This study is to find out changes in medical practice at a university hospital before and after covering intraocular lens (IOL) from the health insurance benefit. The coverage started on March 1, 1993 and a total of 596 cases who were discharged from July 1 to December 31, 1992 and 580 cases who were discharged from July 1 to December 31, 1993 were analyzed. Since the standard reimbursement scheme was changed from March 1, 1993, the charges for 1992 were transformed into 1993 scheme. Major findings are as follows: Average length of stay was statistically significantly decreased from 8.24 days in 1992 to 6 86 days in 1993. Charges except IOL has been statistically significantly decreased from 501,000 won in 1992 to 444,000 won in 1993. Charges for drugs and injection have been reduced. However, charge per day for them was not much different. This is due to decrease in length of stay. Charges for laboratory tests and radiologic examination were quite the same. charges which are not covered by the insurance remained the same. The revenue of the hospital was reduced as expected. However, the hospital reduced the length of stay and increase the turnover rate in order to compensate the potential loss of revenue due to the difference of reimbursement between the out-of-pocket expense and the insurance coverage. By introducing the IOL benefit in the insurance, the insured pays less, hospital generates more revenue through shortening the hospital stay, and the total medical care cost becomes less nationwidely.
Health Care Costs ; Insurance ; Insurance Coverage ; Insurance, Health* ; Length of Stay ; Lenses, Intraocular*

Leiomyosarcoma arising in the skin is rare tumor, and diagnosis usually is made microscopically. After local excision, these lesions recur in large proportion of pat ients. The authors herein report a 53-year-old male with leiomyosarcoma appeared in the skin of the right forearm and presenting as a dark reddish colored, 5*6cm in diameter, superficial ulcerated single firm nodule with intermittent pain. Histopathological examination showed poorly circumscribed tumor consisting of interlacing bundles of spindle shaped smooth muscle cells in the middle and lower parts of the dermis. The nuclei were hyperchromatic, large, vacuolated, and irregular in shape. Electron microscopic findings revealed cytoplasmic organelles such as rough endoplasmic reticulum and mitochondria of malignant smooth muscle cells in the paranuclear area, Characteristic subsarcoelmmal caveolae and dense plaque were noted and myofilaments were distributed in the peripheral cytoplasm. The tumor did not recur in 10 months' follow-up.
Caveolae ; Cytoplasm ; Dermis ; Diagnosis ; Endoplasmic Reticulum, Rough ; Follow-Up Studies ; Forearm ; Humans ; Leiomyosarcoma* ; Male ; Middle Aged ; Mitochondria ; Myocytes, Smooth Muscle ; Myofibrils ; Organelles ; Skin* ; Ulcer

OBJECTIVE: To evaluate the pregnancy outcome, designate the predicting factor of neonatal thrombocytopenia, and reevaluate the treatment scheme of idiopathic thrombocytopenic purpura (ITP) in pregnancy. METHODS: Medical records of 83 patients(98 deliveries) who were diagnosed as having ITP and delivered at the Department of Obstetrics and Gynecology, Yonsei University College of Medicine from January 1990 to May 1999 were reviewed. For statistical analysis Chi-square test and Fisher's exact test were used. RESULTS: Among various maternal characteristics, inability to raise platelet counts more than 100,000/mm3 by any means of treatment, categorized as ""poor response to treatment"", could be designated as the predicting factor of neonatal thrombocytopenia (p<0.05). Pregnant women treated with prednisolone had significantly greater chance of having preterm delivery (p<0.001). The occurrence of postpartum anemia requiring transfusion was higher in the group undertaking cesarean section (p<0.05). Although a control group was missing, the pregnancy outcome was poor in the category of pregnancy induced hypertension(PIH) and preterm labor being 17.3% and 33.7%, respectively. CONCLUSION: The ITP patient should be carefully monitored during the antenatal care visits because of the increased incidence in adverse pregnancy outcome such as PIH and preterm labor. Neonatal thrombocytopenia could be predicted in the presence of inability to raise platelet counts to more than 100,000/mm3 by any means of treatment. Cesarean section should not be performed routinely under the indication of ITP due to the accompanynig morbidity and low incidence of bleeding sequalae in the neonate. The accompanying complications of prednisolone treatment raises questions and warnings about its usage, therefore a prospective study is warranted to evaluate the effect and complications of prednisolone treatment.
Anemia ; Cesarean Section ; Female ; Gynecology ; Hemorrhage ; Humans ; Incidence ; Infant, Newborn ; Medical Records ; Mortuary Practice ; Obstetric Labor, Premature ; Obstetrics ; Platelet Count ; Postpartum Period ; Prednisolone ; Pregnancy Outcome ; Pregnancy* ; Pregnant Women ; Purpura, Thrombocytopenic, Idiopathic ; Thrombocytopenia* ; Thrombocytopenia, Neonatal Alloimmune

