BACKGROUND: The implementation of health care delivery system(HCDS) in 1989 affected the visit pattern of tertiary care hospital. In this study we analyzed the effect of implementation of HCDS in a university hospital. METHODS: We analyzed the yearbook of a university hospital from 1986 to 1992. The clinical departments were divided into three groups of medical departments, surgical departments with application of HCDS and clinical departments without application of HCDS. RESULTS: The total outpatient visits increased after implementation of HCDS. The new outpatient visits decreased after implementation in the medical departments and surgical departments but re-visit patients increased in all clinical departments. The number of emergent patients increased at year 1889, but decreased in 1990, then little changed. Admission rate via emergency room decreased in surgical departments and clinical departments without application of HCDS. The patient from Pusan in which hospital is located was little changed but patients that from other areas increased. So the proportion of patients from Pusan decreased, and from other regions increased. The visit of patients with self pay decreased, but patients with medical insurance increased. CONCLUSIONS: In spite of increased total outpatient visits, the new outpatient visits and patient visits from near place decreased through implementation of HCDS. The new outpatient visits decreased in the medical departments and surgical departments in clinical departments with application of HCDS, but the new outpatient visits increased in clinical departments without application of HCDS.
Busan ; Delivery of Health Care* ; Emergency Service, Hospital ; Humans ; Insurance ; Outpatients ; Tertiary Healthcare

No abstract available.
Family Practice* ; Humans ; Internship and Residency*

PURPOSE: To evaluate the incidence of disc extrusion and neurologic deficit, the relation between disc extrusion and neurologic deficit and the treatment results according to our basic treatment principles in lower cervical facet joint fracture and dislocations MATERIALS AND METHODS: Twelve patients were evaluated, 8 male and 4 female with an average age of 41 years comprised the group. Six injuries were attributable to automobile accidents, 5 to fall from building, bed, floor and hill, and one to stand on her head. One case was distractive-flexion stage (DFS) 1, 9 cases with DFS 2 and 2 cases with DFS 3. Plain X-ray, CT, Myelo CT and MRI were used as a diagnostic tools. As a treatment criteria, feasibility of closed reduction, status of neuroglogic injury, and stability of injured spine were considered. Anterior cervical discectomy and fusion in accompanied disc extrusion, posterior reduction and fusion with triple wiring in unreduced dislocation, and anterior decompression and fusion in incomplete cord and root injury were selected as a basic treatment principles. RESULTS: Ten out of 12 cases (83%) showed neurologic deficits, 2 complete cord injury, 1 incomplete cord injury, and 7 radiculopathy. Nine out of 12 (75%) demonstrated disc extrusion and all disc extruded patients had neurologic deficits. Anterior cervical discectomy and fusion (ACDF) were performed in 5 cases, ACDF and posterior reduction with triple wiring (PRTW) in 4 cases, PRTW in 1 case, and skull traction and philadelphia brace in 2 cases. Seven radiculpathy patients were completely recovered and one incomplete cord injury patient can ambulate with spastic gait after surgery. There were 2 bed sore and 1 pneumonia in complications. CONCLUSION: Soft disc extrusion should be evaluated carefully with MRI and CT in lower cervical spine injury with the facet joint fracture-dislocations before the decision of treatment. As disc extrusion always accompanies neurologic deficit, it must be surgically treated by anterior cervical discectomy and fusion.
Automobiles ; Braces ; Decompression ; Diskectomy ; Dislocations* ; Female ; Gait Disorders, Neurologic ; Head ; Humans ; Incidence ; Magnetic Resonance Imaging ; Male ; Neurologic Manifestations ; Pneumonia ; Pressure Ulcer ; Radiculopathy ; Skull ; Spine ; Traction ; Zygapophyseal Joint*

