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

Percutaneous tansluminal angioplasty(PTA) was done in 38-year-old female patient with membranous obstructionof IVC in the department of Radiology, Seoul National University Hospital. After PTA, pressure gradient between right atrium and IVC was relieved from 16mmHg to 6mmHg. The collateral circulation through hemiazygos vein andreflux into hepatic and right renal vein were disappeared. PTA is suggested to be an effective method in thetreatment of membranous obstruction of IVC.
Adult ; Angioplasty ; Collateral Circulation ; Female ; Heart Atria ; Humans ; Methods ; Renal Veins ; Seoul ; Veins

Kartagener's syndrome is an autosomaly inherited recessive condition characterized by situs inversus, bronchiectasis, and chronic sinusitis. And recently it was recognized as a subclass of dyskinetic cilia syndrome which caused by a defect in mucociliary transport owing to immotile or dyskinetic beating of cilia. Electron microsopy of cilia from sperm tails, nasal and bronchial epithelium of patients reveals the partial or complete absence of dynein arms. Our four patients were diagnosed as a Kartagener's syndrome by classic triad. We carried out electron microscopy of cilia of the nasal mucosa. And many other tests were done. One patient had squamous cell carcinoma of the lung, and another one patient revealed features of adult respiratory distress syndrome at admission. All patients improved with conservative therapy such as physiotherapy, bronchodilater, antibiotics except one patient who mechanical ventilation was required. A brief review of literature was made.
Anti-Bacterial Agents ; Arm ; Bronchiectasis ; Carcinoma, Squamous Cell ; Cilia ; Dyneins ; Epithelium ; Humans ; Kartagener Syndrome* ; Lung ; Microscopy, Electron ; Mucociliary Clearance ; Nasal Mucosa ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult ; Sinusitis ; Situs Inversus ; Sperm Tail

Actinomycosis is defined as a chronic, specific, suppurative, granulomatous disease caused mainly by the anaerobic, gram positive organism, Actinomyces israelii. Actinomycosis in the salivary gland is a rare disease that is caused by an inhabitant of the normal flora. We report the case of the actinomycosis of submandibular gland. A 53-year old man presented with the swelling on left submandiblar area. The lesion was not painful but had been increasing for about 10 days. In the CT view, the internal portion of the mass showed homogeneous moderate signal. The mass had continuities with the inferior portion of the left enlarged submandibular gland. In the MRI, there was a mass that showed a buldging pattern inferiorly in the left submandibular gland without bony invasion sign. The biopsy shows the colony of special organism. Many filaments are discovered with clubbed ends diffused from center of colony. We diagnosed this disease as actinomycosis in the submandibular gland by the postoperational biopsy.
Actinomyces ; Actinomycosis* ; Biopsy ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Rare Diseases ; Salivary Glands ; Submandibular Gland*

PURPOSE: The incidence of secondary malignancies in hematologic patients is known to be higher than it is in other patients. However, the characteristics of secondary malignancy and surveillance have not yet been established for colorectal cancer in leukemic patients. METHODS: From 1995 to 2007, 6,030 patients who were diagnosed with acute myeloid leukemia (AML), acute lymphoid leukemia (ALL), chronic myeloid leukemia (CML), chronic lymphoid leukemia (CLL), and multiple myeloma (MM) were enrolled in this study. Among them, 9 patients were diagnosed with colorectal cancer at St. Mary's Hospital and were analyzed retrospectively. RESULTS: Three of the 2,570 patients with AML, 1 of the 1,158 patients with CML, 2 of the 83 patients with CLL, 2 of the 422 patients with MM, and none of the 1,797 patients with ALL were found to have colorectal cancer. There were no operative mortalities, but 2 patients refused to have surgery. The ratio of observed to expected subsequent colorectal cancer in CLL was higher than it was in the other groups, indicating that the relative risk of colorectal cancer is higher in patients with CLL. CONCLUSION: Compared to the Surveillance, Epidemiology and End-Result (SEER) program at the National Cancer Institute (NCI) in the United State, we have the same high relatively risk in CLL patients. Careful attention should be paid to the possibility of colorectal cancer in CLL patients.
Colon ; Colonic Neoplasms ; Colorectal Neoplasms ; Hematologic Diseases ; Humans ; Incidence ; Leukemia ; Leukemia, Lymphoid ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Leukemia, Myeloid, Acute ; Multiple Myeloma ; National Cancer Institute (U.S.) ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Retrospective Studies

