OBJECTIVES: To estimate the annual socioeconomic costs of stroke in Korea in 2005 from a societal perspective. METHODS: We identified those 20 years or older who had at least one national health insurance (NHI) claims record with a primary or a secondary diagnosis of stroke (ICD-10 codes: I60-I69, G45) in 2005. Direct medical costs of the stroke were measured from the NHI claims records. Direct non-medical costs were estimated as transportation costs incurred when visiting the hospitals. Indirect costs were defined as patients' and caregivers' productivity loss associated with office visits or hospitalization. Also, the costs of productivity loss due to premature death from stroke were calculated. RESULTS: A total of 882,143 stroke patients were identified with prevalence for treatment of stroke at 2.44%. The total cost for the treatment of stroke in the nation was estimated to be 3,737 billion Korean won (KRW) which included direct costs at 1,130 billion KRW and indirect costs at 2,606 billion KRW. The per-capita cost of stroke was 3 million KRW for men and 2 million KRW for women. The total national spending for hemorrhagic and ischemic stroke was 1,323 billion KRW and 1,553 billion KRW, respectively, which together consisted of 77.0% of the total cost for stroke. Costs per patient for hemorrhagic and ischemic stroke were estimated at 6 million KRW and 2 million KRW, respectively. CONCLUSIONS: Stroke is a leading public health problem in Korea in terms of the economic burden. The indirect costs were identified as the largest component of the overall cost.
Adult ; Aged ; Aged, 80 and over ; Female ; *Health Care Costs ; *Health Expenditures ; Humans ; Insurance Claim Review ; Korea ; Male ; Middle Aged ; Prevalence ; Socioeconomic Factors ; Stroke/*economics ; Young Adult

Background: The kinetics of neutralizing antibodies against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) play an important role in evaluating vaccine efficacy and durability, herd immunity, additional vaccination, and prediction models of immune protection against coronavirus disease 2019. Materials and Methods: Serum collection times were 4 and 8 weeks after 1st inoculation of AZD1222 (AstraZeneca, Cambridge, UK), and 2 and 16 weeks after 2nd inoculation with 12-week dosing intervals. Neutralizing antibody (Nab) titers were measured indirectly using commercially available R-FIND SARS-CoV-2 Neutralizing Antibody ELISA Kit (SG Medical Inc., Seoul, Korea). Possible influences of gender, age, and adverse events on neutralizing antibody titer were also investigated. Results: Nab titers (median inhibition %) started to decrease shortly after reaching peaks.This decrease was more pronounced in the elderly group (≥56 years) than in the young group (≤39 years) at 8 weeks (49.5% vs. 55.4%, P = 0.021) and 16 weeks (40.6% vs. 53.9%, P = 0.006) after the 1st and 2nd inoculation. And Nab titers were inversely correlated with age in the 8-week (r = -0.2091, P = 0.0284) and the 28-week group (r = -0.2811, P = 0.0029). Seropositive conversion of Nab reached 89.1% and 100% following 1st and 2nd inoculation. This 100% seropositivity was dropped sharply to 74.5% after 16 weeks. Compared to subjects without adverse events (51.8%), median inhibition was higher in subjects with one or more systemic adverse events (74.2%, P = 0.0203) or those with one or more local and systemic adverse events (77.1%, P = 0.0003). Conclusion Nab induced by AZD1222 (AstraZeneca, UK) vaccination started to degrade shortly after the production period. Nab titers were lower in the elderly than in younger group during the degradation period. This seems to be because the degradation process of Nab is more pronounced in the elderly. This may explain why the frequency of breakthrough infections, disease severity, and mortality were higher in the elderly and may require revaccination to ensure robust immunity.

OBJECTIVE: The purpose of this study was to establish the distribution and obstetric outcomes in women with congenital uterine malformations. METHODS: A review of the medical records from the department of obstetrics and gynecology from January 1995 to June 2004 were diagnosed 79 patients with congenital uterine malformations. All of the cases were divided into groups according to classification of ASRM (American Society for Reproductive Medicine), which is based on the degree of failure of normal development of the female genital tact. The obstetric outcomes were compared between the groups. Statistical processing of the material was carried with Pearson chi square test. RESULTS: 79 patientss with congenital uterine malformations were diagnosed by operation or imaging studies. Symmetric congenital uterine malformations, consisting of bicornuate uterus (45.6%), septate uterus (19.0%), and uterus didelphys (31.6%), were the most common, constituting 96.2% of the malformations. Two patients (2.5%) had unicornuate uterus and one patient (1.3%) had arcuate uterus. No cases of the agenesis type and T-shaped uteri were found. 196 pregnancies occurred in the 74 patients. Only 43.4% of the pregnancies reached term, while 8.2% resulted in preterm delivery, and 48.4% terminated as miscarriages. CONCLUSION: Obstetric complications occur more frequently among women with congenital uterine malformations than among women in general. Knowledge concerning of congenital uterine malformations is important in recognizing and managing the obstetric complications that may result.
Abortion, Spontaneous ; Classification ; Female ; Gynecology ; Humans ; Medical Records ; Obstetrics ; Pregnancy ; Uterus

