The introduction of the strong clover-leafed nail combined with the principle of reaming out the medullary canal and the development of image intensifiers has been extended the indications of the in tramedullary nailing. In this report, an attempt was made to introduce the method and to verify the indications and advantage of retrograde intramedullary nailing of humeral shaft fractures, as compared with the conventionally accepted methods.
Fracture Fixation, Intramedullary ; Humerus ; Methods

Generally, the hemolytic disease of newborn caused by anti-c is characterized by the abnormal titer of anti-c in mother's serum and neonatal progressive jaundice caused by IgG induced hemolytic anemia. A female neonate delivered by cesarean section was admitted to Hangang Sacred Hospital due to severe jaundice and apnea on Jul. 7 1998. On admission, laboratory work up was revealed immune hemolytic anemia, but no incompatibility of ABO and Rh(D) system between mother and baby. Minor blood groups of mother and this second baby was ce and Cce. The serologic examination showed positive direct and indirect Coombs' test and the cause of jaundice was proved as the result of hemolytic disease due to anti-c via antibody screening and identification. After 2 times of exchange transfusion, the jaundice was subsided. So we reported a case of hemolytic disease due to anti-c with review of previous literatures.
Anemia, Hemolytic ; Apnea ; Blood Group Antigens ; Cesarean Section ; Coombs Test ; Erythroblastosis, Fetal* ; Female ; Humans ; Immunoglobulin G ; Infant, Newborn ; Jaundice ; Mass Screening ; Mothers ; Pregnancy

There are increasing interest and need for information on health care consumer with the significance of hospital marketing and strategic planning being increasingly emphasized. This study was conducted to investigate the criteria for selection of medical facilities according to the characteristics of health care consumer by the types of medical services on a sample of 1,500 population aged 20 years and above. Major findings are as follows; 1. When considering the criteria for selection of medical facilities into two factors, namely, quality or convenience factors, convenience factor was the major contributor for outpatient and dental services whereas it was quality factor for inpatient services. 2. Females and those residing in large cities selected medical facilities based on convenience factor in the outpatient services. In the case of inpatient service, persons who considered their present health status to be good and whose ages were 50 years old and above choose medical facilities based on quality factor. 3. Persons who considered medical facilities to be profit-making tended to choose medical facilities based on convenience factor for outpatient services. There were no differences in the cases of inpatient and dental services. 4. There was no significant difference on the criteria for selection of medical facilities according to the decision maker for selection or trust on medical facilities. On the use of health service information, selection of medical facilities was based on qPality factor for those who made more use of the information in the cases of outpatient and dental services. 5. Analysis using the logistic regression model on the criteria for the selection of medical facilities with the characteristics of health care consumer as independent variables was performed. The selection of medical facilities was significantly related with residential area, sex, and use of information on medical facilities for outpatient services and with age, average monthly income, and perception of health status for inpatient services. For dental services significant association with residential area and use of information on medical facilities was seen. The results of this study, despite some limitations, can be used as baseline data for marketing and strategic planning of hospital management.
Delivery of Health Care ; Female ; Health Services ; Humans ; Inpatients ; Logistic Models ; Marketing ; Middle Aged ; Outpatients ; Patient Selection

No abstract available.
Mycobacterium*

No abstract available.
Herpes Zoster* ; Humans ; Immunosuppressive Agents*

We present a case of pemphigus vulgaris developed during pregnancy. The clinical features of this patient were similar to those of hetpes gestationis. By immunofluorescence studies we found that the patient's serum contained autoantibodies to intercellular substance of epidermis. Direct immunofluorescence microscopy of a perilesional skin also demontrated immunoglobulin deposition in the intercellular areas. Additionally we did in vitro C3 staining for further confirmation of the diagnosis but it was negative in basement membrane zone. This patient was initially treated with corticosteroid and azathioprine. Several months later gold compound was given instead of azathioprine and corticosteroid with good therapeutic response.
Autoantibodies ; Azathioprine ; Basement Membrane ; Diagnosis ; Epidermis ; Fluorescent Antibody Technique ; Fluorescent Antibody Technique, Direct ; Humans ; Immunoglobulins ; Microscopy ; Pemphigus* ; Pregnancy* ; Skin

