In this study, literature review was done to examine and compare the current status and problems of different evaluation approaches toward permanent impairment in Korea. Alternatives and improvements in the current approaches in Korea were suggested. Series of cases were also examined to compare different approaches applied to the real cases, using 105 cases from a hospital data and another 207 cases from insurance company data. The main findings of the literature review are as follows; 1. The current evaluation methods of permanent impairment in Korea are grouped into two categories, grading and rating. Grading of impairments are expressly specified in 17 various statutes. 2. In Grading methods, the rigid system of 14 different grades has been adopted uniformally for the convenience of administration, which may not be, appropriate or valid from medical and scientifical aspect. 3. The advantage of McBride method is assessment of occupational disability rate. However the classified compensable occupations are only 280 and limited to manufacturing industries in 1960s' of U.S.A., which is not appropriate to current Korean circumstances. Especially, the job list does not include managerial officers or mental workers. 4. AMA Guides is the scientific and reasonable method for the assessment of physical impairment rate. However compensation and reparation of impairment case is difficult because this method cannot assess the disability rate according to occupation, age, etc. The results of cases comparative study are as follows: 5. The physical impairment could be compared in 167 out of total 312 cases and for the cases of complex impairment, McBride method underestimate physical impairment rate compared with AMA method. 6. When disability rate was assessed, occupation was considered the compensation of only 85 cases, and age was used in only 21 cases. This was because occupation and age compensation in McBride method are unreasonable. 7. The most ideal alternative is to assess physical impairment according to AMA method and then to develop a compensation method appropriate for the circumstances of Korea society.
Compensation and Redress ; Insurance ; Korea* ; Occupations

The effects of resin on the respiratory health have been investigated in 309 workers from four iron and steel foundries and the results compared with those from 122 workers who were not significantly exposed to resin gas and silica dust at the same industries. Phenol-formaldehyde resin was used in the core making and molding processes and workers were exposed to their decomposition products as well as to silica dist containing particulates The subjects were grouped according to formaldehyde, dust and other gas exposures, and smoking habits were considered also in the analysis. Standardized respiratory symptom questionnaire was administered by trained interviewers. Chest radiograph, pulmonary function tests, and methacholine challenge tests were done. Environmental measurements at the breathing zone were carried out to determine levels of formaldehyde, respirable dust and total dust. Foundry workers had a higher prevalence of symptoms of chronic bronchitis with chronic phlegm and chronic cough when exposed to dust. Exposure to gas was significantly associated with lowered FEV1 and obstructive pulmonary function changes. Exposure to formaldehyde and phenol gas was associated with wheezing symptom among workers, but FEV1 changes after methacholine challenge were not significantly different among different exposure groups. When asthma was defined as the presence of bronchial hyperreactivity with more than 20% decrease in FEV1 after methacholine challenge, 17 workers out of 222 tested had asthma. Fewer asthmatic workers were found among groups exposed to for maldehyde, gas and dust, which indicates a healthy worker effects in a cross-sectional study. The concentration of formaldehyde gas ranged from 0.24 to 0.43 ppm among studied foundries. The authors conclude that fornaldehyde and phenol gas from combust resin is probably the cause of asthmatic symptoms and also a selection force of those with higher bronchial reactivity away from exposures.
Airway Obstruction ; Asthma ; Bronchial Hyperreactivity ; Bronchitis, Chronic ; Cough ; Cross-Sectional Studies ; Dust ; Formaldehyde ; Fungi ; Healthy Worker Effect ; Iron ; Methacholine Chloride ; Phenol ; Prevalence ; Surveys and Questionnaires ; Radiography, Thoracic ; Respiration ; Respiratory Function Tests ; Respiratory Sounds ; Silicon Dioxide ; Smoke ; Smoking ; Steel

