In order to discover difference that may exist in quantity of medical care services, length of stay and hospital changes between insured and non-insured patients, records for primary Cesarean section patients discharged between July 1978 and June 1980 from a university hospital were examined. In addition, Cesarean section rates among the total deliveries for a two-year period between the groups were studied. The results showed that volume of services was greater and length of stay was longer among the insured, however, charges were higher among the non-insured. Cesarean section rates were statistically significantly different between insured and non-insured patients for every age group except the group of 35 or more.
Cesarean Section* ; Female ; Humans ; Length of Stay ; Pregnancy

Romberg syndrome is a rare disease and characterized by unilaeril atrophy of the skin, subcutaneous tissue and the underlying structure of half the face. The lesion does not usually cross the midline of the scalp. Roriberg syndrome is sometimes mildsnosed as linear scleroderma, although they differ widely in their clinical and histological apperance. A 13-year-old boy was present with a one year history of idefined atrophic patch on the left side of face and neck. We involved skin was not bound down to the underlying structure. The history revealed no prcvious trauma or disease, He had no abnormal neurologic finding. Computerized tomography demonstrated a diminished subcutaneouat volume and also decreased thickness of back muscle is the left side face from cheek to neck.
Adolescent ; Atrophy ; Back Muscles ; Cheek ; Humans ; Male ; Neck ; Neurologic Manifestations ; Rare Diseases ; Scalp ; Scleroderma, Localized ; Skin ; Subcutaneous Tissue

No abstract available.
Embryonic Stem Cells*

The ankle stability has a vital role in normal gait and walking. An accurate and anatomic reduction with rigid fixation has been emphasized as important regimens as well as early motion and weight bearing exercises. The authors analysed 90 cases(88 patients) of ankle fractures which were admitted and treated in orthopedic department, Chung-Ang Gil General Hospital from March 1987 to May 1992. Males were affected 1.7times than female and the age group of third and fourth decades constituted 60.2%. The most common cause was vehicle accident(35 cases; 38.9%). According to Lauge-Hansen classification, supination-external rotation type was most common(32 cases; 35.6%). Accoompanyng injuries were noted on 45 cases(50%) and fractures in lower extremities were most common(17 cases; 18.9%). According to meyer's assessment of result, the clinical and radiologic results were better in operative method than conservative ones. From the evaluation of clinical results, anatomic reduction and rigid internal fixation of lateral malleoli and distal tibiofibular joint are more important factors. Complications are resulted in 19cases(21.1%) and traumatic arthritis is the most common (10 cases; 11.1%). The extent and degree of injury was an important factor in an overall results of treatment as well as the anatomic reduction of fracture alignment.
Ankle Fractures ; Ankle ; Arthritis ; Classification ; Exercise ; Female ; Gait ; Hospitals, General ; Humans ; Joints ; Lower Extremity ; Male ; Methods ; Orthopedics ; Walking ; Weight-Bearing

A reproducible noninvasive technique for measuring right ventricular ejection fraction (RVEF) was developed using first pass quantitative radionuclide angiocardiography. Tests were carried out in the right anterior oblique position with a computerized multicrystal scintillation camera with high count rate capabilities. RVEF was calculated on beat to beat basis from the high frequency components of the background-corrected right ventricular time-activity curve. The following results were obtained; 1) In 10 normal adults, RVEF averaged 50.9+/-8.2. In 20 patients with chronic obstructive lung diseases (COPD), RVEF was 37.9+/-6.1% and significantly lower than that of normal persons(P<0.005). 2) There was meaningful correlation between RVEF and forced expiratory volume (FEVI) in patients with COPD (r=0.51). And there was significant difference of RVEF between 13 patients with FEVI less than IL/min (6 patients with right ventricular failure, 7 patients with patients without that) and 7 patients with FEVI IL/min or more (35.7+/-6.0%, 42.1+/-3.2% respectively. P<0.005). 3) All 6 patients with clinical manifestation of right heart failure had abnormal RVEF and had FEVI less than IL/min, which was significantly lower than that of 14 patients without clinical manifestation of right heart failure (33.6+/-4.8%, 39.8+/-5.6%, respectively. P<0.005). 4) In 14 patients without clinical manifestation of right heart failure, 11 patients among whom 7 patients had FEVI less than IL/min, had abnormal RVEF.
Adult ; Angiocardiography ; Forced Expiratory Volume ; Gamma Cameras ; Heart Failure ; Humans ; Lung Diseases, Obstructive* ; Pulmonary Disease, Chronic Obstructive ; Radionuclide Ventriculography* ; Stroke Volume ; Ventricular Function, Right*