The authors underwent the serum lipid study, involving the lipoprotein fraction, and the HDL-cholesterol mean values in normal Korean adults visited to Hanyang University Hospital, and also compared with the previously reported serum lipid studies. The results are as follows; 1) The mean values of triglyceride, total cholesterol, and phospholipid were 103.3+/-17.1mg%, 188.9+/-18.2mg%, and 196.7+/-19.8mg%, respectively. 2) Compared with the past 7 years triglyceride showed increasing tendency with significance, and cholesterol and phospholipid showed slightly increasing tendency. 3) In the serum lipoprotein fraction, the mean values of alpha-lipoprotein, pre-beta-lipoprotein, and beta-lipoprotein were 37.2+/-5.9%, 16.0+/-4.2%, and 48.6+/-5.2%, respectively. 4) Compared with the past 10 years, the alpha-, and pre-beta-lipoprotein showed increasing tendency, meanwhile, beta-lipoprotein revealed decreasing tendency. 5) The mean value of HDL-cholesterol was 52.3+/-14.6mg%, and the ratio of HDL-cholesterol to total cholesterol(HDL-cholesterol/total cholesterol) was 28.2+/-7.9. 6) Compared with the past 2 years, HDL-cholesterol level showed slightly increasing tendency.
Adult ; Cholesterol ; Humans ; Lipoproteins ; Triglycerides

Cytomegalovirus retinopathy(CMV)is a necrotizing retinitis which can occur as a late manifestation of the Acquired immunodeficiency syndromde(AIDS), which rapidly increases in number after original description of the disease in 1981 by Gottliebet al. We experienced a patient, who complained of decreased visual acuity of the left eye only we initially diagnosed the patient as CMV retinitis, and during the course of treatment, finally diagnosed the patient as CMV retinitis with AIDS, and the patient was subdivided into Group IV, Subgroup C by center for disease control classification system To our knowledge, for about 10% of the patient of the CMV retinopathy, AIDS was diagnosed like same manner as we did, but we couldn't find any report in korea, so we report this case with a review of literatures.
Centers for Disease Control and Prevention (U.S.) ; Classification ; Cytomegalovirus Retinitis ; Cytomegalovirus* ; Ganciclovir ; Humans ; Korea ; Retinitis ; Visual Acuity

19 cases of non-pineal intracranial germ cell tumors were reviewed retrospectively with both radiologic andclinical featurses. The results were as follows: 1. The age distribution was 8 to 32 year old (16 year old of meanage) and the sex distribution shows male predominence(15:4). 2. The histopathologic diagnosis included 11 cases ofgeminoma, 2 cases of mixed germ cell tumor, 1 case of embryonal cell carcinoma and 5 cases of unknown. 3. Thelocation of tumors was the suprasellar region in 8 cases, the left basal ganglia and thalamus in 5 cases, and theright frontal lobe in 1 case. Among 11 cases of geminoma, 6 cases involve the suprasellar region and 3 cases theleft basal ganglia and thalamus. 4. In clinical features, there were visual disturbance, diabetes insipidus,increased ICP signs, motor weakness, hormonal disorders, and personal changes in order. 5. In tumor marker studyof 6 cases of geminoma, 5 cases show increase in HCG, titie, but all 6 cases were normal in AFP titer. 6. In brainCT, most of all revealed well-defined homogeneous high density with or without small central low density andhomogenous enhancement at solid portion,and there was calcification in only case with mixed germ cell tumor.
Age Distribution ; Basal Ganglia ; Brain ; Diagnosis ; Frontal Lobe ; Germ Cells ; Humans ; Male ; Neoplasms, Germ Cell and Embryonal ; Retrospective Studies ; Sex Distribution ; Thalamus

Borderline thyroid tumors are composed of hyalinizing trabecular tumor (HTT), well differentiated tumor of uncertain malignant potential (WDT-UMP), follicular tumor of uncertain malignant potential (FT-UMP) and non-invasive follicular tumor with papillary like nuclear feature (NIFTP) by World Health Organization (WHO) definition. They have different pathological feature from each other. However, it is difficult to diagnose with diagnostic imaging, fine needle aspiration (FNA) or core biopsy preoperatively. Thus, the diagnosis is usually made after diagnostic lobectomy. Main surgical concerns about borderline tumor are not performing total thyroidectomy because of relatively indolent nature of these tumors. Unfortunately, some of these tumors can be diagnosed as malignant tumor preoperatively. The other surgical concern is performing completion thyroidectomy or not after diagnostic lobectomy. Decision making is difficult even though it is generally considered that lobectomy alone is enough. In this article, we will discuss clinical features of borderline malignant tumors and surgical strategy for these tumors.
Biopsy ; Biopsy, Fine-Needle ; Decision Making ; Diagnosis ; Diagnostic Imaging ; Hyalin ; Thyroid Gland ; Thyroidectomy ; World Health Organization