There is room for debate in appropriate diagnosis and treatment due to physiological and anatomical differences in pediatric facial bone fractures from that of adult's. The objectives of this article is to analyze for our clinical cases and to suggest the appropriate management of facial bone fracture in children. The study included 56 children who had treatment for the craniofacial fractures form March, 1990 to February, 1998. Their ages ranged from 3 to 15. There were 38 males and 18 females. Physical examination, simple x-rays, ultrasonograms and routine CT scans were used for diagnosis. Materials were classified into 28 nasal bone fractures, 4 nasoethmoidal fractures, 6 orbital fractures, 8 mandible fractures, and 10 zygoma fractures. Patients were treated with conservative treatment in 9 cases, with closed reduction in 28 cases and open reduction only, and 14 patients with open reduction and internal fixation using microplates and screws. 3 patients needed autogenous calvarial bone graft. Plates and screws were removed in postoperative 3-6 months. All patients had successful union of fractured bones without no specific complications, and normal bony growths were noticed during the 7 years follow up. We conclude that surgeons should be careful in diagnosis and management for the pediatric facial fracture due to anatomical variations and differences in fracture aspects. First, it is mandatory for surgeous to get accurate diagnosis and identify children's fracture and displacement through routine CT check up along with physical examination. Second, it is important to perform the minimally invasive technique or conservative treatment for the children with mild displacement so that it reduces the incidence of growth retardation which may be caused by extensive operation. However, application of rigid fixation is necessary in case of extensive bony displacement or bony defects because of poor coorporation in postoperative care. Third, plates and screws which were used for the internal fixation should be removed at 3-6 months after the surgery. Fourth, if bone graft is needed, it is better to use autogenous graft than allogeneous graft. Fifth, care for dentition and follow up for growth are necessary for growing children.
Child ; Dentition ; Diagnosis ; Facial Bones* ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Mandible ; Nasal Bone ; Orbital Fractures ; Physical Examination ; Postoperative Care ; Tomography, X-Ray Computed ; Transplants ; Ultrasonography ; Zygoma

Service diversification is recognized as an important strategy against turbulent environmental change. This study is designed to find out the trend of service diversification in Korean health care organizations and also to identify factors associated with the degree of service diversification. Data were collected from 69 hospitals out of 71 hospitals with over 300 beds. Important findings are summarized below. 1. Types of diversification are closely related to hospital size. Large hospitals have a tendency to provide sophisticated service requiring specialized skills and equipment, while small hospital have concentrated their efforts on health screening programs. 2. The more competitive and bigger hospitals are, the greater number of services that provide. Also, hospitals operating rational management information systems provide more services. Contrary to the expectation, hospitals with a low performance during last 3 years showed more service diversification. 3. A trend of more diversification was observed in hospitals whose chief executive officer used a prospector strategy. 4. A multiple regression analysis revealed that bed size, competitive environment, degree of rational management, and the growth pattern were significantly associated with teh service diversification.
Delivery of Health Care ; Health Facility Size ; Hospital Bed Capacity ; Management Information Systems ; Mass Screening

Background:Insulin dependent diabetes mellitus(IDDM) is known to be a disease characterized by a deficiency of insulin caused by destruction of the pancreatic beta-cells. It has been suggested that the clinical and immunological characteristics of IDDM in Korean are different from those of Caucasian. This study was undertaken to investigate the clinical characteristics and the prevalence of autoimmune markers in type I diabetic children and their prediabetic siblings in Korea. METHODS:Insulin autoantibody(IAA), antiglutamic acid decarboxylase(Anti-GAD) antibody, thyroid autoantibodies such as antithyroid antibody(ATA) and antimicrosomal antibody(AMA), and rheumatoid facter(RF) in 54 type I diabetic children have been measured. Diabetic autoimmune antibodies were also measured in 48 siblings. RESULTS: 1)Clinical characteristics of type I diabetic children were that age of onset was 8.6+/-4.4 years, duration of diabetes was 4.1+/-3.3 years. C-peptide at onset of diabetes was fasting 0.7+/-0.5ng/ml, and postprandial 1.2+/-0.5ng/ml, and HbA1c was 12.5+/-4.3%. 2)The positivity of IAA and anti-GAD antibody of type I diabetic children was 74% and 50% respectively. ATA and AMA positivity of type I diabetic children was 3.7% and 5.6%. however RF was not detected at all. Among the diabetic siblings, 48 persons for anti-GAD antibody, 21 for IAA, 27 for ICA were measured but 1 case was positive for IAA. 3)Clinical characteristics of type I diabetic children were not specific different between IAA and anti-GAD antibody positivity. But the mean age of onset of type I diabetic children was younger in case of both positivity of IAA and anti-GAD antibody than both negativity(7.8 vs 11.4 years old, P<0.05). 4)A case in whose brothers are diagnosed as IDDM has shown that autoantibody of elder brother was positive in both IAA and anti-GAD antibody, and younger brother was also strongly positive in IAA. Another case in whose sisters were IDDM, has shown that, while elder sister was positive in IAA, younger sister strongly positive in both IAA and anti-GAD antibody. 5)In a case of identical twin brother, the elder is type I diabetic child and the younger is normal, elder brother's onset of age was 6 years and 8 months old, and titer of anti-GAD antibody was measured as strong positive. Both ICA and anti- GAD antibody were negative in normal younger brother. First phase insulin release in IV GTT and the insulin levels in oral GTT showed reduction from the normal level in normal brother, and repeat check up showed normal ranges but on-going study is needed under observation. CONCLUSION: The prevalence of autoantibody positivity of type I diabetic children of Korea in this study were IAA 74%, and anti-GAD antibody 50%. Cases with both IAA and anti-GAD antibody positive were shown to be earlier onset. Though titers of auto-antibody in IDDM twins, brothers and sisters were strongly positive, auto-antibodies in siblings of IDDM patients were detected only one case with IAA positive(0.47%). We suggest that the pathogenesis of IDDM in Korean is different from foreign countries in terms of prevalence of autoimmune antibodies and more numbers of diabetic siblings should be tested for further study.
Age of Onset ; Antibodies* ; Autoantibodies ; C-Peptide ; Child* ; Diabetes Mellitus, Type 1 ; Fasting ; Humans ; Infant ; Insulin ; Korea ; Prevalence* ; Reference Values ; Siblings* ; Thyroid Gland ; Twins, Monozygotic

