No abstract available.

The objectives of the study were to provide the basic informations needed in the development of balanced medical services throughout the nation. As the national health care system was expanding rapidly along with the economic growth, quantitative re-evaluation of the system is of great need. For that reason, characteristics of the admitted patients were analyzed for the case-mix and patients' flow within and through regions. Materials were 421,530 cases of inpatients, who were reported through Medical Insurance Corporation(KMIC) for insurance claim, during the period of March 1, 1985 through February 28, 1987. Korean Diagnosis Related Groups(K-DRGs) classification system was adopted for the study of case-mix and 189 cities and countries were classified into 5 district groups by factor analysis results of K-DRGs. The major findings of this study were as follows ; 1) Factor analysis of case-mix, employing K-DRG system, revealed 5 distinct functional district groups. Group A(18 district) was prominent for tertiary medical care. In group B(36 districts), rather simple procedures were prevalent. Group C(26 districts) was distinctive for the medical care of well organized internal medicine practices with qualified clinical laboratories. Group D(17 districts) was characterized by relatively high balanced medical care. Group E (92 districts) was with very low level of medical care. 2) Analysis of the case-flow through the districts showed 3 types of flow patterns ; inflow, outflow, and balanced types. Inflow type of case-flow was found in Group A, C and D while Group B and E showed outflow type. Inflow was most prominent in Group A and Group E was of typical outflow type. Group B was consistently the outflow type except for Major Diagnostic Category XX regardless of the disease treaders, but Group C and D were inflow or outflow types according to the disease tracers.
Classification ; Delivery of Health Care* ; Diagnosis ; Economic Development ; Factor Analysis, Statistical ; Humans ; Inpatients* ; Insurance ; Internal Medicine ; Rationalization

No abstract available.
Uterus*

In addition to premedicants, adjuvants and inhalation of dried anesthetic gas mixture during anesthesia, pain after upper abdominal operation may cause obtundation of cough reflex, limitation of lung function, and decreased movement of respiratory cilia, resulting in postoperative pulmonary complications such as pneumonia and atelectasis. Epidural injection of local anesthetic may produce enough analgesic action without depression of pulmonary function for the majority of upper abdominal surgery cases, while intramuscular injection of analgesic which has been applied for postoperative pain relief might cause depression of pulmonary function and increase of mortality and morbidity of pulmonary complications. This study was designed to compare the effects of above two pain-relief methods on pulmonary function at the postoperative 24 hour and 44 adult patients who have been operated in upper abdomen which were allocated randomly with either epidural injection group (10 of male, 9 of female) or intramuscular injection group (17 of male, 8 of female). The results were as follows; 1) All patients have markedly decreased pulmonary function in the preoperative period, comparing with the predictive values. 2) The results of postoperative pulmonary function test of all patients in intramuscular injection group was similar to the results of preoperative pulmonay function test and not improved. 3) Patients in epidural injection group have markedly improved in nearly all pulmonary functions after operation. The degree of improvement was increased in order as following; MEF50> MEF75> IRV (or TV)> FEV1/FVC. And there was no difference of results between male and female. 4) Vital capacity in epidural injection group was increased to about 25~42% from the preoperative period, while it was decreased to about 22~29% in intramuscular injection group. With the above results, we suggest that single or continuous epidural injection of local anesthetic will be an appropriate way of postoperative pain-relief methods, especially in the patients who has markedly decreased pulmonary function and upper abdominal surgery.
Abdomen ; Adult ; Anesthesia ; Cilia ; Cough ; Depression ; Female ; Humans ; Inhalation ; Injections, Epidural* ; Injections, Intramuscular ; Lung ; Male ; Mortality ; Pain, Postoperative ; Pneumonia ; Preoperative Period ; Pulmonary Atelectasis ; Reflex ; Respiratory Function Tests* ; Vital Capacity

The aim of the study was to investigate the effect of surgical therapy combined with the usage of metronidazole gel in the treatment of juvenile periodontitis by comparing clinical indices of flap operation along with application of metronidazole gel and flap operation only. Comparing clinical indices of the baseline, 3 months after surgery, 6 months after surgery statistically, the results are as follows; 1. Bleeding on probing (BOP) was decreased significantly both in the experimental group and the control group at 3 months after surgery (p<0.05). BOP increased 0.9% in the control group 6 months after surgery, while in the experimental group, decreased 4.7% (p>0.05). However, there was no statistically significant difference in these groups (p>0.05). 2. Pocket probing depth (PPD) was decreased significantly both in the experimental group and the control group at 3 months after surgery (p<0.05). PPD increased 0.1mm in the control group 6 months after surgery, while in the experimental group, no increase of the depth could be observed (p>0.05). However, there was no statistically significant difference in these groups (p>0.05). 3. Loss of attachment level(LOA) was decreased significantly both in the experimental group and the control group at 3 months after surgery (p<0.05). LOA increased 0.2mm in the control group 6 months after surgery, while in the experimental group, increased 0.3mm However, there was no statistically significant difference in these groups (p>0.05). In conclusion, flap operation was effective on the treatment of juvenile periodontitis. However, combined therapy of metronidazole gel could not give rise to any significant adjunctive effect on the treatment outcome.
Aggressive Periodontitis* ; Hemorrhage ; Loa ; Metronidazole* ; Treatment Outcome

