BACKGROUND: The purpose of this study was to investigate the characteristics of and to analyze the factors re-lated to the cost of the resolution of a medical dispute. METHODS: We have reviewed 2,346 cases reported to the Korean Medical Association(KMA)mutual-aid association from Nov. 1. 1981 to Oct. 31. 1994. RESULTS: The percentage rate of reported cases of were related field as follows .' obstetric gynecology(OBGYN) 31.9%, general practitice 28.1%, general surgery 13.3%, orthopedics 6.9% and internal medicine 6.4% 1,829 cases (80.0%) were settled out of court and without public intervention. 310 cases(13.2%) were settled by the police, the public procurators office or the court. The mean settlement amount per case was 9,340,000 won with annual growth rate 10.8%, and median settlement amount was 5,890,000 won. The mean settlement amount for OBGYN was 930,000 won, surgical group 8,900,000 won, medical group 7,710,000 won, and general practitice 7,490,000 won. The cases of medical dispute according to the types of medical care were : operation 21.1%, injection 18.0%, treat-ment and care 18.0%, delivery 13.0%, artificial abortion 10.3%, Cesarian section 7.2% and anesthesia 2.5%. The mean settlement amount according to the types of medical care were: delivery and Cesarian section 15,190,000 won, operation and anesthesia 9,500,000 won, others 6,610,000 won, and injection and medication 6,230,000 won. The mean settlement amount that was settled out of court without public intervention was 7,940,000 won. The mean settlement with public intervention in the court was 17,290,000 won. The cases of medical dispute according to the patients status were .' death 37.5%, complications 20.8%, disability 12.2% and others 28.9%. The mean settlement amout for death was 16,150,000 won, disability 9,430,000 won, others 4,850,000 won and complications 3,550,000 won. The mean settlement amount where doctors have asserted that the outcome was inevitable or have not agreed that it was their fault was higher than the cost of cases where they had admitted responsibility. The settlement amout where there was a misdiagnosis present had not shown to be higher than when the misdiagnosis was absent. The mean settlement amount for cases where multiple doctors were involved was higher than for cases of a single doctor. The mean settlement amount for disturbing the medical practice and suspension of are high. The mean settlement amount for complications was lower than others, and the mean settlement amount for disability and death presented were high. Concerning the types of care, the mean settlement amount for operation/anesthesia, delivery/ Cesarian sections were higher than for injection/medication. Concerning the type of settlement, the mean settlement amount in the police and public procurators office was higher than in out of court without public intervention. CONCLUSIONS: The mean settlement amount depended on the patient's status, the type of settlement, and the disturbance of medical practice regardless of the doctors misdiagnosis, fault, and standard care. Therefore, a reason-able method of resolution for medical dispute is needed.
Anesthesia ; Diagnostic Errors ; Dissent and Disputes ; Humans ; Internal Medicine ; Malpractice* ; Orthopedics ; Police

The authors performed a retrospective review to find out optimal treatment plan in infantile fistula-in-ano. There were seventy-one patients in a 2-year period. All were male and other clinical characteristics were similar to previous reports. The onset in 60 patients(97%) of the cases was in the first 1 year of alee, especially in the first 3 months(52%). We investigated patterns of disease progression in multiple-lesion cases(19cases 29%). In 5 out of 9 cases of which we could identify the patterns, new lesion developed from 1 month to 4 months after index lesion. Fifty Patients underwent fistulotomy under principle of early surgical intervention, No recurrence was found except 2cases who needed second operation during 30 months of median follow-up(23~48 months). In 21 patients whose parents did not want operation, we performed simple drainage and followed-up. Six out of 12 patients who could be communicable had no fistula-related symptoms from 20 months to 31 months. This suggests that simple drainage has therapeutic effect in some portion of infantile abscess. We conclude that simple drainage should be initial treatment of choice in infantile perianal abscess. We suggest that definite operation for recurrent abscess and fistula with relatively mild symptoms should be delayed until 1-year of age because of interval ccurrence of multiple lesions and therapeutic effect of simple drainage.
Abscess ; Child ; Disease Progression ; Drainage ; Fistula ; Humans ; Infant* ; Male ; Parents ; Rectal Fistula ; Recurrence ; Retrospective Studies

