Since the male sterilization (vasectomy) has been performed on a large scale as an accepted family planning in Korea on 1980s and this, in turn, has been followed by an increase in the number of patients requesting vasovasostomy. We studies 1000 consecutive cases of vasovasostomy performed from January 1975 to July 1995 in Pusan National University Hospital. In this report, we are going to present serial studies of vasovasostomy through which we attempted to find out what factors are of impotence in influencing the successful outcome of vasovasostomy operation. We inquired the operative results data through the questionnaire and telephone interview with survey of medical records. A total of 259 cases was excluded due to the loss of follow-up. The overall patency and pregnancy rates of 741 cases were 86.9% and 51.1%, respectively. The age of man at the time of anastomosis ranged from 23 to 57 years old with an average of 34.9. The most frequent reason for requesting vasovasostomy was the desire to have more children (43.4%). The average obstructive interval was 60.6 months with range from 1 to 264 months. If the obstructive interval had been less than S years patency rate was 92.4% and pregnancy rate 64.8%, but 6 years or more 84.1% and 48.5% p<0.01, p<0.01). Patency and pregnancy rates according to intraoperative vas fluid were 93.1% and 62.8% for presence and 83.7% and 53.1% for absence p<0.01, p<0.05). Patency and pregnancy rates according to histologically proven sperm granuloma at vasectomy site were 87.7% and 49.2% for presence and 86.9% and 50.6% for absence (p>0.05, p<0.05). Patency and pregnancy rates were not significantly different between microscopic standard vasovasostomy (88.4%, 64.3%) and modified vasovasostomy (89.5%, 56.3%)(p>0.05, p>0.05). Both patency and pregnancy rates according to level of anastomosis were 89.8% and 59.8% in cases of straight vas and 91.5%, 60.1% in cases of convoluted vats (p>0.05, p>0.05). Patency and pregnancy rates according to the kind of suture materials were 91.5% and 56.2% for absorbable, 91.0% and 64.2% for non-absorbable and 93.3% and 53.3% for absorbable plus non-absorbable, respectively 0>0.05, p<0.05). Thus it is suggested that the important factor influencing the success rate of vasovasostomy is the interval of obstruction and nasal ooze with surgical skills.
Busan ; Child ; Erectile Dysfunction ; Family Planning Services ; Follow-Up Studies ; Granuloma ; Humans ; Interviews as Topic ; Korea ; Male ; Medical Records ; Middle Aged ; Pregnancy Rate ; Spermatozoa ; Sterilization, Reproductive ; Sutures ; Thoracic Surgery, Video-Assisted ; Vasectomy ; Vasovasostomy ; Surveys and Questionnaires

BACKGROUND: This study intends to clear that the current cost reimbursement system of Korean medical insurance of health care. METHODS: By using insured medical record of Federation of Korean Medical Insurance Societies used in the demand tendency research of the type of services from feburary 1st to 28th of the year 1990, authors analyze the characterist,ic of components of charges per case in the type of health care facilities. RESULTS: The charge per case in the out-patient care of primary health care facility is 13,498 won, which is 54.6% by comparison with the secondary health care facility and 30.7 % by comparison wit,h the tertiary health care facility. Among these charges the amount of the cost for medical examinations and oral drugs are 73.9% in the primary health care facility and 71.8% in the secondary and 67.5% in the tertiary. Consequently, the services in the primary care are chiefly composed with the medical examinations and oral drugs. In addition to this point the author also finds that the charge per case is 3.5 times, the cost for oral drugs is 5.6 times larger than those of primary care, and therefore tertiary health care facility conduct various diagnostic examinations and prescript more expensive. CONCLUSIONS: There is a difference of basic medical cost ratio between primary, secondary and tertiary health care facility. These points can be lead to the presumption that the diseases under the structure of current medical insurance are overlapped irrespective of the charact.erisitcs of the type of health care facilites, and this is profitable to the tertiary health care facilities which can conduct various types of services. In conclusion, the frame a policy is needed to encourage primary care which are nothing but simple structure of charges.
Delivery of Health Care ; Humans ; Insurance* ; Medical Records ; Outpatients ; Primary Health Care

