During 2 months from December 1979 to January 1980, Medical practitioners in chonnam province were grouped into Si (city), Eup(town) and Myun (rural area) groups according to the locations of their clinic. 40 practitioners were randomly selected in each group and were asked their opinions about rural medical care in general. Total of 88 practitioners replied to the question as 73.3 percent of response rate in average. The most frequently mentioned advantages of rural practice were ease of clinic opening in Si-and Myun-group respondents and good social relationship in Eup-group respondents. The most frequently mentioned disadvantages were medical isolation in Si-group respondents and resident's ignorance in medicine in Eup-and Myun-group respondents. In all groups, most respondents though that rural medicine care should be delivered by and controled by physician. Suggestions made by Eup-and Myun-group respondents for improving rural medical care by structural change focused on the regional medical insurance system, while Si-group respondents noted district hospital or hospital linkage as most preferable system.
Surveys and Questionnaires ; Hospitals, District ; Insurance ; Jeollanam-do

We compared the clinical and radiographic outcomes between femoral varus osteotomy (23 hips) and Salter innominate osteotomy (18 hips) for treatment of Catteral is groups III and IV Perthes disease after 3-12 years follow-up. There were no statistically significant differences in the clinical outcomes using the lowa hip rating score and leg length discrepancy and in the final radiographic outcomes using the femoral head sphericity and Stulberg type between the two groups. However, neckshaft angle and center-edge angle were closer to normal value in the Salter innominate osteotomy group compared with the femoral varus osteotomy group. When the patients underwent femoral varus osteotomy at the older age (7 years), articulotrochanteric distance ratio and neck-shaft angle were significantly less than those of other patients. Salter innominate osteotomy may be better indi- cated as compared to femoral varus osteotomy, when physeal damage of proximal femur is obvious or highly suspicious particularly in the older children (7 years) with severe Perthes disease.
Child ; Femur ; Follow-Up Studies ; Head ; Hip ; Humans ; Leg ; Legg-Calve-Perthes Disease* ; Osteotomy* ; Reference Values

A study was made on 50 cases of epileptic children who had been observed at the pediatric department of Chungnam National University Hospital Taejeon Eul Ji Hospital during the period from July, 1986 to June, 1991. The result are as follows: 1) Epilepsy was most frequent in children from 1 year to 10 year of age (80%). Epilepsy was commoner in female children compare to male representing male to female ratio, 1:1.2. 2) Intractable cases with VPA were 40%, and male to female ratio was 1.2:1. Intractable cases were most common between 1 and 5 years (65%). 3) The most common epileptic type was generalized tonic clonic seizure (38%). 4) The clinical effect of valproic acid was the worst in severely abnormal EEG finding. 5) The mean plasma VPA level was significantly lower for the polytherapy (57.7microgram/ml) than for the monotherapy (69.5microgram/ml). The VPA dose of steady-state was significantly higher for polytherapy (27.9mg/kg/d) than for the monotherapy (20.9mg/kg/d). VPA level: dose ratio was reduced in the polytherapy (2.1) as compared to monotherapy (3.3). 6) The plasma VPA level increased according to dosage. In the same dose, plasma level of monotherapy was significantly higher than polytherapy. 7) The VPA dose of stead-state was highest under 1 year (monotherapy: 24.8mg/kg/day, polytherapy: 33.4mg/kg/day). The VPA dose decreased in accordance with an increase of the age. 8) There was no correlation between EEG change and plasma concentration of VPA. 9) There was linear correlation between clinical affect and plasma VPA level, and plasma concentration of VPA reached 51 to 100microgram/ml at that time. 10) The clinical effect was good in abscence seizure, simple partial seizure, myoclonic seizure, and generalized tonic clonic seizure in decreasing order. 11) The incidence of side effect were gastrointestinal disturbance, behavior disorder, laboratory abnormality, neurologic abnormality in order of frequency. The frequency of overall side effects observed was 40% but toxic effects were generally mild.
Child* ; Chungcheongnam-do ; Daejeon ; Electroencephalography ; Epilepsy ; Female ; Humans ; Incidence ; Male ; Plasma ; Seizures ; Valproic Acid*

