No abstract available.
Muscle, Skeletal* ; Tibial Nerve*

Background: The purpose of this study is to explain the factors influencing the incurrence of catastrophic health expenditure of national health insurance households using panel data observed over a long period. Methods: The study targeted 3,652 households who had no censoring during the 11-year survey period (2007–2017) and householders whose insurance type was consistently maintained as national health insurance. Generalized estimating equations were adopted to identify factors affecting the occurrence of catastrophic health expenditure at 20%, 30%, and 40% threshold levels. A subgroup analysis was conducted by categorizing groups depending on the existence of the elderly in the household. Results: For the last 11 years, the incidence of catastrophic health expenditure in the households without the elderly decreased slightly at all threshold levels, but the households with the elderly seemed to be increased. At baseline, household type showed a statistically significant relationship with all other variables. The results of generalized estimating equations analyses show that household income was not significant at all threshold levels in the households without elderly. On the other hand, in the households with the elderly, the 2nd (odds ratio [OR], 1.33–2.05) and 3rd quintile groups (OR, 1.25–2.55) were more likely to have catastrophic health expenditure compared to the 1st quintile of household income group. Conclusion As the amount of health expenditures relative to the ability to pay is increasing in households with the elderly, the application of an intervention followed by consistent monitoring is needed. This study found that there were differences in influencing factors according to the presence of the elderly in the households. In particular, in households with the elderly, interesting results have been drawn regarding the occurrence of catastrophic health expenditure in the near-poor, so additional research is required.

BACKGROUND: Following the implantation of heart valve prostheses, it is important to maintain therapeutic INR to reduce the risk of thromboembolism. The objective of this study was to suggest a practical dosing guideline for Korean outpatients with prosthetic heart valves managed by a pharmacist-run anticoagulation service (ACS). MATERIAL AND METHOD: A retrospective chart review was completed for all patients enrolled in the ACS at Seoul National University Hospital from March, 1997 to September, 2000. Patients who were at least 6 months post-valve replacement and had nontherapeutic INR value (less than 2.0 or greater than 3.0) were included. The data on 688 patients (1,782 visits) requiring dosing adjustment without any known drug or food interaction with warfarin were analyzed. The amount of adjusted dose and INR changes based on the INR at the time of the event were calculated. Aortic valve replacements (AVR) patients and mitral or double valve replacement (MVR/DVR) patients were evaluated separately. RESULT: Two methods for the warfarin dosage adjustment were suggested: Guideline I (mg-based total weekly dose (TWD) adjustment), Guideline II (percentage-based TWD adjustment). The effectiveness of Guideline I was superior to Guideline II overall in patients with both AVR and MVR/DVR. CONCLUSION: The guideline suggested in this study could be useful when the dosage adjustment of warfarin is necessary in outpatients with mechanical heart valves.
Anticoagulants ; Aortic Valve ; Dose-Response Relationship, Drug ; Food-Drug Interactions ; Heart Valve Prosthesis ; Heart Valves* ; Heart* ; Humans ; International Normalized Ratio ; Outpatients* ; Retrospective Studies ; Seoul ; Thromboembolism ; Warfarin*

