No abstract available.
Delivery of Health Care* ; Health Care Reform* ; Korea*

This study seeks to provide a framework for understanding differential access to medical care. The framework is provided by Andersen Model, a model of health services utilization which suggests a sequence of predisposing, enabling, illness-morbidity characteristics that determine the number of times people will visit a physician. The framework in this study is composed of two models, one is for Adults and the other is for Non-Adults. Models are operationalized using stepwise multiple regression analysis and path analysis. The data come from a national health survey conducted in 1983. The findings of the analysis can be summarized as follows: First, the casual models used in this study are able to explain only a small amount of the variance in medical care utilization(Adjusted R2 is. 144 in the Model for Adults and .243 in that for Non-Adults). This finding suggests that we reconsider the utility of such existing model using the predisposing, enabling, and illness-morbidity characteristics in light of their poor correspondence with these data. Second, while small amount of the variance in medical care utilization is explained, most of the explained variance is due to the illness-morbidity characteristics. The path coefficients of study variables except illness-morbidity variables show these characteristics to be substantially unrelated to medical care utilization, and the indirect effects of the predisposing and enabling characteristics on medical care utilization are also negligible. This casts doubt on the importance of the predisposing and enabling characteristics in explaining medical care utilization. Third, among the predisposing and enabling characteristics, Medical Security variable is the only one having significant direct effect on medical care utilization in both models for Adults and for Non-Adults. Fourth, the amount of the variance explained in the Model for Non-Adults is more than in the Model for Adults. This suggests that medical care utilization of adults is more influenced by behavioral factors than that of children.
Adult ; Child ; Health Services ; Health Surveys ; Humans

HIV-1 tat, a strong transactivator, is essential for the HIV-1 replication and AIDS progression. The Tat function is markedly inhibited by human anti-oncogene p53. This work was initiated to identify the p53-associated inhibitory mechanism on tat-mediated transactivation. Inhibitory function of P53 was confirmed by co-transfection of tat-expressing Jurkat cells with LTR-CAT plasmid, or H3Tl cells (LTR-CAT integrated HeLa cells) with different ratio of pSV-tat/pCDNA-p53 plasmids. Results from the direct protein-protein .interaction between soluble p53 and tat, and yeast two-hybrid experiments showed that the co-suppression mechanism is unlikely to be due to the direct interaction. CAT activity was not affected by tat in Jurkat cells which were transfected with p53-promoter-CAT or p53-enhancer-CAT, suggesting that the tat-mediated p53 suppression is not directly associated with p53-promoter. Finally, we have tested protein kinase activity in p53-tranfected Jurkat cells, which might phosphorylate HIV-1 tat, resulting in inhibition of tat function. Some of our data lead us to assume that the p53-mediated tat inhibition is likely to be associated with p53-associated, signaling-mediated phosphorylation of tat, resulting in the dysfunction of tat. This study is now under investigation.
Animals ; Cats ; Genes, Tumor Suppressor ; HIV-1* ; Humans ; Jurkat Cells ; Phosphorylation ; Plasmids ; Protein Kinases ; RNA Interference ; Trans-Activators ; Transcriptional Activation ; Yeasts

Sixty one cases of gastric adenocarcinoma were studied immunohistochemically for expression of HLA-DR and secretory component(SC) in order to analyze the relationship between expression of these in gastric cancer cells and the adjacent mucosa. Immunostaining was detected within the cytoplasm and on the cell memgrane. The rate of HLA-DR and SC expressions in cancer cells were 59.0% and 49.2%, respectively, and 52.5%/52.5% and 31.2%/50.8% the mucosa in adjacent/remote from the site of to cancer. The SC expression in the adjacent mucosa was lower than that of the remote mucosa(p=0.027). The HLA-DR expression in the cancer cells in the intestinal type of gastric adenocarcinoma(73.9%) was higher than that of the diffuse type(14.3%) and it was statistically significant(p=0.02). The presence of an increased amount of lymphoid infiltration in the gastric mucosa was closely related to the expression of HLA-DR and SC. Decreased or absent expression of SC at the transitional mucosal cells was possibly a result of exposure to genotoxic agents due to the lack of protective function of SC-IgA. From these results, one can postulate that the expression of HLA-DR and SC may play an important role in atleration in microenvironment with lymphoid infiltration.
Adenocarcinoma ; Stomach Neoplasms

Partial knee ankylosis is a recognized complication of following open operative procedure, trauma and disease processes about the knee. Intraarticular trauma or surgical procedures such as TKR, synovectomy or patellar fracture were main source of intraarticular or extraarticular soft tissue adhesion and contracture were resulted from distal femoral and proximal tibial fractures. The purpose of this study is to report the value of arthroscopic adhesiolysis of partial knee ankylosis and to evaluate the clinical results of its application in various conditions. From October 1982 to December 1992, 56 cases in 54 patients who had severe limitation of motion in the knee joint following open operative procedure or trauma about the knee were treated by fibroarthrolysis under the arthroscopic control. For release of thick fibrous tissue, we used our designed blunt metal bar. The following results were obtained. There were 30 males and 24 females and the age at the time of release ranged from 20 to 69 years old(average 38.7 years old). The interval between last open operative procedure or trauma and arthroscopic adhesiolysis ranged from 3 months to 6 years(average 16 months). The interval between arthroscopic adhesionlyssis and the last follow up evaluation ranged from 1 year to 9 years(average 49 months), The average preoperative range of knee motion was 42.2 and the postoperative range of motion under the anesthesia was 115.5 and the average final knee range of motion at follow up was 101.3. So the average loss of motion between postoperative and final motion was 14.2. Complications were one case of patellar and tibial condylar fracture respectively. In the author's experience, arthroscopic adhesiolysis seems to be applied to the various condition of the partial knee ankylosis and the results are better than the other surgical procedures when it was performed early enough16).
Anesthesia ; Ankylosis ; Contracture ; Female ; Follow-Up Studies ; Humans ; Knee Joint ; Knee ; Male ; Range of Motion, Articular ; Surgical Procedures, Operative ; Tibial Fractures ; Tissue Adhesions