A 34-year-old female underwent emergency cesarean section with general anesthesia. The patient was a para 1-0-0-1, referred at 39 weeks in labor with known severe aortic stenosis due to a bicuspid aortic valve. She has been treated with digoxin and furosemide for 5 years. At first, she tried a normal spontaneous vaginal delivery, but dyspnea was aggravated during delivery, so an emergency operation was decided. Anesthesia was induced using ketamine 80 mg, fentanyl 50 microgram and vecuronium 6 mg and maintained with 50% nitrous oxide in oxygen. After fetal delivery and infusion of oxytocin, the systolic blood pressure decreased to 60 mmHg or less, so we injected phenylephrine 100 microgram bolus. However, the blood pressure did not increase, so we injected phenylephrine continuously ( 0.5 microgram/kg/ min). One month postpartum, echocardiography was done. The left ventricle-aortic pressure gradient was 140 mmHg, so the cardiologist recommended an aortic valve replacement operation. She refused the operation and has been medicated with digoxin and furosemide up to date.
Adult ; Anesthesia ; Anesthesia, General* ; Aortic Valve ; Aortic Valve Stenosis* ; Bicuspid ; Blood Pressure ; Cesarean Section* ; Digoxin ; Dyspnea ; Echocardiography ; Emergencies* ; Female ; Fentanyl ; Furosemide ; Humans ; Ketamine ; Nitrous Oxide ; Oxygen ; Oxytocin ; Phenylephrine ; Postpartum Period ; Pregnancy ; Vecuronium Bromide

Idiopathic proximal hemimegacolon is a disorder characterized by bowel dilatation proximal to the splenic flexure. It is a very rare and therefore a poorly understood clinical entity. This report describes a case of idiopathic proximal hemimegacolon in a 44-year-old woman. The patient suffered from 2 episodes of constipation and bowel dilatation over 4 years and was successfully treated by medical therapy.
Adult ; Colon, Transverse ; Constipation ; Dilatation ; Female ; Humans ; Medical Futility

BACKGROUND: In this study, we attempted to generate RBCs from CD34+ cells in cord blood using a 3-step culture protocol and also evaluated a change in immunophenotypic characteristics and expression profile according to erythropoietin (EPO) concentrations and culture duration. METHODS: Using mini-MACS columns, CD34+ cells were isolated from cord blood. The culture procedure comprised three steps. For each step, cells were cultured sequentially for 7 days in a serum free liquid medium with a specific combination of growth factors for 21 days. [1st step: Flt3-ligand (Flt3-L), thrombopoietin and stem cell factor (SCF); 2nd step: IGF-1, SCF and EPO; and 3rd step: IGF-1 and EPO] To evaluate the effect of EPO on proliferation and differentiation, cells were cultured with different EPO concentrations (0, 3, 10 & 20 U/mL). Cell count and morphology were monitored during the culture. For phenotyping, antibodies to CD34, CD38, CD45 and glycophorin A (GPA) were used. The expression profile of cultured cells was analyzed by 17, 000-gene microarray analysis. RESULTS: As EPO concentration increased, cell expansion was also increased, showing a maximum expansion at 20 U/mL. The cell population showed a gradual decrease in expression of CD34 and CD45, whereas the expression of GPA was not prominent in any conditions. However, we observed increased expression in some genes associated with erythropoiesis (e.g. glycophorin A, rhesus blood group CcEe antigens). CONCLUSIONS: This study shows that erythropoietin enhances the proliferation of hematopoietic progenitor cells. Our culture system did not achieve pure production of RBCs, but induced expression changes that indicated erythroid differentiation.
Antibodies ; Cell Count ; Cells, Cultured ; Erythropoiesis ; Erythropoietin ; Fetal Blood* ; Glycophorin ; Hematopoietic Stem Cells ; Humans ; Insulin-Like Growth Factor I ; Intercellular Signaling Peptides and Proteins ; Microarray Analysis ; Stem Cell Factor ; Thrombopoietin

