The purpose of this study is to estimate cesarean section rate in Korea and analyze the socioeconomic variables and health resources which affect regional variation in the rate. Samples were drawn from the record of vaginal and cesarean section deliveries based upon insurance claim bills which have been submitted to the National Federation of Medical Insurance for the first three months, January through March, 1991. The results are obtained as follows: It was found that, cesarean section rate was increasing rapidly up to 23.1% in 1991. Cesarean section per 10 thousand insured people was 4.8 and the number of cesarean section per 10 thousand insured eligible(15-49 years old) female was 7.6. The fee for normal delivery was 109,489 won and that for cesarean section was 390,024 won. The average days of hospitalization in normal delivery was 2.3 days, and those in cesarean section was 7.6 days. On the average cesarean section has a longer of stay as much as by 4.3 days and cost 3.6 times more than normal deliveries. Cesarean section rates vary among medical facilities: 19.8% at clinics 37.6% in small-scale hospitals, and 29.1% in general hospitals. The regional variation of cesarean section rates was also fairly prominent. The South Cheju Gun has the highest rate of cesarean section, 56.2%. Meanwhile no cesarean section cases has been reported in Sunchang Gun during the period of this study. The variation is noted among provinces. The rate for Cheju province has been 3.4 times higher than that for Chunnam. The number of cesarean section per 10 thousand insured people vary greatly among regions, too. This study has found that there exists significant regional variations among various geographic units in terms of average length of stay, average cost, number of obsretricians and number of beds. Multiple regression analysis was done to identify factors explaining the regional variance of various cesarean section rates: In the urban areas, no significant explaining variables were noted except the number of beds for the dependent variable of cesarean section cases per 10 thousand insured eligible females. The smaller the number of bed, the more cases of cesarean section was noted for an urban area. The is mostly because the rate of cesarean section is higher in medium-size hospitals than in large general hospitals. In the rural areas, the factor of education has been found significant for all three dependent variables. The higher the educational level, the rate of cesarean section is most likely to rise. An income variable measured by the amount of monthly insurance contribution has been identified a powerful predictor in explaining the variance of cesarean section rates. The same has been noted for the number of obstetricians. Similar findings are observed for the country as a whole. The income level has been found as the most powerful explaining factor in the regional variance of cesarean section rates. In general the rate is higher in the urban areas, and lower in the area with more small hospitals. As this is the initial attempt to identify the factors relevant to the regional difference in the rates of cesarean section, more elaborated study is urgently required.
Cesarean Section* ; Education ; Fees and Charges ; Female ; Health Resources ; Hospitalization ; Hospitals, General ; Humans ; Insurance ; Jeju-do ; Korea* ; Length of Stay ; Pregnancy

Hypematremia is a rare but important medical condition and is associated with mortality rate of 40 to 70%. However, little has been known about its prognostic factors or treatment guidlines. To evaluate the prognostic factors and the outcome following treatment, we reviewed 22 available medical records among twenty five hypernatremic patients (0.2%) in 12841 admissions at medical ward from January to December 1995. We defined hypernatremia as serum sodium concentration more than or equal to 150 mEq/L. Of these patients, two had hypematrernia at admission and the remaining patients became hypernatremic during admission. Mean peak serum sodium concentration was 158 (150-178) mEq/L and mean total body water deficit was 11.4 (6.7-21.3)%. Factors correlated with the development of hypernatremia were diverse and multiple, and the most frequent factor was diminished access to water. Mortality rate was 59%, but mortality was not correlated with age, correction rate of hyper-natremia, primary route of fluid loss, and the severity of hypernatremia or total body water deficit. Mortality rate was higher in patients whose serum sodium concentrations were below 130 mEq/L at admission (P<0.05). In our study, development of hypernatremia from initial hyponatremic state was significantly associated with poor outcome, and age, rapidity of correction, route of fluid loss, and the severity of hypernatremia or total body water deficit were not.
Body Water ; Humans ; Hypernatremia* ; Medical Records ; Mortality ; Sodium ; Water

