BACKGROUND: It is a recent trend that the birth and mortality rates has been decreased and average life span prolonged in proportion to the socioeconomic and scientific advances. The goal of this study is to suggest basic data for comprehensive and continuous management of elderly patients. METHODS: Based upon ICD-10 (International Classification of Disease), the author analysed the outpatient's diseases 19,367 and inpatient's diseases 6,783 beyond the age of 65 who visited outpatient department and were hospitalized to the Kosin University, Kosin Medical Center in Pusan from January to December in 1997 RESULTS: The ratio of elderly patient in outpatient was 4.5% and inpatient was 15.0%. The number of outpatient each disease group were disease of the circulatory system 5,367 (27.7%), neoplasms 4,007 (20.7%), disease of the digestive system 2,635 (13.6%), endocrine, nutritional and metabolic disease 1,798 (9.8%) in order. Frequent diseases in individual system of outpatient were followed; malignant neoplasms of digestive organs 2,642 (13.6%), hypertensive diseases 2,053 (10.6%), diseases of esophagus, stomach and duodenum 1,804 (9.3%), ischemic heart disease 1,101 (5.7%) in order. The number of inpatient each disease group were disease of the neoplasms 2,138 (31.5%), disease of circulatory system 1,191 (17.6%), disease of the digestive system 730 (10.8%), endocrine, nutritional and metabolic disease 489 (7.2%) in order. Frequent diseases in individual system of inpatient were followed; malignant neoplasms of digestive organs 956 (14.1%), malignant neoplasms of respiratory and intrathoracic organs 351 (5.2%), hypertensive diseases 348 (4.2%), diabetes mellitus 325 (4.1%) in older. CONCLUSION: This result indicate that the elderly patients abounded mostly with disease of circulatory, neoplasm, disease of the digestive system and endocrine, nutritional and metabolic disease.
Aged* ; Busan ; Classification ; Diabetes Mellitus ; Digestive System ; Duodenum ; Esophagus ; Humans ; Inpatients ; International Classification of Diseases ; Metabolic Diseases ; Mortality ; Myocardial Ischemia ; Outpatients ; Parturition ; Stomach

BACKGROUND: The present study was performed in order to identify the possible future location of the Department of Emergency Medicine and future demand for and supply of manpower through a survey of the heads of Kwangju City and Chollanam-do hospitals. The survey covered the degrees of recognition and understanding, the necessity, the future prospects, and the direction of development of the Department of Emergency Medicine. METHODS: A total of 33 large-scale general hospitals were selected in county districts having more than 200 sickbeds as of November 1999. Among them, the heads of 29 hospitals responded to the survey. The survey had a total of 31 questions, including 6 questions on the status of the emergency room. Six(6) questions concerned the degree of recognition of the Department of Emergency Medicine. Six(6) questions concerned the degree of understanding of the Department of Emergency Medicine. Six(6) questions concerned the necessity for the Department of Emergency Medicine, and 7 questions concerned the future prospects and direction of development. The results of the survey were analyzed. RESULTS: 1) As to the question of the degree of recognition, the Department of Emergency Medicine was known to all. That is, 50% of the respondents were well aware of the department, and 50% a little. Nineteen(19) respondents(65%) answered that it was convenient to have the Department of Emergency Medicine in a university hospital, among which 16 respondents(55%) answered that it was because of the rapid treatment of emergency patients. 2) As to the question of the degree of understanding, particularly, the areas of medical examination and treatment by the Department of Emergency Medicine, 15 respondents answered that it was for the treatment of patients who needed to receive emergency treatment, while 12 respondents answered that it was for the diagnosis and treatment of all patients who visited the emergency room. Only 7 respondents(24%) answered positively as to the possibility of the Department of Emergency Medicine using thrombolysis medicine. 3) All except for one respondent had a positive view on the necessity for the Department of Emergency Medicine, and all except for 3 respondents wanted to have specialized doctors in emergency medicine work at the corresponding hospital. As to the type of schedule, 10 hospitals(34%) wanted to have only night shifts, and 11 hospitals(38%) wanted to have both day and night shifts. Most hospitals, needed two or more workers in the field. 4) As to the question of the direction of development, many respondents were of the opinion that the hiring of specialized doctors in emergency medicine would not be of greatly help to the finances of the hospital due to increased labor costs. It seems that improvement of the medical system to improve hospital financing is a required prerequisite for the development of the Department of Emergency Medicine. Also, 21 respondents(83%) were of the opinion that it would take a considerable amount of time to activate the Department of Emergency Medicine with respect to the future prospects of the department. CONCLUSION: It was shown in the present survey that the heads of hospitals in Kwangju City and Chollanam-do recognized the Department of Emergency Medicine in a positive way, but it was necessary to establish both a delivery system for emergency medicine and collaboration with and support by other medical areas for its future development. It was estimated that in the future, more than 55 doctors specializing in emergency medicine would be needed as medical manpower for the general hospitals in the districts.
Appointments and Schedules ; Cooperative Behavior ; Surveys and Questionnaires ; Diagnosis ; Emergencies* ; Emergency Medicine* ; Emergency Service, Hospital ; Emergency Treatment ; Gwangju* ; Head ; Hospitals, General ; Humans ; Jeollanam-do*