No abstract available.
Heart* ; Thoracic Surgery*

BACKGROUND: Urinary tract infections (UTIs) are the most frequent nosocomial infections and are frequently associated with indwelling urinary catheters. It is known that adherence to standard infection control measures for urinary catheters can reduce UTIs in hospitals. This study was performed to evaluate the effect of education in reducing catheter-related UTIs (CR-UTIs) in intensive care units (ICUs) of a university hospital. METHODS: CR-UTIs were prospectively monitored for all patients with indwelling urinary catheters in ICUs from July 2006 through December 2007. Recommendations based on previously known guidelines for catheter insertion, catheter management, and specimen collection to prevent CR-UTIs were formulated and educated in March 2007. Knowledge and adherence level were evaluated before and after educating healthcare workers about the recommendations using questionnaire. Changes in knowledge and adherence level before and after education were compared by Chi-square test. Changes in the rate of CR-UTIs and urinary catheter utilization ratios were also analyzed by Fisher's exact test. RESULTS: After education, knowledge level of and adherence level to most of the recommendations were improved significantly. The rate of CR-UTIs significantly decreased by 48% from 7.43/1,000 catheter-days before intervention to 3.87/1,000 catheter-days after intervention (P=0.02). CONCLUSION: Surveillance for nosocomial infections and education for standard infection control measures are very important in preventing CR-UTIs in ICUs.
Catheters ; Cross Infection ; Delivery of Health Care ; Humans ; Infection Control ; Critical Care ; Intensive Care Units ; Prospective Studies ; Specimen Handling ; Urinary Catheterization ; Urinary Catheters ; Urinary Tract ; Urinary Tract Infections ; Surveys and Questionnaires

Venous thrombosis is uncommon in young individuals. Hypereosinophilia is a rare cause of thrombosis that usually involves the heart and small vessels like retinal vessels. We report a case of massive deep vein thrombosis that developed in a young patient with hypereosinophilia who was successfully treated with continuous local infusion of urokinase.
Eosinophilia* ; Heart ; Humans ; Retinal Vessels ; Thrombosis ; Urokinase-Type Plasminogen Activator* ; Venous Thrombosis*

PURPOSE: The circular stapled hemorrhoidopexy (SH) reduces mucosal prolapse and interrupts the end branches of the upper hemorrhoidal artery through a suitable instrument, Procedure for Prolapse and Hemorrhoids (PPH). However, there are some technical difficulties in routine use of the circular anal dilator (CAD). The goal of this study was to evaluate the efficacy and the safety of a CSH without use of a CAD. METHODS: Between April 2005 and November 2006, 250 patients with Grade III and IV prolapsed hemorrhoids who had undergone CSH with PPH without using a CAD were retrospectively analyzed. The sex and age, the operation time, the type of anesthesia, the number of excised hemorrhoid piles, the degree of hemorrhoids and postoperative pain (consumed analgesics), the hospital stay, the postoperative complications, and the number of follow-up examinations at the outpatient clinic were analyzed. RESULTS: The operation time was 17.76 minutes (10~35 minutes). Most patients (89%) experienced spinal anesthesia. The degrees of hemorrhoids were Grade III (45%) and Grade IV (55%). The numbers of excised piles were 3 (44%), 4 (43%), and more than 5 (13%). The number of consumed postoperative analgesics was 0.97 times (mean). The mean hospital stay was 2.83 days. The postoperative complications were pain, bleeding, and urinary retention. CONCLUSIONS: A CSH without use of a CAD was an effective and safe surgical modality compared with other procedures for treating hemorrhoids. This procedure is feasible and convenient. The procedure is a new alternative in the treatment of severe hemorrhoids.
Ambulatory Care Facilities ; Analgesics ; Anesthesia ; Anesthesia, Spinal ; Arteries ; Follow-Up Studies ; Hemorrhage ; Hemorrhoids ; Humans ; Length of Stay ; Pain, Postoperative ; Postoperative Complications ; Prolapse ; Retrospective Studies ; Urinary Retention

