BACKGROUND: This study intends to clear that the current cost reimbursement system of Korean medical insurance of health care. METHODS: By using insured medical record of Federation of Korean Medical Insurance Societies used in the demand tendency research of the type of services from feburary 1st to 28th of the year 1990, authors analyze the characterist,ic of components of charges per case in the type of health care facilities. RESULTS: The charge per case in the out-patient care of primary health care facility is 13,498 won, which is 54.6% by comparison with the secondary health care facility and 30.7 % by comparison wit,h the tertiary health care facility. Among these charges the amount of the cost for medical examinations and oral drugs are 73.9% in the primary health care facility and 71.8% in the secondary and 67.5% in the tertiary. Consequently, the services in the primary care are chiefly composed with the medical examinations and oral drugs. In addition to this point the author also finds that the charge per case is 3.5 times, the cost for oral drugs is 5.6 times larger than those of primary care, and therefore tertiary health care facility conduct various diagnostic examinations and prescript more expensive. CONCLUSIONS: There is a difference of basic medical cost ratio between primary, secondary and tertiary health care facility. These points can be lead to the presumption that the diseases under the structure of current medical insurance are overlapped irrespective of the charact.erisitcs of the type of health care facilites, and this is profitable to the tertiary health care facilities which can conduct various types of services. In conclusion, the frame a policy is needed to encourage primary care which are nothing but simple structure of charges.
Delivery of Health Care ; Humans ; Insurance* ; Medical Records ; Outpatients ; Primary Health Care

No abstract available.
Stomach Neoplasms* ; Tuberculosis, Pleural*

No abstract available in English.
Transplants

Although the primary repair has been recognized so far, the tendon graft is reported as a primary treatment method for tendon injury in no man's land of Bunnel, judging from the state of injured hand, the ability of operator and the environment of medical operation. The 27 cases of tendon graft that were operated for 11 years from June, 1973 to June, 1984 in the Department of Orthopedic Surgery, Hanyang University College of Medicine have been followed up for clinical study. The results were as follows: 1. The Material of this study was composed of 13 males (21 cases) and 5 females (6 cases) whose age were from 8 to 39 years old. 2. The injured fingers were classified with 3 thumbs, 6 index fingers, 7 middle fingers, 8 ring fingers and and 3 little fingers out of 27 cases and all injured parts of fingers were Zone II except that of thumb which was Zone IV of Bunnel. 6 patients were injured more than 2 fingers. 3. The duration from tendon injury to tendon graft which scattered from 1 month to 9 years and averaged out to 28.2 months is supposed to have little relation to post-operative results. 4. The post-operative results showed up 9 excellent, 7 good and 1 fair out of 17 cases in good gmup, 3 good and 6 fair out of 9 cases in cicatrix group, 1 fair out of 1 case in nerve damage group at pre-operative state. 5. The post-operative results of thumb which show up 2 excellent, 1 good out of 3 cases were most successful among those of all fingers. 6. The pre-operative state is supposed to have great relation to post-operative state judging from 94% satisfactory results of good group at pre-operative state. 7. As multiple injury makes little difference from single injury, the injured state of each hand is supposed to an important effect on post-operative results. 8. As all electric bumed injury show up fair except that of thumb, they are supposed to have unsatisfactory results.
Cicatrix ; Clinical Study ; Female ; Fingers ; Hand ; Humans ; Male ; Methods ; Multiple Trauma ; Orthopedics ; Tendon Injuries ; Tendons ; Thumb ; Transplants

No abstract available.
Humans

The common errors in preoperative treatment plan for the orthognathic surgery can be occurred during cast impression, cast mounting procedure with face-bow transfer, surgical stent fabrication, and so on. One of the most common errors exists during mounting process of the model on the articulator. Accurate mounting of dental casts to articulator should be achieved by transferring the 3- dimensional spatial relationship of the maxillary arch to an articulator. A face-bow is used for transfer this relationship to articulator, usually by relating the face-bow to a plane of reference of maxillary cast. The purpose of this study is evaluation of the accuracy of face-bow transferring of maxillary model to the articulator. The maxillary casts of thirty patients for orthognathic surgery were mounted on articulator with an face-bow instrument. The relationship of occlusal plane angle to Frankfort horizontal plane relations were compared the cephalogram with the cast-mounted articulator. As a result of this study, the significant difference between the maxillary occlusal planes angle in the cephalogram and articulator were found . The results were followed,1. The mean occlusal plane angle in cast-mounted articulator was 13.5.(SD+/-5.4).2. The mean occlusal plane angle in cephalogram was 10.4.(SD+/-4.3).3. The mean difference of occlusal plane angle between cast-mounted articulator and cephalogram was 3.3.(SD+/-4.6).According to the result, we should suggest that the occlusal plane angle to Frankfort plane in cast-mounted articulator is more steeper than that of cephalogram.And then, maxillofacial surgeon should try to get a more predictable result by suggesting the proper correction method and mounting the cast accurately.
Dental Articulators ; Dental Occlusion* ; Humans ; Orthognathic Surgery ; Stents