Studies on milk transfer of drugs in non-human primates (NHPs) are among the crucial components in the assessment of peri- and postnatal toxicity because of the similarity between NHPs and humans. To evaluate the milk transfer of valproic acid (VPA) in NHPs, the toxicokinetics of VPA, an antiepileptic drug, were studied in pregnant cynomolgus monkeys. VPA was administered once daily to pregnant cynomolgus monkeys at doses of 0, 30, 90, and 270 mg/kg by oral gavage from Day 100 of gestation (GD 100) to Day 31 of lactation (LD 31). Concentrations of VPA and its metabolite, 4-ene-VPA, in the maternal plasma on GD 100, GD 140, and LD 30, and concentrations of VPA and 4-ene-VPA in the offspring plasma and milk on LDs 30 and 31, respectively, were quantified using liquid chromatography tandem mass spectrometry (LC/MS/MS). After administration of a single oral dose of VPA to pregnant monkeys on GD 100, the concentrations of VPA and 4-ene-VPA were generally quantifiable in the plasma of all treatment groups up to 24 hr after administration, which showed that VPA was absorbed and that the monkeys were systemically exposed to VPA and 4-ene-VPA. After administration of multiple doses of VPA to the monkeys, VPA was detected in the pup's plasma and in milk taken on LD 30 and LD 31, respectively, which showed that VPA was transferred via milk, and the pup was exposed to VPA. Further, the concentration of VPA in the milk increased with an increase in the dose. Extremely low concentrations of 4-ene VPA were detected in the milk and in the pup plasma. In conclusion, pregnant monkeys were exposed to VPA and 4-ene-VPA after oral administration of VPA at doses of 30, 90, and 270 mg/kg/day from GD 100 to LD 31. VPA was transferred via milk, and the VPA exposure to the pup increased with an increase in the dose of VPA. The metabolite, 4-ene VPA, was present in extremely low concentrations (< 0.5 microg/ml) in the milk and in the pup plasma. In this study, we established methods to confirm milk transfer in NHPs, such as mating and diagnosis of pregnancy by examining gestational sac with ultrasonography, collection of milk and pup plasma and determination of toxicokinetics, using cynomolgus monkeys.
Administration, Oral ; Chromatography, Liquid ; Fatty Acids, Monounsaturated ; Female ; Gestational Sac ; Haplorhini ; Humans ; Lactation ; Macaca fascicularis ; Milk ; Plasma ; Pregnancy ; Primates ; Tandem Mass Spectrometry ; Valproic Acid

PURPOSE: The superior orbital fissure syndrome is a complex of impaired function of the cranial nerves that enter the orbit through this fissure. It is a very rare disease which is characterized by ophthalomoplegia, ptosis and proptosis of the eye, reflex dilation of the pupil, and anesthesia of the upper eyelid and forehead. This syndrome may be the result of craniofacial bone fractures as well as neoplasm of the retrobulbar space, hematomas in the orbital muscle cone and retrobulbar space, and hematoma and infection of the cavernous sinus. In this case, 12 year-old boy was stung at his medial side of the right upper eyelid by fishing-rod. This patient is described with features of a superior orbital fissure syndrome. Superior orbital fissure syndrome is a very rare disease. We report a case of superior orbital fissure syndrome. METHODS: Ptosis and complete external ophthalmoplegia were found in that eye. Snellen acuity of the right eye was 20/20. Dilation of the right pupil with loss of sensation on the right upper side of eyelid and forehead was noted. Under the impression of superior orbital fissure syndrome, systemic steroid was administered orally. RESULTS: A month after trauma, the patinet had no limit of motion at extraocular muscle except upward gaze and improved ptosis. Three months after the trauma, the patient had no signs and symptoms except sluggish pupillary reflex on the right eye.
Anesthesia ; Cavernous Sinus ; Child ; Cranial Nerves ; Exophthalmos ; Eyelids ; Forehead ; Fractures, Bone ; Hematoma ; Humans ; Male ; Ophthalmoplegia ; Orbit* ; Pupil ; Rare Diseases ; Reflex ; Reflex, Pupillary ; Sensation

PURPOSE: The aim of this study was to evaluate the utility of contrast-enhanced MRI with first-pass and delayed images in prediction of myocardial viability after acute myocardial infarction. MATERIALS AND METHODS: Ten patients (M:F=:4, mean age =6 5 years) with acute myocardial infarction underwent first-pass image after bolus injection of gadolinium (one image/sec for 120sec)and delayed image (7 2 minutes later). According to 60 segments on midventricular level, the assessment of MRI were concerned about location of lesion, depth of lesion, enhancement on first-pass image and enhancement pattern on delayed image. MRI findings were compared with wall motion on resting echocardiography and stress or follow-up echocardiography. RESULTS: 1) MRI findings were classified into 4 types: normal enhancement on first-pass and delayed images (type 1), normal enhancement on first-pass image and nontransmural hyperenhancement on delayed image (type 2), non-transmural enhancing defect on first-pass image and transmural enhancement with endocardial non-enhancing defect on delayed image (type 3), and transmural enhancing defect on first-pass image and transmural hyperenhancement on delayed image (type 4).2) Type 2 suggested viable myocardium and type 3 had high porbability of viability. Type was compatible with non-viable myocardium. CONCLUSION: Enhancing defect on first-pass image and involving thickness on both the first-pass image and delayed image in contrast enhanced MRI may predict myocardial viability.
Echocardiography ; Follow-Up Studies ; Gadolinium ; Humans ; Magnetic Resonance Imaging* ; Myocardial Infarction* ; Myocardium