We report a case of ciliated hepatic foregut cyst which was incidentally found in a 64 year-old man. The cyst, 6 cm in diameter, was unilocular, solitary and was located in the medial segment of left lobe, just below the Glisson's capsule. Microscopically, the cyst wall consisted of 4 layers; pseudostratified ciliated columnar epithelium, subepithelial loose connective tissue, smooth muscle bundles and an outermost fibrous capsule. Although cartilage or subepithelial sero-mucous glands were absent, the morphologic features of the cyst correspond with those of an incomplete form of brochogenic cyst.
Cysts

Single photon emission computed tomographic(SPECT) imaging, performed at oral and maxillofacial surgery department, is valuable in assessing temporomandibular dysfunction, looking for metastases in patients with malignancies, diagnosing facial asymmetry. Conventional planar scintigraphy is limited by two-dimensional representation of three-dimensional structures. The SPECT exam, by sectioning through a distribution of tracer, eliminates the obscuring effects of tracer located outside the plane of interest. In our department, we used this image for four type cases retrospectively. 1. Those patients who have facial asymmetry 2. To find metastases in patients with malignacies 3. In combination with magnetic resonance imagine, to confirm the diagnosis of internal joint derangement 4. To evaluate the viability of grafted bone. Recently, this image is able to be used in those patients whose symptoms etiology cannot be explained by other diagnostic techniques.
Diagnosis ; Facial Asymmetry ; Humans ; Joints ; Neoplasm Metastasis ; Radionuclide Imaging ; Retrospective Studies ; Surgery, Oral ; Tomography, Emission-Computed, Single-Photon* ; Transplants

Author reviewed the patients with temperature over 38.5 degress C for longer than two weeks and of undetermined etiology who were admitted and treated in Yonsei Medical Center during the period from Jan. 1974 to Aug. 1978. There have been 120 cases of prolonged fever in that period. The following results were obtained; 1. The children who were admitted with prolonged fever occupied 1.3% of total in-patients at the same period. 2. 16 cases were less than 1 year of age at admission and 64 were 1 to 6 years. So 2/3 of total cases were less than 6 years of age. The ratio of Male to Female was 1.6:1. 3. There Was no apparent difference in seasonal incidence. But from May to September slightly increased number was noted. 4. In 58 cases(48.3%), the fever persisted 2 to 3 weeks before admission and 27 cases lasted longer than a month. . Three patterns of fever were observed; intermittent type 75 cases(62.5%), daily spiking 32(26.7%) and constant 13(10.8%) 5. The final diagnoses as a cause of fever were as follows. Infections accounted for 81 cases(67.5%), malignancy 17(14.2%), collagen diseases 7(5.8%) and miscellaneous cause 1(0.8%). 14 cases(11.7%) remained undiagnosed at the cenclusion of their hospitalization. . Certain relationships between diagnosis and age were noted. Infection was the most common etiology in all age groups but 72.5% of these children were less than 6 years old. 71.4% of collagen diseases were older than 6 years. Malignancy had no age predilection. 6. Over 80% of all cases the diagnosis were made within a week and the fever disappeared in a week in 70% So most of them(75%) discharged within 2 weeks after admission. 7. Careful history suggested the final diagnosis in 84 cases(70%) and repeated physical examinations were helpful in 70 cases(58.3%) Abnormal findings in routine chest P-A were present in 47.5% Erythrocyte sedimentation rate was significantly increased in 26/34 cases(76.5%). 47 cases(39.2%) were anemic for age and all children with malignancy were anemic. Lumbar puncture, bone marrow aspiration, tissue biopsy and explo. Laparotomy were performed only in suspected cases. 8. Outcome on discharge were as follows; 90 cases(75.0%) were much improved, 21(17.5%) discharged without improvement and 9 cases(7.5%) expired.
Biopsy ; Blood Sedimentation ; Bone Marrow ; Child* ; Collagen Diseases ; Diagnosis ; Female ; Fever* ; Hospitalization ; Humans ; Incidence ; Laparotomy ; Male ; Physical Examination ; Seasons ; Spinal Puncture ; Thorax