma ; Polymorphism, Genetic ; Risk Factors* ; Stroke*

PURPOSE: The purpose of this paper is to discuss the characteristic CT and MR findings in persistent hyperplastic primary vitreous(PHPV) and to compare the detectability of those findings in each modality. MATERIALS AND METHODS: We retrospectively evaluated CT and MR findings in 32 patients with PHPV. Twenty-five patients had CT, 13 patients had MR, and 6 patients had both CT and MR. RESULTS: Major findings of PHPV in 32 patients on both imaging modalities were lens deformity(78%), shallow anterior chamber(72%), heterogeneous vitreous opacity(72%), enhancing hyaloid artery or remnant of fibrotic hand(69%), and microophthalmos(67%). Minor findings were retinal detachment(22%), and vitreous hemorrhage(6%). In MRI, lens deformity(92%) and shallow anterior chamber(85%) were detected most commonly whereas in CT, opaque vitreous(80%) was the most common finding. Findings of enhancing hyaloid vessel or remnant of fibrotic band, considered characteristic of PHPV, were more commonly detectable in MR (85%) than CT(52%). CONCLUSION: Characteristic MR and CT findings of PHPV were lena deformity, shallow anterior chanber, heterogeneons vitreons opacity, enhanciny hgalind artery or remnant fibrotic band, and microphthalmos. MR seemed to be more useful than CT in detecting Globe pathology.
Arteries ; Congenital Abnormalities ; Humans ; Magnetic Resonance Imaging ; Microphthalmos ; Pathology ; Retinaldehyde ; Retrospective Studies

Hereditary motor and sensory neuropathy (HMSN; Charcot-Marie-Tooth disease, CMT) was first described by Charcot and Marie in France and, independently, by Tooth in England in 1886. HMSN is the most common form of inherited motor and sensory neuropathy, and is a genetically heterogeneous disorder of the peripheral nervous system. Using positional cloning methods, the chromosomal localization (locus) of more than 40 inherited peripheral neuropathies was found in the last 15 years. However, these genetic analyses also show that many entities do not show linkage to the known loci. This issue deals with a clinical survey of inherited peripheral neuropathies regarding diagnostic approaches based on the molecular findings.
Charcot-Marie-Tooth Disease ; Clone Cells ; Cloning, Organism ; Diagnosis ; Diagnostic Tests, Routine* ; DNA* ; England ; France ; Hereditary Sensory and Motor Neuropathy* ; Peripheral Nervous System ; Peripheral Nervous System Diseases ; Tooth