BACKGROUND: The purpose of this study was to investigate the characteristics of and to analyze the factors re-lated to the cost of the resolution of a medical dispute. METHODS: We have reviewed 2,346 cases reported to the Korean Medical Association(KMA)mutual-aid association from Nov. 1. 1981 to Oct. 31. 1994. RESULTS: The percentage rate of reported cases of were related field as follows .' obstetric gynecology(OBGYN) 31.9%, general practitice 28.1%, general surgery 13.3%, orthopedics 6.9% and internal medicine 6.4% 1,829 cases (80.0%) were settled out of court and without public intervention. 310 cases(13.2%) were settled by the police, the public procurators office or the court. The mean settlement amount per case was 9,340,000 won with annual growth rate 10.8%, and median settlement amount was 5,890,000 won. The mean settlement amount for OBGYN was 930,000 won, surgical group 8,900,000 won, medical group 7,710,000 won, and general practitice 7,490,000 won. The cases of medical dispute according to the types of medical care were : operation 21.1%, injection 18.0%, treat-ment and care 18.0%, delivery 13.0%, artificial abortion 10.3%, Cesarian section 7.2% and anesthesia 2.5%. The mean settlement amount according to the types of medical care were: delivery and Cesarian section 15,190,000 won, operation and anesthesia 9,500,000 won, others 6,610,000 won, and injection and medication 6,230,000 won. The mean settlement amount that was settled out of court without public intervention was 7,940,000 won. The mean settlement with public intervention in the court was 17,290,000 won. The cases of medical dispute according to the patients status were .' death 37.5%, complications 20.8%, disability 12.2% and others 28.9%. The mean settlement amout for death was 16,150,000 won, disability 9,430,000 won, others 4,850,000 won and complications 3,550,000 won. The mean settlement amount where doctors have asserted that the outcome was inevitable or have not agreed that it was their fault was higher than the cost of cases where they had admitted responsibility. The settlement amout where there was a misdiagnosis present had not shown to be higher than when the misdiagnosis was absent. The mean settlement amount for cases where multiple doctors were involved was higher than for cases of a single doctor. The mean settlement amount for disturbing the medical practice and suspension of are high. The mean settlement amount for complications was lower than others, and the mean settlement amount for disability and death presented were high. Concerning the types of care, the mean settlement amount for operation/anesthesia, delivery/ Cesarian sections were higher than for injection/medication. Concerning the type of settlement, the mean settlement amount in the police and public procurators office was higher than in out of court without public intervention. CONCLUSIONS: The mean settlement amount depended on the patient's status, the type of settlement, and the disturbance of medical practice regardless of the doctors misdiagnosis, fault, and standard care. Therefore, a reason-able method of resolution for medical dispute is needed.
Anesthesia ; Diagnostic Errors ; Dissent and Disputes ; Humans ; Internal Medicine ; Malpractice* ; Orthopedics ; Police

Radiation myelitis is a rather rare, but irreversible fatal complication, Etiology, pathologic change, clinical symptoms and the method of diagnosis have been studies, pathogenesis of post-irradiation myelitis and the level of tolerance dose still remain controversial. Thoracolumbar spine of 110 hybrid mice were irradiated with orthovoltage x-ray machine. Mild capillary congestion and axonal welling were observed in 1,000rad irradiated specimens were also observed. These results suggest that 5,000 rad is not a completely safe tolerable dose which have been accepted and we cannot exclude direct radiation damage to nerve tissue as the causative pathology of radiation myelitis in addition to blood vessel damage.
Animals ; Axons ; Blood Vessels ; Capillaries ; Diagnosis ; Estrogens, Conjugated (USP) ; Mice* ; Myelitis ; Nerve Tissue ; Pathology ; Spinal Cord* ; Spine

Ultrasonographic findings in 34 cases of primary hepatoma, and 18 cases of secondary hepatoma, which had been proved histopathologically or suspected clinically and ultrasonographically, were reviewed. The results were summarized as follows. 1. Among 52 cases, 40 cases were male and 12 cases were female. The male predominent than the female with the ratio of 4:1. In 52 cases, 40 cases (77%) of the patients were between 41 years and 60 years.2. The most common ultrasonographic finding of hepatoma was discrete homogeneous hyperechoic mass. 3. Primaryhepatomas were usually solitary and relatively large, while secondary hepatomas were usually multiple andrelatively small. 4. Hepatitis, liver cirrhsis, and clonorchiasis were more common in primary hepatomas than secondary hepatomas.
Carcinoma, Hepatocellular ; Clonorchiasis ; Female ; Hepatitis ; Humans ; Liver ; Male

