BACKGROUND: The implementation of health care delivery system(HCDS) in 1989 affected the visit pattern of tertiary care hospital. In this study we analyzed the effect of implementation of HCDS in a university hospital. METHODS: We analyzed the yearbook of a university hospital from 1986 to 1992. The clinical departments were divided into three groups of medical departments, surgical departments with application of HCDS and clinical departments without application of HCDS. RESULTS: The total outpatient visits increased after implementation of HCDS. The new outpatient visits decreased after implementation in the medical departments and surgical departments but re-visit patients increased in all clinical departments. The number of emergent patients increased at year 1889, but decreased in 1990, then little changed. Admission rate via emergency room decreased in surgical departments and clinical departments without application of HCDS. The patient from Pusan in which hospital is located was little changed but patients that from other areas increased. So the proportion of patients from Pusan decreased, and from other regions increased. The visit of patients with self pay decreased, but patients with medical insurance increased. CONCLUSIONS: In spite of increased total outpatient visits, the new outpatient visits and patient visits from near place decreased through implementation of HCDS. The new outpatient visits decreased in the medical departments and surgical departments in clinical departments with application of HCDS, but the new outpatient visits increased in clinical departments without application of HCDS.
Busan ; Delivery of Health Care* ; Emergency Service, Hospital ; Humans ; Insurance ; Outpatients ; Tertiary Healthcare

No abstract available.
Family Practice* ; Humans ; Internship and Residency*

PURPOSE: To evaluate the incidence of disc extrusion and neurologic deficit, the relation between disc extrusion and neurologic deficit and the treatment results according to our basic treatment principles in lower cervical facet joint fracture and dislocations MATERIALS AND METHODS: Twelve patients were evaluated, 8 male and 4 female with an average age of 41 years comprised the group. Six injuries were attributable to automobile accidents, 5 to fall from building, bed, floor and hill, and one to stand on her head. One case was distractive-flexion stage (DFS) 1, 9 cases with DFS 2 and 2 cases with DFS 3. Plain X-ray, CT, Myelo CT and MRI were used as a diagnostic tools. As a treatment criteria, feasibility of closed reduction, status of neuroglogic injury, and stability of injured spine were considered. Anterior cervical discectomy and fusion in accompanied disc extrusion, posterior reduction and fusion with triple wiring in unreduced dislocation, and anterior decompression and fusion in incomplete cord and root injury were selected as a basic treatment principles. RESULTS: Ten out of 12 cases (83%) showed neurologic deficits, 2 complete cord injury, 1 incomplete cord injury, and 7 radiculopathy. Nine out of 12 (75%) demonstrated disc extrusion and all disc extruded patients had neurologic deficits. Anterior cervical discectomy and fusion (ACDF) were performed in 5 cases, ACDF and posterior reduction with triple wiring (PRTW) in 4 cases, PRTW in 1 case, and skull traction and philadelphia brace in 2 cases. Seven radiculpathy patients were completely recovered and one incomplete cord injury patient can ambulate with spastic gait after surgery. There were 2 bed sore and 1 pneumonia in complications. CONCLUSION: Soft disc extrusion should be evaluated carefully with MRI and CT in lower cervical spine injury with the facet joint fracture-dislocations before the decision of treatment. As disc extrusion always accompanies neurologic deficit, it must be surgically treated by anterior cervical discectomy and fusion.
Automobiles ; Braces ; Decompression ; Diskectomy ; Dislocations* ; Female ; Gait Disorders, Neurologic ; Head ; Humans ; Incidence ; Magnetic Resonance Imaging ; Male ; Neurologic Manifestations ; Pneumonia ; Pressure Ulcer ; Radiculopathy ; Skull ; Spine ; Traction ; Zygapophyseal Joint*