BACKGROUND: Following the implantation of heart valve prostheses, it is important to maintain therapeutic INR to reduce the risk of thromboembolism. The objectives of this study were to determine the causes of nontherapeutic INRs, and to identify the factors associated with nonadherences to warfarin therapy in Korean outpatients with prosthetic heart valves managed by a pharmacist-run anticoagulation service (ACS). MATERIAL AND METHOD: A retrospective chart review was completed for all patients enrolled in the ACS at Seoul National University Hospital from March, 1997 to September, 2000. The data on 868 patients (5,304 visits) who were at least 6 months post-valve replacement were included. All possible causes of nontherapeutic INRs were documented for each patient visit. The association of covariates to noncompliance was investigated by univariate analysis. RESULT: The reasons for nontherapeutic INRs were identified as follows: inadequate dosage adjustment (21%), nonadherences to dosing regimen (13%), drug/herbal interactions (12%), changes in diet (7%), and indeterminate cause (42%). Younger age, shorter duration of ACS and longer duration of warfarin therapy were associated with nonadherence. CONCLUSION: In this study, nonadherence and interactions between diet and medications were found to be important factors influencing nontherapeutic INRs. Longer duration of enrollment in the ACS affected the adherence to warfarin therapy positively whereas younger age and longer duration of warfarin therapy affected negatively.
Anticoagulants ; Blood Coagulation ; Diet ; Heart Valve Prosthesis ; Heart Valves* ; Heart* ; Humans ; International Normalized Ratio* ; Outpatients* ; Retrospective Studies ; Seoul ; Thromboembolism ; Warfarin

STUDY DESIGN: Retrospective case-control study. PURPOSE: To examine the hypothesis that the misuse of thrombin-containing local hemostatics (TCLH) increases the risk of postoperative spinal epidural hematoma (POSEH). OVERVIEW OF LITERATURE: Many studies have focused on hypocoagulability as a risk factor for POSEH. However, there are no prior reports on the increased risk of POSEH in hypercoagulable states. METHODS: Posterior instrumented lumbar spine surgery cases over 2 consecutive years were divided into two groups: a study group (98 patients in whom TCLH was used) and a control group (176 patients in whom TCLH was not used). The excess TCLH matrix that was not associated with blood clot was not removed from the patients in the study group. The senior author decided whether to use TCLH or not. Suction drains were used in all patients. The demographics, coagulation-related factors, and intraoperative factors of the patients in the two groups were analyzed. The development of POSEH was compared between the two groups. RESULTS: The two groups were homogenous in demographics (age and sex), coagulation-related factors (platelet count, prothrombin time, activated partial thromboplastin time, and platelet function analysis), and surgical factors (total blood loss, operation time, blood loss/10 minutes, number of fusion segments, posterolateral fusion/posterior lumbar interbody fusion, and virgin or revision surgery). POSEH developed more frequently in the patients in the study group than in those in the control group (14/98 patients, 14.3% vs. 3/176 patients, 1.7%, respectively; p=0.001; odds ratio, 17.1). CONCLUSIONS: TCLH causes blood clot not only at the edge of damaged vessels but also at the site of extravascular blood. Excess TCLH matrix not associated with blood clot at the epidural space can enhance POSEH development because early clotted hematomas do not drain through suction drains.
Blood Platelets ; Case-Control Studies ; Demography ; Epidural Space ; Hematoma ; Hematoma, Epidural, Spinal* ; Hemostatics* ; Humans ; Odds Ratio ; Partial Thromboplastin Time ; Prothrombin Time ; Retrospective Studies ; Risk Factors ; Spine ; Suction

