The level of copayment increased in order to stabilize the financial condition of the health insurance on 1986. An important question regarding the policy was whether the increase in the level of copayments reduced the utilization of medical services in the poor selectively. In spite of the importance of the research question, no study has been reported. This study was designed to find out changes in nuniU rs of physician visits, to explain charac teristics influencing the difference of utilization before and after the program. Finally the interaction effect between the program and the level of income was examined for the abover question. A total of 10,421 persons from eight institutions was selected as the study sample. Research findings are as follows. 1. The number of physician visits decreased by ten percent as a result of increasing the level of copayment. 2. The decrease was remarkable in some groups such as children, rural area and large family. 3. The most important factor which explained the difference was the number of physician visits before the introduction of the new program.. The more numbers of physian visits during the last year were, the more numbers of physian visits decreased after the program. 4. The interaction term between the program and the level of income was statistically significant in the multiple regression model which explained physician visits and its coefficient was negative. It means that an increase in copayment did not reduced the number of physician visits in the poor, selectively. 5. It can be concluded that imposing adequate copayment reduces the use of medical services as well as medical costs without serious damage in access especially for the poor pule.
Child ; Humans ; Insurance, Health

We report one case of bilateral testicular torsion. A 400 gm male infant, born by cesarean section due to induction failure at 42 weeks gestation, was hospitalized at 9 days of age secondary to bilateral testicular mass. Physical examination revealed an healthy baby with enlarged, firm, nontender mass on both sides of the scrotum. Transillumination of the mass showed no transmission of light. Laboratory data included a normal CBC and a urinalysis. Ultrasonogrophy showed well encapsulated 0.9 x 0.9 x 1.0 cm sized and 1.5 x 1.3 x 1.3 cm sized homogenous hypoechoic solid mass in left and right testicles respectively, remainder testicular parenchyme showed normal structure. Exploration of the testes was performed at 25-days old under general anesthesia. Exploration revealed a infarction of the right testes secondary to spermatic cord torsion, evidenced by clockwise turns outside the tunica vaginalis of 270 degrees. Left testes was infarcted but a quarter of them seemed normal. Orchiectomy on right and fixation on left testes were performed respectively. Left spermatic cord seemed to be detorted spontaneously. Postoperatively the infant did well and discharged 5 days after operation. Follow up examination during the next 3 months have shown appropriated sized testicle with normal colorization and arterial pulse. Testicular scan performed at age 39 days showed good perfusion of left testes.
Anesthesia, General ; Cesarean Section ; Female ; Follow-Up Studies ; Humans ; Infant ; Infant, Newborn* ; Infarction ; Male ; Orchiectomy ; Perfusion ; Physical Examination ; Pregnancy ; Scrotum ; Spermatic Cord ; Spermatic Cord Torsion ; Testis* ; Transillumination ; Urinalysis

An outbreak of dermatosis occurred at a machinery manufacture factory in kyongju on Aug 1995. Authors conducted a questionnaire survey among 92 workers in the factory and a dermatologist examined their skin lesions. Authors also collected moths and identified them. The results are as follows; 1. Forty-two cases of dermatosis were identified with attack rate of 45.7%. Attack rate was not different by company, age, sex, educational level and duration of employment. Attack rate was 47.8% among productive workers, 25.0% among clerical workers and 100.0% among patrolmen. 2. Two cases among 42 dermatosis cases and three subjects among 50 non-cases had a history of same dermatosis last year. Four of dermatosis cases had a history of dermatosis among their family members. 3. skin lesions of the cases were scattered or grouped rice-sized erythematous papules or vesicles. Duration of dermatosis from the onset to the time of survey was from one day to more than 30 days. The most frequent site of skin lesion was the arms(81.0%), and it was also observed at the neck(47.6%), abdomen(45.2%), chest(42.9%), legs(38.1%) and back(35.7%). skin lesion was aggravated with sweating(31.0%), after shower(16.7%) and with scratching(l1.9%). 4. Moths were collected and identified as Euproetis subflava(Bremer). Many poisons stings were observed on their wngs which is harmful to human. 5. Contact with moths' wing droppings to two authors on their forearms for provocation resulted in severe immediate pain followed by prolonged pruritus. Erythematous macules quickly appeared and suoceeded by firm wheal-like red papules. Authors thought that the outbreak of dermatosis was brought about by Euproetix subflava(Bremer). Further studies on the factors contributing to the prosperity of the moths in this area are needed.
Bites and Stings ; Employment ; Epidemiologic Studies* ; Forearm ; Gyeongsangbuk-do ; Humans ; Korea ; Moths* ; Poisons ; Pruritus ; Surveys and Questionnaires ; Skin ; Skin Diseases* ; Wings, Animal

