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

PURPOSE: Dopamine plays a critical role in promoting sexual drive and penile erection through dopamine receptors. This study was performed to investigate whether the cavernousal nerve controls the expression of peripheral dopamine D1 receptors in rat penile tissues after cavernousal nerve injury. MATERIALS AND METHODS: Male rats (n=20) were divided into two groups: a control group consisting of sham-operated rats (n=10) and an experimental group consisting of rats that underwent incision of the bilateral cavernous nerve (n=10). Three months later, the intracavernous pressure response was monitored using an intracavernous papaverine injection of 300 microgram. The expression of dopamine D1 receptor mRNA were studied using an RT-PCR method, and dopamine D1 receptor protein expression by Western blot analysis and immuno-histochemical staining in each group. The expressed band density of the RT-PCR and Western blot were measured by a densitometer. RESULTS: Erectile functions, as studied by intracavernosal papaverine injection at three months, were similar in both groups. The dopamine D1 receptor mRNA and protein expressions were significantly lower in the neurotomy group. The immuno-histochemical staining also showed a reduction in the dopamine D1 receptor expression in the neurotomy group compared with the control group. CONCLUSIONS: Our results show that dopamine D1 receptors in penile tissues were down-regulated following cavernousal nerve injury. These findings suggest that cavernousal nerve injury affects directly the reduction of dopamine D1 receptor expression, and that the action of dopamine on the cavernousal dopamine receptor will be affected in cavernousal nerve injured rats.
Animals ; Blotting, Western ; Dopamine* ; Down-Regulation* ; Humans ; Male ; Papaverine ; Penile Erection ; Penis ; Rats* ; Receptors, Dopamine ; Receptors, Dopamine D1* ; RNA, Messenger ; Wounds and Injuries

A Schwannoma is a tumor originating from the neural sheath of Schwann cells, and is also known as a neurilemmoma, neurinoma or fibroblastoma. It can be either a benign or malignant tumor arising from the associated nerve sheath. Here, a case of a Schwannoma, originated from the obturator nerve of the pelvic cavity, in a patient with urinary frequency is reported, with a brief review of the literature.
Humans ; Neurilemmoma* ; Obturator Nerve* ; Pelvis ; Schwann Cells

PURPOSE: The inducible isoform of heme oxygenase(HO), HO-1, responds to hypoxia. HO-1 regulates vascular smooth muscle tone through carbon monoxide production. To investigate the possible role of HO-1 in low-flow priapism, we examined the expression and activity of HO-1 in artificially induced veno-occlusive priapism in rat. MATERIALS AND METHODS: Fourteen male Sprague Dawley rats were divided into 2 groups with 7 rats each. In the first group, low-flow priapism was induced using a vacuum-constriction device and a constriction rubber band; in the second group, low-flow priapism was induced using papaverine. We measured the expression level and activity of HO-1 in penile tissues after time periods of 0(control), 2, 3, 4, 8, 12, 24, and 48 hours. At the same time, the expression levels of i-NOS, e-NOS, and beta-actin(control) in penile tissues were also measured. RESULTS: In both groups, expression of HO-1 and HO-1 enzyme activities in penile tissue significantly increased in a time dependent fashion(p<0.01). However, there was no difference in the expression of i-NOS and e-NOS in both groups at any time period. CONCLUSIONS: HO-1 was induced over time in rats with artificially induced veno-occlusive priapism. Induction of HO-1 may play a protective role against hypoxic injury, but may also play an important role in the vicious cycle observed for low flow priapism. Increasing induction of HO-1 against hypoxic injury in a prolonged erectile state promotes sustained dilatation of corporal smooth muscle, and this may aggravate low-flow priapism.
Animals ; Anoxia ; Carbon Monoxide ; Constriction ; Dilatation ; Heme Oxygenase (Decyclizing) ; Heme Oxygenase-1* ; Heme* ; Humans ; Male ; Muscle, Smooth ; Muscle, Smooth, Vascular ; Papaverine ; Priapism* ; Rats* ; Rats, Sprague-Dawley ; Rubber

Extrahepatic metastasis of hepatocellular carcinoma (HCC) can be found in various organs, but metastasis to the female genital tract is extremely rare. A 48-year-old woman who had undergone curative left lobectomy for small HCC 4 years earlier was admitted because of sequential alpha-fetoprotein elevation. Upon abdominal MRI and hepatic angiography, no evidence of HCC recurrence was found in the remnant liver. However, a positron emission tomography CT scan showed a hypermetabolic lesion in the uterine fundus, which was revealed as metastatic HCC after total hysterectomy. This is, to our knowledge, the first documented case of metastatic uterine tumor that originated from HCC without intrahepatic recurrence.
alpha-Fetoproteins ; Angiography ; Carcinoma, Hepatocellular ; Female ; Humans ; Hysterectomy ; Liver ; Middle Aged ; Neoplasm Metastasis ; Positron-Emission Tomography ; Recurrence ; Uterine Neoplasms

Extrahepatic metastasis of hepatocellular carcinoma (HCC) can be found in various organs, but metastasis to the female genital tract is extremely rare. A 48-year-old woman who had undergone curative left lobectomy for small HCC 4 years earlier was admitted because of sequential alpha-fetoprotein elevation. Upon abdominal MRI and hepatic angiography, no evidence of HCC recurrence was found in the remnant liver. However, a positron emission tomography CT scan showed a hypermetabolic lesion in the uterine fundus, which was revealed as metastatic HCC after total hysterectomy. This is, to our knowledge, the first documented case of metastatic uterine tumor that originated from HCC without intrahepatic recurrence.
alpha-Fetoproteins ; Angiography ; Carcinoma, Hepatocellular ; Female ; Humans ; Hysterectomy ; Liver ; Middle Aged ; Neoplasm Metastasis ; Positron-Emission Tomography ; Recurrence ; Uterine Neoplasms

