Acute renal failure refers to a rapid reduction in renal function that usually occurs in an individual with no known previous renal disease. Development of a complication of acue renal failure in critically ill surgical patients is not unusual, and it causes high morbidity and mortality. Acute renal failure can be divided as Pre-renal (functional), Renal (organic), and Postrenal (obstructive) azotemia according to their etiologies. Early recognition and proper correction of pre-renal conditions are utter most important to prevent an organic damage of kidney. These measures include correction of dehydration, treatment of sepsis, and institution of shock therapy. Prolonged exposure to ischemia or nephrotoxin may lead a kidney to permanent parenchymal damage. A differential diagnosis between functional and organic acute renal failure may not be simple in many clinical settings. Renal functional parameters, such as FENa+ or renal failure index, are may be of help in these situations for the differential diagnosis. Provocative test utilizing mannitol, loop diuretics and renovascular dilators after restoration of renal circulation will give further benefits for diagnosis or for prevention of functional failure from leading to organic renal failure. Converting enzyme blocker, dopamine, calcium channel blocker, and propranolol are also reported to have some degree of renal protection from bioenergetic renal insults. Once diagnosis of acute tubular necrosis has been made, all measures should be utilized to maintain the patient until renal tubular regeneration occurs. Careful regulation of fluid, electrolyte, and acid-base balance is primary goal. Hyperkalemia over 6.5 mEq/l is a medical emergency and it should be corrected immediately. Various dosing schedules for medicines excreting through kidney have been suggested but none was proved safe and accurate. Therefore blood level of specific medicines better be checked before each dose, especially digoxin and Aminoglycosides. Indication for application of ultrafiltration hemofilter or dialysis may be made by individual base.
Acid-Base Equilibrium ; Acute Kidney Injury* ; Aminoglycosides ; Appointments and Schedules ; Azotemia ; Calcium Channels ; Convulsive Therapy ; Critical Illness ; Dehydration ; Diagnosis* ; Diagnosis, Differential ; Dialysis ; Digoxin ; Dopamine ; Emergencies ; Energy Metabolism ; Humans ; Hyperkalemia ; Ischemia ; Kidney ; Mannitol ; Mortality ; Necrosis ; Propranolol ; Regeneration ; Renal Circulation ; Renal Insufficiency ; Sepsis ; Sodium Potassium Chloride Symporter Inhibitors ; Ultrafiltration

No abstract available.
Multiple Organ Failure*

No abstract available.
Ulcer*

No abstract available.
Insurance*

No abstract available.

No abstract availble.

As the result of a significant improvement in the economic situation and development of scientific techniques in Korea during the last 20 years, the life expectancy of Korea people has lengthened considerably and as a result the number of old aged people has markedly increased. Such an increase of the number of aged people brought about many problems. Authors would like to take a medical look at the “Problem of old aged people” presently facing us in Korea. Currently the number of people over 65 has increased rapidly and is 1,620,000, 4% of total population. But it is still much lower than 8.9% in Japan, 10.7% in U.S.A., and 14.9% in the United Kingdom. Over 25% of these aged people were found to have at least more than one disease which requires medical care. Diseases occur in the circulatory system, 30.9%, respiratory system, 17.1%, digestive system 8.6%, metal disorders, 8.4%, malignant neoplasms, 7.0%. About 51% of the aged over 65 are under medical security benefit, mostly with partial coverage plan. Their clinic visit rate was very low (2.0% in 1981), which might be due to financial reasons. Since diseases affecting the aged progress chronically, early detection and long term care are utter most important. However there is almost no special facility, long term care center or geriatric specialist. For proper management of medical problems in the growing population of the Korea elderly expansion of medical security coverage, greater number of specialized facilities, education of geriatric special manpower and efficient operating system should be established.
Aged ; Ambulatory Care ; Digestive System ; Education ; Great Britain ; Humans ; Japan ; Korea ; Life Expectancy ; Long-Term Care ; Respiratory System ; Specialization

