No abstract available.
Drug Therapy* ; Lung*

This study was designed to investigate factors relating to fiscal deficit for regional health insurance. The financial statements for the fiscal year 1990 of nationwide 254 regional medical insurance societies were analyzed. Important findings are summarized below: 1. There were differences in the main reason for the financial deficit among regions when deficit and surplus societies were compared by regions. The total revenue per enrollee, especially revenue from the premium contribution of a deficit society was significantly smaller than that of a surplus society in large cities and counties. On the other hand, the total expenditure per enrollee of a deficit society was larger than that of a surplus society in small cities. 2. Both low premium irate at the beginning of health insurance program and less effort to increase the premium rate were main factors for the smaller revenue from the contribution of a deficit society in large cities and counties. 3. Larger expenditures per covered person of a deficit society in small cities were explained with larger medical expenditures especially for out-patients services rather than larger administrative expenses. 4. A regression analysis showed that utilization rates in out-patient services were significantly associated with income and numbers of total medical care institution per capita within a region where a health insurance society located. Also expenses paid by insurer per visit were associated with the proportion of utilization for tertiary care hospitals as well as the proportion of utilization of public health centers.
Hand ; Health Expenditures ; Humans ; Insurance ; Insurance Carriers ; Insurance, Health* ; Korea* ; Outpatients ; Public Health ; Tertiary Healthcare

No abstract available.
Disabled Persons* ; Female ; Humans ; Menarche*

OBJECTIVE: To evaluate the accuracy of combined transvaginal ultrasound and beta-hCG discriminatory zone for diagnosing intrauterine pregnancy, abortion, and ectopic pregnancy in early abnormal pregnancy. METHODS: Initial ultrasound findings and beta-hCG level were compared with final pregnancy outcome in 164 early pregnant women who visit our hospital with vaginal bleeding or abdominal pain. The sensitivity, specificity, and predictive value by the combination of two diagnostic tools were calculated. Statistic analysis of collected data used x2 of SPSS(9.0). RESULTS: Of 90 women with normal outcome, 64(71.1%) had a gestational sac 5mm, and in 47 cases, the hCG level was above 1,800 mIU/ml. Transvaginal ultrasound was non-diagnostic in 47(28.6%) of 164 women, and especially, 43(53.1%) of 81 cases with beta-hCG levels below 1,800 mIU/ml. The portion of accurate ultrasound diagnosis was significantly higher in women above 1,800 mIU/ml (85.5%, 71 of 83 cases) compard with levels below 1,800 mIU/ml (37.0%, 30 of 81 cases) : P < 0.001; Relative Risk(RR) 2.31; CI 95%. Sensitivity of transvaginal ultrasound diagnosis of intrauterine pregnancy, abortion, and ectopic pregnancy was 90.2%, 79.3%, and 66.7% in women who presented with beta-hCG levels above 1,800 mIU/ml, and 41.0%, 23.5%, and 75% below 1,800 mIU/ml, respectively. And, negative predictive value was 83.9%, 89.7%, and 98.8% in each of intrauterine pregnancy, abortion, and ectopic pregnancy above 1,800 mIU/ml, and 64.6%, 60%, and 97.3% below 1,800 mIU/ml, respectively. CONCLUSIONS: The sensitivity, specificity, and predictive value of transvaginal ultrasound for diagnosing abnormal early pregnancy were poor except cases of ectopic pregnancy when beta-hCG levels were low than discriminatory zone. Ultrasound impressions were well related with beta-hCG levels.
Abdominal Pain ; Diagnosis ; Female ; Gestational Sac ; Humans ; Pregnancy Outcome ; Pregnancy* ; Pregnancy, Ectopic ; Pregnant Women ; Sensitivity and Specificity ; Ultrasonography* ; Uterine Hemorrhage

