Finances of health insurance can be explained by factors determining benefit expense and premium collection. This study was conducted to analyze factors contributing to the financial status of rural health insurance. Nationwide 134 health insurance associations except the six pilot project counties were analyzed and obtained the followings. 1. In univariate analysis, statistically significant variables that explain 1) outpatient benefit expenditures include public health center utilization, proportion of pregnant women, premium and collection rate of premium 2) inpatient benefit expenditures include public health center utilization, proportion of old age, proportion of pregnant women, premium and collection rate of premium 3) profits include public health center utilization, proportion of old age, proportion of pregnant women and collection rate of premium. 2. In multiple regression analysis, statistically significant determinants in 1) outpatient benefit include premium and public health utilization 2) inpatient benefit include premium 3) profit include public health center utilization, premium and collection rate of premium.
Female ; Health Expenditures ; Humans ; Inpatients ; Insurance ; Insurance, Health* ; Outpatients ; Pilot Projects ; Pregnant Women ; Public Health ; Regression Analysis ; Rural Health

No abstract available.
Cellulitis* ; Staphylococcus aureus* ; Staphylococcus*

Placement of an endoprosthesis for palliative decompression of biliary obstruction has been advocated as an effective alternative for interanl-external drainage catheters, of which the care and psychological impact of the external segment protruded through the skin has been a difficult problem. (continue...)
Catheters ; Decompression ; Drainage* ; Skin

Metastatic cancer of the esophagus is unusual, Toreson discovered 19 in 599 autopsies on carcinoma patients, an incidence of 3.2%, Most of the patients had primary tumors of the lung, stomach, larynx or breast. Contiguous spread of tumor into the esophagus may produce an ulcerative lesioin resembling primary cancer of the esophagus, as examplified by the direct extension of tumor from the gastric cardia. These tumors may produce esophageal symptoms, notable dysphagia, and present no particular problem to the endoscopist because the ulcerative tumor in the lumen of the eaophagus makes diagnosis easy. Unusuually these tumor will extend into the esophagus submucosally producing submucosal nodules or cicatricial stricture of the esophagus without ulceration inito the lumen. This increases the diagnostic problems because of the difficulty of obtaining a endoscopic biopsy. We experienced a case of multiple nodular metastatic esophageal carcinoma, which was submucosally extended from the stomach cancer, confirmed by endoscopic biopsy. So we report this case with brief review of the previous litera- tures.
Autopsy ; Biopsy ; Breast ; Cardia ; Constriction, Pathologic ; Deglutition Disorders ; Diagnosis ; Esophageal Neoplasms ; Esophagus ; Humans ; Incidence ; Larynx ; Lung ; Stomach Neoplasms* ; Stomach* ; Ulcer

Acute food impaction of the esophagus is not an unusual problem on an emergency ward. It has been termed the Steakhouse syndrome or the Backyard barbecue syndrome, indicating that meet is the obstrueting bolus in the majority of cases. Most esophageal stenoaes are located distally, and this ie also the area where most food impations occur. The obstruction quickly becomes apparent to the patient when further swallowing of food or liquid is impossible. Various obstructive lesions or motility disorders of the esophagus have been implicated as etiological factors in acute food impaction. Common,disorders include reflux esophagitis with stricture, hiatal hernia, abnormal rings and postoperative strictures at anastomotic sites. Malignant stenoses have been very rarely described. Recently we experienced of 4 patients who suffered from acute dysphagia after they had ingestion of food such as beef, pork, chicken, and dog meat, repectively. All of them were diagnased as steakhouse syndrome due to acute food impaction of the esophageal after examinations of esophagogram and endoscopy. They had hiatal hernia, esophageal cancer, reflux esophagitis with stricture, and abnormal ring as underlying diseases, repectively. All of them were treated with endoseopic removal of foreign body by a Dormia basket.
Animals ; Chickens ; Constriction, Pathologic ; Deglutition ; Deglutition Disorders ; Dogs ; Eating ; Emergency Service, Hospital ; Endoscopy ; Esophageal Neoplasms ; Esophagitis, Peptic ; Esophagus* ; Foreign Bodies ; Hernia, Hiatal ; Humans ; Meat

The Schatzki ring, a submucosal fibrotic thickening of the lower esophagus, occurs at the squamocolumnar junction and is invariably associated with an esophageal histal hernia The ring is discrete narrowing covered with squamous epithelium on its superior aspect and columnar epithelium on its inferior aspect, with various degrees of submucosal fibrosis supporting the annulair ring. Symptoms, when present, are generally those of distal esophageal obstruction to the passage of solids and highly associated with ring diameter. The pathogenesis and etlology are obscure. But one theory suggests that they are caused by gastroesophageal reflux. The vast maiority of symptomatic Schatzki rings sre ameneble to dilation, a few patients will require surgical antireflux measures after dilatation. We have experienced a case of Schatzki ring associated with reflux esophagitis and esophageal hiatal hernia by the esophagogram after barium swallowing and endoscopy. So we report this case with brief review of the previous literatures.
Barium ; Carcinosarcoma ; Deglutition ; Dilatation ; Endoscopy ; Epithelium ; Esophageal Neoplasms ; Esophagitis, Peptic* ; Esophagus* ; Fibrosis ; Gastroesophageal Reflux ; Hernia ; Hernia, Hiatal* ; Humans