Primary gastric lymphomas can be defined as lymphomas which are confined to the stomach without systemic metastasis. Primary gastric Burkitt's lymphoma is a rare disease that belongs to the aggressive non-Hodgkin's lymphomas. Chemotherapy is the mainstay of treatment, even in the localized disease. We report a case of primary gastric Burkitt's lymphoma in a 24-year-old female presenting with an intermittent epigastric pain for 3 months. Upper gastroduodenal endoscopy detected an ulcer with thickened folds on the greater curvature side of the lower body, and histologic examination of the biopsy specimens revealed infiltration of medium-sized lymphoblasts with characteristic "starry sky" macrophages. Abdominal CT scan demonstrated marked gastric wall thickening and regional lymph node enlargement.
Biopsy ; Burkitt Lymphoma* ; Drug Therapy ; Endoscopy ; Female ; Humans ; Lymph Nodes ; Lymphoma ; Lymphoma, Non-Hodgkin ; Macrophages ; Neoplasm Metastasis ; Rare Diseases ; Stomach ; Tomography, X-Ray Computed ; Ulcer ; Young Adult

Primary gastric lymphomas can be defined as lymphomas which are confined to the stomach without systemic metastasis. Primary gastric Burkitt's lymphoma is a rare disease that belongs to the aggressive non-Hodgkin's lymphomas. Chemotherapy is the mainstay of treatment, even in the localized disease. We report a case of primary gastric Burkitt's lymphoma in a 24-year-old female presenting with an intermittent epigastric pain for 3 months. Upper gastroduodenal endoscopy detected an ulcer with thickened folds on the greater curvature side of the lower body, and histologic examination of the biopsy specimens revealed infiltration of medium-sized lymphoblasts with characteristic "starry sky" macrophages. Abdominal CT scan demonstrated marked gastric wall thickening and regional lymph node enlargement.
Biopsy ; Burkitt Lymphoma* ; Drug Therapy ; Endoscopy ; Female ; Humans ; Lymph Nodes ; Lymphoma ; Lymphoma, Non-Hodgkin ; Macrophages ; Neoplasm Metastasis ; Rare Diseases ; Stomach ; Tomography, X-Ray Computed ; Ulcer ; Young Adult

Achalasia can be provoked by organic causes, and it is called secondary achalasia. Sometimes it is very difficult to distingush secondary achalasia from primary achalasia. We report a case of secondary achalasia due to recurrence of stomach cancer. A 45-year-old man came to our hospital due to three months history of dysphagia and regurgitation. Barium esophagogram showed concentric narrowing at the distal esophagus and dilatation of proximal esophagus. The esophagogastroduodenoscopy showed stenosis of gastroesophageal junction and the endoscope could not pass through it, but there was no evidence of malignancy. Esophageal manometry showed aperistalsis, compatible with achalasia. Abdominal CT showed soft tissue density near the gastroesophageal junction. However it was not possible to differentiate whether it was due to adhesion or malignancy. For correct diagnosis and treatment, explorolaparotomy was performed and it was diagnosed as secondary achalasia due to recurrence of stomach cancer.
Barium ; Constriction, Pathologic ; Deglutition Disorders ; Diagnosis ; Dilatation ; Endoscopes ; Endoscopy, Digestive System ; Esophageal Achalasia* ; Esophagogastric Junction ; Esophagus ; Humans ; Manometry ; Middle Aged ; Recurrence* ; Stomach Neoplasms* ; Stomach* ; Tomography, X-Ray Computed