BACKGROUND: To assess the efficacy and safety of perindopril, a new angiotensin-converting enzyme(ACE) inhibitor, perindopril was compaired to nifedipine LP. METHODS: Perindopril(4mg q.d.) was compaired to nifedipine LP(20mg b.i.d.) in the double blind, parallel-group study involving total of 41 hypertensive patients with diatolic blood pressure(DBP) of 95-125mmHg. A 4-week single-blind placebo period preceeded 12 weeks of active tratment. Dose titration was at weeks 4 and 8 if the DBP was >90mmHg. The dose was doubled and, if necessary, a diuretic(hydrochlorthiazide 25mg) was added. The analysis of efficacy was performed on the 36 patients who completed the trial after 12 weeks; active treatment. The analysis of tolerance involved all 41 patients who entered the study. RESULTS: 1) The two groups were homogeneous prior to treatment. 2) The fall in blood pressure(BP) with perindopril was 22/11mmHg(from 160+/-14/101+/-6mmHg to 139+/-15/90+/-6mmHg) and 32/19mmHg(from 164+/-18/104+/-7 to 132+/-17/85+/-10mmHg) for nifedipine. 3) 65% of the perindopril group and 84% of the nifedipine group achived the target BP(diastolic BP< or =90mmHg). 4) The respone rate(DBP< or =90mmHg or the fall in DBP> or =10mmHg) was similar between two groups(88% cersus 89%). 5) Heart rate was not changed in the perindopril group. but increased in the nifedipine group. 6) Five patients withdrew from the study ; two were attributed to adverse events. one in the perindopril group and one in the nifedipine group. 7) The incidence of side effects in the perindopil group was less than that in the nifedipine group. Cough was reported by 10% of patients of the perindopril group. 8) Both groups did not induce changes in blood glucose and lipid profiles. 9) We could not find any significant relationship between the amount of blood pressure decline and 24 hour urine sodium excretion. 10) There were no clinically significant changes in laboratory parameters. CONCLUSION: Perindopril reduced blood pressure to slightly less extent than nifedipine, but had as similar efficacy as nifedipine. Perindopril had less side effects than nifedipine.
Blood Glucose ; Blood Pressure ; Cough ; Heart Rate ; Humans ; Incidence ; Nifedipine* ; Perindopril* ; Sodium

Talus tuberculosis is a rare disease, even in an endemic tuberculosis area. In reviews of the worldwide literature, only 18 cases of talus tuberculosis have been reported. Recently, we experienced a case of a 70-year-old polycythemia vera patient with right metatarsopharyngeal joint pain for 2 months duration who was diagnosed with talus tuberculosis with prostate involvement. Tuberculosis should be considered as one of the causes of monoarticulitis, especially in countries, where the disease is endemic. Additionally, we highly recommend taking a biopsy of the site of suspected infection because an early diagnosis is the key to successful treatment.
Aged ; Arthralgia ; Biopsy ; Early Diagnosis ; Humans ; Osteomyelitis ; Polycythemia ; Polycythemia Vera ; Prostate ; Rare Diseases ; Talus ; Tarsal Bones ; Tuberculosis

Two-dimensional echocardiography is a simple, noninvasive method of evaluating cardiac strucures and pericardiac structures. The diagnosis of pericarial cyst is strongly suggested by the prominent roentgenographic appearance of a round, sharply demarcated mass along the right cardiac silhouette in an asymptomatic patient. Two-dimensional echocardiography is also useful method for diagnosing pericardial cyst, but differential diagnosis is difficult when other mass revealed echo-lucent cystic nature is located adjacent to the right atrial wall. We report the similar two-dimensional echcardiography findings located adjacent to the right atrial wall which are diagnosed different disease entity each oter. We suggest that two-dimensional echocardiography helps diagnosis of mass adjacent to the right atrial wall and may need more extensive investigation for accurate differential diagnosis.
Diagnosis ; Diagnosis, Differential ; Echocardiography ; Heart Atria ; Humans ; Mediastinal Cyst ; Methods

PURPOSE: Recently allergic diseases have gradually increased in schools and among preschool aged childhood. Pollen amount of weeds also, especially ragweed, were increased. We evaluated the increased pollen count of weed was associated with the sensitization rate to weed in childhood. METHODS: Airborne particles carrying allergens were collected daily from eight stations nationwide(Seoul, Guri, Cheongju, Daegu, Kwangju, Busan, Kangneung, and Jeju) by using 7 days-Burkard sampler(Burkard Manufacturing Co Ltd, Hertfordshire, UK), for 7 years in South Korea(July 1, 1997-June 30, 2004). They were counted and recorded along with the weather. Data was collected through pediatric patients with allergic symptoms, who visit the pediatrics allergy clinics and capable of allerfy skin test among hospitals that have pollen collecting centers. RESULTS: Airborne pollen has two peak seasons:May and September in Korea. There were the tree pollen seasons from the middle of February to late July, then followed the grasses and weed season from the middle of July to the end of October. Ragweed was one of the most common pollens of autumn in Korea. In skin prick tests, Mugwort was the highest sensitization rate(7.6 percent), followed by ragweed(7.1 percent), birch(6.1 percent), alder, grasses mix among the pollen extracts in Korean school aged children. Ragweed pollen counts have gradually increased since 2000. In the same period, sensitization rates for airborne pollen, especially weeds, in Korean children have increased annually(1999:4.4 percent, 2000:7.1 percent, 2001:7.4 percent, 2002:8.5 percent, 2003:7.7 percent). CONCLUSION: Sensitization rates for outdoor airborne pollens have increased in Korean children. These findings might result from the changes of life styles and living environments in Korea.
Allergens ; Alnus ; Ambrosia ; Artemisia ; Busan ; Child* ; Chungcheongbuk-do ; Daegu ; Gangwon-do ; Gwangju ; Humans ; Hypersensitivity ; Korea* ; Life Style ; Pediatrics ; Poaceae ; Pollen* ; Seasons ; Skin ; Skin Tests ; Weather

