The increase of health care expenditures is an important problem in the almost countries. Also, suppression of the health care expenditures is an important problem in the health field of Korea since the national health insurance for total people in 1989. Thus, it is very important to grasp the change of the health care expenditures of family and proportions of the health care expenditures to total expenditures of family, because they are the basis of national health care expenditures in Korea. While the health care expenditures of urban family were increased during 1980-1993 by 12.8% annually, the total expenditures of urban family were increased by 14.8% annually. consequently, the proportions of health care expenditures to total expenditures were decreased from 5.98% to 4.76%. The proportions of health care expenditure for 3 years to come were predicted to 4.75% in 1994, 4.67% in 1995, and 4.63% in 1996 by the time-series ana]ysis. That is, it was predicted that they would be decreasing slowly. The product elasticity of health care expenditure was less than 1 in the multiple regression analysis, so the health care is normal good rather than superior good. Therefore, it seems that the household economy is able to bear the expense pursuing the improvement of quality of health care by actualizing the medical insurance fee.
Delivery of Health Care* ; Elasticity ; Family Characteristics ; Fees and Charges ; Hand Strength ; Health Expenditures* ; Humans ; Insurance ; Korea ; National Health Programs ; Quality of Health Care

BACKGROUND: It is known that 20% of childhood epilepsy is refractory to anticonvulsants therapy, Recently, a few new anticonvulsants has been introduced. One of these, gabapentin is known to effective in such refractory cases. This study has been done to estimate the effectiveness of gabapentin in refractory childhood as well as adult epilepsies. SUBJECTS AND METHODS: 43 patients(male 25, female 18) has been selected among refractory epilepsies during the period of March, 1981 to Feb, 1996 diagnosed and treated at pediatric neurologic clinic School of Medicine, Yonsei University Those were already treated with various anticonvulsants and gabapentin was added to previous medication, and effectiveness of seizure frequency and the degree has been investigated over more than 3 month period as well as the side effect. RESULTS: 30 patients out of 43, showed seizure free or decreased frequency of seizure, those patients whose the seizure frequency was decreased over 50% was 11 cases, partial seizure 10 cases, generalized seizure 1 cases. 15 case out of 43 showed no changes or increased frequencies of seizure in 4 out of 27 in partial epilepsies, 1 out of 16 in generalized seizure, and 6 cases out of 43 manifested side effects such as behaviour change, abdominal pain and headache. CONCLUSION: Gabapentin was effective by add on therapy in refractory epilepsies and reducing the frequency of seizure over 50% was 25.6%. Most of these patients was partial seizure. We concluded that gabapentin as add on therapy is effective at least in 1/4 cases of refractory partial seizures.
Abdominal Pain ; Adult ; Anticonvulsants ; Epilepsies, Partial ; Epilepsy ; Female ; Headache ; Humans ; Seizures*

Most studies on the pathophysiology, natural history, diagnosis by imaging and outcomes after operative or nonoperative treatment of rotator cuff tear have focused on those of full-thickness tears, resulting in limited knowledge of partial-thickness rotator cuff tears. However, a partial-thickness tear of the rotator cuff is a common disorder and can be the cause of persistent pain and dysfunction of the shoulder joint in the affected patients. Recent updates in the literatures shows that the partial-thickness tears are not merely mild form of full-thickness tears. Over the last decades, an improved knowledge of pathophysiology and surgical techniques of partial-thickness tears has led to more understanding of the significance of this tear and better outcomes. In this review, we discuss the current concept of management for partial-thickness tears in terms of the pathogenesis, natural history, nonoperative treatment, and surgical outcomes associated with the commonly used repair techniques.
Diagnosis ; Humans ; Natural History ; Rotator Cuff* ; Shoulder Joint

In recent years there has been an increase in the number of outpatient surgical procedures performed using local anesthesia with intravenous sedation. However, many patients are reluctant to undergo surgery because of their concerns about pain and pain-awareness during the operation. We performed a study to evaluate the effectiveness and safety of midazolam during outpatient surgical procedures. Between March 1997 and December 1998, 50 patients were anesthetized with bolus intravenous injection of 0.1mg/kg of midazolam, followed by local anesthesia. The blood pressure, pulse and oximeter values were monitored. There was no significant change of arterial oxygen saturation. Midazolam induced antegrade amnesia in most cases. All patients except three (94%) said they would willingly choose this anesthetic technique again. Major complications were not noted. We concluded that midazolam is a good sedative agent in providing favorable antegrade amnesia, as well as reduced anxiety and fear of pain during surgical procedures. This suggests that midazolam may be used routinely in outpatient surgical procedures. Monitoring of oxygen saturation, however is essential in preventing severe hypoxia during procedures.
Amnesia ; Anesthesia, Local* ; Anoxia ; Anxiety ; Blood Pressure ; Humans ; Injections, Intravenous ; Methods ; Midazolam* ; Outpatients ; Oxygen