No abstract available.
Heart* ; Thoracic Surgery*

BACKGROUND: Urinary tract infections (UTIs) are the most frequent nosocomial infections and are frequently associated with indwelling urinary catheters. It is known that adherence to standard infection control measures for urinary catheters can reduce UTIs in hospitals. This study was performed to evaluate the effect of education in reducing catheter-related UTIs (CR-UTIs) in intensive care units (ICUs) of a university hospital. METHODS: CR-UTIs were prospectively monitored for all patients with indwelling urinary catheters in ICUs from July 2006 through December 2007. Recommendations based on previously known guidelines for catheter insertion, catheter management, and specimen collection to prevent CR-UTIs were formulated and educated in March 2007. Knowledge and adherence level were evaluated before and after educating healthcare workers about the recommendations using questionnaire. Changes in knowledge and adherence level before and after education were compared by Chi-square test. Changes in the rate of CR-UTIs and urinary catheter utilization ratios were also analyzed by Fisher's exact test. RESULTS: After education, knowledge level of and adherence level to most of the recommendations were improved significantly. The rate of CR-UTIs significantly decreased by 48% from 7.43/1,000 catheter-days before intervention to 3.87/1,000 catheter-days after intervention (P=0.02). CONCLUSION: Surveillance for nosocomial infections and education for standard infection control measures are very important in preventing CR-UTIs in ICUs.
Catheters ; Cross Infection ; Delivery of Health Care ; Humans ; Infection Control ; Critical Care ; Intensive Care Units ; Prospective Studies ; Specimen Handling ; Urinary Catheterization ; Urinary Catheters ; Urinary Tract ; Urinary Tract Infections ; Surveys and Questionnaires

Venous thrombosis is uncommon in young individuals. Hypereosinophilia is a rare cause of thrombosis that usually involves the heart and small vessels like retinal vessels. We report a case of massive deep vein thrombosis that developed in a young patient with hypereosinophilia who was successfully treated with continuous local infusion of urokinase.
Eosinophilia* ; Heart ; Humans ; Retinal Vessels ; Thrombosis ; Urokinase-Type Plasminogen Activator* ; Venous Thrombosis*

Barrett's esophagus is a metaplastic process in which the squamous epithelium of the lowet esophagus is replaced by columnar epithelium. Most cases are believed to be related to prolonged gastroesophageal reflux. Detection of Barretts esophagus is important in that it results in adenocarcinoma in about 10% of patients. We report a case of adenocarcinoma arising from Barrett's esophagus in a 56 year-old man, diagnosed incidentally at a physical check-up. Grossly, the esophagogastric junction was irregular and there were two small ulcers in the lower esophagus. Microscopically, ihe squamous epithelium of the lower hagus was replaced by specialized intesinal mucosa with a small focus of adenocarcinona confined to the submucosa in one area. Many separate dysplastic foci were also present in the nearby esophageal mucosa.
Adenocarcinoma* ; Barrett Esophagus* ; Epithelium ; Esophagogastric Junction ; Esophagus* ; Gastroesophageal Reflux ; Humans ; Intestines* ; Middle Aged ; Mucous Membrane ; Stomach* ; Ulcer

PURPOSE: To compare results between in femtosecond laser and microkeratome LASIK correction of myopia METHODS: We retrospectively analyzed the result of 94 eyes of 47 patients in the femtosecond group (F) and 103 eyes of 52 patients in the microkeratome group (M). All patients had undergone LASIK using either a femtosecond laser or a microkeratome for making of flap. Patients were divided into groups I (6D< or =) and II (> or =6D) according to preoperative myopia. Each patient was followed up for over 6 months with measurements of uncorrected visual acuity and manifest refraction at 1 week and 1, 3, and 6 months after operation. Complications during and after the operation were reviewed retrospectively in two groups 6month after the operation. RESULTS: In groups F-I, F-II, M-I, and M-II, postoperative 6-month uncorrected visual acuity was 0.98+/-0.08, 0.96+/-0.09, 0.97+/-0.03, 0.98+/-0.09. At the 6-month follow-up, there were no significant differences between the two groups in uncorrected visual acuity and mean spherical equivalent. Corneal opacity was found in 3 eyes in group M and complication related with flap was found 1 eye in group F and 4 eyes in group M. CONCLUSIONS: During a 6-month follow up, LASIK using either a femtosecond laser or a microkeratome has an similar effect in uncorrected visual acuity and mean spherical equivalent. Thus LASIK for using femtosecond laser can be used as an alternative procedure to correct myopia.
Corneal Opacity ; Follow-Up Studies ; Humans ; Keratomileusis, Laser In Situ* ; Myopia* ; Retrospective Studies ; Visual Acuity

