No abstract available.
Intestinal Fistula*

The purpose of this study was to examine the trends of length of hospital stay (LOS), which is most likely to be a major attribute to hospital performance From 1984 to 1994, an average LOS of each hospital was analyzed by factors such as medical departments, bed size, occupancy rate, region and ownership. This study was analyzed changing rate of LOS during 11 years. This rate was calculated by simple regression, which was used only with hospital without missing data during 11 years. This study findings are as follows. 1. The results indicated that the average LOS was steadily increased until 1990 but it was slightly decreased after 1990. 2. This trend could be found in all hospital scale and all group of occupancy rate. Specifically this trends of LOS were found in internal medicine, corporate owned hospitals, and hospitals in major city. But LOS of individual owned hospital was continuously increased until 1994. 3. Means of changing rates of LOS were calculated from 1984 to 1994. If we divided it into two parts, before 1990 and after 1990, most changing rates of LOS before 1990 except individual owned hospital were found positive sign. The changing rates after 1990 were negative sign but small hospital(lesser then 200 bed), individual owned hospital, national & public hospital and hospital in small urban have little change of LOS after 1990. Finally from this results we thought that most hospitals in korea began to be concerned with LOS. Nevertheless LOS of several hospital such as small hospital or individual owned hospital was increased. And this trend may be caused by a few patients, low occupancy rate, or low profit. This trend of LOS is different from that of other countries. Perhaps this phenomenon is resulted from the reimbursement method. Because of fee for service reimbursement system in korea the hospitals didn't need to shorten LOS in order to save the cost and increase the profit. Therefore reform of hospital cost reimbursement method will be reduced to reduce hospital cost in korea. we thought that the korean health authority should consider the reimbursement method by unit of bundle of services, for example DRG and prepayment in the united states. This study presents some limitations such as on insight of severity of disease, case-mix measurement of hospital, and other clinical characteristics that can possibly affect LOS, However, this study reports an important trend in LOS from 1984 to 1994.
Diagnosis-Related Groups ; Fee-for-Service Plans ; Hospital Bed Capacity ; Hospital Costs ; Hospitals, Public ; Humans ; Internal Medicine ; Korea* ; Length of Stay* ; Ownership ; United States

We observed the clinical and histopathologic characteristics of acquired, bilateral nevus of Ota-like macules in each 80 and 23 patients. The results were as follows: 1. All patients were female and the peak age of onset was third decade with an a,verage age of 27.4 years. 2. The colors of lesions were slate, brown, dark brown, and blue black in order of freguency. 3. The lesions were most comrnonly observed in the malar area and alae nasi. 4. Three patients had family history of acquired, bilateral nevus of Ota-like :macules. 5. Histopathologically pigment-bearing cells, bipolar or irregular in shape, were found mostly in the upper- and mid-portion of the dermis. The melanocytes showed weakly positive dopa reaction. 6. In electron microscopic observation, these pigrnent-bearing cells contained many singly dispersed melanosomes in stage 3 and 4 of melanization and wece surrounded by an extracellular sheath.
Age of Onset ; Dermis ; Dihydroxyphenylalanine ; Female ; Humans ; Melanocytes ; Melanosomes ; Nevus of Ota* ; Nevus*

She describe herein two cases of eccrine spiradenoma. One is an indolent and the other is painful or tender multiple small nodules distributed in a zosteriform pattern. Histopathologically, the encapsulated lobules of the tumor are composed of two types of cells, intensely staining cells and pale staining cells, usually arranged in whorls, cords, and pseudoglands. In the second case, enzyme histochemical staining and electron microscopic examination have been done and are compared with other cases in the literature.

No abstract available.
Facial Asymmetry

No abstract available.
Acoustics*

No abstract available.
Wegener Granulomatosis*

Although the operation for the ventral lesion of craniovrtebral junction and atlantoaxial area is considered difficult to perform, the transoral approach made it safer and easier. The authors report 10 cases(9 patients) treated by the transoral approach for the lesion of craniovertebral junction over the past 13 years at the Ajou University Hospital and the Presbyterian Medical Center. Of these 10 cases, there were 4 odontoid type II fractures, 1 atlantoaxial dislocation, 1 os odontoideum, 1 chordoma at lower clival area, 1 rheumatoid arthritis, 1 epidural abscess and 1 wound revision due to slippage of grafted bone after clivoaxial fusion. The surgical methods included 4 cases of anterior decompression and clivoaxial fusion, 2 cases of anterior decompression and C1-2 interarticular joint fusion, 1 case of anterior decompression and clivoaxial fusion followed by posterior fusion, and 3 cases of anterior decompression and posterior fusion. In nonreducible atlantoaxial dislocation or ventral cord compression le sion, if the clivoaxial angle was less than 120 degree, the transoral approach was selected. The appropriate surgical approach must be selected according to the degree of compression of the neural tissue involving the craniovertebral junction and atlantoaxial dislocation.
Arthritis, Rheumatoid ; Chordoma ; Decompression ; Dislocations* ; Epidural Abscess ; Joints ; Protestantism ; Transplants ; Wounds and Injuries

An experimental model was devised to elucidate the role of spinal blockade in post-traumatic syringomyelia. 38 White adult rabbits were divided into four groups:in Group 1, eight animals received traumatic injury only to the midthoracic area via the weight-drop method but no further treatment;in Group 2, 12 animals received a traumatic injury following injection of 100mg kaolin suspended in 1cc normal saline into subarachnoid space at the midthoracic trauma level;in Group 3, nine animals received traumatic injury following injection of 200mg kaolin in 1cc of normal saline into subarachnoid space;in Group 4, nine animals without injury received an injection of 00mg kaolin in 1cc normal saline solution into subarachnoid space at the midthoracic level. The subjective criteria for syrinx formation were the presence of a definite round cyst having a smooth margin and an upper or lower extension of more than 2cm from the injured site. Syrinx formation was seen in 12.5% in Group 1, 41.7% in Group 2, 55.5% in Group 3 , and 0% in Group 4(p<0.05). In subarachnoid space, the specimen of trauma and kaolin groups showed neutrophils infiltration and obstruction of subarachnoid space on acute stage. The pathologic changes in subarachnoid space on chronic stage were infiltration of kaolin-laden macrophages and chronic arachnoiditis. In parenchyma, hemorrhagic necrosis of the cord, edema, microinfarcts and liquefaction of hematoma were found on acute stage, and multiple cysts in white mater, cell-debris-laden macrophages in the cyst, formation of foam cells, microcysts, and large yst were shown. In Group 4, the same findings as other groups were shown in the subarachnoid space, but in the parenchyma there was no cyst formation. The results suggest that subarachnoid block secondary to adhesive arachnoidities is important in initiating the extension of the syringomyelia cavity that have already formed at the time of initial injury.
Adhesives ; Adult ; Animals ; Arachnoid ; Arachnoiditis ; Edema ; Foam Cells ; Hematoma ; Humans ; Kaolin ; Macrophages ; Models, Theoretical ; Necrosis ; Neutrophil Infiltration ; Neutrophils ; Rabbits ; Sodium Chloride ; Subarachnoid Space ; Syringomyelia*

The transoral approach to anteriorly placed lesions at the upper cervical region is not new, but is still infrequently used by neurosurgeons for lesions in this region. The indications and surgical methods vary widely, and there is much room for discussion of the technical details. We are reporting our experience with this technique in two patients; one is a traumatic odontoid fracture and another is a cervical epidural abscess.
Epidural Abscess* ; Humans ; Microsurgery