No abstract available.
Female ; Fibronectins* ; Hypertension, Pregnancy-Induced* ; Plasma* ; Pregnancy ; Pregnancy*

Recently posterior stabilization with various instrumentation and fusion has been used for fractures of the thoracolumbar spine involving anterior and middle columns. However, these methods are sometimes inadequate to gain anatomical reduction and complete decompression especially in burst fractures. So anterior decompression and interbody fusion were frequently added as a second operation. Biomechanically a rigid anterior spinal instrument such as kaneda device can provide enough anterior decompression through partial or total corpectomy and adequate correction of kyphosis as an one stage operation. We have experienced 27 cases of Kaneda instrumentation via anterior approach for thoracolumbar fracture, most of them were burst fractures, from Jan. 1989 to June 1990. Of there 27 cases, 12 were followed up at least 1 year and reviewed. The results were as followed: l. Anterior spinal approach using Kaneda instrumentation provided sufficient anterior neural decompression and adequate correction of kyphotic deformity. It eliminates the second posterior procedure in most cases and enhances early solid union. Simultaneously, it allows early mobilization of patient with an application of brace. 2. Post-operative courses were eventful in most cases except a case of pathological fracture. 3. This procedure seemed to be one of the most suitable method for the treatment of burst fractures of the thoracolumber region. 4. Complications by Kaneda device itself were not developed in the early evaluation stage. However, on longer follow-up study over 1 year revealed some complications including 2 cases of screw breakage and one lateral wedging deformity.
Braces ; Congenital Abnormalities ; Decompression ; Early Ambulation ; Follow-Up Studies ; Fractures, Spontaneous ; Humans ; Kyphosis ; Methods ; Spine

Alveolar soft part sarcoma is a clinically and morphologically distinct soft tissue tumor that was first defined and named by Christopherson et al in 1952. Since 1953, alveolar soft part sarcoma invading bone have been reported sporadically. We experienced a case of alveolar soft part sarcoma with metastasis to femoral shaft, which was treated by wide resection & vascularized fibular strut graft.
Neoplasm Metastasis ; Sarcoma, Alveolar Soft Part ; Transplants

No abstract available.
Biopsy, Fine-Needle* ; Humans ; Pathology, Surgical* ; Thyroid Gland* ; Thyroid Nodule*

Various kinds of spinal instruments have been developed for the treatment of lumbar spinal disordors. Recently, the Graf instrument as soft stabilizer has been introduced in treating lumbar spinal disordors associated with instability. To determine the reliability of Graf instrument providung spinal stability we have analysed 19 cases of unstable lumbar degenerative disease treated with adequate decompression and Graf instrumentation between May 1991 and March 1992. There were 15 females and 4 males. Average age at operation was 50.8 years (Range, 35 to 70). Minimum follow up was 14 months. The main surgical indication was serious limitation of daily activity caused by intractable symptoms and signs with spinal instability. Clinical assesment based on authors modified criteria revealed satisfactory (Exellent/Good) in 16 cases (84.2%). The Graf instrument has many advantages over rigid implant such as enough stability without arthrodesis after extensive surgical decompression, rapid rehabilitation, less operative risk and preservation of spinal motion. These results suggests Graf instrument instead of rigid implant is highly recommendable in managing unstable lumbar disordors.
Arthrodesis ; Decompression ; Decompression, Surgical ; Equidae ; Female ; Follow-Up Studies ; Humans ; Male ; Rehabilitation