OBJECTIVE: Flow cytometric deoxyribonucleic acid (DNA) content analysis has been shown to be of prognostic importance in some cancers. In this study, DNA patterns obtained by flow cytometry in patients with cervical cancer have been shown to be related to a prognostic importance in cervical carcinoma. METHODS AND MATERIALS: We retrospectively reviewed 59 cervical cancer patients who admitted to the department of obstetrics and gynecology, Samsung Medical Center firom January 1995 to May 1997. RESULTS: A total of 59 archival paraffin-embedded blocks were proc 42.4 percent were found to be DNA content aneuploid (DNA-A) and 57.6 percent DNA content diploid (DNA-D). The S-phase fraction was significantly increased with stage. The incidences of aneuploid and relative DNA index were not significantly increased with the stage(P=0.280) and age of patients(P=0.088). The results had no significant differences between the squamous cell carcinoma and adenocarcinoma, and no relationship between the groups with keratinizing cell type and nonkeratinizing type(P=0.409). The DNA ploidy patterns were not significantly correlated with metastasis to lymph node(P=0.179), tumor size(P=0.109), invasion depth(P=0.361) and recurrent group(P=0.285). High S-phase fraction had a tendency to correlate with the invasion depth(P=0,011), size(P=0.027), lymph node metastasis(P=0.039) and recurence(P=0.099) of cervical cancer. CONCLUSION: Flow cytometric DNA content analysis is being used more frequently in the management of different malignant tumors. Our study shows that DNA content analysis may not serve as an important biological indicator in determining the prognosis in cervical carcinoma, but High S-phase fraction has been connected with more aggressive tumors.
Adenocarcinoma ; Aneuploidy ; Carcinoma, Squamous Cell ; Cervix Uteri* ; Diploidy ; DNA* ; Female ; Flow Cytometry ; Gynecology ; Humans ; Incidence ; Lymph Nodes ; Neoplasm Metastasis ; Obstetrics ; Ploidies ; Prognosis ; Retrospective Studies ; Uterine Cervical Neoplasms

Choriocarcinoma associated with a normal pregnancy is rare. Futhermore, choriocarcinoma coexistent with a viable pregnancy is even rarer and associated with a greater risk of hepatic and cerebral involvement. So timely diagnosis of the disease is important for successful treatment and aggressive diagnostic procedures may therefore warranted. The patient should be treated with primary intensive combination chemotherapy(EMA-CO) and the selective use of irradiation and surgical therapy. We experienced a case of metastatic choriocarcinoma of lung and kidney following preterm delivery at 34th week of pregnancy and so present it with brief review of literature.
Choriocarcinoma* ; Diagnosis ; Female ; Humans ; Kidney ; Lung ; Pregnancy ; Pregnancy*

No abstract available.
Stents

PURPOSE: Classically air in the portal vein has been detected on plain radiography, but computed tomography and ultrasonography have been shown to be more sensitive. We report a case of air in the PV in a 10-day-old infant with pneumatosis intestinalis with its ultrasonographic and Doppler findings. MATERIAL AND METHODS: The patient was a 10-day-old infant born by cesarean section at 41 weeks. Simple abdomen film revealed branching pattern of radiolucent air shadows within the contour of liver, gas distention of bowel loops and thickenod bowel walls with lincar intraluminal air shadows in abdomcn, suggesting neerotizing enterocolitis. So we performed Doppler ultrasonography. RESULTS: Ultrasonography showed branching pattern of hyperechogenic dots along the lumen of left portal vein. The color Doppler study revcaled an aliasing duo to increased velocity and whirling pattern of blood flow, and the Duplex Doppler spectral display showed sharp, vertical bidirectional spikes by air in portal vein. CONCLUSION: Air in the portal voin can be easily diagnosed by the followign signs:hyperechogenic dots in the portal vein on ultrasonography and vertical, sharp bidirectional spikes superimposod on the usual Doppler tracing of the portal vein on Duplex ultrasonography.
Abdomen ; Cesarean Section ; Enterocolitis ; Female ; Humans ; Infant ; Liver ; Portal Vein* ; Pregnancy ; Radiography ; Ultrasonography ; Ultrasonography, Doppler

The antihypertensive efficacy and safety for once daily dosing of amlodipine, a new calcium channel blocker, was studied in a series of 36 patients with essential hypertension. The starting dose of amlodipine were 5mg/day, which were doubled after 4 weeks, if normalization of diastolic blood pressure was not reached. Amlodipine induced a clinically significant reduction in blood pressure(17.7mmHg in systolic blood pressure and 11.9mmHg in diastolic blood pressure) with similar heart rates after 12 weeks therapy. The efficacy of amlodipine therapy was noted an excellent in 18 patients(51.4%), good in 8 patients(22.9%), fair in 5 patients(14.3%), and failed in 4 patients(11.4%). There were few side reactions such as fatigue, headache, constipation and indigestion, but all studied patients completed for 12 weeks therapy except one patients who did not return. And also there was no abnormal results of laboratory tests before and after the amlodipine therapy. This results indicated that amlodipine is an effective and safe new long-acting calcium channel blocker in the treatment of hypertension.
Amlodipine* ; Blood Pressure ; Calcium Channels ; Constipation ; Dyspepsia ; Fatigue ; Headache ; Heart Rate ; Humans ; Hypertension*