OBJECTIVES: To identify clinical features and risk factors helpful for the prevention and early diagnosis of neurological complications.OVERVIEW OF LITERATURE: Previous studies have investigated postoperative complications only for specific disease entities and did not present distinctive clinical features. MATERIALS AND METHODS: This was an observational study of patients who underwent posterior thoracolumbar spinal surgery in the orthopedic department of a single hospital over the course of 19 years (1995-2013). The incidence, cause, onset time, and risk factors of complications were investigated. Neurological deterioration was graded on a 5-point numeric scale: G1, increased leg pain or sensory loss, G2, unilateral motor weakness; G3, bilateral motor weakness; G4, cauda equina syndrome; and G5, complete paraplegia. RESULTS: Sixty-five cases out of 6574 (0.989%) developed neurological complications due to the following causes: epidural hematoma, 0.380%; instrumentation with inadequate decompression, 0.213%; mechanical injury, 0.167%; inadequate discectomy, 0.061%; and unknown cause, 0.167% (p=0.000). The grade of neurological deterioration was G1 in 0.167% of patients, G2 in 0.517%, G3 in 0.228%, G4 in 0.046%, and G5 in 0.030%. Neurological deterioration was most severe in patients who experienced epidural hematoma, followed by those in whom complications occurred due to instrumentation with inadequate decompression, unknown causes, mechanical injury, and inadequate discectomy, in order (p=0.009). Revision surgery was a significant risk factor (p=0.000; odds ratio, 2.741). The time that elapsed until symptom development was as follows, in order: unknown cause, 0.6 hours; epidural hematoma, 5.4 hours; mechanical injury, 6.6 hours; inadequate discectomy, 18.0 hours; and instrumentation with insufficient decompression, 36.0 hours (p=0.001). CONCLUSIONS The incidence of neurological complications in our cohort was 1%. Revision surgery increased the risk by 3 times. Severe cases (cauda equina syndrome or complete paraplegia) rarely developed, occurring in 0.08% of patients. The major causes of neurological decline were epidural hematoma and instrumentation with inadequate decompression. Close observation in the early period was important for the diagnosis because most patients developed symptoms within 12 hours. Delayed diagnosis was most common in complications caused by instrumentation with inadequate decompression.

STUDY DESIGN: Retrospective study. PURPOSE: To determine prognostic factors of neurological complications (NCs) of posterior thoracolumbar surgeries. OVERVIEW OF LITERATURE: There have been few reports on the prognosis of NCs according to the causes and treatment methods. METHODS: The subjects were 65 patients who had NCs for 19 years (1995–2013) after posterior thoracolumbar surgeries in Seoul Sacred Heart General Hospital. The degree of neurological injury was assessed using numeric scales as follows: G1, increased leg pain or sensory loss; G2, hemiparesis; G3, paraparesis; G4, cauda equine syndrome; and G5, complete paraplegia. The relative degree of neurological recovery was evaluated using four numeric scales as follows: Gr1, complete recovery; Gr2, almost complete recovery with residual sensory loss or numbness; Gr3, partial recovery with apparent neurological deficit; and Gr4, no recovery. The prognostic factors were investigated in terms of demographic and surgical variables that were available in a retrospective review. RESULTS: The causes were as follows: epidural hematoma (EH), 25 patients (38.5%); insufficient decompression and fusion, 14 patients (21.5%); mechanical injury, 11 patients (16.9%); insufficient discectomy, four patients (6.2%); and unknown, 11 patients (23.1%). The grade of neurological injury was as follows: G1, 11 patients (16.9%); G2, 34 patients (52.3%); G3, 15 patients (23.1%); G4, three patients (4.6%); and G5, two patients (3.1%). Thirteen patients received conservative treatment, and 52 underwent revision surgeries. Neurological recovery was as follows: Gr1, 21 patients (32.3%); Gr2, 17 patients (26.2%); Gr3, 20 patients (30.8%); and Gr4, seven patients (10.8%). The prognosis depended on the causes (p =0.041). The subgroup analysis of the revision group revealed a significant correlation between the degree of neurological recovery and the timing of revision, irrespective of causes (r =0.413, p =0.002). CONCLUSIONS: The prognosis of NC depended on the causes. EH was the best and unknown was the worst prognostic factor. Revision should be performed as soon as possible for a better prognosis.
Decompression ; Diskectomy ; Heart ; Hematoma ; Hospitals, General ; Humans ; Hypesthesia ; Leg ; Paraparesis ; Paraplegia ; Paresis ; Prognosis ; Retrospective Studies ; Seoul ; Weights and Measures