Thirty-nine healthy pigs (28-32 days old) were purchased from a commercial swine farm and housed at swine pens of the College. The animals were vaccinated intramuscularly (1 ml) with an attenuated live hog cholera virus (HCV, LOM strain) and then boostered at 5 weeks after the first vaccination. The animals were divided into 4 experimental groups: 0.05% (w/w) PowerFeel-supplemented diet (T-1, n = 10); 3% (w/w) SuperFeed-supplemented diet (T-2, n = 10); diluted PowerFeel solution (1 : 500, v/v) as drinking water (T-3, n=9); control (n=10). PowerFeel is an original form of ionized alkali mineral complex (IAMC) and SuperFeed is a commercial product of IAMC. The subpopulation of lymphocyte in blood was assayed by a flow cytometry and HCV-specific antibody was determined by an indirect immunofluorescence assay. In IMAC-treated groups, the proportions of subpopulation expressing MHC-class II, CD2+, CD4+, CD8+, and surface IgM+ B lymphocytes were significantly decreased at 5-weeks after the first vaccination. Significant decreases were also observed in the proportions of MHC-class II, CD2+ and CD8+ lymphocyte at 3-weeks after the booster injection. The humoral immune responses in T-1 and T-2 groups were greater than those in T-3 or control group. These results suggest that IAMC-supplemented diets may have an HCV-specific immunostimulatory effect in pigs.
Animal Feed ; Animals ; Antibodies, Monoclonal/*blood/isolation & purification ; Antigens, CD2/blood ; B-Lymphocytes/immunology ; CD4-Positive T-Lymphocytes/immunology ; CD8-Positive T-Lymphocytes/immunology ; Classical Swine Fever/*immunology ; Classical swine fever virus/*immunology ; Dietary Supplements ; Ions ; Lymphocyte Subsets/*immunology ; *Minerals ; Swine ; Vaccines, Attenuated/*administration & dosage ; Viral Vaccines/*administration & dosage

OBJECTIVE: To know the clinical features of overuse injury in performing musicians and to evaluate related factors that may affect the overuse injury and playing related pain. METHODS: Eighty professional musicians and music college students were examined during 1 year. All were examined by a history taking, physical examination, radiologic exam and if needed electromyography. Nonparametric Sperman's correlation were used for the statistic analysis and 5 interval grading system, visual analog scale for pain, and stress, criteria of joint hypermobility were used for various measurements. RESULTS: Fifty four men were studied in 3 music colleges and a professional orchestra. Frequency of symptom was 46.3%. The string players were most frequently affected (65%), whereas the wind instrument players were least frequently affected (11.5%). The most commonly affected site was the hand and wrist (54.2%) followed by the spine. Patients were divided by the severity into 5 groups and among them the grade 1 was most common (29.6%). No significant correlation was seen between the practice hours per week but a significant correlation was noted between the stress and playing related pain. Joint hypermobility plays an important role in music playing which is dependent on the kind of instruments. CONCLUSION: Incidence of the overuse injury in musicians is high in Korea and the prevention and early treatment are essential for the good outcome of overuse syndrome.
Cumulative Trauma Disorders* ; Electromyography ; Hand ; Humans ; Incidence ; Joint Instability ; Korea ; Male ; Music ; Physical Examination ; Spine ; Visual Analog Scale ; Wind ; Wrist

It has been generally assum d that eccrine poroma arises from acrosyringium, the epidermal sweat duct unit. Eccrine poroma mainly involves the non hairy surfaces of the skin, but it has also been found on hair-bearing areas. One of the characteristics of this structure is absence of melanocytes and melanin granules arnong its cells. However a complete absence of melanocytes and melanin granules in eccrine poroma is not invariable and a few reports of such an occurrence have been presented. The authors report herein a case of unusual and rare eccrine poroma. The eccrine poroma had melanin pigment and melanocytes, was pedunculated and occurred on the parietal scalp which was the unusual site of involvement. The eccrine poroma was also combined with a pedunculated congenital melanocytic nevus on the supraauricular scalp.
Melanins ; Melanocytes ; Nevus, Pigmented* ; Poroma* ; Rabeprazole ; Scalp* ; Skin ; Sweat