BACKGROUND: It is generally accepted that most colorectal cancers develop from adenomas, so the detection and removal of them can reduce the incidence of colorectal cancers. Sigmoidoscopy is the effective tool for detecting and removing adenomatous polyps in the rectosigmoid region, but its major limitation is that sigmoidoscopy alone can not detect considerable portion of colorectal adenomas. METHODS: From October, 1996 to August, 1997, we performed 2017 sigmoidoscopies and 1683 colonoscopies. We analysed the anatomical distribution of adenomas and compared the detection rate of adenomas between two groups. In 32 cases, adenomas detected by sigmoidoscopy were followed by colonoscopy in less than 2 months. RESULTS: We found 125 cases of adenomas in 2017 sigmoidoscopies and 281 cases of adenomas in 1683 colonoscopies. In 281 cases of adenomas found by colonoscopy, 151 cases had rectosigmoid adenomas only and 25 cases had rectosigmoid and proximal adenomas, 105 cases had proximal adenomas only. The detection rate of adenomas by sigmoidoscopy was significantly lower than that by colonoscopy in the rectosigmoid region(6.1% vs. 10.5%, p=0.002). In 32 cases of adenomas found by sigmoidoscopy that were followed by colonoscopy, 7 cases of proximal adenomas and 6 cases of additional rectosigmoid adenomas were detected. CONCLUSION: Sigmoidoscopy cannot detect adenomas in the proximal colon beyond the sigmoid, it also can miss a significant portion of adenomas in the rectosigmoid.
Adenoma* ; Adenomatous Polyps ; Colon ; Colon, Sigmoid ; Colonoscopy ; Colorectal Neoplasms ; Incidence ; Mass Screening* ; Sigmoidoscopy*

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

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: In the Republic of Korea, there had been no reports about indigenous malaria cases since 1984 until a vivax malaria case was detected in 1993. Thereafter vivax malaria has been a reemerging disease in Korea, the number of cases of malaria increasing recently and the prevalent area being more wider. We suggested that we should take malaria into consideration as the differential diagnosis whenever we meet the febrile patients. We analyzed the cases of malaria who were treated in Myoungji hospital located in Goyang-Si during 4years. METHODS: We retrospectively analyzed data of 79 confirmed cases of malaria treated in the Myoungji hospital from January 1, 1998 to December 31, 2001. All of the patients had no histories of traveling abroad, drug abuse or blood transfusion. The clinical manifestation, hematologic abnormalities and prognosis of patients were reviewed. RESULTS: Seventy-nine cases of malaria were diagnosed as vivax malaria by blood smears. Vivax malaria was developed in Goyang-Si from May through November. Common symptoms were fever (100%), chilling (84.8%), headache (64.6%) and myalgia (55.7%). Splenomegaly was detected in 77.2% of cases by sonography. In 1998, Tertian fever pattern was most frequent. Since 1999, irregular and atypical fever patterns, such as almost-daily high fever or the every fourth or fifth-day fever, were increased in numbers. Laboratory findings included thrombocytopenia (92.4%), anemia (29.1%), leukopenia (25.3%) and leukocytosys (5.1%). CONCLUSION: ICases of indigenous malaria have been progressively increasing in the Republic of Korea. Therefore early diagnosis, treatment and prevention of malaria are very important. Fortunately, patients were well responsed to treatment.
Anemia ; Blood Transfusion ; Diagnosis, Differential ; Early Diagnosis ; Fever ; Headache ; Humans ; Korea ; Leukopenia ; Malaria* ; Malaria, Vivax ; Myalgia ; Plasmodium vivax ; Prognosis ; Republic of Korea ; Retrospective Studies ; Splenomegaly ; Substance-Related Disorders ; Thrombocytopenia

