In this study, the number of physicians presently living in Korea thoroughly estimated by several means and, on this bases, their productivity and level of supply were estimated. The results were as follows : First, the number of physicians who did not notify the Korea Medical Association in May 1987 were 10,110, including 4,093 emigrant physicians(40.5%), 861 military medical officers, 745 public health doctors, and 107 decreased physicians. A total of 1,330 physicians could not be identified by any effort. Second, among the 34,897 registered physicians as of May 1987, 29,933(85.8%) were residing in Korea, 4,115 physicians(11.8%) had emigrated to other countries, and 849 physicians(2.4%) were decreased. Practicing physicians defined as those in Korea who were not retired, serving in the military, or completing residencies or internships, comprised 78.6%(27,414 physicians) of the total number of registered physicians. Third, it is estimated that in the year 2000 the number of registered physicians, physicians residing in Korea, and practicing physician will be 75,040, 64,038 and 57,655, respectively and these are increases of 115.0%, 113,9%, and 110.3%, respectively, compared to 1987. Fourth, the population physician ratio will be 759 to one physician in the year 2000. Fifth, the productivity of physicians, as calculated by relative values defining the productivity of 35 to 44 year-old male physicians as 10, will increase 110.7% in the year 2000 compare to that of 1987, and this increment is almost the same level as that of physicians supply. From the results of the present analysis of physicians manpower and supply projection, it can be recognized that the development of a regular notification system is necessary in order to identify precisely the number of physicians. Also a policy a physician supply is essential in order to adjust in advance the number of physicians, otherwise there will be surplus to the medical demand.
Adult ; Efficiency ; Emigrants and Immigrants ; Humans ; Internship and Residency ; Korea* ; Male ; Military Personnel ; Public Health

Background: Single room isolation with contact precautions is widely regarded as a fundamental strategy to prevent the transmission of multidrug-resistant organisms (MDROs). However, its implementation demands substantial resources, limiting its universal application to all MDROs. In this study, we assessed the effect of discontinuing single room isolation for vancomycin-resistant Enterococcus (VRE). Methods: This is a retrospective, observational study conducted at a single 750-bed tertiary center. We conducted an interrupted time series analysis to compare incidence rates and trends of new-onset VRE colonization and bacteremia during the one year before and after the strategy change on January 1, 2023. Results: Single-room occupancy decreased from 79.7% pre-intervention to 23.6% postintervention (P < 0.001). The incidence rate of new-onset VRE colonization was 0.452 and 0.535 per 1,000 patient-days in the pre- and post-intervention periods, respectively, with no statistically significant difference (P = 0.202). However, there was a slightly increasing trend (0.036 [95% confidence interval, −0.002, 0.074] increase per month, P = 0.066). The new-onset VRE bacteremia incidence rate was not differed in incidence (0.060 and 0.055, P= 0.571) or trend (P = 0.720). Conclusion Our study suggests that discontinuing single-room isolation for VRE patients may not affect the incidence of new-onset VRE bacteremia, but caution is needed due to the potential increase in colonization.

Background: Single room isolation with contact precautions is widely regarded as a fundamental strategy to prevent the transmission of multidrug-resistant organisms (MDROs). However, its implementation demands substantial resources, limiting its universal application to all MDROs. In this study, we assessed the effect of discontinuing single room isolation for vancomycin-resistant Enterococcus (VRE). Methods: This is a retrospective, observational study conducted at a single 750-bed tertiary center. We conducted an interrupted time series analysis to compare incidence rates and trends of new-onset VRE colonization and bacteremia during the one year before and after the strategy change on January 1, 2023. Results: Single-room occupancy decreased from 79.7% pre-intervention to 23.6% postintervention (P < 0.001). The incidence rate of new-onset VRE colonization was 0.452 and 0.535 per 1,000 patient-days in the pre- and post-intervention periods, respectively, with no statistically significant difference (P = 0.202). However, there was a slightly increasing trend (0.036 [95% confidence interval, −0.002, 0.074] increase per month, P = 0.066). The new-onset VRE bacteremia incidence rate was not differed in incidence (0.060 and 0.055, P= 0.571) or trend (P = 0.720). Conclusion Our study suggests that discontinuing single-room isolation for VRE patients may not affect the incidence of new-onset VRE bacteremia, but caution is needed due to the potential increase in colonization.