An analysis of echocardiograms was made in 50 patients with pericardial effusion of various origins, diagnosed by clinical and M-mode echocardiographic examinations. In these cases the estimated volume of pericardial effusion ranged between 40 ml and 999 ml. The width of echo-free space behind the left ventricular wall which reflect the amount of effusion showed a significant positive correlation with the systolic excursion and the diastolic mean velocity of both right and left ventricular epicardial surfaces. The echocardiographic patterns of so-called pseudo-mitral valve prolapse and a notch on the right ventricular epicardial surface during systole were found more frequently in patients with large pericardial effusion. Thus, in pericardial effusion, and echocardiographic examination is useful for the visualization of the abnormal motions of cardiac structures as well as for its diagnosis.
Diagnosis ; Echocardiography* ; Humans ; Pericardial Effusion* ; Prolapse ; Systole

The cardiac dimensions and functions were studied by analyzing simultaneously recorded M-mode echocardiograms and phonocardiograms in 24 cases of essential hypertension with no evidence of heart faliure, and also in 20 healthy adults for comparison. Thirteen hypertensives out of 24 had findings consistent with left ventricular hypertrophy on either routine chest roentgenograms or electrocardiograms or both(group II) and the remaining 11 had no such findings(group I). The posterior wall and septal thickness, and isovolumic relaxation time were significantly was increased even in the group I as well as in the group II. The isovolumic relaxation time was correlated well with the septal thickness in both groups. In contrast, a significant increase in left atrial and left ventricular systolic dimensions was noted only in the group II, and so was a significant reduction in the fractional shortening and mean velocity of circumferential fiber shortening. These findings suggest that the echocardiographic examination is useful in patients with essestial hypertension for the early dagnosis of the increased thickness of the posterior wall and the septum, and the abnormality during early diastolic relaxation of the left ventricle, prior to the appearance of the ventricular hypertrophy on the routine chest films amd/or electrocardiograms, and also that echocardiograms enable early detection of the systolic dysfunction of the hypertrophied left ventricle in the absence of apparent failure.
Adult ; Echocardiography* ; Electrocardiography ; Heart ; Heart Ventricles ; Humans ; Hypertension* ; Hypertrophy ; Hypertrophy, Left Ventricular ; Relaxation ; Thorax

BACKGROUND: Aprotinin, which is a nonspecific serine protease inhibitor, has an antiinflammatory and thrombogenic effect. However, it has an antithrombogenic effect during the cardiopulmonary bypass. This study was performed to evaluated the effects of aprotinin on the activated clotting time(ACT) and the total amount of the heparin used during the cardiopulmonary bypass. MATERIAL AND METHOD: From December 1998 to November 1999, 82 consecutive patients electively underwent open heart surgery at Gachon medical school. The patients were older than 18 years. Eighty two patients were classified into a control group(group C, n=36) and a aprotinin-treated group(group A, n=46). Body weight, height, body surface area(BSA), pump time(PT), aortic cross clamping time(ACCT), and body temperature(BT) were determined. Total amount of heparin and protamine during the CPB were also measured. ACT was determined before heparin administration, at 20, 40 and 60 minutes after heparin administration, and after protamine administration. RESULT: No significant differences were noted in either group in body weight, height, BSA, BT, and the total amoun of heparin and protamine. Group A demonstrated a significant(p<0.05) increase in age, PT, ACCT, and ACT at 20, 40, and 60 minutes after heparin administration. CONCLUSION: In summary, the use of aprotinin prime resulted in an increase in ACT. The total amount of heparin in aproinin-treated patient was similar to that of the control group in spite of having the prolonged pump time. Therefore aprotinin may reduce the requirement of heparin.
Aprotinin* ; Body Height ; Body Weight ; Cardiopulmonary Bypass ; Constriction ; Heart* ; Heparin* ; Humans ; Schools, Medical ; Serine Proteases ; Thoracic Surgery*

OBJECTIVE: To evaluate whether the rate of early mouse embryonal development could be enhanced by cumulus cell coculture in vitro. METHODS: Ham's F-10 culture media supplemented with 0.4% bovine serum albumin were used. Two-cell F1 mouse embryos were cultured in media with or without cumulus cells of female ICR mouse embryo for 96 hours, and the rates of embryonal development were observed and compared. RESULTS: The percentage of hatched blastocyst in the coculture group was significantly higher than that in the control group by 87.3% vs 64.8% respectively (p< 0.05). CONCLUSION: This study provides confirmative information that cumulus cell coculture will be useful in enhancing early mouse embryonal development.
Animals ; Blastocyst ; Coculture Techniques* ; Culture Media ; Cumulus Cells* ; Embryonic Structures ; Female ; Humans ; Mice* ; Mice, Inbred ICR ; Serum Albumin, Bovine