No abstract available.
Diabetes Mellitus* ; Tuberculosis*

The Marfan syndrome is classified as a heritable disorder of connective tissue with clinical and pathological alterations involving supporting elements. In its classic form, the Marfan syndrome is associated with abnormalities of the eye(ectopia lentis), aorta(aortic dilatation and aortic regurgitation) and skeleton(dolichostenomelia, arachnodactyly and pectus deformity). The authers have experienced a case of marfan syndrome recently. The patient was 30-years-old male complaining of anterior chest pain radiating to upper back. Physical examination showed tall status, increased length of the limbs as compared with the trunk and arachnodactyly. On auscultation, heart sound was normal without murmur. He wore glasses because of moderate myopia. Roentgenogram of the chest P-A revealed normal cardiac and aortic contours and lung fields. Left lateral view of chest X-ray revealed concave depression of sternum showing mild pectus excavatum, fusiform dilatation of aorta from aortic root to mid portion of thoracic aorta and resulting in obliteration of retrosternal clear space. Echocardiogram demonstrated moderate dilatation of aortic root A-P diameter(4.5cm) without aortic or mitral valvular abnormalities and normal size of left ventricular cavity(EDD:5.3cm). These data coupled with a distinct family history could permit the diagnosis of Marfan syndrome.
Aorta ; Aorta, Thoracic ; Arachnodactyly ; Chest Pain ; Connective Tissue ; Depression ; Diagnosis ; Dilatation ; Extremities ; Eyeglasses ; Funnel Chest ; Glass ; Heart Auscultation ; Humans ; Lung ; Male ; Marfan Syndrome* ; Myopia ; Physical Examination ; Sternum ; Thorax

BACKGROUND: Polyethylene glycol(PEG) has been the most widely used colonic lavage solution. But large volume and salty taste of PEG solution is a problem which can lead to the noncompliance and the poor bowel cleansing. Recent reports have suggested that sodium phosphate solution of much smaller volume is more effective in colon cleansing ability and more easier to complete. Therefore, this study was designed to compare two solutions for colonoscopy and to determine the differences in either patient compliance or cleansing ability. METHOD: Eighty-two patients were randomized to take either oral sodium phosphate solution or 2 liter of PEG solution. Patient's discomfort and tolerance during ingestion was asessed by questionnaire and one colonoscopist who did not know the type of solution, assessed colonic preparation status. RESULTS: Among 25 patients experiencing two separate colonoscopies with PEG solution and sodium phosphate solution respectively, 19(76%) patients preferred sodium phosphate solution. Sodium phosphate solution was found to be easier to take. Sodium phosphate caused thirst more frequently(p=0.013) than PEG solution. Particulate stool and water retention status were similar in two groups. Gas bubble formation that disturbs luminal observation was more frequently found in sodium phosphate preparation group(P=0.00). Sodium phosphate was more effective in right colon cleansing ability than PEG preparation(P=0.04). The Colonoscopist assessed sodium phosphate as "good" in 47.2% vs 58.6% after PEG preparation as a whole, but there was no statistical difference. CONSLUSION: Sodium Phosphate solution is better tolerated and more easier to take than PEG solution. Gas bubble formation is a correctable problem, but right colonic cleansing effect is not. Our results showed that sodium phosphate is likely to be more effective in colonic cleansing effect comparing to polyethylene glycol solution.
Colon ; Colonoscopy ; Eating ; Humans ; Patient Compliance ; Phenobarbital ; Polyethylene Glycols* ; Polyethylene* ; Surveys and Questionnaires ; Sodium* ; Therapeutic Irrigation ; Thirst ; Water