STUDY DESIGN: This is a retrospective radiologic study OBJECTIVES: The aim of this study is to analyze the signals and configurations of the MRI findings of osteoporotic vertebral fractures and the clinical consequences of each type of the MRI findings. SUMMARY OF THE LITERATURE REVIEW: There have been some reports that have focused on the MR findings for the differentiation of osteoporotic and metastatic fractures, but there are few reports on the characteristics of the early stage of osteoporotic vertebral fractures. MATERIALS AND METHODS: From July 2002 to April 2008, the MRI findings and medical records of 97 patients who were diagnosed with acute or subacute osteoporotic vertebral fractures and who were followed-up for more than 1 year were analyzed. The patients with minor trauma within 3 months before obtaining MRIs and they had decreased bone density were included in this study. Those with fractures due to severe trauma or pathologic causes or normal bone density were excluded. Three spine surgeons evaluated, at three times per each surgeon, the T1-weighted, T2-weighted and fat suppression T1-enhanced sagittal images for the signal of the vertebral body bone marrow and the type of the intravertebral body lesion shape. The relationships between the type of MRI findings and the time from the trauma and the follow up clinical consequences were analyzed. RESULTS: The MRI patterns of 97 patients with 111 fractures of the vertebrae were divided into three types. There were 56 cases of Type I (50.5%), which was defined as diffuse typical signal intensity in the vertebral body, 39 cases (35.1%) of Type II, which was defined as geographic low signal in the center of the vertebral body with typical signal changes, and 16 cases (14.4%). of type III, which was defined as atypical signal intensity or a shape of lesion that did not correspond to type 1 nor type 2. The average time from trauma was 10.8+/-19.0days (0~90) for type I, 19.1+/-24.9days (0~90) for type III and 37.5+/-31.1days (0~90) for type III, which showed differences among each types (p<0.001). CONCLUSIONS: The analysis of the relationship between the time from trauma and the signal intensity and the type of lesion on MRI examination revealed that the low signal intensity in the typical vertebral body signal or an atypical signal or shape were poor prognostic factors of osteoporotic vertebral fracture
Bone Density ; Bone Marrow ; Follow-Up Studies ; Humans ; Medical Records ; Osteoporosis ; Retrospective Studies ; Spine

Colorectal cancer is extremely rare in children. Unlike adult colorectal cancer, the overall prognosis of colorectal cancer in children is poor. Delayed diagnosis, advanced stages of the disease at presentation, and mucinous type of histology are the major determinants of poor outcome in childhood. A 13-year-old boy with abdominal pain visited our hospital. Physical examination andabdominal ultrasonography identified acute appendicitis with perforation. He underwent appendectomy and then the pathologic findings revealed mucinous adenocarcinoma. The cancer was located at the transverse colon and had metastases on peritoneal wall at 2nd laparotomy. Extended right hemicolectomy was performed. He underwent palliative chemotherapy. After 4 months later, hepatic metastasis and aggravated peritoneal seedings developed. He died of renal failure and pneumonia 13 months after operation. We need to have a high index of suspicion for the possibility of a malignant colorectal tumor in any childhood case with nonspecific signs and symptoms.
Abdominal Pain ; Adenocarcinoma, Mucinous ; Adolescent ; Adult ; Appendectomy ; Appendicitis ; Child ; Colon ; Colon, Transverse ; Colonic Neoplasms ; Colorectal Neoplasms ; Delayed Diagnosis ; Humans ; Laparotomy ; Mucins ; Neoplasm Metastasis ; Physical Examination ; Pneumonia ; Prognosis ; Renal Insufficiency ; Seeds