Amipaque is a water soluble, non-ionic myelographic contrast media, and owing to its high diagnostic accuracy and safety, its use is gradually increasing. The authors studied the complications after Amipaque lumbermyelography in 61 patients with low back pain during the period from Jan. 1981 to Nov. 1981 in Chung Ang University Hospital. The results were as follows; 1. Total complication rate was 52%(32 of 61) and there was nosexual difference in its occurrence. 2. In total, no difference in complication rate was found between head-up positioned group with a degree of 30degrees (group I) after procedure and head-up positioned group with a degree of 70degrees (group II) but female patients had more complication rate in group I than in group II (75% vs 50%).Headache was more common in group I and nausea was more common in group II. 3. Headache was most common complicaiton (44%) and there was no sexual difference in its occurrence. 4. No significant difference in complication rate was found between patients proved to have HBP and patients to have not. 5. Complications were less common in patients with punctured level of L4-5 than in patients with L2-3 or L3-4 level puncture.
Contrast Media ; Female ; Headache ; Humans ; Low Back Pain ; Metrizamide ; Myelography ; Nausea ; Punctures ; Water

Rectus sheath hematoma of the abdominal wall is a well-recognized, but uncommon condition, caused by a tear in an epigastric vessel and characterized by sudden onset of severe abdominal pain and palpable mass. In most cases, a precipitating cause can be demonstrated. Causes include external trauma, strenuous activities, coughing, lifting, sneezing, vomiting, straining while urinating or defecating, golfing, pregnancy and the puerperium, anticoagulation therapy, infection, chronic diesase, arteriosclerosis, hypertension, prior paracentesis or laparotomy, inadequate hemostasis or excessive retraction in surgery, and idiopathy. Unfortunately, the correct diagnosis often is missed, and the hematoma is found only during an exploratory laparotomy. Treatment should be conservative in most instances. Although the mortality rate for patients with rectus sheath hematoma is low, the condition may be fatal if the volume of the hemorrhage is large and if treatment is delayed. Hence, it should be included in the differential diagnosis of any patient who presents to the emergency department with acute onset of abdominal pain. Our purpose is to familiarlize emergency physicians with the pathophysiology, the diagnosis, and the treatment of rectus sheath hematoma. We describe a patient with fatal rectus sheath hematoma presenting to the emergency department and give a review of the literature.
Abdominal Pain ; Abdominal Wall ; Arteriosclerosis ; Cough ; Diagnosis ; Diagnosis, Differential ; Emergencies ; Emergency Service, Hospital ; Golf ; Hematoma* ; Hemorrhage ; Hemostasis ; Humans ; Hypertension ; Hypovolemia* ; Laparotomy ; Lifting ; Mortality ; Paracentesis ; Postpartum Period ; Pregnancy ; Shock* ; Sneezing ; Vomiting