BACKGROUND: Medical dispute is increasing and its effect on society is serious, but reasonable settlement system is absent. Nevertheless patients and families choose medical dispute. But there is little research on patients and their families who choose to settle by medical dispute. Therefore this study examines the impact of medical malpractice to patients and their families and their reasons for choosing medical dispute after mishap. METHODS: Data were collected from 234 subjects who inquired of Medical Malpractice Family Association about malpractice suit. Questionnaire was composed of demographic characteristics, characteristics of hospital, characteristics of medical malpractice, degree of satisfaction with explanation and attitude of the treating doctor, effect of medical malpractice on patients' life and reasons patients and their families choose to settle by medical dispute. Factor analysis with varimax rotation was carried out to reduce the reasons to a smaller number of clearly interpretable factors. Multiple regression analysis was carried out to identify the variables relevant to these main themes. RESULTS: Degree of satisfaction with doctor's explanation and attitude was less than 10%. Over 60% of respondents stated that medical malpractice seriously affected their lives. Four main themes emerged from the factor analysis of reasons for dispute which includes dissatisfaction with doctor's attitude, wanting to prevent similar incident in the future, call t? account, and compensation. The relative importance in the order of frequency was wanting to prevent similar incident in the future, dissatisfaction with doctor's attitude, call to account, followed by compensation. Multiple regression analysis was used to identify the variables relevant to these four main themes. Clinical speciality group and degree of satisfaction on attitude were signi(icantly associated with the dissatisfaction with doctor's attitude. Clinical speciality group, patient's condition, effect of medical malpractiee on life and degree of satisfaction on attitude were significantly associated with the call to account. Academic carrier, clinical speciality group, patient's condition, effect of medical malpractice on life and degree of satisfaction on attitude were significantly associated with the compensation. CONCLUSIONS: From the above results, the reasons patients and their families cheese to settle by medical dispute were diverse and associated with demographic characteristics, doctor's attitude, effect of mishap on life, et. at.
Cheese ; Compensation and Redress ; Surveys and Questionnaires ; Dissent and Disputes* ; Humans ; Malpractice ; Social Responsibility

Acoustics ; Adult ; Humans ; Malocclusion ; Mandible ; Noise ; Osteotomy, Sagittal Split Ramus

BACKGROUND: Medical decisions concerning the prolongation of life, the right to die and euthanasia are among the most extensively discussed issues within medicine and law today. The purpose of this study was to evaluate the attitudes of medical students and housestaff toward euthanasia. METHODS: From July 15 to September 15 of the 1998, the responses of 180 medical students and 132 housestaff to a self-administered questionnaire were analyzed to identify attitudes toward euthanasia. Over 312 respondents about attitudes toward euthanasia, the analysis of differences between proportions was made by the Chi-square test. RESULTS: About 69.9% of the respondents thought euthanasia should be legalized. The findings suggest that Buddhists (77.5%) and non-religious groups (88.1%) tend to support euthanasia more than Christians. Futhermore, medical students (74.4%) support euthanasia more than housestaffs(63.6%), male(75.1%) more often than female(57.9%). About 73.1% of the respondents said that active euthanasia is not justifiable, and 79.2% said that they do not like performing active euthanasia. In respect to passive euthanasia, 69.0% said that it is not ethically justifiable, but 63.0% would perform this as if it were legal. Housestaffs of internal medicine (76.9%) were more willing to do euthanasia than pediatrics (70.0%), surgery (63.6%), family practice (53.8%) and Ob/Gyn (33.3%). CONCLUSION: Respondents have positive attitudes toward legalization of euthanasia.. Most considered that passive euthanasia is not morally justifiable. But if it were legalized, they would be willing to do euthanasia, while they would still be disturbed by active euthanasia. The opinions of physician and medical students directly affect patient care and their attitudes must be considered if clear policies are to be developed concerning euthanasia.
Surveys and Questionnaires ; Euthanasia* ; Euthanasia, Active ; Euthanasia, Passive ; Family Practice ; Humans ; Internal Medicine ; Jurisprudence ; Life Support Care ; Patient Care ; Pediatrics ; Right to Die ; Students, Medical*