Background The clinical significance of complete revascularization for ST segment elevation myocardial infarction (STEMI) pa-tients during admission is still debatable. Methods A total of 1406 STEMI patients from the Korean Myocardial Infarction Registry with multivessel diseases without cardiogenic shock who underwent primary percutaneous coronary intervention (PPCI) were analyzed. We used propensity score matching (PSM) to control differences of baseline characteristics between culprit only intervention (CP) and multivessel percutaneous coronary interventions (MP), and between double vessel disease (DVD) and triple vessel disease (TVD). The major adverse cardiac event (MACE) was analyzed for one year after discharge. Results TVD patients showed higher incidence of MACE (14.2%vs. 8.6%, P=0.01), any cause of revascularization (10.6%vs. 5.9%, P=0.01), and repeated PCI (9.5%vs. 5.7%, P=0.02), as compared to DVD patients during one year after discharge. MP reduced MACE effectively (7.3%vs. 13.8%, P=0.03), as compared to CP for one year, but all cause of death (1.6%vs. 3.2%, P=0.38), MI (0.4%vs. 0.8%, P=1.00), and any cause of revascularization (5.3%vs. 9.7%, P=0.09) were comparable in the two treatment groups. Conclusions STEMI patients with TVD showed higher rate of MACE, as compared to DVD. MP performed during PPCI or ad hoc during admission for STEMI patients without cardiogenic shock showed lower rate of MACE in this large scaled database. Therefore, MP could be considered as an effective treatment option for STEMI patients without cardiogenic shock.

OBJECTIVE: Atopic dermatitis is a chronically relapsing inflammatory skin disease. However, little is known about the prevalence of atopic dermatitis outside of North America and Europe. We evaluated the nationwide prevalence of atopic dermatitis with the comparison of prevalence between 1995 and 2000, and between Seoul and provincial cities in Korea. We also evaluated the risk factors for atopic dermatitis. METHODS: A cross-sectional ISAAC based questionnaire survey was conducted on random samples of schoolchildren (6 to 15 year olds) in 1995 and 2000. And kindergarten children (5 year olds) were surveyed in 2003, throughout South Korea. RESULTS: The lifetime and last twelve months prevalence of atopic dermatitis in Korean school-aged children was increased from 1995 to 2000. The twelve-month prevalence of atopic dermatitis was higher in Seoul than in other provincial cities in 1995, but the prevalence of atopic dermatitis in Seoul and Provincial Centers became similar in 2000. CONCLUSION: The prevalence of atopic dermatitis in Korean school-aged children was increased from 1995 to 2000. The further evaluations that include objective examination are necessary to confirm these outcomes because the environmental and risk factors may be different among the countries according to their life styles.
Child* ; Dermatitis, Atopic* ; Epidemiology ; Europe ; Humans ; Korea* ; Life Style ; North America ; Prevalence ; Surveys and Questionnaires ; Risk Factors ; Seoul ; Skin Diseases

Background: It is well known that a large number of patients with diabetes also have dyslipidemia, which significantly increases the risk of cardiovascular disease (CVD). This study aimed to evaluate the efficacy and safety of combination drugs consisting of metformin and atorvastatin, widely used as therapeutic agents for diabetes and dyslipidemia. Methods: This randomized, double-blind, placebo-controlled, parallel-group and phase III multicenter study included adults with glycosylated hemoglobin (HbA1c) levels >7.0% and <10.0%, low-density lipoprotein cholesterol (LDL-C) >100 and <250 mg/dL. One hundred eighty-five eligible subjects were randomized to the combination group (metformin+atorvastatin), metformin group (metformin+atorvastatin placebo), and atorvastatin group (atorvastatin+metformin placebo). The primary efficacy endpoints were the percent changes in HbA1c and LDL-C levels from baseline at the end of the treatment. Results: After 16 weeks of treatment compared to baseline, HbA1c showed a significant difference of 0.94% compared to the atorvastatin group in the combination group (0.35% vs. −0.58%, respectively; P<0.0001), whereas the proportion of patients with increased HbA1c was also 62% and 15%, respectively, showing a significant difference (P<0.001). The combination group also showed a significant decrease in LDL-C levels compared to the metformin group (−55.20% vs. −7.69%, P<0.001) without previously unknown adverse drug events. Conclusion The addition of atorvastatin to metformin improved HbA1c and LDL-C levels to a significant extent compared to metformin or atorvastatin alone in diabetes and dyslipidemia patients. This study also suggested metformin’s preventive effect on the glucose-elevating potential of atorvastatin in patients with type 2 diabetes mellitus and dyslipidemia, insufficiently controlled with exercise and diet. Metformin and atorvastatin combination might be an effective treatment in reducing the CVD risk in patients with both diabetes and dyslipidemia because of its lowering effect on LDL-C and glucose.