To provide the information necessary for the insurance medicine management plan, price discount rates among the insurance medicines were studied. A total of 2,107 items of insurance medicine of which prices were discounted via government inspections of real transactional process of insurance medicine were analysed. The conclusions are as follows; 1. Among the variables relevant to the characteristics of manufacturers, price discount rates of insurance medicines were statistically significant with production rankings of manufacturers, incorporation year, existence of investments by foreign corporation, existence of a research institute, and enrollment in the exchange. And among the variables relevant to the properties of medicines, the number of enrolled items which have the same components, classification, the date of new enrollment, the sales of items, and the number of raw materials in the items were statistically significant. 2. Stepwide multiple regression was done to identify the factors which affect the price discount rates of insurance medicines. The number of enrolled items which have the same components, production rankings of manufactures, classification number (medicines for function of tissue cells), incorporation year (1940-1949), existence of investments by foreign corporations, classification number (anti-germ medicines), number of raw materials in the items, the sales of items, and medicines whose major objective is not treatment were significant variables and the R2-value for these variables was 21.2%. Considering all of the above results, for management of insurance medicines, it seems important that the real transactional prices of insurance medicines should be identified systematically, focusing on the properties which affect the price discount rates of insurance medicines.
Academies and Institutes ; Classification ; Commerce ; Insurance* ; Investments

No abstract available.
Hearing*

The alcoholic neuropathies developed in approximately 34% of chronic alcoholics and the sexual dysfunction had been experienced in 8-54% of male alcoholics(Schiavi 1990). The aims of this study were to identify the prevalence of subclinical polyneuropathies and sexual disorders in alcohol dependence, and to evaluate the association between them. The nerve conduction velocity(NCY), electromyography(EMG), and pudendal somatosensory evoked potentials(SEPs were tested for the male alcoholics(N=34) and controls(N=17 for NCV & EMG, N=25 for pudendal SEPs). The pudendal SEPs were measured by the following procedures, in which we simulated the dorsal nerve of penis attached by the ring electrode(stimulus intensity, three times of threshold ; stimulus rate, 1-4.7Hz: stimulus duration, 0.1 or 0.2msec), and recorded at the scalp(active electrode, 2cm behind Cz ; reference electrode, Fz. The NCV and EMG detected signs of peripheral neuropathies in 79.4% of alcoholics. Among the alcoholics, 64.7% were abnormal on the pudendal SEPs. Among the alcoholics who revealed abnormality on EMG and NCV, 81.4% were abnormal on the pudendal SEPs, in which 51.9% were not responded. The P1 latencies between peripheral neuropathies and sexual disorders in the alcoholic. The prevalence of subclinical neuropathies and sexual disorders seemed to be much higher in alcohol dependence that expectation, and these two problems were relatively correlated, and our results suggested that the peripheral polyneuropathies were one of the prerequisites of sexual disorders.
Alcoholic Neuropathy ; Alcoholics ; Alcoholism* ; Electrodes ; Humans ; Male ; Neural Conduction ; Peripheral Nervous System Diseases* ; Polyneuropathies ; Prevalence ; Pudendal Nerve

The brain metastasis of prostatic carcinoma is rare and is distinguished by its poor prognosis in cases which are not surgically resectable. Herein we described a 72 year old male with brain metastasis from prostatic carcinoma, which regressed with chemotherapy. Pathological examination of a transrectal needle biopsy disclosed moderatedly differentiated adenocarcinoma of the prostate. Magnetic resonance imaging of brain demonstrated a brain tumor at the occipital lobe suspected to be a metastasis of prostatic carcinoma. The tumor could not be detected on the brain MRI after 3 months of chemotherapy.
Adenocarcinoma* ; Aged ; Biopsy, Needle ; Brain Neoplasms ; Brain* ; Drug Therapy* ; Humans ; Magnetic Resonance Imaging ; Male ; Neoplasm Metastasis* ; Occipital Lobe ; Prognosis ; Prostate