BACKGROUND AND OBJECTIVES: We performed this study to evaluate the common carotid artery intima-media thickness (CCA IMT), and its correlation with several clinical variables, including the 10 year coronary heart disease (10 Yr CHD) risk in both healthy and hyperlipidemic hypertensive (HH) Koreans. SUBJECTS AND METHODS: This was a multi-centered prospective epidemiological study. The study population consisted of 227 healthy subjects without risk factors, with the exception of age (mean 49 years old, 114 males), and 243 HH subjects (mean 51 years old, 120 males). The carotid IMT and presence of plaques were semi automatically measured in both carotid arteries at a central reading facility. RESULTS: Linear regression analysis of all the subjects revealed that the independent factors of both CCA IMT were age, pulse pressure (PP) and HDL-cholesterol, and that of the right CCA IMT were sex and 10 Yr CHD risk. In healthy subjects, the independent factor of both CCA IMTs was age, and that of the right CCA IMT was body weight. In the HH subjects, age, sex, total cholesterol, HDL-cholesterol and PP were independent factors of both CCA IMTs, but 10 Yr CHD risk was an independent factor of only the right CCA IMT. Carotid plaques were seen in 17% of the healthy subjects and 35% of the HH subjects. An ROC curve analysis showed a right CCA IMT of 0.646 mm and left CCA IMT of 0.656 mm demonstrated 60% sensitivity and specificity in differentiating healthy from HH subjects. CONCLUSION: This result reliably demonstrates the Korean CCA IMT, as well as several other significant pieces of information.
Blood Pressure ; Body Weight ; Carotid Arteries ; Carotid Artery, Common ; Carotid Intima-Media Thickness* ; Cholesterol ; Coronary Disease ; Epidemiologic Studies* ; Humans ; Korea* ; Linear Models ; Middle Aged ; Prospective Studies ; Risk Factors* ; ROC Curve ; Sensitivity and Specificity

BACKGROUND: The peroxisome proliferator-activated receptor (PPAR) is a member of the nuclear receptor family known to be involved in adipocyte differentiation. Recent studies have revealed the inhibitory role of PPAR in osteoblastogenesis, which suggests its possibility as a candidate gene for osteoporosis. The frequency of C161-->T substitution in exon 6 of PPAR was observed in Korean men and the association of different genotypes with bone turnover markers, bone mineral density (BMD) and serum osteoprotegerin (OPG), which play inhibitory roles in osteoclastogenesis, examined. METHODS: In 72 healthy Korean men (mean age 54.5 6.4 yrs; range 42~69 yrs), anthropometric measurements, and lumbar spine and femoral neck BMD, and bone turnover markers, such as alkaline phosphatase (ALP), serum calcium, phosphorus, osteocalcin and cross-linked C-telopeptides of type I collagen (ICTP) measurements were performed. The levels of serum testosterone, estradiol and insulin-like growth factor (IGF-I), and those of serum OPG levels, were measured with a sandwich enzyme-linked immunosorbent assay (ELISA) method. The DNAs were extracted from the samples, and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and the sequencing of the products were performed to confirm the substitution. RESULTS: The allele frequencies were 0.799 and 0.201 for the C and T allele, respectively, which were in Hardy-Weinberg equilibrium (p=0.80). Subjects with the CT genotype were older and those with the T allele showed higher blood pressure levels and lower body mass indices (p<0.05) than those with the CC genotypes. There were no differences in the bone turnover markers between the different genotypes (p>0.05). The levels of serum testosterone, estradiol, IGF-I and OPG were not different among the different genotype groups (p>0.05). The lumbar, femoral neck BMD (g/cm2) and T scores were significantly lower in subjects with T alleles, and those with CT genotypes showed the lowest BMD values (p<0.05). When the subjects were divided into 3 groups, i.e., normal, osteopenic and osteoporotic groups, according to the lumbar spine BMD, the group with the T allele had a significantly higher prevalence of osteopenia and smaller numbers with normal BMD than those with the CC genotype (p=0.032). CONCLUSION: The frequencies of the C161-->T substitution in exon 6 of the PPAR gene in Korean men were similar to those observed in other races, and those with the T alleles showed significantly lower BMD values. These data imply the PPAR gene might be a candidate gene for the pathogenesis of osteoporosis
Adipocytes ; Alkaline Phosphatase ; Alleles ; Blood Pressure ; Bone Density ; Bone Diseases, Metabolic ; Calcium ; Collagen Type I ; Continental Population Groups ; DNA ; Enzyme-Linked Immunosorbent Assay ; Estradiol ; Exons* ; Femur Neck ; Gene Frequency ; Genotype ; Humans ; Insulin-Like Growth Factor I ; Male ; Metabolism* ; Osteocalcin ; Osteoporosis ; Osteoprotegerin* ; Peroxisome Proliferator-Activated Receptors ; Peroxisomes* ; Phosphorus ; Prevalence ; Spine ; Testosterone