Total knee arthroplasty is indicated for painful joints, with or without deformity, secondary to rheumatoid arthritis, osteoarthritis, traumatic arthritis, and certain other forms of nonseptic arthropathy. Many patients with arthritic knees have symetrical involvement and thus require a bilateral operation. Staged bilateral arthroplastis were performed with many drawbacks such as prolonged hospitalization, repeated anesthetic risks, and increased cost. Simultaneous bilateral arthroplasty under one anesthesia by two teams offers several advantages over staged procedure. We studied the results of 145 total knee arthroplasties, performed over a five-year period, to compare unilateral(group I;45 knees), staged bilateral(group II; 24 knees), and simultaneous bilateral arthroplasties(group III; 76 knees) by 2 team approach. Duration of mean follow-up was 1 year and 9 months. The results are as flollows; 1. The mean anesthetic times were 189 minutes, 312 minutes, and 218 minutes for the group I,II,III, respectively. 2. The mean blood loss was 1075ml for the group I, 1644ml for the group II, and 1902ml for the group III. 3. The hospitalization period was 74.1 days in two stage procedures, while it was 48.6 days in simultaneous bilateral procedures. 4. Knee scores by Knee Rating Scale of Hospital for Special Surgery were increased to 85.3 points, 80.7 points, and 85.4 points for group I,II,III, respectively. 5. There were no difference in complication among three groups. 6. Group III had advantages such as reduced anesthetic risk, reduced rehabilitation period, and decreased cost.
Anesthesia ; Arthritis ; Arthritis, Rheumatoid ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Congenital Abnormalities ; Follow-Up Studies ; Hospitalization ; Humans ; Joints ; Knee ; Osteoarthritis ; Rehabilitation

STUDY DESIGN: This is a retrospective study analyzing 76 patients treated by decompression, pedicle screw instrumentatin and fusion for spondylolytic spondylolisthesis with symptomatic spinal stenosis. OBJECTIVES: This is to verify the advantages of adding posterior lumbar interbody fusion (PLIF) to the usual posterolateral fusion (PLF) with pedicle screw instrumentation. SUMMARY OF BACKGROUND DATA: Stabilization after decompression of spondylolytic spondy- lolisthsis is difficult due to insufficiency of fusion base, gap between the bases and incompetent anterior disc support. PLIF offers anterior support, reduction and a broad fusion base. METHODS: Forty patients were treated with PLF and 36 were treated with additional PLIF. They were compared for union, reductin of the deformity and clinical results. RESULTS: The patients were followed up for more than 2 years (mean: 4.6 years). Nonunion was observed in 3 PLF cases (7.5%) and none in PLIF. Reduction of slippage was 28.3% in PLF and 41.6% in PLIF (p < 0.05). In PLF group, 8 patients (20%) had recurrence of deformity with loss of reduction more than 50%. Hardware failures occurred in 2 with PLF. There was no major neurologic complications in both groups. Both groups had a few difference in the satisfactory results, but some difference in the excellent result by Kirkaldy-Willis criteria. Excellent result was 45% in PLF and 75% in PLIF. CONCLUSIONS: Addition of PLIF to PLF following a complete decompression and pedicle screw flxation is a recommendable procedure for the treatment of spondylolytic spondylolisthesis with spinal stenosis.
Congenital Abnormalities ; Decompression ; Humans ; Pedicle Screws ; Recurrence ; Retrospective Studies ; Spinal Stenosis ; Spondylolisthesis