OBJECTIVE: Stenotrophomonas maltophilia has been emerging as an important nosocomial pathogen in recent years in patients with impaired host- defense mechanism or who has been exposed to large amount of inocula. This organism is usually resistant to multiple (commonly used) antimicrobial agents, particularly to those of the beta-lactam class. To evaluate the clinical feature of Stenotrophomonas maltophilia infection and in vitro anti- microbial susceptibility, we performed a retrospective study. METHODS: We analyzed the result of in vitro antimicrobial susceptibility test for 200 isolates of S. maltophilia and the annual isolation rate during the period between January 1990 and December 1994 in our institution, and performed a retrospective study for the available records of 165 cases among them. The data were obtained with only the first isolation of the organism for each patients. RESULTS: Total of 165 initial isolates, the isolates were from wounds in 50(30.3%), urine in 47(28.5%), the respiratory tract in 37(22.4%), blood in 9(5.5%), bile in 6(3.6%), and miscellaneous sources in 16(9.7%). The 84.2% of isolates were hospital-acquired isolate and 58.3% of these patients had received antecedent antibiotic therapy: polymicrobial growth was demonstrated in 61.9% of the cases. In vitro antimicrobial susceptibiiity test, ofloxacin was active against the isolates in 89.2%, moxalactam in 85.9%, ciprofloxacin in 83.9%, TMP-SMX(trimethoprim-sulfamethoxazole) in 64.2%, As expected, S. maltophilia isolates were, in general, not susceptible to cephalosporins, penicillins. The annual isolation rate at Kyung Hee University hospital was not increased significantly from 1990 to 1994, 19.53 per 10,000 patients dismissals in 1990, 13.56 in 1994. The major underlying diseases of patients were malignancy(17.6%), cerebrovascular disorder(17%), diabetic mellitus(13.3%). Mortality rate is 10.3%. CONCLUSION: S. maltophilia has been emerging as an important nosocomial pathogen in immunocompromised patients, especially those receiving broad-spectrum antimicrobial therapy. And this organism is resistant to multiple antimicrobial agents, particularly to those of the beta-lactam class. When antimicrobial treatment is necessary, the clinician should be guided by results of in vitro susceptibility testing because of the notable in vitro resistance of S. maltophilia to commonly used antibiotics. And when S. maltophilia has been recovered from a patient, wound and contact isolation is warranted.
Anti-Bacterial Agents ; Anti-Infective Agents ; Bile ; Cephalosporins ; Ciprofloxacin ; Humans ; Immunocompromised Host ; Mortality ; Moxalactam ; Ofloxacin ; Penicillins ; Respiratory System ; Retrospective Studies ; Stenotrophomonas maltophilia ; Stenotrophomonas* ; Wounds and Injuries

Gallbladder torsion, also known as volvulus, is a rare condition that can be fatal unless surgery is performed expediently.AWe report a case of gallbladder torsion. A 92-year-old woman presented with acute abdominal pain. Laboratory parameters were all within normal limits, with the exception of leukocytosis. Plain abdominal radiography showed no remarkable findings. Abdominal CT revealed an abnormal gallbladder with wall thickening, suggesting the presence of acute cholecystitis. At operation, the gallbladder was twisted, and the wall of was thickened with acute inflammation. We report the details of this case along with a review of the literature.
Abdominal Pain ; Cholecystitis, Acute ; Female ; Gallbladder ; Humans ; Inflammation ; Intestinal Volvulus ; Leukocytosis ; Radiography, Abdominal

Ganglioneuromas have their origin in neural crest and are found along the path of the sympathetic chain from the base of the skull to the pelvis, including the adrenal medulla. Clinically, ganglioneuromas may be incidentally found or detected secondarily by pressure effects on adjacent structures. Endocrine activity is rare among ganglioneuromas. Symptoms and signs such as hypertension, profuse perspiration, cutaneous flushing, rash, pallor, polyuria, and diarrhea are well documented. Recently we experienced a case of ganglioneuroma arising from the retroperitoneal sympathetic chains in a 46 year-old-female and, herein, report with review of the literatures.
Adrenal Medulla ; Diarrhea ; Exanthema ; Flushing ; Ganglioneuroma* ; Hypertension ; Neural Crest ; Pallor ; Pelvis ; Polyuria ; Skull

BACKGROUND: Transthoracic fine needle aspiration and biopsy(TNAB) has become a frequently used technique in the investigation of the intrathoracic lesions because of its safety, reliability, and accuracy. METHOD: Data on 125 patients who underwent TNAB from 1990 through 1994 were studied to determine the diagnostic sensitivity, accuracy and complications of this procedure as related to lesion type and location. RESULTS: 1. The over-all diagnostic sensitivity of TNAB was 61.6%(77 of 125 patients). 2. The diagnostic yields were as high as 89.9% for malignant lesions, but a specific diagnosis of benign lesions were obtained only in 30% of benign lung lesions. 3. The correlation between results of TNAB cytology and of final histology was as high as 88.2%. 4. Lung lesions that were greater than 3cm in size had a higher proportion of correct diagnosis(73.3%) as compared with lesions 3cm or less in size(38.1%). But there was no significant difference between the central and peripheral lung lesions. 5. There were no serious complications to TNAB. In 12.8% of the procedures a pneumothorax developed, indicating a chest tube in 1.6% of the procedures. In 2 cases, minimal hemoptysis developed which did not require treatment. CONCLUSION: In our experience, TNAB represents a minor and safe procedure, which permits a direct approach to localized malignant lung lesions with a high degree of accuracy.
Biopsy* ; Biopsy, Fine-Needle ; Chest Tubes ; Diagnosis ; Hemoptysis ; Humans ; Lung* ; Pneumothorax

