No abstract available.
Drug Therapy* ; Germ Cells* ; Neoplasms, Germ Cell and Embryonal*

BACKGROUND: This study intends to clear that the current cost reimbursement system of Korean medical insurance of health care. METHODS: By using insured medical record of Federation of Korean Medical Insurance Societies used in the demand tendency research of the type of services from feburary 1st to 28th of the year 1990, authors analyze the characterist,ic of components of charges per case in the type of health care facilities. RESULTS: The charge per case in the out-patient care of primary health care facility is 13,498 won, which is 54.6% by comparison with the secondary health care facility and 30.7 % by comparison wit,h the tertiary health care facility. Among these charges the amount of the cost for medical examinations and oral drugs are 73.9% in the primary health care facility and 71.8% in the secondary and 67.5% in the tertiary. Consequently, the services in the primary care are chiefly composed with the medical examinations and oral drugs. In addition to this point the author also finds that the charge per case is 3.5 times, the cost for oral drugs is 5.6 times larger than those of primary care, and therefore tertiary health care facility conduct various diagnostic examinations and prescript more expensive. CONCLUSIONS: There is a difference of basic medical cost ratio between primary, secondary and tertiary health care facility. These points can be lead to the presumption that the diseases under the structure of current medical insurance are overlapped irrespective of the charact.erisitcs of the type of health care facilites, and this is profitable to the tertiary health care facilities which can conduct various types of services. In conclusion, the frame a policy is needed to encourage primary care which are nothing but simple structure of charges.
Delivery of Health Care ; Humans ; Insurance* ; Medical Records ; Outpatients ; Primary Health Care

OBJECTIVE AND METHODS: To determine correlations among ambulatory renin activity, ambulatory blood pressure and microalbumin excretion rate, 66 Korean essential hypertensives were studied after 4 week wash-out period. The ambulatory blood pressure was monitored every 30 minutes and mean BP were calculated automatically. Urinary microalbumin excretion rate(UAER) and ambulatory plasma renin activity(aPRA) collected at mid-day were measured by radioimmunoassays. Subjectives were divided into 2 groups by aPRA value(2ng/ml/hr). RESULT: 14 cases were high renin group and 52 cases low renin group. The mean BP were 148.83/94.69mmHg in low renin group, and 146.57/98.07mmHg in high-renin group without difference. UAER were not different also between both groups. 23.07%(4/14) of non-dippers were included in high renin group and 25.58%(12/52) in low renin group without statistical difference. The aPRA was significantly related to UAER and systolic and diastolic mean blood pressure. Also UAER was related significantly to day mean blood pressures. CONCLUSION: Thus aPRA is thought to be a meaningful indicator to predict hypertensive renal target organ damage as well as blood pressure measured with 24-hr ABPM.
Blood Pressure* ; Hypertension* ; Plasma* ; Radioimmunoassay ; Renin*

The authors carried out various treatment modalities in 74 consecutive patients with hypertensive basal ganglionic-thalamic intracerebral hemorrhage and were admitted to the Department of Neurosurgery. Konkuk University Hospital, from Jan. 1991 to Dec. 1993. A variety of prognostic factors that influence mortality were observed. The locaton of hematoma was at the basal ganglia in 47 cases and at the thalamus in 27 cases. The prognosis gets poorer as the hematoma extended wider and deeper. The prognosis was unfavorable when the hematoma was over 30cc(P<0.001). The mortality rate was higher in cases with IVH than in cases without IVH(P<0.005). In cases with IVH, 19 cases(26%) showed dilated 4th ventricular hemorrage and higher mortality rate(P<0.001). Cases in which the GCS were less than 9 on admission showed higher mortality rate(P<0.0001). The mortality rate was also higher if the midline shift was more than 10mm on the initial brain CT scan(P<0.005). THe group where the unilateral or bilateral pupillary light reflex was unreactive(35cases) showed poorer prognosis than the group where the bilateral pupillary light reflex was reactive(P<0.0001). The ventriculocranial ratio(VCR), hydrocephalus, surrounding edema edema around the heamtoam, and treatment modality were not related to the prognosis. The significant prognostic factors in patients with hypertensive basal ganglionic-thalamic intracerebral hemorrhage were location and type of hematoma, whether or not the volume of hematoma is more than 30cc, IVH, dilated 4th ventricular hemorrhage, Graeb's score of more than 7, GCS of less than 9, midline shift of more than 10mm, and reactivity of pupillary light reflex.
Basal Ganglia ; Brain ; Cerebral Hemorrhage* ; Edema ; Ganglion Cysts* ; Hematoma ; Hemorrhage ; Humans ; Hydrocephalus ; Mortality ; Neurosurgery ; Prognosis ; Reflex ; Thalamus