BACKGROUND AND OBJECTIVES: To investigate the effectiveness of fine needle aspiration (FNA) conducted by the otolaryngologists, we compared the ultrasound (US)-guided FNA results conducted by a radiologist (RD-US), the US-guided FNA results (ENT-US), and the palpation guided FNA results (ENT-palpation) conducted by an otolaryngologist. SUBJECTS AND METHOD: 1646 patients who underwent FNA were classified according to the site and periods of investigation (2007-2015), and their sampling adequacy was retrospectively reviewed. They were also divided into three groups (ENT-US, ENT-palpation, and RD-US); each group was then investigated for sampling adequacy. Results of further surgical excisional biopsy were compared with the those of the FNA results to investigate the diagnostic accuracy of all three groups. RESULTS: The sampling adequacy identified by the groups showed the result of ENT-US at 87.9%, ENT-palpation at 87.1% and RD-US at 91.3%. The periodical inadequacy rate failed to show any significant differences between the groups. The sensitivity of ENT-palpation was lower than other two groups. Diagnostic accuracy identified by the groups showed the result of ENT-US at 95.2%, ENT-palpation at 93.6%, and RD-US at 97.4%. CONCLUSION: FNA performed by otolaryngologists demonstrates the effectiveness of diagnosis and treatment, and that doing so would improve economic efficiency. Therefore, it is recommended that well-trained otolaryngologists conduct FNA actively.
Biopsy ; Biopsy, Fine-Needle* ; Diagnosis ; Humans ; Methods ; Palpation ; Retrospective Studies ; Ultrasonography

STUDY DESIGN: Retrospective study. OBJECTIVES: To identify clinical features and risk factors helpful for the prevention and early diagnosis of neurological complications. OVERVIEW OF LITERATURE: Previous studies have investigated postoperative complications only for specific disease entities and did not present distinctive clinical features. MATERIALS AND METHODS: This was an observational study of patients who underwent posterior thoracolumbar spinal surgery in the orthopedic department of a single hospital over the course of 19 years (1995-2013). The incidence, cause, onset time, and risk factors of complications were investigated. Neurological deterioration was graded on a 5-point numeric scale: G1, increased leg pain or sensory loss, G2, unilateral motor weakness; G3, bilateral motor weakness; G4, cauda equina syndrome; and G5, complete paraplegia. RESULTS: Sixty-five cases out of 6574 (0.989%) developed neurological complications due to the following causes: epidural hematoma, 0.380%; instrumentation with inadequate decompression, 0.213%; mechanical injury, 0.167%; inadequate discectomy, 0.061%; and unknown cause, 0.167% (p=0.000). The grade of neurological deterioration was G1 in 0.167% of patients, G2 in 0.517%, G3 in 0.228%, G4 in 0.046%, and G5 in 0.030%. Neurological deterioration was most severe in patients who experienced epidural hematoma, followed by those in whom complications occurred due to instrumentation with inadequate decompression, unknown causes, mechanical injury, and inadequate discectomy, in order (p=0.009). Revision surgery was a significant risk factor (p=0.000; odds ratio, 2.741). The time that elapsed until symptom development was as follows, in order: unknown cause, 0.6 hours; epidural hematoma, 5.4 hours; mechanical injury, 6.6 hours; inadequate discectomy, 18.0 hours; and instrumentation with insufficient decompression, 36.0 hours (p=0.001). CONCLUSIONS: The incidence of neurological complications in our cohort was 1%. Revision surgery increased the risk by 3 times. Severe cases (cauda equina syndrome or complete paraplegia) rarely developed, occurring in 0.08% of patients. The major causes of neurological decline were epidural hematoma and instrumentation with inadequate decompression. Close observation in the early period was important for the diagnosis because most patients developed symptoms within 12 hours. Delayed diagnosis was most common in complications caused by instrumentation with inadequate decompression.
Cohort Studies ; Decompression ; Delayed Diagnosis ; Diagnosis ; Diskectomy ; Early Diagnosis ; Hematoma ; Humans ; Incidence ; Leg ; Observational Study ; Odds Ratio ; Orthopedics ; Paraplegia ; Polyradiculopathy ; Postoperative Complications ; Retrospective Studies ; Risk Factors

No abstract available.
Acute Lung Injury* ; Prostaglandin-Endoperoxide Synthases* ; Sus scrofa*