BACKGROUND/AIMS: The caudal anesthesia for anal surgery is simple and effective. Also, it is relatively safe because there is no headache or other neurologic complications. But, during the operation under caudal anesthesia, the unwanted symptoms such as lower abdominal pain or hypotensive symptoms were experienced in some patients. These unwanted symptoms may occur due to anal and lower rectal dilatation. The precise mechanism is unknown. But we speculated that some sensory nerve endings in rectal submucosa may be involved in this mechanism. So, we think that it is possible to prevent or reduce these symptoms if we block these sensory nerve endings effectively with local anesthetics. Therefore, the aim of this study is to see whether the locally injected lidocaine can reduce or prevent the unwanted symptoms during anal surgery under caudal anesthesia. METHODS: There were 100 consecutive patients in this study who had hemorrhoidectomy with Jack-knife position under caudal anesthesia at our clinic. We divided evenly these 100 patients into two groups, injection and control groups(in each group, 50 patients were included.). In injection-group, We injected 10 cc(100 mg) of 1% lidocaine solution cir cumferentially into the lower rectal submucosa at the beginning of the operation. In control-group, we did not inject lidocaine solution initially, but the lidocaine injection was done during the operation in the same manner in the injection-group if the severe unwanted symptoms occurred. We used Parks-type retractor to dilate the anus and recorded the patient,s complaints. RESULTS: In injection-group, male to female ratio was 33:17, mean age was 42.1 years(20~69) and mean operation time was 38.3 minutes(15~80). In control-group, male to female ratio was 25:25, mean age was 43.7 years(17~65) and mean oeration time was 38.5 minutes(15~80). Lower abdominal pain was present in 11 patients(22%) among injection-group and in 37 patients(74%) among control-group(p=0.000). Hypotensive symptoms such as nausea, vomiting, sweating and dizziness were present in 1 patient(2%) among injection-group and in 8 patients(16%) among control-group(p=0.014). We injected lidocaine solution into lower rectal submucosa during the operation in 18 patients with severe symptoms among control-group. The effect of the injected lidocaine solution in 18 control patients was good in 13(72%) and fair in 5(28%). With regard to factors influencing the occurrence of symptoms, there was a tendency of higher occurrence in male, the younger-aged and the longer-operation groups. CONCLUSION: The lower rectal submucosal lidocaine injection reduced the unwanted symptoms such as lower abdominal pain and hypotensive symptoms during the anal surgery under the caudal anesthesia.
Abdominal Pain ; Anal Canal ; Anesthesia, Caudal* ; Anesthetics, Local ; Dilatation ; Dizziness ; Female ; Headache ; Hemorrhoidectomy* ; Humans ; Lidocaine* ; Male ; Nausea ; Sensory Receptor Cells ; Sweat ; Sweating ; Vomiting

OBJECTIVE: The purpose of this study is to evaluate the types of aphasia and the clinicoanatomic correlation in aphasic patients with subcortical lesions, and to investigate the change in the types of aphasia during the recovery stage. METHOD: Twenty-three stroke patients (16 men and 7 women) with left subcortical lesion was investigated. On the basis of the brain CT or MRI findings, the patients were divided into the 4 groups. Language dysfuntion was evaluated using the modified Western Aphasia Battery (WAB) and the type of aphasia and aphasia quotient were determined. Initial examination was performed within 2 months post-onset in all of the patients and the follow-up examination was done after 6 months post-onset in 9 patients. RESULTS: The most common type was anomic aphasia (39%). The type of subcortical aphasia was variable regardless of the sites of left subcortical lesion. Aphasia quotient was significantly related with the lesion size (gamma = 0.05, p<0.05) and the initial Barthel index (gamma = 0.65, p<0.05). The scores of all the subtests of the modified WAB and aphasia quotient were significantly decreased in the group with the cortical involvement or the history of operation. On the follow-up examination, the scores of fluency, information and naming subtests were significantly increased. CONCLUSION: The most common type of aphasia was anomic aphasia and the type of subcortical aphasia was not correlated to the anatomic lesion. Severity of subcortical aphasia would be related with the lesion size, the history of operation or the cortical involvement. The prognosis of subcortical aphasia was generally good.
Anomia ; Aphasia* ; Brain ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Prognosis ; Stroke

With the advent of checkpoint inhibitors, it has opened up opportunities for numerous cancer patients. However, as is the case with every treatment, complications need to be weighed. Gastrointestinal adverse effects, such as diarrhea and colitis are well-known complications for checkpoint inhibitors. In severe cases, colitis-induced colonic perforation may occur with an estimation of 1.0% to 1.5% in anti-CTLA-4 antibodies. However, only a handful of cases of such devastating complications have been reported in anti-PD-1 antibodies such as pembrolizumab and nivolumab. We here report a case of intestinal perforation in a patient treated with nivolumab.

With the advent of checkpoint inhibitors, it has opened up opportunities for numerous cancer patients. However, as is the case with every treatment, complications need to be weighed. Gastrointestinal adverse effects, such as diarrhea and colitis are well-known complications for checkpoint inhibitors. In severe cases, colitis-induced colonic perforation may occur with an estimation of 1.0% to 1.5% in anti-CTLA-4 antibodies. However, only a handful of cases of such devastating complications have been reported in anti-PD-1 antibodies such as pembrolizumab and nivolumab. We here report a case of intestinal perforation in a patient treated with nivolumab.