BACKGROUND: The safety of ergonovine provocation for coronary vasospasm (CVS) performed outside the catheterization laboratory has been questioned. We sought to address the issues of safety, feasibility and clinical impact of noninvasive diagnosis of CVS. METHOD AND RESULTS: We retrospectively analyzed the results of bedside ergonovine provocation testing with monitoring of left ventricular regional wall motion abnormalities (RWMAs) by 2-dimensional echocardiography (ergonovine echocardiography, Erg Echo). After confirmation of no significant fixed epicardial coronary artery disease, 1,504 Erg Echo were performed in 1,372 patients from July 1991 to December 1997. Erg Echo was prematurely terminated in 13 patients (0.9%) due to limiting side effects unrelated with myocardial ischemia. Among 1,491 completed tests, 32% (477) showed positive results with development of RWMAs in 467 tests (98%) or ST displacement in ECG in 10 tests (2%). During the test, transient arrhythmias developed in 1.7% (26/1491) including transient ventricular tachycardia (2) and atrioventricular block (4), which were promptly reversed with nitroglycerin. There were no procedure-related death or development of myocardial infarction. On the basis of angiographic criteria in 218 patients, who also underwent invasive spasm provocation test during coronary angiography, the sensitivity and specificity of Erg Echo for the diagnosis of CVS were 93% and 91% respectively. From 1990 to 1997, total 2,073 spasm provocation tests were performed either during invasive coronary angiography in the catheterization or in the echocardiography laboratory. Since 1994, noninvasive Erg Echo became a more popular diagnostic method and comprised more than 95% of all spasm provocation tests in recent 3 years. Erg Echo was also performed safely in outpatient clinic setting without hospital admission in 34% (500/1491). CONCLUSIONS: Erg Echo is highly feasible, accurate and safe for diagnosis of CVS and can replace the invasive spasm provocation test during coronary angiography in the catheterization laboratory.
Ambulatory Care Facilities ; Arrhythmias, Cardiac ; Atrioventricular Block ; Catheterization ; Catheters ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vasospasm* ; Diagnosis* ; Echocardiography ; Echocardiography, Stress* ; Electrocardiography ; Ergonovine* ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Nitroglycerin ; Retrospective Studies ; Sensitivity and Specificity ; Spasm ; Tachycardia, Ventricular

BACKGROUND: The safety of ergonovine provocation for coronary vasospasm (CVS) performed outside the catheterization laboratory has been questioned. We sought to address the issues of safety, feasibility and clinical impact of noninvasive diagnosis of CVS. METHOD AND RESULTS: We retrospectively analyzed the results of bedside ergonovine provocation testing with monitoring of left ventricular regional wall motion abnormalities (RWMAs) by 2-dimensional echocardiography (ergonovine echocardiography, Erg Echo). After confirmation of no significant fixed epicardial coronary artery disease, 1,504 Erg Echo were performed in 1,372 patients from July 1991 to December 1997. Erg Echo was prematurely terminated in 13 patients (0.9%) due to limiting side effects unrelated with myocardial ischemia. Among 1,491 completed tests, 32% (477) showed positive results with development of RWMAs in 467 tests (98%) or ST displacement in ECG in 10 tests (2%). During the test, transient arrhythmias developed in 1.7% (26/1491) including transient ventricular tachycardia (2) and atrioventricular block (4), which were promptly reversed with nitroglycerin. There were no procedure-related death or development of myocardial infarction. On the basis of angiographic criteria in 218 patients, who also underwent invasive spasm provocation test during coronary angiography, the sensitivity and specificity of Erg Echo for the diagnosis of CVS were 93% and 91% respectively. From 1990 to 1997, total 2,073 spasm provocation tests were performed either during invasive coronary angiography in the catheterization or in the echocardiography laboratory. Since 1994, noninvasive Erg Echo became a more popular diagnostic method and comprised more than 95% of all spasm provocation tests in recent 3 years. Erg Echo was also performed safely in outpatient clinic setting without hospital admission in 34% (500/1491). CONCLUSIONS: Erg Echo is highly feasible, accurate and safe for diagnosis of CVS and can replace the invasive spasm provocation test during coronary angiography in the catheterization laboratory.
Ambulatory Care Facilities ; Arrhythmias, Cardiac ; Atrioventricular Block ; Catheterization ; Catheters ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vasospasm* ; Diagnosis* ; Echocardiography ; Echocardiography, Stress* ; Electrocardiography ; Ergonovine* ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Nitroglycerin ; Retrospective Studies ; Sensitivity and Specificity ; Spasm ; Tachycardia, Ventricular