Adventitial cystic disease (ACD) of venous system is an extremely rare condition. Very few reports of ACD in venous system have been described. In this report we discuss two cases of common femoral vein ACD that presented with a swollen leg by the obstruction of the vein. Ultrasound imaging showed the typical hypoechoic fluid filled cyst with a posterior acoustic window. Computed tomography scan and ascending venogram showed a stenosis to flow in the common femoral vein caused by an extrinsic mass. Trans-adventitial evacuation of cyst with removal of vein wall was performed for both cases. During operation we found the gelatinous material in the cysts arising in the wall of the common femoral vein and compressing the lumen. The patients were released after short hospitalization and have remained symptom free with no recurrence.
Acoustics ; Adventitia ; Constriction, Pathologic ; Femoral Vein ; Gelatin ; Hospitalization ; Humans ; Leg ; Recurrence ; Veins

A survey was carried out in order to know the status of student health service and student medical insurance of universities and colleges in Korea from 1 July to 30 September, 1978. And the following results were obtained; 1. Out of seventy universities and colleges, 54.8% of them had student health service facility such as student health center(30.0%) or health room(24.8%). 2. Out of twenty-seven national and public universities and colleges, 44.4% of them had student health service facility and out of forty-three private universities and colleges, 60.5% of them had student health service facilities. 3. Each of 80.8% of 25 universities, 43.3% of 30 colleges and 33.3% of 15 junior colleges had student health service facility. 4. Major roles of student health service were physical examination (92.1%), health counselling (86.8%), primary medical care (78.9%), tuberculosis control (68.4%), insect and rodent control (52.6%), parasite control (47.4%), water source sanitation (44.7%), and dental health care (28.9%). 5. Out of 21 universities and colleges, 66.7% of them had full time doctor and 81.0% of them had full time nurse for student health center. And out of 17 universities and colleges, 5.9% of them had full time doctor and 35.3% of them had full time nurse for student health room. 6. The range of health fee was varied from 100 won to 1,400 won per student per semester and the average was 520 won. 7. Among 55 universities and colleges, 78.6% of them had carried out annual physical examination in 1977 and the rate of physical examination was 57.4%. 8. Out of 70 universities and colleges, 45.7% of them had tuberculosis control program and the prevalence rate was 6.0 per 1,000 students. 9. Student medical insurance program was developed by ten universities and one college among 25 universities and 45 colleges. 10. Student medical insurance benefit was varied according to university and college ; the reduction rate of medical fee was 20% to 80% for not only in-patient but also out-patient. 11. The upper limit of pay claim was varied according to the university and college from 5,000 won to no-limitation for out-patient and from 30,000 won to no-limitation for in-patient. 12. The highest utility rate of student medical insurance program was found in university "F" with the rate of 791 for out-patient and 12 for admitted patient per 1,000 students.
Communicable Disease Control ; Delivery of Health Care ; Fees and Charges ; Fees, Medical ; Humans ; Insects ; Insurance ; Insurance Benefits ; Korea* ; Outpatients ; Physical Examination ; Prevalence ; Rodent Control ; Sanitation ; Student Health Services* ; Tuberculosis ; Water

The basic criteria of facial reconstruction with the flap are consisted of easy and wide applicability, good color and texture matching to the face and reliable anatomical basis. On these points, the submental island flap is superior to other regional flaps such as tissue expansion technique and free flaps It is based on the submental vessels branching from the facial vessels located at the medial groove of submandibular gland. Its pedicle has a reliable course along the inferior border of mandible with a constant distance and its perforator(s) is (are) located at the submental area around the anterior belly of digastric muscle. We report on its use in 4 cases of facial resurfacing on the cheek, the preauricular area and the nose in arteriovenous malformation and malignant skin cancer patients. The mylohyoid and anterior belly of digastric muscles could be included within the flap and the reverse submental island flap was also useful for obtaining the wide rotation of arc. The mean follow-up period was 8.3 months and the results were satisfactory to the patients. The submental island flap is reliable flap for facial resurfacing because of its good color and texture, acceptable donor scars, and thin, flexible flap. The flap also can incorperate with the skin, the muscle, and the bone in case of complicated facial defects. The long vascular pedicle also enables a wide applicability of the flap And also it can be used as a free flap, expanded flap and reverse island flap for the facial resurfacing.
Arteriovenous Malformations ; Cheek ; Cicatrix ; Follow-Up Studies ; Free Tissue Flaps ; Humans ; Mandible ; Muscles ; Nose ; Skin ; Skin Neoplasms ; Submandibular Gland ; Tissue Donors ; Tissue Expansion