Hip fusion has provided disease eradication, stabilization, pain relief and strenuous activity, but the possible complication of pseudarthrosis as well as loss of all motion is a drawback. Total hip replacement arthroplasty has not been a good procedure for active young patients. This study was perforrned to clarify the indications, the best position, the functional results of hip fusion and the effect of hip fusion on the adjacent joint. The authors reviewed 32 cases of hip fusion performed at the Department of Orthopedic Sugery, Seoul National University Hospital during the period of 11 years from April 1973 to June 1984 and the following results were obtained. 1. The average age of the patients at the time of operation was 20.3 years. 2. Tuberculosis of the hip was the most common cause (56.2%). 3. The satisfactory fusion was obtained in 26 cases (81,2 %). 4. The average position of fusion was 20±9 degrees of flexion, 1±5 degrees of abduction and 10±4 degrees of external rotation. 5. Although there was a disability due to limitation of motion after hip fusion, leg length discrepancy was reduced from 3cm (preoperative) to 2.5cm (postoperative) and scoliosis was decreased from 18' of Cobbs angle (preoperative) to 12' of Cobbs angle (postoperative). 6. After hip fusion, walking capacity was increased and back pain was reduced. 7. Age was barely correlated with absolute clinical scores, but better functional results were obtained in younger patients than in older patients. 8. The results were excellent or good in 24 cases (75%).
Arthroplasty ; Arthroplasty, Replacement, Hip ; Back Pain ; Disease Eradication ; Hip ; Humans ; Joints ; Leg ; Orthopedics ; Pseudarthrosis ; Scoliosis ; Seoul ; Tuberculosis ; Walking

The antihypertensive effect and side reaction of pindolol were studied in 48 cases of essential hypertension 5mg to 15mg once regiment for average period of 6 weeks. 1) Average reduction of 25.11mmHg in systolic and 16.36mmHg in diastolic pressure were observed and their percentile reduction was 15.20% and 14.79%, respectively. The overall effect rate was 83.21%. The blood pressure was lowered significantly since 1 week of both in systolic and diastolic pressure with the daily of 10-15mg. 2) There was no significant change in heart rate before and after treatment. 3) No specific side reaction was observed except 1 cases in which discontinued the medication because of severe headache and fatigability on 2nd day of medication.
Blood Pressure ; Headache ; Heart Rate ; Hypertension ; Pindolol

In this paper, authors discussed the classification of swelling (Chong), swelling-treatment methods (Chi-Chong) in Choson period, traditional notions about the natural history, treatment principles, popular healing methods of swelling, and depicted specially designed acupuncture instruments applied to it. Among the six professional guide books at that time, A Secret Recipe of Swelling Treatment (16th century) introduced the invasive surgical method into the narrow disease category i.e. carbuncle and furuncle, cellulitis, erysipelae, and gravitation abscess. The writer named these diseases as 'fire, stone, water, hemp, silk carbuncle', following each specific characteristics. Another surgical book, Orientation to Swelling Treatment (16th century) extended the surgical method to 'non-external' but 'looks-like swelling' diseases, such as pleurisy, tympanitis, testicular swelling, sequestrum of osteomyelitis. It is natural that some researchers doubted whether the book was used in real practice. However, the content of the book is too detailed to be regarded as an imaginary product. From these books and other materials, we found that the traditional notion of swelling was closely related with the notions of 'knotted' or 'pent in'. So 'pent-up rancor' or grudge was thought to aggravate any kind of swelling, and was tabooed or contraindicated in swelling treatment. 'Knotting in mind' was regarded as one of the principal etiologies of 'swelling and abscess formation in the body'. 'Fire in mind' was also regarded as one of the causes of phlegm aggregation resulting in swelling.
Abscess/*history ; Disease ; English Abstract ; History of Medicine, 16th Cent. ; History of Medicine, 17th Cent. ; History of Medicine, Early Modern ; Human ; Korea ; Surgery/*history