OBJECTIVE: Weight gain and DM can be serious side effects in the use of atypical antipsychotics (AAP), although conventional antipsychotics (CAP) have also been implicated. Also weight gain & DM are the adverse effects that are often associated with noncompliance and medical problems. The relationship between weight gain, dyslipidemia and DM is well established. Patients with schizophrenia are not only at risk of DM, but also taking antipsychotic medication further increases the chance of developing non-insulin-dependent hyperglycemia. Thus, this pilot study was conducted to investigate the risk of hyperlipidemia & DM in Korean patients taking antipsychotic medications. METHODS: After receiving informed consent, demographic data and history of medication were collected from medical records of 174 inpatients (92 male, 82 female). For the laboratory tests blood sampling was done at 7 A.M. before the meal and medication. RESULTS: For all subjects, the mean age was 41.10+/-9.56 years (range 14-65 years); 88% were diagnosed with schizophrenia. Of these, 55% were treated with antipsychotics alone (Monotherapy) and 45% were treated with combination therapy (such as antipsychotics plus a mood stabilizer). The mean age of onset of illness was 24.8+/-47.25 years old and mean duration of admission was 45.44+/-133.84 months. In the monotherapy group, the duration & dosage of each medications were 42.1+/-60.5 weeks and 12.2+/-8.22 mg/day of haloperidol (N=35), 6.95+/-9.52 weeks & 5.03+/-1.88 mg/day of risperidone (N=19), 9.1+/-11.1 weeks & 13.9+/-6.5 mg/day of olanzapine (N=8), 10.2+/-6.3 weeks and 287.6+/-62.9 mg/day of lodopine (N=4), 15.7+/-9.54 weeks and 335+/-172.8 mg/day of clozapine (N=5), 20+/-22.23 & 620+/-265.9 mg/day of chlorpromazine (CPZ; N=5). Mean weight gains of CAP group and AAP group, which was divided by the main therapeutic drug, were 0.18+/-5.99 and 2.18+/-6.38 kg in total subjects, however, there was no statistical significance between the groups. Moreover, there was no statistically significant difference in weight gain between groups when comparing each individual monotherapy (haloperidol, risperidone, olanzapine, lodopine, clozapine, CPZ: ANOVA; df=5, f=1.12, p=0.35). In the laboratory test results of total subjects abnormality of total cholesterol was 23.6%, triglyceride was 50.6%, fasting blood sugar (FBS) 1.7%, hemoglobin A1c (HbA1c) 27.6%, insulin 3.4%. There were statistical significances of correlations between HbA1c & FBS (r=0.489, p<0.01), total cholesterol (r=0.286, p<0.01), low density lipid (LDL; r=0.299, p<0.01) and triglyceride (TG; r=0.277, p<0.05), high density lipid (HDL; r= -0.192, p<0.05), original weight (r=0.154, p<0.05). With ANOVA for the evaluations of drug effect in monotherapy groups, the level of ALT (SGPT; p=0.04) was higher in olanzapine group, TG was higher in clozapine & CPZ group (p=0.03). HDL was lower in lodopine, clozapine & CPZ group (p=0.01). LDLwas highr in olanzapine & lodopine group (p=0.01). Abnormalities of ALT in olanzapine & clozapine group were 37.5% & 40%, those were statistically significant (p=0.02). Although there was no statistical significance (p=0.05), clozapine (60%), CPZ (60%) & olanzapine (37.5%) groups revealed more abundant abnormalities than haloperidol (11.4%) & risperidone (21%) groups in total cholesterol. CPZ (100%), clozapine (80%), lodopine (75%), olanzapine (75%) groups revealed more abundant abnormalities than haloperidol (48.6%) & risperidone (57.9%) groups in TG, however, there was no statistical significance. And the abnormality of HbA1c was 62.5% in olanzapine group and 40% in CPZ group, those were more abundant than other groups (20-25.1%), even though no statistical significance. CONCLUSION: In the cases of Korean patients taking antipsychotic medication, the tentative risk rate of hyperlipidemia might be 18.3% and hyperglycemia might be 27.6%. CPZ, clozapine and olanzapine, as compared with haloperidol and risperidone, may be associated with more adverse changes in total cholesterol and TG. Olanzapine and CPZ, as compared with haloperidol, risperidone and clozapine, may be more risky in the development of hyperglycemia. HbA1c may be an indicator to detect the risk of hyperlipidemia and hyperglycemia in patients taking antipsychotic medications.
Age of Onset ; Antipsychotic Agents* ; Blood Glucose ; Chlorpromazine ; Cholesterol ; Clozapine ; Dyslipidemias ; Fasting ; Haloperidol ; Humans ; Hyperglycemia* ; Hyperlipidemias* ; Informed Consent ; Inpatients ; Insulin ; Male ; Meals ; Medical Records ; Pilot Projects ; Prevalence* ; Risperidone ; Schizophrenia ; Triglycerides ; Weight Gain