No abstract available.
Denture, Partial, Fixed* ; Finite Element Analysis*

Purpose: This study analyzed the changes in the number of surgeries and surgical patterns due to the adoption and diffusion of new medical technology while focusing on radical prostatectomy. Materials and Methods: Medical equipment status report data and the National Health Insurance claims data from 2007 to 2019 were used. A total of 62798 radical prostatectomies from 135 medical facilities were analyzed. Radical prostatectomy was classified into open radical prostatectomy (ORP), laparoscopic radical prostatectomy (LRP), and robot-assisted laparoscopic radical prostatectomy (RARP) using the fee schedule codes. A linear mixed model was used to determine whether the adoption of a robotic surgical system had an effect on the number of surgeries and surgical patterns after adjusting for medical characteristics. Results: The number of radical prostatectomies performed in Korea increased from 1756 in 2007 to 8475 in 2019. During this period, the proportion of RARP in total surgery increased from 17.5% to 74.3%. The mean number of surgeries at medical facilities adopting the robotic surgical system was 128.3, which was higher compared to 18.5 cases in medical facilities that did not adopt it. The adoption of a robotic surgical system increased the number of radical prostatectomy surgeries by 12.1 cases and the RARP share by 47.2% in a linear mixed model.  Conclusion The adoption and diffusion of robotic surgical systems in Korea increased the number of surgeries as well as the share of robotic surgery. It is necessary to manage a technology that is widely used in a state where its clinical effectiveness is uncertain.

The Ilizarov technique for gradual distraction osteogenesis was developed in the 1950s. A correctly performed osteotomy is essential to the success of distraction osteogenesis and prepares for limb lengthening. Between Sept. of 1991 and 1994, thirty-four patients were treated by Ilizarov technique at St. Benedict Hosp. and Gang-Dong Hosp.. And then assigned to two separate groups : a corticotomy group (group A) and osteotomy group (group B; osteotomy with Gigli saw or osteotomy with multiple drill holes and osteotome). The regenerate segments were evaluated weekly for the first six weeks after operation. After the initial six-week evaluation period, observations of these segments were continued through a series of monthly radiographs. Distraction began on postoperative day seven in group A and on day eleven in group B; and continued at a rate of 1 mm/day and a frequency of 4 times/day. Group A displayed new bone formation earlier than group B: group A's mean was 16.5 ± 4.9 days, while B's mean was 25.3 ± 4.6 days. The first bridging callus occurred earlier in group A than it did in group B: A's mean was time of 36.7 ± 9.9 days, while B's mean was 44.0 ± 7.9 days. There was no significant difference between groups A & B in terms of first cortical formation : A's mean was 86.9 ± 24.0 days, and B's mean was 100.6 ± 25.2 days. There was no significant difference between groups A & B in terms of the bone healing index : A's mean was 41.6 ± 13.5 days and B's mean was 41.15 ± 8.10 days.
Bony Callus ; Extremities ; Humans ; Ilizarov Technique ; Methods ; Osteogenesis ; Osteogenesis, Distraction ; Osteotomy

BACKGROUND: To identify the prevalence and related factors for vitamin D deficiency in the patients who admitted to the medical intensive care unit (ICU) of a Korean tertiary care hospital. METHODS: We retrospectively analyzed the data from ICU patients requiring mechanical ventilation (MV) for a period of > 48 h to identify the prevalence and associated factors for vitamin D deficiency. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D [25(OH)D] level < 20 ng/mL. RESULTS: Among 570 patients admitted to the ICU, 221 were enrolled in the study, 194 in the vitamin D deficient group and 27 in the non-deficient group. Prevalence of vitamin D deficiency in critically ill patients was 87.8%. The patient age was lower in the vitamin D deficient group compared with the non-deficient group (64.4 ± 15.4 vs. 71.0 ± 9.6 years, p = 0.049). A higher acute physiology and chronic health evaluation II (APACHE II) score (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.10-1.37) and chronic illness (OR 3.12, 95% CI 1.08-9.01) were associated with vitamin D deficiency after adjusting for age and body mass index. Clinical outcomes of duration of MV, ICU stay, and 28- and 90-day mortality rates were not significantly different between the vitamin D deficient and nondeficient groups. CONCLUSIONS: Vitamin D deficiency was common in critically ill patients, particularly among younger patients. Higher APACHE II score and chronic illness were associated with vitamin D deficiency.
APACHE ; Body Mass Index ; Calcitriol ; Chronic Disease ; Critical Care ; Critical Illness* ; Humans ; Intensive Care Units ; Mortality ; Prevalence* ; Respiration, Artificial ; Retrospective Studies ; Tertiary Healthcare ; Vitamin D Deficiency* ; Vitamin D* ; Vitamins*

This study examined the expression of the bcl-2 protein in 59 cases of transitional cell carcinomas (TCCs) of the bladder and evaluated the relationship of bcl-2 and p53 with apoptosis. The cases were divided into 41 low-grade TCCs, 18 high-grade TCCs, 32 superficial TCCs, and 27 invasive TCCs. p53 and bcl-2 protein were detected by the immunohistochemical method and apoptosis was analysed by using hematoxylin-eosin stained slide. The results were as follows: bcl-2 protein was detected in 8 (14%) TCCs and all of these cases were low grade TCCs. Expression of bcl-2 protein was not correlated with clinical stage. There was no correlation between bcl-2 and p53 protein. According to the immunohistochemical results of bcl-2 and p53 protein, the cases were divided 4 groups. Apoptotic index (AI) was higher in p53 positive/ bcl-2 negative group than other groups but the significance was recognized only between p53 positive/bcl-2 negative group and p53 negative/bcl-2 negative group (p<0.05). p53 protein was detected in 20 (36%) TCCs and its expression was correlated positively with histologic grade and clinical stage (p<0.05). AI correlated positively with histologic grade and clinical stage (p<0.01). These data indicate that overexpression of bcl-2 protein is rare in TCC of the bladder and associated with low grade TCCs. Overexpression of p53 is associated with the tumor progression in the TCCs. AI correlates with p53 positivity but does not correlate with bcl-2 positivity.
Apoptosis* ; Carcinoma, Transitional Cell* ; Urinary Bladder*