BACKGROUND: The evaluation of behavioral and psychological symptoms (BPS) in ALS is important because its existence may serve as a prognostic factor and suggest a shared pathology with frontotemporal dementia (FTD) in ALS. In this study, we sought to identify the prevalence of the BPS of ALS patients and evaluate its relationship with the clinical profiles and survival of ALS patients. METHODS: One hundred sixty-six patients were enrolled in a cross-sectional cohort analysis from September 2008 to February 2012. All patients had sporadic ALS without a genetic mutation and were collected clinical profiles. The t-test and chi-square test were used to assess differences in the clinical characteristics and caregiver-administered neuropsychiatric inventory (CGA-NPI) scores. The Kaplan-Meier method and Cox proportional hazard model were used for the survival analysis. RESULTS: Forty-two patients had clinically significant BPS (42/166, 25.3%). ALS patients with BPS had worse clinical dementia rating (CDR), ALS Functional Rating Scale-Revised (ALSFRS-R) score, and progression rate of disease than those without BPS. Among CGA-NPI subscales, depression, irritability, apathy, and agitation were higher prevalent than the others. There was a trend for ALS patients with BPS having short survival time than those without BPS in the Kaplan-Meier analysis (p=0.006). However, in the Cox proportional hazard model, BPS in ALS patients were not associated with poor survival. CONCLUSION: These results support the presence of an overlapping spectrum between ALS and FTD and emphasize the importance of neuropsychiatric evaluations in ALS. Although the association between BPS and prognosis are not explained clearly, these results could be used to stratify ALS patients according to neuropsychiatric symptoms and help investigators to evaluate the BPS in ALS patients.
Amyotrophic Lateral Sclerosis* ; Apathy ; Cohort Studies ; Dementia ; Depression ; Dihydroergotamine ; Frontotemporal Dementia ; Humans ; Kaplan-Meier Estimate ; Pathology ; Prevalence ; Prognosis ; Proportional Hazards Models ; Research Personnel

PURPOSE: To evaluate the diurnal variation of macular thickness in eyes with diabetic macular edema. METHODS: We measured macular thickness using optical coherence tomography in 33 eyes with diabetic macular edema and 33 normal control eyes at 7 am, 11 am, 2 pm, and 5 pm. We investigated the correlation between macular thickness change and several factors such as sex, duration of diabetes mellitus, presence of hypertension, HbA1c, creatinine clearance, blood urea nitrogen, serum creatinine, blood sugar, blood pressure, severity of diabetic retinopathy, and whether PRP was done or not. RESULTS: Retinal thickness in 3.45 mm macular area was the thickest at 7 am and then decreased over the day to be thinnest at 5 pm (p Blood Glucose ; Blood Pressure ; Blood Urea Nitrogen ; Creatinine ; Diabetes Mellitus ; Diabetic Retinopathy ; Hypertension ; Macular Edema* ; Retinaldehyde ; Tomography, Optical Coherence

PURPOSE: To investigate the effects of 0.15% brimonidine tartrate ophthalmic solution spray on the luminal changes in the nasolacrimal excretory system. METHODS: A prospective study was performed on 52 eyes in 26 patients complaining of epiphora in both eyes. The randomly-assigned 26 test eyes (cases) received spray of the solution through the nasal cavity, and the other 26 eyes (controls) were irrigated with the same drug through the inferior calnaliculus. Dacryocystography was then performed to observe the luminal changes jn the nasolacrimal excretory system, patient symptoms and physiologic drainage functions. RESULTS: The changes in lumen width of the nasolacrimal duct (NLD) were noted, and the changes in lumen width of the lacrimal sac were not significant in either mode. The upper and middle parts of the NLD were widened more in the irrigation group, and the lower part of the NLD was widened more in the spray group. Though there was no significant difference in the physiologic drainage functions, the patients in both groups reported reduced symptoms. CONCLUSIONS: Brimonidine tartrate spray altered the width of the NLD and improved the subjective symptoms of patients. Therefore, the spray can be applied in functional NLD obstruction patients before the surgical procedure.
Drainage ; Eye ; Humans ; Lacrimal Apparatus Diseases ; Nasal Cavity ; Nasolacrimal Duct ; Phenobarbital ; Prospective Studies ; Quinoxalines ; Brimonidine Tartrate