BACKGROUND: Propofol, 2,6-diisopropyl phenol, is a short-acting, potent intravenous anesthetics agent. In both general anesthetic care and the anesthetic care of patients undergoing cardiovascular surgery, the unique characteristics of propofol might make it a logical part of the anesthetic plan for patients such as pulmonary hypertension. But there are limited experimental and clinical data on the effects of propofol on pulmonary vascular resistance, and they are somewhat contradictory. the purpose of this study was to investigated.the effect and mechanism of vasodilation induced by propofol using isolated rat pulmonary artery rings. METHODS: Cumulative dose-response curves for propofol(10(-6)~10(-3)M) were obtained from tension measurements of rings that contracted with phenylephrine(10(-6)M) and KCI(40 mM) in the presence and absence of endothelium, and in the pretreatment of L-NAME(3x10(-4)M) and substance P(3x10(-4)M). Thereafter the effect of propofol(10(-4)M) on vascular smooth muscle contration in response to Ca++ mobilization in vscular rings were investigated. RESULTS: Propofol(10(-6)~10(-3)M) produced dose-dependent relaxation and had no signficant effect from endothelium. Pretreatment of L-NAME and substance P failed to have influence on cumulative dose-respose curves. Therefore vasodilator effect of propofol was not endothelium-dependent. And 10(-4)M propofol attenuated a contraction in response to CaCl2 in vascular rings depolarized by KCI, and vasoconstraction in response to calcium entry in the presence of phenylephine was attenuated by 10(-4)M propofol. Ryanodine preteament had not influence on contractile response. CONCLUSIONS: These results suggest that vasodilation produced by propofol is not endothelium-dependent but is probably due to nonspecific intracellular Ca++ influx blockade through voltage-operated calcium channels and receptor-operated channels.
Anesthetics ; Anesthetics, Intravenous ; Animals ; Calcium ; Calcium Channels ; Endothelium ; Humans ; Hypertension, Pulmonary ; Logic ; Muscle, Smooth, Vascular ; NG-Nitroarginine Methyl Ester ; Phenol ; Propofol* ; Pulmonary Artery* ; Rats* ; Relaxation ; Ryanodine ; Substance P ; Vascular Resistance ; Vasodilation

BACKGROUND: The hemoglobin A1c (HbA1c) level is widely used to monitor glycemic control in diabetes mellitus patients, and various methods are used for its determination. The CAPILLARYS 2 FLEX Piercing (Sebia) is a fully automated, high-throughput glycohemoglobin (HbA1c) analyzer based on capillary electrophoresis. METHODS: The analytical performance of the CAPILLARYS 2 FLEX Piercing analyzer was evaluated for its precision, linearity, correlation with the Variant II Turbo (Bio-Rad Laboratories, Inc.) analyzer, and its vulnerability to interference by carbamylated hemoglobin. We also investigated its agreement with National Glycohemoglobin Standardization Program (NGSP) targets. All evaluations were performed according to CLSI guidelines EP05, EP06, and EP09. RESULTS: The coefficients of variation (CVs) for within-run and total imprecision were 1.7% and 1.8% at low concentrations and 1.2% and 1.3% at high concentrations, respectively. Linearity was excellent, with R2=0.9882 in the range of 5.13-13.83%; these results highly correlated with those produced by Variant II Turbo (R2=0.9978). The 95% confidence interval (for differences from the NGSP target) was -0.3618-0.3343%. No significant interference of carbamylated hemoglobin was noted. CONCLUSIONS: The CAPILLARYS 2 FLEX Piercing analyzer showed excellent precision and linearity. Its results correlated with those obtained by the Variant II Turbo analyzer, and were agreement with the NGSP target. Therefore, its analytical performance is satisfactory for diabetes diagnosis and treatment monitoring.
Capillaries ; Diabetes Mellitus ; Electrophoresis, Capillary ; Hemoglobins ; Humans ; Organothiophosphorus Compounds

This study was undertaken to investigate the change of ear swelling response (ESR) of the mice according to repetitive ultraviolet radiation. 100mJ/crn of UVB was irradiated daily for 4 weeks, and a total of 25 C57BL mice were used as subjects. The results were as follows : 1. After 1 day, 2 days and 3 days irradiation of UVB, ESR reached 21.3+/-1.5, 22.3+/-1.1 and 24.3+/-1.6 respectively with increasing tendency, but there was no statistical significance (Wilcoxon rank sum test p>0.05). 2. ESR reached at maximum, 78.0+/-1.8, after 1 week(p<0.01), thereafter ESR decreased gradually with reparative process. 3. Inspite of continued irradiation, ESR decreased gradually after 2 weeks. After 2 weeks, 3 weeks and 4 weeks irradiation, ESR decreased to 51.6+/-11.8, 45.1+/- 3.3 and 42.8+/-6.8 respectively, but, there were still increment of ESR (p<0.01).
Animals ; Ear* ; Mice ; Mice, Inbred C57BL* ; Skin*