This study was conducted to investigate food and meal preference of workers (435 male and 212 female) in the Chonnam Yeosu industrial area. The results of the survey were analyzed by principal components analysis. The results were obtained as follows: 19.3% of the subjects were twenties, 28.3% were thirties, 28.8% were forties and 23.7% were fifties. Females liked rice rolled in dried laver, rice cakes, janchi-noodle and breads, on the other hand males liked thick beef soup, loach soup, an eel stew and soju. The young liked instant noodles, fried chicken, sweet and sour pork, pork cutlet, pizza, hamburger, ham, sausage and fruit beverage, on the other hand the old liked a fish pot stew, loach soup, eel stew, fish boiled in soy with spices, panfried fish, sea slug, ascidian, bunder, green laver and boiled burdock-lotus root in soy. Females who are young liked hamburger and sweet and sour pork whereas males who are young liked instant noodles, pork cutlet, ham, sausage and fruit beverage. Aged females liked fish boiled in soy with spices, panfried fish, bunder, green laver, boiled burdock-lotus root in soy whereas aged males liked a fish pot stew, loach soup, eel stew, sea mussel and oysters. Boiled rice was located within the middle irrespective of age and sex, but noodles, wheat flour meal, fast foods and fruits were situated at the young female side. Aged males liked soup and pot stew. Young males liked meats and eggs whereas fish and shellfish and kimch were located at the aged people side. Aged females liked sea weeds and most people disliked vegetables but females liked some vegetables irrespective of age. Processed foods, salted foods, and alcohol were generally disliked foods by subjects but males liked those foods. Soybean curd was liked more males than females, and teas, except coffee, was liked by males.
Aged ; Beverages ; Bivalvia ; Bread ; Chickens ; Coffee ; Eels ; Eggs ; Fast Foods ; Female ; Flour ; Fruit ; Gastropoda ; Hand ; Humans ; Male ; Meals ; Meat ; Ostreidae ; Ovum ; Shellfish ; Soybeans ; Spices ; Tea ; Triticum ; Urochordata ; Vegetables

Pathological study was performed on the 135 cases (137 lesion) of early gastric cancer (EGC) diagnosed during the period from 1970 to 1988. The gastrectomy specimens were obtained from Pusan National University Hospital and Pusan Paik Hospital. The statistical analysis was applied on the point of pathological and epidemiological aspects. The results obtained were summarized as follows: 1) The proportion of patients with EGC of all gastric cancer diagnosed in Pusan area during the period of 1970 to 1974 was 1.3%, those during 1975 to 1979 was 1.7%, those during 1980 to 1984 was 7.8%, and those during 1985 to 1988 was 20.0% respectively. 2) The model age group was 6th decade in both sexes. The average age of patients with EGC was 50. 1-year-old in men and 47. 9-year-old in women respectively. The sex ratio (M/F) was 2 : 1 but it was lower for young people than for old people. 3) The proportion of sites involved by the EGC in the stomach was as follows : the antrum 61%, the body 39%, and the cardia and fundus 0.01%. The intestinal type cancer more frequently involved the lower portion than the upper portion of the stomach. 4) Regarding the distribution of the gross types of EGC, the elevated group (Type I, IIa) accounted for 14%, the flat type (Type IIb) accounted for 4%, and the depressed group (Type IIc, III) accounted for 82%. There was no correlation between the gross type and the depth of the lesion. The elevated group was more frequent in intestinal type than in diffuse type. 5) The size distribution of the EGC was as follows : 46% of the lesions were smaller than 2.0 cm in diameter, 47% were between 2.1 to 5.0 cm, and 7% were larger than 5.1 cm. There was no correlation between the size of the lesion and the gross type. 6) The intestinal type of EGC was 77 lesions (56.2%) and the diffuse type 60 lesions (43.8%). The ratio of both types (I/D) was 1.3 : 1, and it was lower for younger people than for old people. 7) Ten of 135 cases (7%) had lymph node metastases. The metastatic rate of EGC confined to submucosa was much higher than that of EGC confined to mucosa only, but the metastatic rate was not related with the size of the lesion.
Female ; Male ; Humans ; Neoplasm Metastasis ; Stomach Neoplasms