PURPOSE: We applied lateral lithotomy position to the severe ureteral stricture cases supposed to fail with only retrograde approach. MATERIAL AND METHODS: From October 1997 to April 1999, 13 patients with severe ureteral stricture (lenghth>2cm or complete obstruction) supposed to fail with only retrograde approach and one patient with study. The causes of ureteral strictures were pelvic malignancy in 5, tuberculosis in 4, trauma in 2 and others in 2. The patient's ipsilateral shoulder was rotated and fixed like lateral position. And ipsilateral pelvis was elevated with sandbag or pad and rotated about 45 degrees, too. The retrograde approach was tried at first, if fail, antegrade approach was combined. RESULTS: We could insert ureteral stent via retrograde approach only in 3 patients and we needed aid of antegrade approach for passage through ureteral stricture in the other 11 patients (79%). Percutaneous antegrade approaches were combined in those 11 patients and we could pass the guide wire and indwell the stent in 10 of 11 patients (91%) using this position. CONCLUSIONS: The lateral lithotomy position was very helpful to the simultaneous retrograde and antegrade approach in severe fibrotic or malignant ureteral strictures.
Constriction, Pathologic ; Humans ; Pelvis ; Shoulder ; Stents ; Tuberculosis ; Ureter*

Hypereosinophilic syndrome represents a heterogenous group filisorders with the common features of idiopathic prolonged eosinophilia of undetectable cause and orgar, system dysfunction. We experienced a case af hypereosinophilic syndrome in a 58 year old man who has been suffered from fever, chilling, generelized exfoliative dermatitis, periorbital sngioedema and oral ulcer for 3 weeks duration. The blood eosinophil count was 7436/mm and skin, liver, bone marrow biopsy revealed marked infiltration of eosinophils. We treated him with co ticosteroid, but 5 months later, he died due to hepatoencephalopathy, hepatorenal syndrome, dissernimted intravascular coagulopathy and acute respiratory distress syndrome.
Biopsy ; Bone Marrow ; Dermatitis, Exfoliative ; Eosinophilia ; Eosinophils ; Fever ; Hepatorenal Syndrome ; Humans ; Hypereosinophilic Syndrome* ; Liver ; Middle Aged ; Oral Ulcer ; Respiratory Distress Syndrome, Adult ; Skin

The reservoir hosts of Thelazia callipaeda were examined. The eyes of the 76 dogs raised at farm, 78 military dogs (shepherds), 96 cattle, and 105 pigs were investigated for the presence of eyeworm. Among them, six worms of T. callipaeda were collected from two dogs raised at farm (2.7%), and 188 worms from 26 shepherds (33.5%). No worms were recovered from the cattle or pigs. These results suggest that the dogs, especially the military dogs are serving as a reservoir host of T. callipaeda. in Korea.
Animals ; Cattle ; Disease Reservoirs/*veterinary ; Dog Diseases/epidemiology/*parasitology ; Dogs ; Eye/parasitology ; Female ; *Host-Parasite Interactions ; Korea/epidemiology ; Male ; Prevalence ; Spirurida Infections/epidemiology/parasitology/*veterinary ; Swine ; Thelazioidea/*isolation & purification