Necrolytic migratory erythema is a rare, distinctive, necrotizing cutaneous eruption usually associated with glucagonoma, an alpha-cell tumor of the pancreas. Other clinical features include ane- mia, diabetes mellitus and weight loss. However, it also occurrs without the pancreatic glucagonoma. So this rare condition is called pseudoglucagonoma syndrome, and has been described in association with chronic hepatic diseases, malabsorption with villous atrophy, chronic pancreatitis, celiac sprue, hypoproteinemia and odontogenic infection. We report a case of pseudoglucagonoma syndrome induced by malnutrition without glucagonoma. A 28-year-old Korean female was referred to our department complaining of multiple erythematous, desquamative, crusted and erosive patches on the extremities, and diffuse scalp alopecia for 5 years. She also had perianal erosion, angular cheilitis without glossitis, amenorrhea, axillary and pubic hair loss, and weight loss. Six years previously she had had Whipples operation for a pancreatic solid and papillary neoplasm. The laboratory data showed hypoalbuminemia, essential fatty acid deficiency, diabetes mellitus and slightly high levels of zinc and glucagon. A skin biopsy showed irregular acanthosis, epidermal edema and pallor, dyskeratosis, areas of superficial epidermal necrosis and vascular dilatation of the papillary dermis. The patient improved dramatically after intravenous hyperalimentation and oral intake of mediurn chain triglyceride. For 2.5 years she has taken medium-chain triglycerides without any other treatment, and no side effects on recurrence has been observed.
Adult ; Alopecia ; Amenorrhea ; Atrophy ; Biopsy ; Celiac Disease ; Cheilitis ; Dermis ; Diabetes Mellitus ; Dilatation ; Edema ; Extremities ; Female ; Glossitis ; Glucagon ; Glucagonoma ; Hair ; Humans ; Hypoalbuminemia ; Hypoproteinemia ; Malnutrition ; Necrolytic Migratory Erythema* ; Necrosis ; Pallor ; Pancreas ; Pancreatitis, Chronic ; Parenteral Nutrition, Total ; Recurrence ; Scalp ; Skin ; Triglycerides* ; Weight Loss ; Zinc

Peritoneal adhesion is one of the most common cause of intestinal obstruction in most parts of the world. In 1989, Thompson and others proposed reduced peritoneal plasminogen activating activity as a possible mechanism of adhesion formation. We used adult Sprague-Dawley rats weighing between 250~350 gm of both sexes. An ether jar was used to induce anesthesia, and a 15 to 20 mg intramuscular injection of ketamine into the hind leg was used to maintain anesthesia. The rat was fixed supine on a rat board, its midabdomen shaved, and povidone-iodine applied. Then the abdomen was opened using Metzenbaum scissors and 2.5 2.5 cm2 area of the parietal peritoneum was abraded in the flank area, left or right side, using sterilized electro-surgical tip cleaner until the preperitoneal fat layer was completely destroyed and blood ooze was emitted from the burst capillaries. The procedure lasted 2~3 minutes. Then, the animals were randomly selected either to apply topically one cc of saline as a control group or to apply drugs dissolved in one cc of saline as on experimental groups. The drugs were disodium cromolycate, verapamil, and urokinase. Disodium cromolycate was used 3 mg/animal, verpamil 0.5 mg, and urokinase 2,000 units/on the animal. The same drugs and the same amounts were used at the same site topically on the 2nd and the 3rd postoperative days without anesthesia by using smooth-tipped needle. Then the animals were examined on the 7th postoperative day under ether anesthesia to find adhesion formations and to grade them into no adhesion, mild, moderate, or severe adhesions according to severity of the adhesions. We used about 15 animals in each group. The results for the peritoneal adhesions were expressed as present or not present to compare the presence of adhesion between the control group and the study groups. The Chi-square test was used, and p values below 0.05 were regarded as significant. In the control rats, there were no adhesions in 3 animals, and adhesions in 12 animals. In the disodium cromolycate-treated groups, there were no adhesions in 8 and adhesions in 8 rats, indicating less frequent adhesion formation, but the p value was 0.081. In the verapamil group, the ratio of no adhesion to adhesion was 4 : 11 which was almost the same as that of the control group(p=0.666). However, in the urokinase group, the ratio was 8 : 6 and the p value was 0.039, so the effects are ignificantly different. With these result, we can conclude that intraperitoneal topical application of urokinase is effective in prevention of rat peritoneal adhesion formation. The effect of disodium cromolycate was only marginal. Verapamil was not effective in prevention of peritoneal adhesion in this study.
Abdomen ; Adult ; Anesthesia ; Animals ; Capillaries ; Ether ; Humans ; Injections, Intramuscular ; Intestinal Obstruction ; Ketamine ; Leg ; Needles ; Peritoneum ; Plasminogen ; Povidone-Iodine ; Rats* ; Rats, Sprague-Dawley ; Urokinase-Type Plasminogen Activator ; Verapamil

