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

The purpose of the study was to obtain information on the clinical and radiographic features of the fibro-osseous lesions in the jaws. For this study, the author examined and analysed the clinical records and radiographs of 71 cases of 68 patients in fibrous dysplasia diagnosed by clinical and radiographic or histopathological examinations. The obtained results were as followings : 1. Fibrous dysplasia occured most frequently in the 2nd decade(30.0%), ossifying fibroma in the 3rd-4th decades, periapical cemental dysplasia in the 4th decade, and all of three lesions showed slight predilection in females. In most cases, chief complaints were painless facial swelling in fibous dysplasia and ossifying fibroma, and periapical cemental dyplasia was found accidentally in radiographs. 2. Fibrous dysplasia was occured more frequently in maxilla, ossifying fibroma in mandible and both lesions in premolar-molar area. Periapical cemental dysplasia was larger than that of ossifyng fibroma, and the shape of ossifying fibroma was more round and elliptical than fibrous dysplasia whose was fusiform. 3. Fibrous dysplasia was shown homogeneous radiopaque shadow of 57.6% and ossifying fibtoma & periapical cemental dysplasia were shown mixed appearance of radiolucency and radiopacity shadows at 74.2%, 60.0%, respectively. 4. Fibrous dysplasia was entirely shown poorly defined at 87.7%, but ossifying fibroma & periapical cemental dysplasia were shown well outlined at 60.0%, 70.0%, repectively. 5. Cortical thinning and expasion were observed in fibrous dysplasia and ossifying fibroma, and severe in ossifying fibroma than fibrous dysplasia, and those signs were not seen in periapical cemental dysplasia. Loss of lamina dura was dominant in fibrous dysplasia and root resorption was dominant in ossifyingfibroma. Displacement of mandibular canal and the degree of the increase of vertical dimension were alike in both lesions. Displacement of maxillary sinus or nasal cavity, thinning & expansion of the maxiilary sinus were dominant in fibrous dysplasia. 6. Polyostotic fibrous dysplasia was occured at 5.9%, Multiple periapical cemental dysplasia at 43.7%. Occurrence rate in the edentulous area of fibrous dysplasia and ossifying fibroma were 7.0%, 8.6%, respectively.
Female ; Fibroma ; Fibroma, Ossifying ; Fibrous Dysplasia, Polyostotic ; Humans ; Jaw* ; Mandible ; Maxilla ; Maxillary Sinus ; Nasal Cavity ; Root Resorption ; Vertical Dimension

Purpose: We compared retropubic radical prostatectomy (RRP) with various laparoscopic radical prostatectomy procedures with RRP as previous performed in our institution.
Materials and Methods: Demographics, perioperative and functional outcomes of 78 patients that underwent modified RRP (mRP; N=53) or established RRP (eRP; N=25) at our institution from January 2013 to December 2018 were evaluated retrospectively. Postoperative incontinence and erectile dysfunction are involved functional outcomes. During the modified procedure, with preserving endopelvic fascia, the prostate was dissected in an antegrade fashion with bilateral nerve sparing, and then urethrovesical anastomosis was performed with continuous suture.
Results: The mean age was older in mRP (68.7±5.3 years) than mRP (65.9±5.0 years) and mean prostate volume was larger in mRP (40.1±18.6 mL) than eRP (30.4±14.0 mL). Mean operative time was longer in eRP (227.0±111.1 minutes) than mRP (154.6±31.6 minutes) and estimated blood loss and complicate rate were similar in 2 groups. The pathologic stage was all T2 stage in eRP, however, in mRP T2 stage was 31 and T3 stage was 22. The pathologic Gleason score was higher in mRP than eRP (p=0.001). Positive surgical margin was significantly higher in mRP, however, biochemical recurrence was insignificantly higher in mRP. Incontinence rates at 3 and 12 months after eRP decreased from 96.0% to 28.0% and after mRP decreased from 49.1% to 7.5%. Overall postoperative potency rate at 12 months was significant different in eRP and mRP groups (8.0% and 34.0%).
Conclusions The mRP was found to have favorable functional outcome and short operative time. This technique might be adopted by inexperienced urologic surgeons as a standard procedure. (Korean J Urol Oncol 2020;18:47-52)