BACKGROUND: The choice of anesthetic agents and adjuvants during outpatient surgery is of critical importance. Propofol is widely used for the induction and maintenance of outpatient anesthesia. Because propofol lacks analgesic properties, very high concentrations may be required when propofol is used as the sole anesthetic drug. Propofol is used with adjuvants such as nitrous oxide or opioid. This study was designed to evaluate the intraoperative hemodynamic response, recovery characteristics and side effects of propofol-fentanyl anesthesia compared with propofol-N2O anesthesia for outpatient surgery. METHODS: Twenty six healthy and unpremedicated patients scheduled for outpatient surgery were randomly allocated to receive either propofol-N2O anesthesia (N-group) or propofol-fentanyl anesthsia (F-group). The patients in N-group were ventilated with nitrous oxide 60~70% in oxygen and the patients in F-group were ventilated with oxygen 40% in nitrogen via laryngeal mask airway (LMA). RESULTS: There was no significant difference in blood pressure during anesthesia, recovery time and side effects between two group. There was significant decrease of heart rate in F-group. CONCLUSION: We concluded that nitrous oxide and fentanyl are reasonable adjuvants of propofol anesthesia in outpatient anesthesia.
Ambulatory Surgical Procedures* ; Anesthesia* ; Anesthetics ; Blood Pressure ; Fentanyl ; Heart Rate ; Hemodynamics ; Humans ; Laryngeal Masks ; Nitrogen ; Nitrous Oxide ; Outpatients* ; Oxygen ; Propofol

Author reviewed the patients with temperature over 38.5 degress C for longer than two weeks and of undetermined etiology who were admitted and treated in Yonsei Medical Center during the period from Jan. 1974 to Aug. 1978. There have been 120 cases of prolonged fever in that period. The following results were obtained; 1. The children who were admitted with prolonged fever occupied 1.3% of total in-patients at the same period. 2. 16 cases were less than 1 year of age at admission and 64 were 1 to 6 years. So 2/3 of total cases were less than 6 years of age. The ratio of Male to Female was 1.6:1. 3. There Was no apparent difference in seasonal incidence. But from May to September slightly increased number was noted. 4. In 58 cases(48.3%), the fever persisted 2 to 3 weeks before admission and 27 cases lasted longer than a month. . Three patterns of fever were observed; intermittent type 75 cases(62.5%), daily spiking 32(26.7%) and constant 13(10.8%) 5. The final diagnoses as a cause of fever were as follows. Infections accounted for 81 cases(67.5%), malignancy 17(14.2%), collagen diseases 7(5.8%) and miscellaneous cause 1(0.8%). 14 cases(11.7%) remained undiagnosed at the cenclusion of their hospitalization. . Certain relationships between diagnosis and age were noted. Infection was the most common etiology in all age groups but 72.5% of these children were less than 6 years old. 71.4% of collagen diseases were older than 6 years. Malignancy had no age predilection. 6. Over 80% of all cases the diagnosis were made within a week and the fever disappeared in a week in 70% So most of them(75%) discharged within 2 weeks after admission. 7. Careful history suggested the final diagnosis in 84 cases(70%) and repeated physical examinations were helpful in 70 cases(58.3%) Abnormal findings in routine chest P-A were present in 47.5% Erythrocyte sedimentation rate was significantly increased in 26/34 cases(76.5%). 47 cases(39.2%) were anemic for age and all children with malignancy were anemic. Lumbar puncture, bone marrow aspiration, tissue biopsy and explo. Laparotomy were performed only in suspected cases. 8. Outcome on discharge were as follows; 90 cases(75.0%) were much improved, 21(17.5%) discharged without improvement and 9 cases(7.5%) expired.
Biopsy ; Blood Sedimentation ; Bone Marrow ; Child* ; Collagen Diseases ; Diagnosis ; Female ; Fever* ; Hospitalization ; Humans ; Incidence ; Laparotomy ; Male ; Physical Examination ; Seasons ; Spinal Puncture ; Thorax