Background: Single room isolation with contact precautions is widely regarded as a fundamental strategy to prevent the transmission of multidrug-resistant organisms (MDROs). However, its implementation demands substantial resources, limiting its universal application to all MDROs. In this study, we assessed the effect of discontinuing single room isolation for vancomycin-resistant Enterococcus (VRE). Methods: This is a retrospective, observational study conducted at a single 750-bed tertiary center. We conducted an interrupted time series analysis to compare incidence rates and trends of new-onset VRE colonization and bacteremia during the one year before and after the strategy change on January 1, 2023. Results: Single-room occupancy decreased from 79.7% pre-intervention to 23.6% postintervention (P < 0.001). The incidence rate of new-onset VRE colonization was 0.452 and 0.535 per 1,000 patient-days in the pre- and post-intervention periods, respectively, with no statistically significant difference (P = 0.202). However, there was a slightly increasing trend (0.036 [95% confidence interval, −0.002, 0.074] increase per month, P = 0.066). The new-onset VRE bacteremia incidence rate was not differed in incidence (0.060 and 0.055, P= 0.571) or trend (P = 0.720). Conclusion Our study suggests that discontinuing single-room isolation for VRE patients may not affect the incidence of new-onset VRE bacteremia, but caution is needed due to the potential increase in colonization.

Background: Single room isolation with contact precautions is widely regarded as a fundamental strategy to prevent the transmission of multidrug-resistant organisms (MDROs). However, its implementation demands substantial resources, limiting its universal application to all MDROs. In this study, we assessed the effect of discontinuing single room isolation for vancomycin-resistant Enterococcus (VRE). Methods: This is a retrospective, observational study conducted at a single 750-bed tertiary center. We conducted an interrupted time series analysis to compare incidence rates and trends of new-onset VRE colonization and bacteremia during the one year before and after the strategy change on January 1, 2023. Results: Single-room occupancy decreased from 79.7% pre-intervention to 23.6% postintervention (P < 0.001). The incidence rate of new-onset VRE colonization was 0.452 and 0.535 per 1,000 patient-days in the pre- and post-intervention periods, respectively, with no statistically significant difference (P = 0.202). However, there was a slightly increasing trend (0.036 [95% confidence interval, −0.002, 0.074] increase per month, P = 0.066). The new-onset VRE bacteremia incidence rate was not differed in incidence (0.060 and 0.055, P= 0.571) or trend (P = 0.720). Conclusion Our study suggests that discontinuing single-room isolation for VRE patients may not affect the incidence of new-onset VRE bacteremia, but caution is needed due to the potential increase in colonization.

Tailgut cyst is a rare congenital lesion in retrorectal space. The clinical significance of tailgut cyst presents its morbidity that occurs in the unrecognized and incompletely treated lesion. A forty four year-old female patient visited with lower abdominal pain during defecation. Preoperative abdominopelvic MRI and endorectal ultrasonography revealed a retrorectal mass suggestive of leiomyoma, dermoid cyst, teratoma, or duplication cyst of rectum. She underwent complete resection of retrorectal mass by transsphincteric approach. The mass was multilocular cyst lined by multiple types of epithelium. It was histologically confirmed as a tailgut cyst. She recovered uneventfully. This report includes the case and a brief review of tailgut cyst.
Abdominal Pain ; Defecation ; Dermoid Cyst ; Epithelium ; Female ; Humans ; Leiomyoma ; Magnetic Resonance Imaging ; Rectum ; Teratoma ; Ultrasonography