The incidence of traumatic brain injury (TBI) has increased with the advanced technology of society. A careful evaluation of associated problems, initial severity, and complications is important for the acute management and rehabilitation of patients with TBI. To predict the rehabilitation potentials of patients with TBI, we have retrospectively investigated the causes, types of injury, associated problems, and complications in 186 patients and also assessed the rehabilitation outcomes by measuring the functional gains according to the types of brain injury and the initial severities evaluated by the Glasgow coma scale in 82 patients. The functional gains were measured by differences of the Mini-mental status examination, PULSES profile, and Barthel index of pre- and post-rehabilitation states. The incidence of TBI was highest in the 3rd decade men and the most common cause was a traffic accident (120 cases, 64.5%). The types of brain injury were a diffuse axonal injury, 87 cases (46.8%); epidural hematoma, 21 cases (11.3 %); subarachnoid hemorrhage, 25 cases (13.4%); subdural hematoma, 28 cases (15.1%); and intracerebral hematoma, 25 cases (12.9%). Common associated problems were fractures and injuries of nervous system. The 7th cranial nerve and the peroneal nerve were the most common injuries for cranial and peripheral nerves, respectively. Common complications were pulmonary and skin disorders. Total hospital stay and the duration for rehabilitation were not significantly different by the types of injury. Functional gain tended to be higher in the intracerebral hematoma compared to the other types of brain injury. The functional gain was statistically higher in patients with initial severity of moderate degree according to the Glasgow coma scale. In conclusion the moderate traumatic brain injured patients seem to have a higher potential for the good functional outcome.
Accidents, Traffic ; Brain ; Brain Injuries* ; Cranial Nerves ; Diffuse Axonal Injury ; Glasgow Coma Scale ; Hematoma ; Hematoma, Subdural ; Humans ; Incidence ; Length of Stay ; Male ; Nervous System ; Peripheral Nerves ; Peroneal Nerve ; Rehabilitation* ; Retrospective Studies ; Skin ; Subarachnoid Hemorrhage ; Treatment Outcome*

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*

The purpose of this study was to investigate effects of the natural coral(NC) and the hydroxyapatite/calcium sulfate hemihydrate(HA/CS) on an early stages of wound healing in the rat periodontal fenestration defects. In this experiment, twelve male rats(Mean : 520g in BW) aged 8 to 9 months were used. Experimental periodontal fenestration defects were surgically created with tapered fissure bur at the buccal surface of the left mandibular 1st, 2nd molars. The buccal aspects of molar roots were carefully denuded of their periodontal ligament through a bony window created in the left mandibles of rats under general anesthesia. Each experimental periodontal fenestration defect was grafted with natural coral and HA/CS, randomly. An area without bone graft was assigned for negative control group. At 10, 35 days, rats were serially sacrificed via intracardiac perfusion with 2.5% glutaraldehyde and specimens were processed with Hematoxylin-Eosin stain for light microscopic evaluation. The results of this study were as follows: 1. The defect areas were filled with dense connective tissues at 10 days in control group. But in the test(NC, HA/CS) groups, the connective tissues around graft materials were formed more loosely and the response of inflammation by graft materials itself was not found. 2. The defect areas were filled with new osteoid tissues and new cementum was not formed on the cut root surface at 35 days in the control group. 3. New osteoid tissue formation was more prominent at 35 days in control than test groups. 4. The NC and HA/CS particles were encapsulated by loose connective tissues at 10 days and by dense connective tissues at 35 days, respectively. 5. In the test groups, resorption of graft particles was not found through the experimental time. From the above results, natural coral and hydroxyapatite/calcium sulfate hemihydrate may be biocompatible and osteoconductive and have a weak adverse reaction to the periodontal tissues.
Anesthesia, General ; Animals ; Anthozoa ; Connective Tissue ; Dental Cementum ; Glutaral ; Humans ; Inflammation ; Male ; Mandible ; Molar ; Perfusion ; Periodontal Ligament ; Rats* ; Transplants* ; Wound Healing

BACKGROUND: Weight loss through low-calorie diets (LCDs) decreases visceral fat (VF). However, the effects on muscle mass, changes of dietary quality, and insulin sensitivity are unknown for Korean obese type 2 diabetic subjects. Therefore, this study examined such effects of LCDs. METHODS: A total of 30 obese type 2 diabetic subjects (body mass index, 27.0 +/- 2.2 kg/m2) were randomly assigned to an LCD or control group. Subjects on LCDs took 500~1,000 kcal fewer energy than their usual dietary intake (1,000~1,500 kcal/day) over the course of 12 weeks. The abdominal VF and femoral muscle mass were evaluated by computed tomography, and insulin sensitivity was assessed using an insulin tolerance test (Kitt; rate constant for plasma glucose disappearance, %/min). Dietary nutrient intake consumed by subjects was assessed by 3-day food records. RESULTS: The percent VF reduction was -23.4 +/- 17.2% in the LCD group and -9.8 +/- 11.8% in the control group after 12 weeks (P < 0.001, P = 0.002). However, significant decrease in femoral mass or proportional change of marcronutrient intake and mean adequacy ratio were not found in the LCD group, as compared to the control group. Insulin sensitivity improved in the LCD group, as compared to the control group (P = 0.040). CONCLUSION: LCD effectively improved insulin sensitivity and reduced abdominal VF without reduction of femoral muscle and dietary quality in obese type 2 diabetic subjects.
Caloric Restriction ; Diabetes Mellitus, Type 2 ; Glucose ; Insulin ; Insulin Resistance ; Intra-Abdominal Fat ; Muscles ; Plasma ; Weight Loss