STUDY DESIGN: A case report. OBJECTIVES: To report a rare case of epidermoid cyst in the spinal canal. SUMMARY OF LITERATURE REVIEW: Epidermoid cyst in the spinal canal is rare. Idiopathic epidermoid cyst in the spinal canal not associated with a trauma or infection is even rarer. MATERIAL AND METHODS: A 73 year-old female presented with a 1 year history of progressive paresthesia and motor weakness of both lower extremeties. MRI showed a cystic mass on the 7th thoracic canal. We performed total laminectomy at the T6-T8 level. The cystic mass was excised after durotomy using a posterior approach. RESULTS: We confirmed the presence of an epidermoid cyst for histopathology. CONCLUSION: Idiopathic epidermoid cyst in the spine is very rare and requires accurate differential diagnosis. Preoperative MRI scans are necessary to differentiatie epidermoid cysts from other intradural masses. Confirmative diagnosis can be done by histopatholoty.
Diagnosis ; Diagnosis, Differential ; Epidermal Cyst* ; Female ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Paresthesia ; Spinal Canal ; Spine

BACKGROUND: Currently, combined spinal-epidural anesthesia (CSE) is frequently administered, especially in obstetrics and orthopedic surgery. The aim of this study is to determine the appropriate concentration of bupivacaine to use with epidural volume extension that is suitable for total knee replacement during CSE. METHODS: Eighty patients (ASA physical status I and II) scheduled for totalknee replacement were randomly allocated to four groups of 20 patients each: All patients intrathecally received 2 ml of 0.5% hyperbaric bupivacaine. After fixation of spinal anesthesia, the groups received the following treatments. Group S patients received a 10 ml administration of normal saline for 15 min followed by a continuous 10 ml/hr epidural infusion. Group B1 patients received a 10 ml administration of 0.125% bupivacaine for 15 min followed by a continuous 10 ml/hr epidural infusion. Group B2 patients received a 10 ml administration of 0.25% bupivacaine for 15 min followed by a continuous 10 ml/hr epidural infusion. Group B3 patients received a 10 ml administration of 0.5% bupivacaine for 15 min followed by a continuous 10 ml/hr epidural infusion. RESULTS: The incidence of intraoperative movement in group S and group B1 patients were significantly greater than the incidence for group B2 and B3 patients. The incidence of intraoperative pain in group S patients was significantly greater than for patients in any of the other groups. CONCLUSIONS: We conclude that it is necessary to administer more than a 0.25% concentration of epidural bupivacaine load and provide continuous administration after a spinal block during total knee replacement.
Anesthesia* ; Anesthesia, Spinal ; Arthroplasty, Replacement, Knee* ; Bupivacaine* ; Humans ; Incidence ; Obstetrics ; Orthopedics

PURPOSE: Sentinel lymph node (SLN) biopsy has become a new standard procedure in the treatment of patients with early breast cancer. Furthermore, many institutions have begun offering the sentinel lymph node biopsy without simultaneous axillary dissection as a possible standard procedure when the SLN was free from tumors. For appropriate intraoperative decision making on the presence of cancer cells in axillary lymph nodes, a fast and accurate method to assess the SLN is required. The authors performed a prospective investigation of the relative merits of rapid cytokeratin immunohistochemical (IHC) staining of the SLN removed during the operations of breast cancer patients. METHODS: Between December 2002 and August 2003, 38 patients with T1and T2 breast cancer were enrolled after undergoing successful sentinel lymph node biopsy. A total of 60 sentinel lymph nodes (mean number, 1.58) were biopsied and first examined by hematoxylin-eosin (H&E) staining. All the tumor free sentinel lymph nodes by H&E stained section were immunostained for cytokeratin using a rapid immunohistochemical assay (Cytokeratin (PAN), 1:50, Newcastle, UK) during the operation. Finally, the sentinel lymph nodes were submitted for paraffin embedding and serial section after surgery. Both H&E stained and cytokeratin immunostained sections were also performed. RESULTS: This technique has a turnaround time of less than 20 minutes during the operation. Rapid IHC staining revealed 4 positive sentinel lymph nodes that were negative for metastasis by H&E staining. Among these false negative 4 cases, two cases had problems with the frozen section of H&E staining and the other 2 cases had problems due to micrometastasis. This study showed a sensitivity of 88.89%, a specificity of 100%, an accuracy of 98.33%, and a negative predictive value of 98.08%. The false-negative case (1 of 52), which was negative on H&E staining and rapid IHC staining during the operation, was disclosed as positive only after a serial permanent section examination with IHC stain. CONCLUSION: The introperative examination of sentinel lymph nodes is a highly accurate and effective way of predicting the axillary lymph node status of patients with breast cancers. This may be a promising technique in deciding whether to spare axillary lymph node dissection for the patient in the operating room.
Biopsy ; Breast Neoplasms* ; Breast* ; Decision Making ; Frozen Sections ; Humans ; Keratins* ; Lymph Node Excision ; Lymph Nodes* ; Neoplasm Metastasis ; Neoplasm Micrometastasis ; Operating Rooms ; Paraffin Embedding ; Prospective Studies ; Sensitivity and Specificity ; Sentinel Lymph Node Biopsy

No abstract available.
Induction Chemotherapy* ; Nasopharyngeal Neoplasms*