Virtually all monochorionic twin placentas contain vascular connections between the circulatory domains of each twin. In contrast, vascular anastomoses are generally thought not to occur in fused, dichorionic placentation. In the twin-to-twin transfusion syndrome (TTTS) one twin is preferentially perfused by blood from the cotwin via unbalanced placental vascular anastomoses. This vascular shunting results in twins born with discrepant weights, colors and hemoglobins. When one of the TTTS criteria was not present, the pregnancy was defined as "pseudo" TTTS. In pregnancies complicated by "pseudo" TTTS indicate that small twins have abnormal cord insertion more frequently than large twins. We present a case of vascular anastomoses in dichorionic diamniotic-fused placentas resulting in "pseudo" TTTS with a brief review of the literatures concerned.
Female ; Fetofetal Transfusion* ; Humans ; Placenta* ; Placentation ; Pregnancy ; Weights and Measures

OBJECTIVE: The purpose of this study was to identify retrospectively the different computed tomography markers and sonography in a series of surgically and pathologically proven cases of tubo-ovarian abscesses in order to achieve correct preoperative diagnosis of this life-threatening condition. METHODS: A review of the medical and pathological records from the department of obstetrics and gynecology, Catholic University Medical College from January 1993 to January 2003 confirmed 79 patients with the diagnosis of tubo-ovarian abscess. Patient were divided into two groups. From this group 15 patients who underwent CT prior to therapy were identified, and the medical records, pathologic reports and CT of these patients were retrospectively reviewed and correlated. RESULTS: All 79 patients underwent operative surgery and were confirmed tubo-ovarian abscess. CT findings of tubo-ovarian abscess present in our patients were (a) a thick-walled fluid-density mass in an adnexal location, (b) septation or partial septation within the mass, (c) indistinct borders with the uterus and adjacent bowel loops, (d) anterior displacement of the mesosalpinx, indicating a probable adnexal origin, and (e) bilateral or unilateral hydronephrosis with hydroureter. CONCLUSION: Tubo-ovarian abscess must be considered in the differential diagnosis of cystic unilateral or bilateral pelvic masses identified on CT. CT usually plays a secondary role in the diagnosis of tubo-ovarian abscess but can be valuable in difficult cases. Lack of a typical clinical presentation should not dissuade the radiologist from suggesting this diagnosis; indeed, the atypical presentation may be the reason why the patient is being evaluated initially with CT rather than with ultrasound.
Abscess* ; Diagnosis ; Diagnosis, Differential ; Gynecology ; Humans ; Hydronephrosis ; Medical Records ; Obstetrics ; Retrospective Studies ; Ultrasonography ; Uterus

Placental abnormality is the important predisposing cause of intrauterine growth retardation. Massive subchorionic hematoma is defined as a large size of maternal blood clot that separates the chorionic plate from the villous chorion and can result in serious obstetrical complications. We report a case of massive subchorionic hematoma diagnosed prenatally, and propose an additional peculiar finding detectable on both the ultrasound and magnetic resonance images: a large hematoma in the subchorionic region at 17 weeks gestation. At 18 weeks 2 days gestation, the fetus was miscarried. The clinical and pathological findings were compatible with massive subchorionic hematoma. Recurrent massive subchorionic hematoma without thrombophilic finding was observed at the next pregnancy in 17 weeks 5 days by ultrasound. The patient was managed conservatively and had successful outcome at term. So we report the case with the brief review of literatures.
Chorion ; Fetal Growth Retardation ; Fetus ; Hematoma* ; Humans ; Pregnancy ; Ultrasonography

OBJECTIVES: We aimed to estimate the annual socioeconomic burden of coronary heart disease (CHD) in Korea in 2005, using the National Health Insurance (NHI) claims data. METHODS: A prevalence-based, top-down, cost-of-treatment method was used to assess the direct and indirect costs of CHD (International Classification of Diseases, 10th revision codes of I20-I25), angina pectoris (I20), and myocardial infarction (MI, I21-I23) from a societal perspective. RESULTS: Estimated national spending on CHD in 2005 was 2.52 billion dollar . The majority of the spending was attributable to medical costs (53.3%), followed by productivity loss due to morbidity and premature death (33.6%), transportation (8.1%), and informal caregiver costs (4.9%). While medical cost was the predominant cost attribute in treating angina (74.3% of the total cost), premature death was the largest cost attribute for patients with MI (66.9%). Annual per-capita cost of treating MI, excluding premature death cost, was 3183 dollar, which is about 2 times higher than the cost for angina (1556 dollar). CONCLUSIONS: The total insurance-covered medical cost (1.13 billion dollar) of CHD accounted for approximately 6.02% of the total annual NHI expenditure. These findings suggest that the current burden of CHD on society is tremendous and that more effective prevention strategies are required in Korea.
Adult ; Age Factors ; Aged ; Aged, 80 and over ; Angina Pectoris/economics/epidemiology ; Coronary Disease/*economics/epidemiology ; *Cost of Illness ; Female ; Health Care Costs/statistics & numerical data ; Humans ; Insurance, Health/statistics & numerical data ; Male ; Middle Aged ; Myocardial Infarction/economics/epidemiology ; Prevalence ; Republic of Korea/epidemiology ; Sex Factors ; Socioeconomic Factors ; Young Adult

Retroperitoneal neurilemmoma is relatively rare and benign tumor. We report a case of a benign retroperitoneal pelvic neurilemmoma that presented with constipation and an adnexal mass and brief review of literatures.
Constipation ; Neurilemmoma*