Laparoscopic cholecystectomy was introduced into Korea in 1990 and has been rapidly replacing open cholecystectomy when the indications were met. In this study a medical utilization and technology was assessed on the selected hospitalized patients with cholelithiasis who underwent open or laparoscopic cholecystectomy from April 1, 1991 to March 31, 1994. The results are as follows. Despite the low reimbursement rate by the health insurance, the number of laparoscopic cases have been steadily increased. The post-operative days before health insurance coverage were significantly shortened from 8.4 days to 4.6 days. The preoperative days before health insurance coverage were significantly shorted from 8.4 days to 4.0 days. The total length-of-stays in the hospital were also significantly shortened from 15.2 days to 10.7 and 9.8 days in laparoscopic cholecystectomy. The laparoscopic cholecystectomy showed low expenses in all aspects expect the average hospital charges per day. For the hospital to have cost containment, it is more effective if length-of-stay is shorter because of high daily inpatient hospital charge. The laparoscopic cholecystectomy also showed shortened anesthesia time and operation time compared with open cholecystectomy that were statistically significant. The mean anesthesia and operation time for open cholecystectomy were 113.2 and 90.2 minutes but those of laparoscopic cholecystectomy were 105.7 and 68.6 minutes. According to this study the laparoscopic cholecystectomy has reduced the medical expenditure and we recommend this procedure over open cholecystectomy. The further discussion on the different morbidity rate between two types of procedure is essential in providing quality medical care, and to educate specialist.
Anesthesia ; Cholecystectomy* ; Cholecystectomy, Laparoscopic* ; Cholelithiasis ; Cost Control ; Health Expenditures ; Hospital Charges ; Humans ; Inpatients ; Insurance, Health ; Korea ; Specialization

No abstract available.

No abstract available.
Female ; Fetal Blood* ; Humans ; Hypertension, Pregnancy-Induced* ; Infant, Newborn* ; Mothers* ; Pregnancy ; Pregnancy*

Sodium nitroprusside given by intravenous drip has been used to control hypertensive crises since 1929. Its evanescent action makes it suitable for controlled hypotension during general anesthesia with enflurane. The patients (n=10) were all undergoing Cotrel-Dubousset instrumentation for the operative treatment of scoliosis or spinal stenosis. Hemodynamic variables were obtained during administration of sodium nitroprusside. Mean arterial pressure was decreased to 50-60mmHg, while cardiac output, central venous pressure, systemic vascular resistance showed only minor changes. The average dosage of sodium nitroprusside (ug/kg/ min), plotted against age, showed a significant correlation (p<0.05, r= -0.63). The amonut of whole blood transfused during operation was 5.7+/-2.2 units (mean+/-SD) and postoperative hemoglobin and hematocrit (11.19+/-1.21g/dl, 33.49+/-3.79%, respectively, mean+/-SD) were singificantly lowered than preoperative hemoglobin and hematocrit (12.94+/-1.78g/dl, 37.22+/-4.88%, respectively, mean+/-SD) (hemoglobin: p<0.004, hematoorit: p<0.006).
Anesthesia, General* ; Arterial Pressure ; Cardiac Output ; Cardiovascular System* ; Central Venous Pressure ; Enflurane* ; Hematocrit ; Hemodynamics ; Humans ; Hypotension* ; Hypotension, Controlled ; Infusions, Intravenous ; Nitroprusside* ; Scoliosis ; Sodium* ; Spinal Stenosis ; Vascular Resistance

The purpose of this paper is to develop an efficient method for the quick determination of multiple isocenters plans to provide optimal dose distribution in stereotactic radiosurgery. A Spherical dose model was developed through the use of fit to the exact dose data calculated in a 18cm diameter of spherical head phantom. It computes dose quickly for each spherical part and is useful to estimate dose distribution for multiple isocenter. An automatic computer search algorithm was developed using the relationship between the isocenter move and the change of dose shape, and adapted with a spherical dose model to determine isocenter separation and collimator sizes quickly and automatically. A spherical dose model shows a comparable isodose distribution with exact dose data and permits rapid calculation of 3-D isodoses. The computer search can provide reasonable isocenter settings more quickly than trial and error types of plans, while producing steep dose gradient around target boundary. A spherical dose model can be used for the quick determination of the multiple isocenter plans with a computer automatic search. Our guideline is useful to determine the initial multiple isocenter plans.
Head ; Radiosurgery*

PURPOSE: In medulloblastoma, craniospinal radiation therapy combined with chemotherapy improves the prognosis of tumors but results in significant endocrine morbidities. We studied the endocrine morbidity, especially growth pattern changes. METHODS: The medical records of 37 patients with medulloblastoma were reviewed retrospectively for evaluation of endocrine function and growth. We performed the growth hormone stimulation test in 16 patients whose growth velocity was lower than 4 cm/yr. RESULTS: The height loss was progressive in most patients. The height standard deviation score (SDS) decreased from -0.1+/-1.3 initially to -0.6+/-1.0 after 1 year(P<0.01). Growth hormone deficiency(GHD) developed in 14 patients. During the 2 years of growth hormone(GH) treatment, the improvements of height gain or progressions of height loss were not observed. Twelve patients(32.4 percent) revealed primary hypothyroidism. One of six patients diagnosed with compensated hypothyroidism progressed to primary hypothyroidism. Primary and hypergonadotropic hypogonadism were observed in two and one patients respectively. There was no proven case of central adrenal insufficiency. CONCLUSION: Growth impairment developed frequently, irrespective of the presence of GHD in childhood survivors of medulloblastoma. GH treatment may prevent further loss of height. The impairment of the hypothalamic-pituitary-gonadal and hypothalamic-pituitary-thyroidal axis is less common, while central adrenal insufficiency was not observed.
Adrenal Insufficiency ; Axis, Cervical Vertebra ; Child* ; Drug Therapy ; Growth Hormone ; Humans ; Hypogonadism ; Hypothyroidism ; Medical Records ; Medulloblastoma* ; Prognosis ; Retrospective Studies ; Survivors