Intercellular Adhesion Molecule-1(ICAM-1) plays an important role in a variety of inflammatory and immune-mediated mechanisms, including lymphocyte recruitment and targeting, antigen presentation and recognition, and lymphocyte cytotoxicity.In order to study the changes of soluble ICAM-1 and relationship to the immune mechanism of Graves' disease, we performed the measurement of a soluble form of ICAM-1 in sera from patients with Graves' disease before and after treatment with antithyroid drugs using a highly sensitive ELISA method.Our results were as followed.1) The serum levels of soluble ICAM-1 in patients with Graves' disease before treatment were significantly elevated than normal controls(p<0.001).2) The serum levels of soluble ICAM-1 in patients with Graves' disease after treatment significantly decreased after treatment(p<0.001) but not as low as normal controls. 3) The serum levels of soluble ICAM-1 molecule in patients with ophthalmopathy were not elevated compared to patients with no ophthalmopathy(p>0.2).4) The serum levels of soluble ICAM-1 showed no significant correlation with serum titers of anti-thyroperoxidase antibody and anti-thyroglobulin antibody, serum T_3, T_4, TSH and goiter size in patients with Graves' disease.In conclusion, the soluble ICAM-1 levels reflect the activity of autoimmune reaction and might be used as a index of efficacy of antithyroid drug treatment of Graves' disease.
Antigen Presentation ; Antithyroid Agents ; Enzyme-Linked Immunosorbent Assay ; Goiter ; Graves Disease ; Humans ; Intercellular Adhesion Molecule-1 ; Lymphocytes

Objectives: To investigate clinical factors affecting constipation in patients with schizophrenia taking clozapine. Methods: The participants were patients with schizophrenia taking clozapine and tested for the Therapeutic Drug Monitoring from September 1, 2020 to July 1, 2022 at a university hospital. To evaluate the effect of clozapine on constipation, clozapine dosage, clozapine concentration, and norclozapine concentration were investigated. To evaluate effects of drugs other than clozapine on constipation, dosage and type of other drug were investigated. Anticholinergic Drug Scale was used to evaluate anticholinergic action. Results: A total of 56 patients were enrolled in the study. Clozapine daily dose, clozapine concentration, and norclozapine concentration were higher in the constipated patient group. Through logistic regression analysis, it was discovered that the risk of constipation increased as the norclozapine concentration increased, and the results remained similarly even after adjustments of related variables was performed. Conclusion It was discoverd that among patients taking clozapine, the higher the norclozapine concentration, the higher the probability of constipation. Among patients taking clozapine, patients with high norclozapine concentration may need additional evaluation and management of constipation.

Purpose: Radiation-induced oral mucositis limits delivery of high-dose radiation to targeted cancers. Therefore, it is necessary to develop a treatment strategy to alleviate radiation-induced oral mucositis during radiation therapy. We previously reported that inhibiting reactive oxygen species (ROS) generation suppresses autophagy. Irradiation induces autophagy, suggesting that antioxidant treatment may be used to inhibit radiation-induced oral mucositis. Materials and Methods: We determined whether treatment with N-acetyl cysteine (NAC) could attenuate radiation-induced buccal mucosa damage in vitro and in vivo. The protective effects of NAC against oral mucositis were confirmed by transmission electron microscopy and immunocytochemistry. mRNA and protein levels of DNA damage and autophagy-related genes were measured by quantitative real-time polymerase chain reaction and western blot analysis, respectively. Results: Rats manifesting radiation-induced oral mucositis showed decreased oral intake, loss of body weight, and low survival rate. NAC intake slightly increased oral intake, body weight, and the survival rate without statistical significance. However, histopathologic characteristics were markedly restored in NAC-treated irradiated rats. LC3B staining of rat buccal mucosa revealed that NAC treatment significantly decreased the number of radiation-induced autophagic cells. Further, NAC inhibited radiation-induced ROS generation and autophagy signaling. In vitro, NAC treatment significantly reduced the expression of NRF2, LC3B, p62, and Beclin-1 in keratinocytes compared with that after radiation treatment. Conclusion NAC treatment significantly inhibited radiation-induced autophagy in keratinocytes and rat buccal mucosa and may be a potentially safe and effective option for the prevention of radiation-induced buccal mucosa damage.