BACKGROUND: Combination fitness regimens (including aerobic and resistance exercises) are effective for improving cardio-respiratory fitness, reducing visceral fat and increasing insulin sensitivity in diabetic patients. The combination exercise intensity that a patient is capable of is limited by his or her aerobic capacity and one repetition maximum (1RM). We investigated the relationships between 1RM, aerobic exercise capacity and body mass index in patients with type 2 diabetes. METHODS: A total of 177 (men: 85, women: 92) diabetic subjects with HbA1c < or = 10% were enrolled. Muscle strength and 1RM were assessed bychest press (upper body) and leg press (lower body). We assessed aerobic capacity by VO2max and muscle mass by bioimpedance analysis. RESULTS: There was no correlation between 1RM and VO2max in type 2 diabetic patients (upper: P = 0.122, lower: P = 0.138 for men, and upper: P = 0.952, lower: P = 0.570 for women). However, 1RM was significantly correlated with muscle mass both in men and women (upper: r = 0.493, P < 0.001, r = 0.315, P = 0.002 lower: r = 0.437 P < 0.001, r = 0.307, P =0.003, respectively). There was also a significant correlation between 1RM and BMI. In obese male subjects with BMI > or = 25 kg/m2, we observed a significant correlation between muscle mass and BMI (r = 0.374, P = 0.032), but this correlation was not observed in women. CONCLUSION: Clinicians treating Korean type 2 diabetic subjects should recommend resistance exercise to their patients. In particular, obese women with diabetes may receive greater benefits by increasing muscle mass through resistance exercises.
Body Mass Index ; Diabetes Mellitus ; Exercise ; Female ; Humans ; Insulin Resistance ; Intra-Abdominal Fat ; Leg ; Male ; Muscle Strength ; Muscles ; Resistance Training

BACKGROUND: Our goal was to investigate the effects of low intensity resistance training on body fat, muscle mass and strength, cardiovascular fitness, and insulin sensitivity in type 2 diabetes. METHODS: Twenty-eight overweight women with type 2 diabetes were randomly assigned to a resistance training group (RG, n = 13) or a control group (CG, n = 15). RG performed resistance training using elastic bands, of which strength was equal to 40 to 50% of one repetition maximum (1RM), for three days per week. Each exercise consisted of three sets for 60 minutes. We assessed abdominal fat using computed tomography, muscle mass using dual-energy X-ray absorptiometry, and muscle strength using Keiser's chest and leg press. Insulin sensitivity was measured using the insulin tolerance test, and aerobic capacity was expressed as oxygen uptake at the anaerobic threshold (AT-VO2) before and after the 12-week exercise program. RESULTS: The age of participants was 56.4 +/- 7.1 years, duration of diabetes was 5.9 +/- 5.5 years, and BMI was 27.4 +/- 2.5 kg/m2, without significant differences between two groups. During intervention, a greater increase in muscle mass and greater decreases in both total fat mass and abdominal fat were observed in RG compared to those of CG (P = 0.015, P = 0.011, P = 0.010, respectively). Increase in 1RM of upper and lower extremities was observed in the RG (P = 0.004, P = 0.040, respectively), without changes in AT-VO2 and insulin resistance in either group. CONCLUSION: In conclusion, the low intensity resistance training was effective in increasing muscle mass and strength and reducing total fat mass without change of insulin sensitivity in type 2 diabetic patients.
Abdominal Fat ; Absorptiometry, Photon ; Adipose Tissue ; Anaerobic Threshold ; Diabetes Mellitus, Type 2 ; Female ; Humans ; Insulin ; Insulin Resistance ; Leg ; Lower Extremity ; Muscle Strength ; Muscles ; Overweight ; Oxygen ; Resistance Training ; Thorax

Percutaneous mitral ballon valvuloplasty(PMV) is an effective nonsurgical procedure for patients with mitral stenosis. PMV was performed in 13 patients(mean age, 41 years) with mitral stenosis. All patients underwent echophonocardiography(Echophono) before and after PMV. Two dilatation balloons were used in which the diameters approximately equaled the mitral valve annulus diameter as determined. After PMV, the mean mitral valve pressure gradient decreased(22.3+/-1.89mmHg to 5.2+/-2.6mmHg), the mean left atrial pressure decreased(21.3+/-5.1mmHg to 9.0+/-4.5mmHg) and the mitral valve area increased from 0.8+/-0.3cm2 to 1.7+/-0.6cm2. The Echophono data are correlated with clinical and hemodynamic changes produced by PMV. PMV resulted in echophono changes consistent with decresed severity of mitral stenosis ; shortening of Q-S1, from 88+/-14 to 73+/-11 mses(p<0.01) and (Q-S1)-(S2-OS), from 0.9+/-1.7 to -2.1+/-1.6(p<0.001) ; prolongation of S2-OS from 80+/-15 to 103+/-14 msec(p<0.001) and increase of EF slope from 14.7+/-5.4 to 26.7+/-8.1 mm/sec(p<0.001). Compared with pre-PMV, post-PMV Echophono showed significant decrease in the severity of mitral stenosis. Thus Echophono is a simple, low cost method helpful in evaluation and follow-up patients undergoing PMV.
Atrial Pressure ; Balloon Valvuloplasty ; Dilatation ; Follow-Up Studies ; Hemodynamics ; Humans ; Mitral Valve ; Mitral Valve Stenosis