OBJECTIVES: Although bronchoscopy is an important diagnostic tool for lung disease, patients compliance is low due to discomfort. Recently, midazolam which has a favorable anterograde amnesia effect and short action duration, has been used to relieve patients discomfort during bronchoscopy. Midazolam was investigated in order to see the beneficial effect and safety during bronchoscopy. METHODS: The study design was single blind, randomized, prospective. 102 patients were included, in whom bronchoscopy was performed between June, 19% and October, 1995 at Samsung Medical Center. They were categorized into midazolam group and control group. Patients were asked about the amnesic effect, discomfort of procedure and the willingness to repeat procedure. The consciousness level of patients during procedure, patient cooperation during procedure and ease of procedure were also reported by bronchoscopists. RESULTS: 1) The difference of oxygen saturation between two groups: There was no significant difference in oxygen saturation between midazolam group and control group before and after bronchoscopy. During procedure, however, mean oxygen saturations in midazolam group (90+/-6.4%) was significantly lower than in control group (93+/-4.7%)(p<0.05). 2) Evaluations by patients (1) Effect of amnesia: 41 patients (82%) in midazolam group could not recall the procedure but 52 patients (100%) recalled the entire procedure in control group. A favorable amnesic effects could be found in midazolam group(p<0.05). {2) The discomfort during the procedure: 43 patents(86%) did not experience discomfort from procedure in midazolam group but 25 patients(48%) complained of discomfort in control group (p<0.05). (3) Most patients except two(96%) were willing to repeat fiberoptic bronchoscopy in midazolam group but 13 patients (25%) answered that they would never repeat bronchoscapy. There was a statistically significant difference between two groups in the willingness to repeat bronchocopy (p<0.05). 3) The evaluations by bronchoscopists Cooperations of the patients and ease of procedure were not different between two groups. The patients in midazolam group except eight could not respond to verbal stimuli but most patients were awakened during procedure in control group(p<0.05). CONCLUSION: Midazolam is a good sedative agent for a patient to give a favorable amnesia, reduction of discomfort during bronchoscopy. We concluded that midazolam is a safe and useful sedative agent and midazolam may be used routinely during bronchoscopy. Monitoring of oxygen saturation, however, is essential to prevent severe hypoxia during procedure.
Amnesia ; Amnesia, Anterograde ; Anoxia ; Bronchoscopy* ; Compliance ; Consciousness ; Humans ; Lung Diseases ; Midazolam* ; Oxygen ; Patient Compliance ; Prospective Studies*

Optic neuritis (ON) is an acute or subacute inflammatory or demyelination process affecting the optic nerve. ON can be classified ophthalmologically as retrobulbar neuritis, papillitis, neuroretinitis. Retrobulbar neuritis, in which the optic disc appearance is normal, is the most common type of ON in adults. Multiple sclerosis is the most common cause of ON, but in many cases no apparent etiology is found. Paranasal sinusitis as a cause of ON is rare. Management of retrobulbar neuritis which is combined with paranasal sinusitis is controversial. Recently, we experienced a case of retrobulbar neuritis which was combined with paranasal sinusitis without orbital complication. It was treated by endoscopic sinus surgery and endoscopic optic nerve decompression in addition to intravenous antibiotics and corticosteroids. Visual acuity was improved nearly to a normal state after the treatment. The most possible pathophysiologic mechanism of retrobulbar neuritis may be the direct spread of infection of the sphenoid sinus to the optic nerve.
Adrenal Cortex Hormones ; Adult ; Anti-Bacterial Agents ; Decompression* ; Demyelinating Diseases ; Humans ; Multiple Sclerosis ; Optic Nerve* ; Optic Neuritis* ; Orbit ; Papilledema ; Retinitis ; Sinusitis* ; Sphenoid Sinus ; Visual Acuity