Fecal incontinence is a disabling condition with devastating psychosocial impact due to diverse etiology. This study was performed to assess various causes of fecal incontinence, clinical evaluation, and adequate surgical treatment. METHODS: Eighty patients presenting fecal incontinence during July 1989 and June 1997 were included. They were evaluated by clinical parameters and physiologic tests including the defecography, electromyography, transanal ultrasonography, and anorectal manometry. Surgery was performed in 31 patients based on those evaluation. Pre- and post-operative comparison of manometric findings, clinical assessment, incontinence score, and the outcome of surgery were assessed. Mean postoperative follow-up was 22 (2~84) months. RESULTS: Inappropriate anal surgery was the most common cause, and then injuries during delivery, trauma, rectal prolapse, and hysterectomy in descending order. Defecography was performed in 21 patients and mean values of anorectal angles were 115+/-15degrees at rest, 98+/-18degrees during squeezing, and 136+/-10degrees during push. Electromyography was performed in 8 patients showing pudendal neuropathy in 2, bilateral lumbosacral polyradiculopathy in 4, and normal finding in 2 patients, respectively. Transanal ultrasonography was performed in 33 patients and 22 among them showed finding of an injury of the anal sphincters. Surgery was performed in 31 patients due to anal sphincter damage, rectovaginal fistula, and anal stricture in descending order. Type of surgery was determined by respective cause: plication, triple repair (sphincteroplasty, anoplasty, perineorrhaphy), and posterior rectopexy in descending order. Nerve preserving graciloplasty was performed in a 12 year-old girl who had severe defect of the anal sphincters by traffic accident, showing sound recovery with a good functional outcome. Although there was no significant difference of manometric variables between pre- and post-operative periods, sphincter length, and maximum resting and squeezing pressure, revealed an increasing tendency postoperatively. According to the clinical assessment between pre- and post-operative periods, urgency to evacuate, soiling, sensation on defecation, and quality discrimination were significantly improved postoperatively (P<0.01). Incontinence score was markedly decreased from 10.6+/-6.1 during preoperative period to 2.9+/-4.7 during postoperative period (P<0.01). Eighty one percent of the patients undergone surgery experienced a significant symptomatic improvement. CONCLUSIONS: According to the analysis of the causes of fecal incontinence, inappropriate anal surgery, injuries during delivery, and trauma were main causes. Adequate application of physiologic tests, such as, defecography, electromyography, transanal ultrasonography, and anorectal manometry, were helpful in determining treatment modality and types of surgery. We got satisfactory results with adequate surgery based on the physiologic tests.
Accidents, Traffic ; Anal Canal ; Child ; Constriction, Pathologic ; Defecation ; Defecography ; Discrimination (Psychology) ; Electromyography ; Fecal Incontinence* ; Feces ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Manometry ; Polyradiculopathy ; Postoperative Period ; Preoperative Period ; Pudendal Neuralgia ; Rectal Prolapse ; Rectovaginal Fistula ; Sensation ; Soil ; Ultrasonography

BACKGROUND: Transcatheter coil embolization has been described as a method of nonsurgical closure of variable pathologic vascular structures. This study was aimed to evaluate the outcome of transcatheter coil embolization in variable clinical conditions. METHODS AND RESULTS: We collected data from patients' medical record and their cardiac angiography films. From January 1995 to June 1997, coil embolization was attempted in 51 patients who were 38 patients with systemic-pulmonary collaterals (5 patients have venous collaterals, too), six patients with venous collaterals, nine patients with patent ductus arteriosus (PDA), one patient with Blalok-Taussig shunt (BT shunt), one patient with coronary-right atrial fistula and one patient with coronary-right ventricular fistula. In 38 patients with systemic-pulmonary collaterals, 123 coils were inserted to 70 collaterals, therefore mean 1.79+/-0.77 coils were inserted to one collateral. The results were complete occlusions (74%), incomplete occlusions (21%), and partial occlusions (4%). In six patients with venous collaterals, the outcomes were complete occlusions (50%) and incomplete occlusions (50%). In a patient with BT shunt, hemolytic anemia occurred in 1st attempt and in 2nd attempt, shunt was incompletely occluded and one coil was carried away and embolized the peripheral pulmonary artery. In nine patients with PDA, ten cases of transcatheter coil embolization was executed. Mean minimum ductal diameter was 2.1+/-0.85 mm. The results were initial occlusion (30%), occlusion within one month (66%), and occlusion within one year (75%). Left pulmonary artery stenosis owing to coil insertion was not found. In one case of coil malposition, retrieval and reinsertion of coil was successful. In two patients who have coronary artery fistula, coil embolization was successfully executed without any complications. CONCLUSIONS: Transcatheter coil embolization executed in variable clinical conditions without significant complications. It was effective and safe nonsurgical method.
Anemia, Hemolytic ; Angiography ; Child* ; Constriction, Pathologic ; Coronary Vessels ; Ductus Arteriosus, Patent ; Embolization, Therapeutic* ; Fistula ; Humans ; Medical Records ; Pulmonary Artery