In 1, 345 patients suspected of having pancreatic or biliary tract disease, 23 patients were shown to have biliary ascariasis demonstrated by endseopic retrograded cholangiopancreatog raphy, at Kwang Ju Christian Hospital from Sep. 1976 to Aug. 1983. Authors report the clinical study and ERCP finding of 23 cases of biliary ascariasis. The result were as follows. 1) Out of 1,345 cases of ERCP, biliary ascariasis were 28 cases, The ascaris were found in CHD & IHD in 21 cases, and 2 casee were found in Ampulla of Vater. 2) There was no specifia age incidence and male to female ratio was 1: 1.9, 3) The disease was more prevalent in spring & summer, and more prevalent in rural area than urban area. 4) The chief eomplaints were RUQ and epigastric abdominal pain. The cases which were admitetted within 2weeks of onset were 16 cases. 5) Ascaris in biliary tract were removed by operation in 14 cases, and EST were performed in 5 cases. Two cases werere moved by DORMIA basket under the endoscopic direct visualization. 6) We report E.S.T. as a new therapeutic method of biliary ascariasis.
Abdominal Pain ; Ampulla of Vater ; Ascariasis* ; Ascaris ; Biliary Tract ; Biliary Tract Diseases ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis* ; Female ; Gwangju ; Humans ; Incidence ; Male

PURPOSE: A lateral internal sphincterotomy (LIS) is a safe and effective surgical treatment that is the most commonly used one for patients with chronic anal fissure. However, reports on the recurrence rate and complications after LIS published in Korea are rare. The purpose of our study is to identify the types and rates of recurrence, the complications after LIS, and the differences in clinical outcomes between open and closed LIS. RESULTS: We used hospital records and telephone interviews to study retrospectively the rates of recurrence and complications of 898 patients who underwent a LIS for chronic anal fissure from July, 2003, to June 30, 2004. RESULTS: There were 292 male (mean age: 36.8 years, range: 16~84) and 606 female (mean age: 32.4 years, range: 1~68) patients. The preoperative mean maximum resting pressure in anal manommetry was 99.2 cmH2O in male patients and 97.7 cmH2O in female patients. Recurrence of fissure after LIS was present in five cases (0.6%). All underwent a LIS, on the same side of a previous LIS in four cases and on the opposite side in one case. Delayed healing of the fissure was present in six cases (0.7%). All of these patients were improved by conservative management. Complications of the LIS were thrombus formation, perianal abscess, fistula, and incontinence. Thrombus formation was present in eight cases (0.9%). Five patients underwent a thrombectomy and three patients were cured by conservative management. Perianal abscess or fistula was present in three patients (0.3%), who underwent incision and drainage or a simple fistulotomy. Incontinence was present in two cases (0.2%). One patient was lost to follow up, and the other patient was improved by conservative management. CONCLUSIONS: LIS is a safe and effective treatment for patients with chronic anal fissure, and recurrence and complications of LIS are rare.
Abscess ; Drainage ; Female ; Fissure in Ano* ; Fistula ; Hospital Records ; Humans ; Interviews as Topic ; Korea ; Lost to Follow-Up ; Male ; Recurrence ; Retrospective Studies ; Thrombectomy ; Thrombosis

BACKGROUND: Medical dispute is increasing and its effect on society is serious, but reasonable settlement system is absent. Nevertheless patients and families choose medical dispute. But there is little research on patients and their families who choose to settle by medical dispute. Therefore this study examines the impact of medical malpractice to patients and their families and their reasons for choosing medical dispute after mishap. METHODS: Data were collected from 234 subjects who inquired of Medical Malpractice Family Association about malpractice suit. Questionnaire was composed of demographic characteristics, characteristics of hospital, characteristics of medical malpractice, degree of satisfaction with explanation and attitude of the treating doctor, effect of medical malpractice on patients' life and reasons patients and their families choose to settle by medical dispute. Factor analysis with varimax rotation was carried out to reduce the reasons to a smaller number of clearly interpretable factors. Multiple regression analysis was carried out to identify the variables relevant to these main themes. RESULTS: Degree of satisfaction with doctor's explanation and attitude was less than 10%. Over 60% of respondents stated that medical malpractice seriously affected their lives. Four main themes emerged from the factor analysis of reasons for dispute which includes dissatisfaction with doctor's attitude, wanting to prevent similar incident in the future, call t? account, and compensation. The relative importance in the order of frequency was wanting to prevent similar incident in the future, dissatisfaction with doctor's attitude, call to account, followed by compensation. Multiple regression analysis was used to identify the variables relevant to these four main themes. Clinical speciality group and degree of satisfaction on attitude were signi(icantly associated with the dissatisfaction with doctor's attitude. Clinical speciality group, patient's condition, effect of medical malpractiee on life and degree of satisfaction on attitude were significantly associated with the call to account. Academic carrier, clinical speciality group, patient's condition, effect of medical malpractice on life and degree of satisfaction on attitude were significantly associated with the compensation. CONCLUSIONS: From the above results, the reasons patients and their families cheese to settle by medical dispute were diverse and associated with demographic characteristics, doctor's attitude, effect of mishap on life, et. at.
Cheese ; Compensation and Redress ; Surveys and Questionnaires ; Dissent and Disputes* ; Humans ; Malpractice ; Social Responsibility

