This study was designed to investigate factors relating to fiscal deficit for regional health insurance. The financial statements for the fiscal year 1990 of nationwide 254 regional medical insurance societies were analyzed. Important findings are summarized below: 1. There were differences in the main reason for the financial deficit among regions when deficit and surplus societies were compared by regions. The total revenue per enrollee, especially revenue from the premium contribution of a deficit society was significantly smaller than that of a surplus society in large cities and counties. On the other hand, the total expenditure per enrollee of a deficit society was larger than that of a surplus society in small cities. 2. Both low premium irate at the beginning of health insurance program and less effort to increase the premium rate were main factors for the smaller revenue from the contribution of a deficit society in large cities and counties. 3. Larger expenditures per covered person of a deficit society in small cities were explained with larger medical expenditures especially for out-patients services rather than larger administrative expenses. 4. A regression analysis showed that utilization rates in out-patient services were significantly associated with income and numbers of total medical care institution per capita within a region where a health insurance society located. Also expenses paid by insurer per visit were associated with the proportion of utilization for tertiary care hospitals as well as the proportion of utilization of public health centers.
Hand ; Health Expenditures ; Humans ; Insurance ; Insurance Carriers ; Insurance, Health* ; Korea* ; Outpatients ; Public Health ; Tertiary Healthcare

The treatment of massive bone and soft tissue defect in the lower leg has a high complication rate of nonunion, chronic infection, and amputation without well-vascularized tissue coverage of the open fracture. Despite adequate free soft tissue coverage, massive skeletal defect may result in segmental bone defects, angulation deformity, and limb length discrepancies. In the last decade, major advances have occurred in the Ilizarov method of distraction osteogenesis in lower leg salvage as a delayed procedure or simultaneous distraction after free-tissue transfer. The authors have performed Ilizarov transport in conjunction with muscle and musculocutaneous flap coverage in nine cases of lower leg salvage. The flaps consist of rectus, gracilis, latissimus dorsi, parascapular, and serratus muscle or musculocutaneous fashioning using ipsilateral or contralateral pedicle in consideration of vessel condiation. Revision, recorticotomy and flap elevation were also used as a secondary procedure for satisfactory results. The conclusions, were as follows: 1) Multidisciplinary team approach with conjoining departments at the time of preoperative evaluation, postoperative care and rehabilitation care; 2) Muscle flap covered with split-thickness skin graft was preferred to musculocutaneous flap; 3) To reduce the total reconstructive period, simultaneous free tissue transfer with Ilizarov distraction should be considered.
Amputation ; Congenital Abnormalities ; Extremities ; Fractures, Open ; Ilizarov Technique ; Leg* ; Myocutaneous Flap ; Osteogenesis* ; Osteogenesis, Distraction ; Postoperative Care ; Rehabilitation ; Skin ; Superficial Back Muscles ; Transplants

OBJECTIVE: To examine the effect of cold spray (Ethyl chloride) on reducing pain during needle electromyography (EMG). METHOD: Seventy-six adults, who had experienced needle electromyographic examination, were studied. They were randomly assigned to either experimental or control group. In experimental group, cold spray was applied to needling point of examining muscles before each needle examination. In control group, needle examination was performed without pre-treatment. The intensity of pain was assessed by the Visual analogue scale (VAS) and Verbal rating scale (VRS). Denial to re-examination was evaluated after EMG study. RESULTS: The VAS, VRS and denial to re-examination were significantly lower in experimental group (p<0.05). CONCLUSION: The application of cold spray before needle examination decreased the intensity of pain and denial to re-examination.
Adult ; Denial (Psychology) ; Electromyography* ; Humans ; Muscles ; Needles*