We reviewed 205 hips (in 151 patients, 125 men and 26 women) which were diagnosed osteonecrosis of femoral head and treated with bipolar endoprosthesis from 1985 to 1993 in Seoul National University Hospital to delineate the efficacy and indication of use of bipolar endoprosthesis in osteonecrosis. They were followed up for an average of 56 months (16 to 100 months). The mean age at operation was 44 years (21 to 84 years). The types of prosthesis used were as follows : Omnift (107), AML (57), Harris-Galante (19) and others (22). The preoperative Harris hip score improved from 49 points preoperatively to 89 points at last follow-up. The pain score improved from 18 points to 39 points, activity score from 9 points to 12 points and gait scare from 19 points to 31 points. The improvement pattern of activities and gait was converse, but that of pain was diverse. One hundred and seventy-eight hips (87%) were satisfactory (Harris hip score : more than 80 points) and 27 (13%) were unsatisfactory. Radiologic findings of last follow-up showed stable bony fixation in 186 hips (91%), stable fibrous fixation in 12 hips (6%) and unstable fixation in 7 hips (3%), Ten migrations of prosthesis were noted: cup migration 5 (2.4%) and stem sinking 5 (2.4%). Heterotopic ossification was noted in 9 (4.4%). Osteolysis in acetabular side was observed in 6 (3%) and in femoral side, 22 (11%). Complications were as follows : 4 stem loosening (1.9%), 5 fixed varus position of cup (2.4%) and 1 dislocation of cup (0.5%). Revision was performed in 4 (1.9%) and the causes were 1 infection, 1 protrusio acetabuli, 1 stem loosening and 1 cup dislocation. In conclusion, biopolar endoprosthesis generally gave good results. However, the improvement of pain was unpredictable. Increasing tendency of osteolysis was noted with increasing follow-up duration. Long-term follow-up is mandatory for the accurate determination of osteolysis.
Acetabulum ; Dislocations ; Follow-Up Studies ; Gait ; Head ; Hip ; Humans ; Male ; Ossification, Heterotopic ; Osteolysis ; Osteonecrosis ; Prostheses and Implants ; Seoul

Vitelliform macular dystrophy, adult type, is a type of pattern dystrophies of the pigment epithelium characterized by autosomal daminant inheritance, mid-life onset and small, round or oval, yellow deposits located at the level of the pigment epithelium. The authors report a case of this dystrophy which showed small yellow round lesion measuring 1/4-1/3 D.D. within the macula, normal electroretinogram, subnormal electrooculogram light-peak/dark-traugh ratio. typical irregular ring-like transmitted fluorescence surrounding the central non-fluorescent Iesion and leakage from perifoveal capillaries on fluorescent angiogram.
Adult* ; Capillaries ; Electrooculography ; Epithelium ; Fluorescence ; Humans ; Vitelliform Macular Dystrophy* ; Wills

The E-cadherin, alpha-catenin, and beta-catenin expressions were immunohistochemically investigated in paraffin-embedded materials of 80 cases of colorectal adenocarcinomas. The staining similar to normal colorectal mucosa with preserved strong membranous staining pattern was considered normal or preserved expression. The X2 test was used to analyse the statistical correlation of cadherin/catenin expression with clinicopathologic parameters and the Breslow test for the correlation with survival length. Normal colorectal mucosa showed strong membranous expression of cadherin/catenin complex. The reduced E-cadherin, alpha-catenin, and beta-catenin expression were found in 53/80 (66.3%), 46/80 (57.5%), and 44/80 (55.5%) cases of colorectal cancers examined, respectively. There were significant correlations between E- cadherin and alpha -catenin (p=0.035), and between alpha-catenin and beta-catenin (p=0.013). The reduced E-cadherin expression was associated with histologic dedifferentiation, tumor depth, lymph node metastasis, clinical stage (p<0.05), poor clinical outcome in stage II (p=0.016) and the reduced alpha-catenin expression with lymph node metastasis and clinical stage (p<0.05). Reduced expression of two or more proteins was correlated with lymph node matastasis, histologic dedifferentiation, clinical stage, and survival (p<0.05). The present study demonstrates a significant down-regulation of E-cadherin and alpha-catenin expression in colorectal cancer is associated with tumor invasiveness, histologic dedifferentiation, lymph node metastasis, and clinical stage. These results suggest that E-cadherin and alpha-catenin may be useful markers of invasiveness, lymph node metastatic potential, and clinical stage and of value as prognostic markers in the earlier stage. Further studies are needed to confirm the prognostic value of these cadherin/catenin complex.
Adenocarcinoma* ; alpha Catenin* ; beta Catenin* ; Cadherins* ; Colorectal Neoplasms ; Down-Regulation ; Lymph Nodes ; Mucous Membrane ; Neoplasm Metastasis

No abstract available.
Carcinoma* ; Nevus*