We performed a retrospective analysis of twenty-four consecutive hip arthroplasties (Total Hip Arthroplasty 18, Bipolar Arthroplasty 1, Cup revision 5) during which intraoperative frozen sections were analyzed to identify the occult active infection. We also reviewed the data such as laboratory findings (ESR, CRP), intraoperative culture, hip joint sonographic evaluation and permanent histologic section. Among the twenty-four patients those who received hip arthroplasties, 10 cases received revisional hip arthroplasties due to painful hip prosthesis loosening, 9 cases with infected hip prosthesis, 3 cases with infection after open reduction and internal fixation due to hip fracture and 2 cases with septic hip sequelae. Intraoperative frozen section had been obtained during staged revisional hip arthroplasties to determine the presence of active infection. We considered positive for infection if it shows more than 10 PML/HPF (Polymorphonuclear leukocyte /high power field) in at least 5 distinct microscopic fields from intraoperative tissue frozen section and postponed implantation of prosthesis. If it shows less than 5 PML/HPF, we performed revisional hip prosthesis implantation. We decided the implantation based on patient's condition, laboratory findings and intraoperative tissue conditions if it shows between 5 and 10 PML/HPF from intraoperative frozen section. At last follow up, 20 of 21 patients who had a revisional hip arthroplasties as below 10 PML/HPF from intraoperative frozen section remained free of infection (Specificity; 95%). We concluded that analysis of the intraoperative frozen sections is a reliable predictor as a guide to sepsis for the successful hip joint arthroplasties.
Arthroplasty* ; Arthroplasty, Replacement, Hip ; Follow-Up Studies ; Frozen Sections* ; Hip Joint ; Hip Prosthesis ; Hip* ; Humans ; Leukocytes ; Prostheses and Implants ; Retrospective Studies ; Sepsis* ; Ultrasonography

Articular cartilage is a highly differentiated tissue, lacking a vascular supply and having only limited regenerative capability. Cut or other mechanical damage restricted to the cartilage does not repair. Experimentally and clinically, cartilage defect that penetrate the subchondral bone undergoes repair through the formation of tissue usually characterized as fibrous, fibrocartilaginous or hyaline-like cartilaginous tissue. There is little definitive informations about local or systemic factors that control the differentiation of mesenchymal cells to osteoblast, chondroblast or fibroblast. Our study was designed to evaluate the effect of transforming growth factor-beta (TGF-pl) and autogenous periosteal graft on the healing of osteochondral defect of distal femur of rabbit and also the possibility of these method to be clinically applicable to human. The experimental model used in the present study for including cartilage in rabbit was based mainly on the model used by Frukawa et al14). in rabbit. A full thickness osteochondral defect of 80 rabbit were made with 2mm diameter of drill-bit and electrically driven drill. Experimental animals were divided into four group: 1) group I, osteochondral defect only, 2) group II, osteochondral defect with infiltration of phosphate buffer solution, 3) group III, osteochondral defect with infiltration of TGF-Bl, 4) group IV, osteochondral defect with autogenous periosteal graft. The healing of the defect was assessed at 1 week, 3 weeks, 5 weeks, 12 weeks after operation by gross and histochemical examination. At 1 week, fibrinoid material in edge to edge arcade arrangement was present in group I,II,III,IV. At 3 weeks, spindle shaped undifferentiated mesenchymal cell present in the periphery of fibrinous network, but there is no appearance of mesenchymal cell in group I,II. At 5 weeks, essentially complete repopulation of the defect with progressive differentiation of cells to chondroblast, chondrocyte, osteoblast and synthesis of cartilage and matrix in their appropriate location in group III and IV were found. At 12weeks, hyaline like cartilage formation was observed in group III and IV. but early trace of degeneration of the cartilage were seen in many defect with the prevalence and intensity of the degeneration increasing at group I and 3 . Our study demonstrated in detail the repair of full-thickness defect in rabbit articular cartilage extending into cancellous bone of the marrow cavity under influence of local growth factor (TGF-pl) and autogenous periosteal graft. Excellent reconstruction of articular cartilage was observed in TGF- Bl infiltration group and autogenous periosteal graft group as early as 5 weeks after the creation of defect. Although the further study should be carried out for their clinical application, we conclude that TGF-Bl regulates the overall mechanism of matrix constituent in connective tissue and autogenous periosteal graft have a chondrogenic potential to repair major osteochondral defect. these suggest that TGF-Bl and autogenous periosteal graft may be a important pathophysiological regulator of chondro- genesis.
Animals ; Bone Marrow ; Cartilage ; Cartilage, Articular ; Chondrocytes ; Connective Tissue ; Femur ; Fibrin ; Fibroblasts ; Humans ; Hyalin ; Models, Theoretical ; Osteoblasts ; Prevalence ; Transplants*