BACKGROUND: Transcatheter coil embolization has been described as a method of nonsurgical closure of variable pathologic vascular structures. This study was aimed to evaluate the outcome of transcatheter coil embolization in variable clinical conditions. METHODS AND RESULTS: We collected data from patients' medical record and their cardiac angiography films. From January 1995 to June 1997, coil embolization was attempted in 51 patients who were 38 patients with systemic-pulmonary collaterals (5 patients have venous collaterals, too), six patients with venous collaterals, nine patients with patent ductus arteriosus (PDA), one patient with Blalok-Taussig shunt (BT shunt), one patient with coronary-right atrial fistula and one patient with coronary-right ventricular fistula. In 38 patients with systemic-pulmonary collaterals, 123 coils were inserted to 70 collaterals, therefore mean 1.79+/-0.77 coils were inserted to one collateral. The results were complete occlusions (74%), incomplete occlusions (21%), and partial occlusions (4%). In six patients with venous collaterals, the outcomes were complete occlusions (50%) and incomplete occlusions (50%). In a patient with BT shunt, hemolytic anemia occurred in 1st attempt and in 2nd attempt, shunt was incompletely occluded and one coil was carried away and embolized the peripheral pulmonary artery. In nine patients with PDA, ten cases of transcatheter coil embolization was executed. Mean minimum ductal diameter was 2.1+/-0.85 mm. The results were initial occlusion (30%), occlusion within one month (66%), and occlusion within one year (75%). Left pulmonary artery stenosis owing to coil insertion was not found. In one case of coil malposition, retrieval and reinsertion of coil was successful. In two patients who have coronary artery fistula, coil embolization was successfully executed without any complications. CONCLUSIONS: Transcatheter coil embolization executed in variable clinical conditions without significant complications. It was effective and safe nonsurgical method.
Anemia, Hemolytic ; Angiography ; Child* ; Constriction, Pathologic ; Coronary Vessels ; Ductus Arteriosus, Patent ; Embolization, Therapeutic* ; Fistula ; Humans ; Medical Records ; Pulmonary Artery

PURPOSE: Metastasis to the pancreas is rare, and the benefit of resection for pancreatic metastasis is poorly defined. The aim of this study was to review our experiences of the operative management of metastasis to the pancreas. METHODS: Between 1995 and 2009, 11 patients (8 men and 3 women; median age, 54 years) were admitted to our institution with a metachronously metastatic lesion to the pancreas and later underwent pancreatic resection. The clinical features and outcomes of treatments were examined. RESULTS: The primary cancers were renal cell carcinoma (RCC, n = 7), carcinoid tumor (n = 2), rectal cancer and leiomyosarcoma. Six patients underwent distal pancreatectosplenectomy, 3 pancreaticoduodenectomy and 2 patients underwent enucleation for small RCC. One patient died of metastatic RCC at 53 months after surgery and ten patients remain alive; four patients without disease at 7 to 69 months postoperatively, and the other six with disease at 11 to 68 months. Median postoperative survival of all patients was 34 months. CONCLUSION: Patients with a low surgical risk should be considered for pancreatic metastasectomy if curative resection is possible. Primary cancer type, which is associated with survival benefit, would be the best candidate for surgical resection of metastases to the pancreas.
Carcinoid Tumor ; Carcinoma, Renal Cell ; Humans ; Leiomyosarcoma ; Male ; Metastasectomy ; Neoplasm Metastasis ; Pancreas ; Pancreaticoduodenectomy ; Rectal Neoplasms