Malignant esophago-bronchial fistula is an incurable and distressing condition. The passage of swallowed saliva and solid or liquid food into the bronchial tree causes coqghing and frequent pulmonary infection and collapse. Most patients are unfit for major surgery, but intubation offers a quick, simple and effective treatment with improved length and quality of life. However, intubation with simple esophageal tubes are liable to result in failure to occlude the fistela, migration of the tube, erosion, and in the case of latex tubes, disintegration. To overcome these problems, the fistula is intubated perorally with a prosthesis surrounded by a foam rubber cuff contained ia silicone sheath, in which vacuum can be created. This cuffed prosthesis is the most satisfactory design for the treatment of malignant esophago-bronchial fistula with effiective and gentle occlusion of the fistula without risk of pressure necrosis. We experienced a case of the endoscopic treatment with a cuffed prosthesis for malignant esophago-bronchial fistula. So we report this case with brief review of the previous literatures.
Bronchial Fistula* ; Esophageal Neoplasms ; Fistula ; Humans ; Intubation ; Latex ; Necrosis ; Prostheses and Implants* ; Quality of Life ; Rubber ; Saliva ; Silicones ; Vacuum

To determine how closely end- tidal PCO2 measured by capnometer(Datex, Finland), a kind of infrared gas analyzer, reflects arterial PCO2(measured by Corning 175: U.S.A.) during general anesthegia, peak- tidal PCO2 and arterial were measured simultaneously. Thirty patients ranging between the age of 18 and 49, having no apparent abnomalities and having physical status class I by American Society of Anesthesiologist's classification-were seleted for the study. The anesthesia was induced with 2.5% pentothal sodium 4~5 mg/kg, succinylcholine 1mg/kg and incubated. The anesthesia was maintained with each 2 L/min gas flow of nitrous oxide, oxygenand 1 halothne. The patients were ventilated br anesthetic ventilator with tidal volume 8~10 ml/kg and ramie of 15 Per minute. The measurement of CO2 gas tension was performed 20 minutes after the induction when the patient's anesthetic conditions were stabilized. The CO2 gas ganlples were taken from mouth piece inserted between endotracheal adapter and circle breathing circuit, The arterial blood tramples were taken from the radial artery. There was a significant correlation between the end-tidol PCO2 and the arterial PCO2 in this series. The mean arterial PCO2 was 37.57+/-4.59 mmHg and the mean end tidal PCO2 was 23.73+/-5.78 mmHg. The mean difference between the arterial and the end tidal PCO2 was 6.53+/-2.23 mmHg. The correlation index between the two measurement was 0.8. In conclusion, the measurement of the end-tidal PCO2 by Datex Capnometer reflected the blood PCO2 and is convenient method of clinical use for its non invasiveness and continuous measurement of ventilatory status of patients under general anesthesia.
Anesthesia ; Anesthesia, General* ; Boehmeria ; Carbon Dioxide* ; Carbon* ; Humans ; Mouth ; Nitrous Oxide ; Radial Artery ; Respiration ; Sodium ; Succinylcholine ; Thiopental ; Tidal Volume ; Ventilators, Mechanical ; Zea mays

Emphysematous cystitis is a rare condition characterized by gas collection in the wall and lumen of the bladder. We experienced three cases of emphysematous cystiris. All patients were female; one was associated with a long term history of diabetes mellitus and another with urinary indwelling catheter. All of the cases were easily diagnosed on plain radiograph and CT scan, and were successfully treated with antibiotic therapy. In one of the cases, however, associated abscess due to perivesical extension of inflammation was treated by combined external drainage.
Abscess ; Catheters, Indwelling ; Cystitis* ; Diabetes Mellitus ; Drainage ; Female ; Humans ; Inflammation ; Tomography, X-Ray Computed ; Urinary Bladder

The diagnosis of hilar cholangiocarcinoma (CCA) is usually accomplished through a combination of imaging modalities and endoscopic examination including tissue sampling. Although high quality cross-sectional imagings provide evidences for hilar obstruction and a malignancy arising from the bile duct, a definitive diagnosis and staging often obtained through the use of endoscopic procedures. It can provide complementary information for accurate tumor extension and tissue acquisition for histologic confirmation. These informations are important in determining therapeutic options. However, despite the various available techniques, the diagnosis and accurate staging of hilar CCA is often still challenging. Newly developed adjunctive diagnostic endoscopic techniques including intraductal ultrasound and cholangioscopy improve the accuracy of endoscopic diagnosis of this lesion. Multiple endoscopic modalities can be tried to obtain accurate assessment of the tumor. Therefore, endoscopy will continue to occupy an important position in assessment of the hilar CCA.
Bile Ducts ; Cholangiocarcinoma ; Endoscopy