BACKGROUND: Superoxide dismutase(SOD) is an essential enzyme of protective defense mechanism in cellular compartments against the potential cytotoxicity of superoxide anion. It seems SOD activity is increased in psoriasis because of an increase in oxygen intermediates due to hyperoxia. However SOD activity is decreased paradoxically. OBJECTIVE: In order to understand the pathophysiology of psoriasis and to elucidate the significance of SOD activity in keratinocyte proliferation, we measured the SOD activities in psoriatic and in normal skin. METHODS: Authors assayed the level of SOD activities in 16 psoriatic and 16 and skin specimens, which were obtained from face/neck(1 and 4 specimens), forearm(5 and 4 specimens), trunk(6 and 3 specimens), and lower extremity( 4 and 5 specimens). We also investigated changes of SOD activity by age and regional differences of SOD activities in the psoriatic and normal skins. RESULT: First, activities of total SOD, Mn-SOD and Cu, Zn-SOD were 12.75+/-8.15, 4.28+/-3.62, 8.48+/-6.37 units/mg protein respectively in the psoriatic skin. Activities of total SOD, Mn-SOD and Cu, Zn-SoD were 17.63+/-9.10, 3.38+/-14.25+/-8.16 units/mg protein respectively in the normal skin. There as a significant difference between psoriatic and normal skins in Cu, Zn-SOD and Cu, Zn-SOD activities showed no significant differences between the age groups. Third, in sun exposed area and unexposed area, there were no significant differences between the psoriatic and normal skins in SOD activities. But it the normal skin, there were significant differences between sun exposed area and unexposed area in total SOD and Cu, Zn-SOD activities. CONCLUSION: There is a significant difference between psoriatic and normal skins in Cu, Zn-SOD activity. Namely, the Cu, Zn-SOD activity is significantly decreased in psoriasis.
Humans ; Hyperoxia ; Keratinocytes ; Oxygen ; Psoriasis ; Skin* ; Solar System ; Superoxide Dismutase* ; Superoxides*

PURPOSE: The purpose of this study is to evaluate the diagnostic availability of the morphology of mitochondria to identify the nature or the origin of neoplasms. MATRIALS AND METHODS: We analysed two cases of ovarian malignancy- a case of malignant steroid cell tumor, unclassified and a case of metastatic carcinosarcoma from the adrenal cortex- which were difficult to identify the origin and the nature of the tumor for special staining, immunohistochemical and ultrastructural methods. RESULTS: To evaluate the nature or the origin of neoplasms, we performed immuno histochemistry for various antigens and special stains, however the specific diagnostic clues were not provided by these modalities. The ultrastructural characteristics of mitochondria of neoplastic cells showing tubular or tubulo-vesicular inner mitochondrial membranes provided diagnostic clues as a marker for steroidogenic potential. The morphology of mitochondria is related to the enzyme activity and steroid-biosynthetic capacity of cells. Especially, the inner mitochondrial membrane structure is believed to be related to the steroid biosynthetic activity. In hypofunctional state of corticosteroid productian, a reduced number of inner mitochondrial membranes showing tubular patterns is noted. In cantrast, the stimulation of steroidogenesis result in a progressive increase of mitochondrial membrane showing densely packed rounded vesicular patterns via tubulo-vesicular patterns according to the activity of steroidogenesis. CONCLUSION: The tubular, the vesicular and the tubulo-vesicular mitochondria will be valuable to identify the uncertainty of nature and origin of tumor as a stemidogenic.
Carcinosarcoma ; Coloring Agents ; Diagnosis* ; Mitochondria ; Mitochondrial Membranes ; Uncertainty

Juxtaductal coarctation is usually distal to the origin of the left subclavian artery, occasionally the orifice of the subclavian artery is involved in the coarctation and partially obstructed. An anomalous origin of the right subclavian artery from the descending aorta below the coarcted segment is also occasionally encountered. Reversed vertebral artery flow to a subclavian artery arising at or below a coarctation may produce the subclavian steal syndrome. Rarely both subclavian arteries arise beyond the coarctation. These abnormal subclavian arteries are important in clinical diagnosis and treatment. We report a case of Turner syndrome with coarctation, which present as juxtaductal type and the left subclavian artery from the descending aorta below the coarcted segment with reversed vertebral artery flow to a subclavian artery producing the subclavian steal syndrome. Resecton of coarctation segment and end-to-end anastomosis was successfully performed after transfer of left subclavian artery to distal segment of descending aorta.
Aorta, Thoracic* ; Aortic Coarctation ; Diagnosis ; Subclavian Artery* ; Subclavian Steal Syndrome* ; Turner Syndrome* ; Vertebral Artery