Primary epiploic appendagitis (PEA) occurs due to inflammation of an epiploic appendage, which is a peritoneal pouch that arises from the serosal surface of the colon. PEA is often associated with infarction caused by torsion or spontaneous venous thrombosis. PEA is a self-limited disease with a course of approximately 10 days, and it requires only symptomatic management for pain. But it clinically manifests with localized abdominal pain that is often mistaken for appendicitis, diverticulitis, or cholangitis. Therefore, PEA had been diagnosed at surgery for the past few decades. Making the preoperative diagnosis of PEA through ultrasound and computed tomography (CT) has recently become possible. We report here on four cases of PEA that were diagnosed and treated by symptomatic management.
Abdomen, Acute ; Abdominal Pain ; Appendicitis ; Cholangitis ; Colon ; Colonic Diseases ; Diverticulitis ; Infarction ; Inflammation ; Peas ; Venous Thrombosis

BACKGROUND & OBJECTIVES: A growing body of research has documented that occupational stress is closely associated with increased risk of fatigue. This study was conducted in an effort to assess the relationship of occupational stress to self-perceived fatigue among Korean white collar employees. METHODS: Data were obtained from the National Study for Development and Standardization of Occupational Stress (NSDSOS Project, 2002-2004). Among them, a total of 4,502 white collar employees were recruited. A structured questionnaire was employed to evaluate the participants' sociodemographics, job-related factors, health-related behaviors, occupational stress, and self-perceived fatigue. Occupational stress and self-perceived fatigue were assessed using the Korean Occupational Stress Scale-Short form (KOSS-SF) and the Multidimensional Fatigue Scale (MFS), respectively. RESULTS: In logistic regression analyses, occupational stress was associated with an increased risk of fatigue, and some domains of occupational stress had different effects on fatigue by gender (job demand, job insecurity, and lack of reward for men, job demand, lack of reward, and discomfort in occupational climate for women), which indicates that occupational stress may perform a slightly different role in increasing the risk of fatigue by gender. CONCLUSION: The results of this study suggest that occupational stress is a determinant predictor of selfperceived fatigue. Thus, a stress management program for the reduction of occupational stress, and the promotion of white collar worker's health and quality of life is strongly recommended. Some limitations of this study and considerations for future studies were also discussed.
Climate ; Fatigue ; Humans ; Logistic Models ; Male ; Quality of Life ; Questionnaires ; Reward

To determine the validity of a repeat thyroid function test for preterm infants, and to investigate factors that influence thyroid function of preterm infants, thyroid functions of 105 infants born at <32 weeks' gestational age were evaluated. Initial serum free thyroxine (fT4) and thyrotropin (TSH) levels were measured during the first 10 days of life, and repeated tests were performed more than 2 weeks apart. We analyzed the effects of gestational age, systemic diseases, and nutrition on the development of thyroid dysfunction. Thirty-one infants (30%) had low fT4 levels (<0.7 ng/dL) in the absence of elevated TSH levels (<7 microU/mL). Thirteen infants (12%) had hypothyroidism (fT4 <0.7 ng/dL, TSH > or =10 microU/mL) and mean age at diagnosis was 28+/-17 days. Twelve infants had moderately elevated TSH (TSH 10-30 microU/mL) with normal fT4 levels after 1 week of postnatal life. The history of undergone surgical procedure which needed iodine containing disinfectants was significantly frequent in the infant with hypothyroidism and transient TSH elevation. Repeated thyroid function tests are necessary for preterm infants, even though they initially show normal thyroid function, and are especially important for infants who have been exposed to excessive or insufficient levels of iodine.
Female ; Gestational Age ; Humans ; Hypothyroidism/*diagnosis/epidemiology/metabolism ; Incidence ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases/*diagnosis/epidemiology/metabolism ; Pregnancy ; Thyroid Function Tests ; Thyrotropin/*blood ; Thyroxine/*blood

An important problem in radiosurgery is the utilization of the proper beam parameters, to which dose shape is sensitive. Streotactic radiosurgery techniques for a linear accelerator typically, use circular radiation fields with multiple arcs to produce an spherical radiation distribution. Target volumes are irregular in shape for a certain case, and spherical distributions can irradiate normal tissues to high dose as well as the target region. The current improvement to dose distribution utilizes treating multiple isocenters or weighting various arcs to change treatment volume shape. In this paper another premising study relies upon dynamically shaping the treatment beam to fit the beam's eye view of the target. This conformal irradiation technique was evaluated by means of visual three dimensional dose distribution, dose volume histograms to the target volume and surrounding normal brain. It is shown that using even less arcs than multiple isocenter irradiation technique, the conformal therapy yields comparable dose gradients and superior homogeneity of dose within the target volume.
Brain ; Particle Accelerators ; Radiosurgery*