Total knee arthroplasty (TKA) is a successful and cost-effective treatment for end-stage degenerative arthritis. The aging of society and an increase in the prevalence of obesity has led to increases in the prevalence of arthritis and the incidence of TKA. Currently, the total number of procedures in Korea per year has reached 90,000. With the rapid growth, we need to know about the current state of TKA. The purpose of this review is to summarize the recent literature regarding TKA. The main indication for TKA is end-stage arthritis with severe pain, reduced function, and no response to conservative management. Metal on the polyethylene-bearing surface and cobalt alloy are used in most TKAs. Despite good clinical outcomes and long-term survival rates after TKA in many papers, 20% of patients are dissatisfied with the outcome of surgery. To improve the patient’s satisfaction, surgeons should understand factors affecting patient’s satisfaction, including patient’s expectations, age, and preoperative mental state. Navigationassisted surgery and robotic surgery have been introduced in knee arthroplasty to achieve more precise and accurate alignment. There is some evidence to suggest that computer-assisted surgery reduces revision rates. However, clinical efficacy is also controversial, and a long-term follow-up study is required. The common complications of TKA include infection, polyethylene wear, loosening, stiffness, periprosthetic fracture, and thromboembolism. An understanding of the potential complications and pitfalls of TKA is essential for prevention.

Colonna capsular arthroplasty is a two-stage procedure for congenital dislocation of the hip, but is not suitable for congenital subluxation. The bone architecture of the femoral head should approach the nearly normal and the child preferably should be more than three years old and less than eight if the best functional result is to be obtained. These brief case reports of five patients who could be followed for from one year and one month to more than seventeen years document the fact that the procedure may produce a hip with an excellent roentgenographic appearance and enduring satisfactory function.
Arthroplasty ; Child ; Dislocations ; Head ; Hip ; Humans

False aneurysms (Pseudoaneurysms) and arteriovenous fistulas have only rarely been reported in the facial region. In this region the false aneurysm arises most frequently in the superficial temporal and facial artery, but other branches of the external carotid are sometimes involved, including the maxillary and lingual artery. False aneurysms can be occurred by blunt trauma that either laceration or rupture the full thickness of the arterial wall. The diagnosis of a false arterial aneurysm can be often made solely on the basis of physical examination. Angiography is helpful for conformation, for delineating the lesion and its vascular supply, and for ruling out the presence of associated vascular lesions such as arteriovenous fistulas. Ultrasonography may also be useful in delineating lesions that are not easily accessible for physical examination. Treatment of false aneurysms is excision, ligation, and arterial embolization. This is a case of false aneurysm of the lingual artery after facial trauma caused by traffic accident. The lesion was successfully treated by embolization and ligation of the lingual and facial branches of the external carotid artery.
Accidents, Traffic ; Aneurysm ; Aneurysm, False* ; Angiography ; Arteries* ; Arteriovenous Fistula ; Carotid Artery, External ; Diagnosis ; Lacerations ; Ligation ; Physical Examination ; Rupture ; Ultrasonography

Acinic cell carcinoma is a rare salivary gland carcinoma, usually being found in the parotid gland and is uncommon in the other major and minor salivary glands. The tumor cells consist of either serous or mucous acinar cells with few ductal or myoepithelial cell elements. The tumor is a low-grade malignancy with slow growth potential. Surgical therapy depends on tumor size and the extent of infiltration into neighboring tissues. Superficial parotidectomy or total parotidectomy is the initial method of therapy in case of acinic cell carcinoma on parotid gland. When regional neck lymph nodes are involved, the operation is combined with a neck dissection, or with radiation therapy. In the short follow up period, acinic cell carcinoma has good prognosis with 5 year survival rate after surgery is over 80%. In the long-term follow-up, however, there is a tendency to increase in recurrence or metastasis. We experienced a case of acinic cell carcinoma of the parotid gland in a 57-year-old female, so we report it with literatures review.
Acinar Cells* ; Carcinoma, Acinar Cell* ; Female ; Follow-Up Studies ; Humans ; Lymph Nodes ; Middle Aged ; Neck ; Neck Dissection ; Neoplasm Metastasis ; Parotid Gland* ; Prognosis ; Recurrence ; Salivary Glands ; Salivary Glands, Minor ; Survival Rate