STUDY DESIGN: A case report. OBJECTIVE: We present a rare case of acute spinal cord infarction and usefulness of diffusion weighted MR imaging. SUMMARY OF LITERATURE REVIEW: T1-weighted and T2-weighted images are often normal in a patient with acute spinal cord infarction. MATERIAL AND METHODS: An 82-year-old presented with acute onset of paraplegia and urinary retention. His symptoms developed 6 days ago without any trauma. He had a history of vertebroplasty due to compression fracture of 12th thoracic vertebral body 6 years ago. There was no evidence of spinal cord compression on routine T1-and T2-weighted MRI. RESULTS: In diffusion-weighted MRI, a high intensity signal intensity lesion in the spinal cord and conus medullaris was observed. CONCLUSION: We report an example for the usefulness of diffusion-weighted image for early and accurate diagnosis of acute spinal cord infarction.
Conus Snail ; Diffusion ; Fractures, Compression ; Humans ; Infarction ; Paraplegia ; Spinal Cord ; Spinal Cord Compression ; Urinary Retention ; Vertebroplasty

Adequate dialysis is essential for improving dialysis therapies and reducing all-cause mortality in end-stage renal disease (ESRD) patients. Efficient removal of the uremic toxins in the blood remains the fundamental role of dialysis therapies. Therefore, urea clearance as assessed by urea kinetic modeling (Kt/Vurea) is a surrogate marker for dialysis adequacy in ESRD patients undergoing dialysis, and the NKF-DOQI recommends a Kt/Vurea of no less than 1.2. The current status of dialysis adequacy in Korea has not been fully investigated. Our Clinical Research Center for End Stage Renal Disease revealed that the mean Kt/Vurea in maintenance hemodialysis patients was 1.49+/-0.28, and 91.5% of patients satisfied the target level of Kt/Vurea. In addition to Kt/Vurea, clinical parameters such as the volume status, residual renal function, blood pressure, acid-base disorders, anemia, nutrition, inflammation, mineral metabolism, and middle molecule clearance are important for determining adequate dialysis treatment. Further evaluation of clinical parameters is needed to improve dialysis adequacy.
Anemia ; Biomarkers ; Blood Pressure ; Dialysis ; Humans ; Inflammation ; Kidney Failure, Chronic ; Korea ; Renal Dialysis ; Renal Insufficiency ; Urea ; Uremia

Neonatal and Infantile conjunctivitis are common disease in ophthalmologic outpatient department but, a study of causative organisms and antibiotics sensitivity tests are insufficient till now We divided 117 babies(117eyes) having conjunctivitis into neonatal and infantile group who were visited Sung-Ae General Hospital from Jan, 1989 to May, 1990. We performed bacterial culture and antibiotic sensitivity test. The results were as follows; 1) Culture positive rates are 65% in neonates and 87% in infants. There is no sexual difference of ratio. 2) The incidence of isolated organisms is Staphylococcus aureus, Coagulase negative staphylococcus and Streptococcus. 3) Cephalothin is most sensitive antibiotics and Chloramphenicol shows relatively lower sensitivity.
Anti-Bacterial Agents ; Cephalothin ; Chloramphenicol ; Coagulase ; Conjunctivitis* ; Hospitals, General ; Humans ; Incidence ; Infant ; Infant, Newborn ; Outpatients ; Staphylococcus ; Staphylococcus aureus ; Streptococcus

OBJECTIVE: We attempted to confirm the effects of the combined treatment of medication and parent training on the behavioral problems of referred ADHD children, the maternal behavior, and the parenting stress of their mothers. METHODS: Twenty-four children between the ages of 5 to 11 and their mothers were selected as subjects from Child Psychiatric Clinics of Hanyang University Hospital. Three groups were organized : combined treatment group of medication and parent training(N=6) ; wating list group(N=6) ; and medication only group(N=6). Methylphenidate(0.5-0.7 mg/kg/day) was prescribed for children. Mothers of the combined treatment group of medication and parent training and the wating list group attended the parent training once a week for nine weeks and a booster session 4 weeks later. Treatment outcomes were evaluated by comparing both treatment groups at pre- and post-treatment using the various rating scales. Especially the combined treatment group was followed up after 6 months to evaluate the stability of treatment effects. RESULTS: This study showed greater effectiveness of the combined treatment of medication and parent training relative to the medication only in decreasing the overall behavioral problems of ADHD children and the parenting stress of mothers as well as in increasing the desirable maternal behavior. In addition, these improvements were maintained at 6 month follow-up. CONCLUSION: The combined treatment of medication and parent training facilitated the behavioral improvement of referred ADHD children in several aspects.
Child* ; Drug Therapy ; Follow-Up Studies ; Humans ; Maternal Behavior ; Mothers ; Parenting ; Parents* ; Weights and Measures