BACKGROUND: A growth factor cocktail (GFC) including fibroblast growth factor 9 (FGF9) in combination with microneedling is an effective and safe treatment for patients with androgenetic alopecia (AGA). However, there is a lack of studies evaluating its effects based on microneedle depth. OBJECTIVE: This study aimed to evaluate the effects of a GFC including FGF9 on hair growth in patients with AGA, and compare the differences in efficacy according to microneedle depth. METHODS: The study was performed on patients with AGA who were treated with topical GFC including FGF9 with microneedling once every 2 weeks for 3 months. The scalp was divided into right and left sides, and treated with GFC including FGF9 (right side) and normal saline (left side). The microneedle depth was 0.8 mm for both sides. A total of 22 patients (11 males and 11 females) were enrolled. GFC including FGF9 was topically applied with a microneedle medical device. Treatment efficacy was evaluated through phototrichogram and digital photograph analyses after 6 repeated treatments for 3 months. RESULTS: The phototrichogram images showed that 3 months of treatment with GFC including FGF9 with microneedling increased hair density (27.4±4.4/cm²) and diameter (2.7±2.7 µm); increases in hair density (5.7±4.4/cm²) and diameter (2.2±2.3 µm) were also seen in the region of the scalp that received normal saline. These results were statistically significant (p < 0.05). The treatment effect was not significantly different between microneedle depths of 0.8 mm (used in this study) and 0.5 mm (used in our previous study) in terms of both hair density and hair diameter. CONCLUSION: GFC including FGF9 with microneedling is an effective and safe treatment for patients with AGA. According to the results of this study and our previous report, we believe that microneedle depths of 0.5∼0.8 mm can sufficiently stimulate the scalp to increase drug-delivery.
Alopecia ; Fibroblast Growth Factor 9* ; Fibroblast Growth Factors* ; Fibroblasts* ; Hair* ; Humans ; Male ; Scalp ; Therapeutic Uses* ; Treatment Outcome

This study was primarily undertaken to assess the value of continuous spinal anesthesia for total hip replacements (Charnley's low friction arthroplasty), which had been done under the Filtered Air Flow System for the prevention of wound contamination due to long term exposure. The results were as follows: 1. Preoperative diagnosis was in 4 cases hip joint tuberculosis,in 2 cases avascular necreosis, in 2 cases femur fracture, and in 2 cases osteoarthritis of the hip joint. 2. Average blood loss was 2, 800 ml for a one side operation and 5, 000 ml for a bilateral one. Overall average blood loss with continuous spinal anesthesia was 2, 600 ml and with general anesthesia was 1, 725 ml, and with amount of difference being 1. 175 ml more in the spinal anesthesia group (p<0. 025). 3. In 4 eases (40%) the hypotensive range was over 30% of the preoperative level, but recovery occurred soon after administration of Effortil. 4. Practically management of a patient with continuous spinal anesthesia is easier' thai with general anesthesia for total hip replacement, with fieeing of the anesthesio1ogist'a hands for better care of the patient during anesthesia.
Anesthesia ; Anesthesia, General ; Anesthesia, Spinal* ; Arthroplasty, Replacement, Hip* ; Asian Continental Ancestry Group ; Diagnosis ; Etilefrine ; Femur ; Friction ; Hand ; Hip Joint ; Humans ; Osteoarthritis ; Wounds and Injuries