This study refers to the origin of the modern health care system in Korea. The modern health care system was emerged in order to solve the problem of the infectious diseases and to increase the national population between 1876 and 1910. 'Opening a Country'(1876) urged the Chos?n dynasty to strengthen her national power to compete with the imperial powers, and the increase of the population was one of the major concerns. 'Opening a Country' also provided the methods of controlling the infectious diseases which were the most important factors causing population unstability. The modern health care system in Korea had been formed for about 30 years since 'Opening a Country'. The new health care system aimed at controlling population. It was different from the old system that claimed for Confucian ideology, loyalty and paternal love of the people. The new system was consisted of three sectors - public health, medical care, and the surveillance of the private practitioners and drug-sellers. Vaccination for smallpox, sanitation, quarantine and hospitals for Western medicine were established in the medical care sector. Licensing for herbal doctors and pharmacists was taken in order to control the quality of private practitioners. In addition, the Sanitary Board was set to provide the systematic health care and the police was created to enforce many sanitary affairs. The emergence of modern health care system took several steps. Generally speaking, the Western health care and medicine which were very poor at first became the dominant, while the once strong indigenous medicine and health care tended to the marginal. As soon as Chos?n was opened to the outside world, Chos?n government regarded herself to be able to select some Western health care methods, for example, vaccination, sanitation and quarantine, to control the infectious diseases without changing the existing social order. But because of international environment surrounding Chos?n and people's uprising to destroy the feudalistic dynasty, more fundamental changes were needed. The Reform in 1894-5 was the product of these movements. As result of the Reform movements the governmental health care system based on Confucian 'Wangdo' ideology was changed into modern one calling for the quantitative and qualitative control of population. The Sanitary Board was established, and police was created, while royal medicine, which had represented the government health care for long time, was limited to just the practice of royal physicians. In spite of this drastic changes the reformation was not substantial because of the instability of political regimes. Thus most of the modern health care system had been achieved during the Kwangmu Reform period(1896-1904) directed by the Emperor and his followers. The system included the health care organization, public health, medical care, and the surveillance of the private practitioners. And the respect for the traditional herbal medicine was one of the prominent features in this Reform period. As Imperial Japan started to colonialize Korea after, the policy of health care system was greatly changed. Japanese controlled Korean health care institutions and they built high-level Western hospitals for only their health. And they eliminated Korean traditional medicine out of the public sectors. They strengthened the control of the infectious diseases by police and the military police, but they exploited it as the means of the surveillance of everyday life of Korean in the name of hygiene. The modern health care system emerged during 1876-1910 seems to be similar to the present health care system because it aimed at the control of population. However it is different because it showed paternalistic authority unlike the present system which is based on the individual right. In the Kwangmu Reform period, health care was dependent on the mercy of the Emperor, and in the Japanese occupation period, the health care system contributed to the increase of the autocratic, paternalistic colonial power.

To clarify possible causes, pathogenesis, and appropriate prevention method of remote intracerebral hemorrhage (RICH), we analyzed the clinical findings and the possible predisposing factors of six cases who developed RICH among the 206 surgical series of cerebral aneurysm operated in our hospital over recent 5-year period. The locations of aneurysm were anterior communicating artery in three cases and internal carotid artery in three other cases. The sites of RICH were dependent regions considering the operative position in five of six cases, con-tralateral cerebellum in three cases, bilateral cerebellum in one case, and contralateral occipital area in one case. Peripheral low density around the RICH, suggesting hemorrhagic infarction, was observed on computed tomography in four cases. No patient had preoperative hypertension; however, significant elevation of blood pressure was observed intraoperatively or postoperatively in three cases. The factors which could have induced brain shift(large amount of removed or drained cerebrospinal fluid, large amount of infused mannitol, too low PaCO2) were observed in all cases except one case. There was no case with coagulopathy or underlying occult lesion. Two patients in whom detection of RICH was delayed showed poor outcomes. The possible underlying mechanisms involved in such complication seem to be shifting of brain due to sudden decreased intracranial pressure and excessive removal of cerebrospinal fluid, and subsequent injury of blood vessels such as compression or breakdown of vein. Moreover, the sudden elevation of blood pressure may have played a role as contributing factor. Therefore, consideration should be given to the maintenance of an adequate volume of intracranial cerebrospinal fluid and the appropriate blood pressure to prevent this complication. Early detection and immediate treatment with awareness of the possibility of this complication should be borne in mind when treating these patients to prevent such complications and to obtain good results.
Aneurysm* ; Arteries ; Blood Pressure ; Blood Vessels ; Brain ; Carotid Artery, Internal ; Causality ; Cerebellum ; Cerebral Hemorrhage* ; Cerebrospinal Fluid ; Hemorrhage ; Humans ; Hypertension ; Infarction ; Intracranial Aneurysm ; Intracranial Pressure ; Mannitol ; Veins