Hemobilia is a cause of obscure gastrointestinal hemorrhage. Most cases have an iatrogenic or traumatic origin but cases of hemobilia with non-traumatic causes are rare. The non-traumatic causes of hemobilia are inflammation, gallstones, neoplasm and vascular lesions. Currently, various therapeutic options are available for hemobilia, and transarterial embolization is now the first line of intervention used to stop the bleeding of hemobilia, which shows a high success rate of approximately 80% to 100% with a lower morbidity and mortality rate than with surgery. We report a rare case of non-traumatic hemobilia caused by a pseudoaneurysm of the hepatic artery that was successfully treated with transarterial embolization.
Aneurysm, False* ; Gallstones ; Gastrointestinal Hemorrhage ; Hemobilia* ; Hemorrhage ; Hepatic Artery* ; Inflammation ; Mortality

A 72-year-old diabetic male patient with high grade fever, right upper quadrant abdominal pain and Klebsiella pneumoniae septicemia is reported. He suffered from high fever and abdominal pain in spite of aspiration of liver abscess and antibiotic treatment. A few days later, we found a palpable pulsating abdominal mass on physical examination. Computed tomography and angiography revealed infected abdominal aortic aneurysm associated with pyogenic liver abscess. He was treated by antibiotics and Endovascular stent without surgical resection. He improved without complications and has been followed-up after discharge with excellent condition. To our knowledge, this is the first case of infected abdominal aortic aneurysm as a septic metastatic lesion secondary to liver abscess.
Abdominal Pain ; Aged ; Aneurysm, Infected ; Angiography ; Anti-Bacterial Agents ; Aortic Aneurysm, Abdominal* ; Fever ; Humans ; Klebsiella pneumoniae ; Liver Abscess* ; Liver Abscess, Pyogenic ; Liver* ; Male ; Physical Examination ; Sepsis ; Stents*

BACKGROUND/AIMS: Colorectal cancer, one of the most common cancers in developed countries, is curable when diagnosed at an early stage. However, for better screening, both a test that patients will tolerate and diagnostic accuracy are required. We compared patient experiences and preferences between computed tomographic (CT) colonography and conventional colonoscopy (CC) under conscious sedation. METHODS: Patients referred to the gastrointestinal clinic for CC were enrolled to also undergo CT colonography prior to CC. After each procedure, patients completed a questionnaire in which variables, such as abdominal pain, abdominal discomfort, and loss of dignity, were assessed using a 7-point Likert scale, with the highest score representing the worst experience. To verify response stability, a telephone questionnaire followed within 24 h after each procedure. Patients were then asked about their preference for CT colonography or CC. RESULTS: Data were collected from 51 patients who fulfilled all requirements, including CT colonography, CC, the two questionnaires after each procedure, and a follow-up questionnaire. Severity of abdominal pain, abdominal discomfort, and a loss of dignity were reported to be higher in CT colonography than in CC (p<0.01). In addition, the preference for CC was significantly higher than that for CT colonography (p<0.01). CONCLUSIONS: Although CT colonography is a safe and noninvasive screening test for colorectal cancer, further study is required to increase patient acceptance.
Colonography, Computed Tomographic/*methods/psychology ; Colonoscopy/*methods/psychology ; Colorectal Neoplasms/*diagnosis ; Diagnosis, Differential ; Female ; Humans ; Male ; Mass Screening/*methods/psychology ; Middle Aged ; Patient Acceptance of Health Care/*psychology ; *Patient Satisfaction ; Prospective Studies ; Questionnaires