No abstract available.
Amnion* ; Dinoprostone*

PURPOSE: To evaluated the usefulness of pressure-flow study (PFS) as a preoperative technique, and to compare its sensitivity and specificity, with uroflow, post void residual urine and prostate volume, in benign prostatic hyperplasia patients. MATERIALS AND METHODS: The records of 109 men, with lower urinary tract symptoms that underwent a transurethral resection of prostate (TURP), between May 1995 and June 2002, were retrospectively analyzed. Fifty one patients underwent preoperative PFS and 58 did not. The PFSs were performed with an 8Fr suprapubic catheter. The results of the PFS were divided into two groups: obstructed and unobstructed, using an ICS nomogram, pQ slope or the minimal urethral opening pressure. The outcomes of the operations were estimated with IPSS and the maximal flow rate 3 month after the operations. RESULTS: With the PFS operations, 47 cases (81.0%) were obstructed and 11 (19.0%) unobstructed. The success rates of the TURP for the obstructed, unobstructed and non-invasive study groups were 87.2, 63.6 and 88.2%, respectively. The sensitivity and specificity of the PFS were 84.5 and 40.4%, respectively. The sensitivity of the maximal flow rate (or=30gm) was 50.0%. CONCLUSIONS: PFS is not a mandatory preoperative technique for men, with lower urinary tract symptoms, who undergo a TURP. However, it can decrease the TURP failure rate. Other noninvasive parameters can be preoperatively useful for men who undergo TURP, as long as they are applied compositely carefully.
Catheters ; Humans ; Lower Urinary Tract Symptoms ; Male ; Nomograms ; Prostate ; Prostatic Hyperplasia* ; Retrospective Studies ; Sensitivity and Specificity ; Transurethral Resection of Prostate ; Urodynamics

OBJECTIVE: To assess the jumper's knee for the symptoms and diagnostics by MRI and ultrasonography in basket ball players. METHOD: Twenty knees of 10 basketball players with chronic knee pain were assessed by the history taking, physical examination and diagnosis by magnetic resonance imaging and ultrasonography. Their average age was 17.4 years. Stanish classification is used for grading the symptoms of jumper's knee. RESULTS: Nine proximal patellar tendons were diagnosed as jumper's knees (45%) and 11 distal tendons were diagnosed as jumper's knees (55%). In ultrasonographic findings, average proximal patellar tendon thickness was 4.5 mm+/-1.2 mm, and distal patella tendon thickness was 7.1+/-1.1 mm. Sensitivity was 63% (12/19) and specificity was rated as 100% (21/21). By the MRI findings, sensitivity was rated as 32% (6/19) and specificity was rated as 90% (16/21). Study between the patient's clinical severity level by Stanish classification and thickness of patellar tendon showed no significant correlation (<0.5). CONCLUSION: The ultrasonography to be more convenient and easier as a diagnostic method for the jumper's knee than MRI.
Basketball ; Classification ; Diagnosis ; Knee* ; Magnetic Resonance Imaging* ; Patellar Ligament ; Physical Examination ; Sensitivity and Specificity ; Tendons ; Ultrasonography*