Balancing the rates of cell proliferation and cell death is important in maintaining normal tissue homeostasis. The relationship among apoptosis, cell proliferation and factors influencing apoptosis according to the histologic types in chemically induced mammary tumorigenesis appears important in understanding the pathogenesis of breast carcinoma. In this study, we investigated alterations in the kinetics of cell proliferation and apoptosis during rat mammary tumorigenesis induced by 7, 12-dimethylbenzanthracene (DMBA) and we related these changes to the expressions of bcl-2, p53, and TGF-beta. Seven-week-old female Sprague-Dawley rats were divided into an experimental group (20 mg/ml DMBA by oral intubation) and a control group. The results were as follows. 1. In the experimental group, breast tumors occurred in twenty two of fifty nine rats(37.3%, 22/59), and the total number of tumors was 100 (4.5 2.0/rat). The histological classification was infiltrating ductal carcinomas (n=5), ductal carcinomas with focal invasion (n=10), intraductal carcinomas (n=36), adenomas accompanied with intraductal proliferation (n=35), intraductal proliferation (n=9), and adenomas (n=5); 2. The differentiation of terminal end bud into alveolar bud (AB) in the experimental group was significantly lower than that of the control group (p<0.05); 3. BrdU labeled tumor cells were mainly located at the peripheral portion of tumor cell nests. BrdU labeling indices were highest in ductal carcinomas, less pronounced in intraductal proliferation, and lowest in adenomas, whereas apoptosis levels were highest in adenomas, less pronounced in intraductal proliferation, and lowest in ductal carcinomas (p<0.05); 4. p53 protein was not expressed in any breast tumors. Although the expression of bcl-2 protein was highest in infiltrating and focal infiltrative ductal carcinomas (58.3%), compared with adenomas, intraductal proliferation, and intraductal carcinomas (p<0.05), the extent of its expression was less than 1% of all tumor cells; 5. TGF-beta was mainly expressed in the central portion of tumor cell nests rather than in peripheral portion, and TGF-beta immunoreactive tumor cells displayed good differentiation and did not reveal BrdU immunoreactivity. TGF-beta labeling index of infiltrating and focal infiltrative ductal carcinomas was significantly higher than that of intraductal carcinomas, intraductal proliferation, and adenomas (p<0.05). Based on these results, it is thought that high cell proliferation and the suppression of apoptosis are closely associated with DMBA-induced rat mammary carcinogenesis. However, the suppression of apoptosis is not related to p53 mutation, bcl-2, and TGF-beta. TGF-beta seems to be reversely related to tumor cell proliferation but closely associated with the progression of the tumor, especially an invasion of breast carcinomas.
9,10-Dimethyl-1,2-benzanthracene ; Adenoma ; Animals ; Apoptosis* ; Breast Neoplasms ; Bromodeoxyuridine ; Carcinogenesis* ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Cell Death ; Cell Proliferation* ; Classification ; Female ; Homeostasis ; Humans ; Kinetics ; Rats* ; Rats, Sprague-Dawley ; Transforming Growth Factor beta