BACKGROUND AND AIMS: The colorectal polyp, particularly the adenoma, has been regarded as a precursor of cancer. The incidence of colorectal polyps has been reported at various rates according to investigation centers in foreign countries. In Korea, the incidence of colorectal polyps has been reported as very low according to the few reports, which was involved a few cases and were partial. Therefore, the aim of this study is to evaluate prospectively the incidence and the clinicopathologic features of colorectal polyps. METHODS: A colonoscope was inserted up into the cecum in 1,889 patients among 2,001 trials from Oct. 1996 to Aug. 1997 (success rate: 94.4%). Of the 1,889 full colonoscopies, the following were excluded; 1) referred patients with suspicious colorectal cancer or polyps, 2) patients with suspicious rectal cancer determined by rectal examination, 3) patients who had follow-up colonoscopy after a polypectomy or cancer surgery, and 4) patients who had periodic colonoscopy due to FAP or HNPCC. There were a total of 1,683 full colonoscopies in this study. The majority of the total cases involved a colonoscopy due to benign anal disease, irritable bowel syndrome, or routinechecks for health. RESULTS: There were 946 men (56.2%) and 737 women (43.8%). The mean age was 48.2 yrs (13~88 yrs) for men and 48.1 yrs (18~89 yrs) for women. 422 patients were found to have 645 colorectal polyps (1.52 polyps per patient). The incidence of polyps was 25.1% (32.0% for men, 16.1% for women) and increased after the 6th decade in men (44.0%) and in women (23.0%). 281 patients were found to have 426 colorectal adenomas. The incidence of adenomas was 16.6% (21.9% for men, 9.9% for women) and increased after the 6th decade, 32.0% in men, and 15.9% in women. Solitary polyps were present in 277 patients (65.6%) while 94 patients (22.3%) had two polyps and 51 patients (12.1%) had between 3 and 8 polyps. The polyp retrieval rate was 96.9%. There were 426 adenomas (66.0%), 75 hyperplastic (11.7%), 120 inflammatory (18.6%), and 24 miscellaneous (3.7%) polyps. Of the 426 adenoma, there were 397 tubular adenoma (93.2%), 18 tubulovillous adenoma (4.3%), 4 villous adenoma (0.9%), 6 in situ carcinoma (1.4%), and 1 invasive carcinoma (0.2%). 6 in situ carcinoma's were detected in tubular adenoma and 1 invasive carcinoma in tubulovillous adenoma. Of 645 polyps, the sessile type was 87.9%. The polyp size varied from 1 mm to 25 mm and 79.2% were under 5mm. Also, 85.7% of adenomas were sessile and 74.7% were under 5mm. 22.0% of polyps were located in rectum, 35.4% in sigmoid colon, 9.5% in descending colon, 13.3% in transverse colon, 19.8% in ascending colon and cecum. The distribution of adenoma was similar to that of polyp. 40.1% of adenoma showed moderate to severe dysplasia. CONCLUSIONS: This study revealed that the incidence of polyp in Korea was higher than that in previous reports and 42.6% of polyps were proximal to rectosigmoid colon. Therefore, we suggest that we should try to detect and remove colorectal polyps by more active colonoscopy.
Adenoma ; Adenoma, Villous ; Cecum ; Colon ; Colon, Ascending ; Colon, Descending ; Colon, Sigmoid ; Colon, Transverse ; Colonoscopes ; Colonoscopy* ; Colorectal Neoplasms ; Female ; Follow-Up Studies ; Humans ; Incidence ; Irritable Bowel Syndrome ; Korea ; Male ; Polyps* ; Prospective Studies* ; Rectal Neoplasms ; Rectum