BACKGROUND: With the increasing numbers of foreign residents and tourists in Korea, the need of medical care systems for foreign patients seems to be growing, but there are few studies related with foreigners staying in Korea so far. This study was conducted to obtain the basic clinical data of foreign patients for the better medical care of them. METHODS: This study is an analysis of 1,405 outpatients in International(Foreign) Clinic of Kangbuk Samsung Hospital from Jan. 1 1994 to Dec. 31 1996. Patient charts were reviewed and analyzed. RESULTS: Of the total of 1,405 cases, 833 cases(59.3%) were males and 572 cases(40.7%) were females. The largest age group was the 4th decades, which were 408 cases(29.0%). By racial grouping, Japanese were the largest, accounting for 507 cases(36.1%) of all, followed by Europeans(including Oceanians) with 384 cases(27.3%) and North Americans with 335 cases (23.8%). The total number of hospital visits was 3,823. According to departments, Family Medicine had 968 visits(25.3%) of all, follewed by Pediatrics with 503 visits(13.2%), Internal Medicine 406visits(10.6%) and Dermatology 355visits(9.3%). The most common diagnoses were preventive medical cares such as general medical examination(6.0%), vaccination(4.5%), antenatal care(3.4%) and special investigations (3.1%), followed by acute infectious diseases such as acute upper respiratory infection including acute pharyngitis(7.4%), bronchitis(5.0%), infectious diarrhea(3.6%) and otitis media(2.9%) among top 20 ranks. preventive medical cares such as general medical examination and vaccination were more common in Family Medicine, and acute infectious diseases such as acute upper respiratory infection and bronchitis were more common in Internal Medicine and Pediatrics. preventive medical cares and acute infectious diseases were common without any differences between advanced countries(North America, Europe and Oceania, Japan) and developing countries(Asia, Africa, Latin America), except infectious diarrhea. Hospital visits due to infectious diarrhea were much more frequent among advanced countries (4.3% in Japan, 3.4% in the others) than developing countries(0.9%). CONCLUSIONS: According to the results, it showed the certain characteristics of the high medical need about preventive medical care and acute infectious diseases among foreign patients staying in Korea. It also shows the need of family physicians who could play important roles in practicing preventive medical care and acute common diseases for foreigners. Therefore it is believed that further studies for foreign patients in Korea will be necessary and should be conducted in the future.
Africa ; Americas ; Asian Continental Ancestry Group ; Bronchitis ; Communicable Diseases ; Dermatology ; Diagnosis ; Diarrhea ; Emigrants and Immigrants ; Europe ; Female ; Humans ; Internal Medicine ; Japan ; Korea ; Male ; Oceania ; Otitis ; Outpatients* ; Pediatrics ; Physicians, Family ; Vaccination

BACKGROUND: With the increasing numbers of foreign residents and tourists in Korea, the need of medical care systems for foreign patients seems to be growing, but there are few studies related with foreigners staying in Korea so far. This study was conducted to obtain the basic clinical data of foreign patients for the better medical care of them. METHODS: This study is an analysis of 1,405 outpatients in International(Foreign) Clinic of Kangbuk Samsung Hospital from Jan. 1 1994 to Dec. 31 1996. Patient charts were reviewed and analyzed. RESULTS: Of the total of 1,405 cases, 833 cases(59.3%) were males and 572 cases(40.7%) were females. The largest age group was the 4th decades, which were 408 cases(29.0%). By racial grouping, Japanese were the largest, accounting for 507 cases(36.1%) of all, followed by Europeans(including Oceanians) with 384 cases(27.3%) and North Americans with 335 cases (23.8%). The total number of hospital visits was 3,823. According to departments, Family Medicine had 968 visits(25.3%) of all, follewed by Pediatrics with 503 visits(13.2%), Internal Medicine 406visits(10.6%) and Dermatology 355visits(9.3%). The most common diagnoses were preventive medical cares such as general medical examination(6.0%), vaccination(4.5%), antenatal care(3.4%) and special investigations (3.1%), followed by acute infectious diseases such as acute upper respiratory infection including acute pharyngitis(7.4%), bronchitis(5.0%), infectious diarrhea(3.6%) and otitis media(2.9%) among top 20 ranks. preventive medical cares such as general medical examination and vaccination were more common in Family Medicine, and acute infectious diseases such as acute upper respiratory infection and bronchitis were more common in Internal Medicine and Pediatrics. preventive medical cares and acute infectious diseases were common without any differences between advanced countries(North America, Europe and Oceania, Japan) and developing countries(Asia, Africa, Latin America), except infectious diarrhea. Hospital visits due to infectious diarrhea were much more frequent among advanced countries (4.3% in Japan, 3.4% in the others) than developing countries(0.9%). CONCLUSIONS: According to the results, it showed the certain characteristics of the high medical need about preventive medical care and acute infectious diseases among foreign patients staying in Korea. It also shows the need of family physicians who could play important roles in practicing preventive medical care and acute common diseases for foreigners. Therefore it is believed that further studies for foreign patients in Korea will be necessary and should be conducted in the future.
Africa ; Americas ; Asian Continental Ancestry Group ; Bronchitis ; Communicable Diseases ; Dermatology ; Diagnosis ; Diarrhea ; Emigrants and Immigrants ; Europe ; Female ; Humans ; Internal Medicine ; Japan ; Korea ; Male ; Oceania ; Otitis ; Outpatients* ; Pediatrics ; Physicians, Family ; Vaccination

OBJECTIVE: It is generally accepted that ectopic pregnancy (EP) may adversely affected on the female fertility. However, it is not fully understood how it influences on the future fertility after treatment of an EP, so we intended to evaluate its effects, METHODS: This study was undertaken on 473 patients with clinically and pathologically proven diagnosis of ectopic pregnancies at the Department of Obstetrics and Gynecology, Anam Hospital, Kroea University Medical College hom Jan. 1, 1989 to Aug. 31, 1996. RESULTS: The incidence of ectopic pregnancy was 1 in 19.6 deliveries (5.1%). The overall spontaneous conception rate after treatment of ectopic pregnancy was 67.4%, and among them, the rate of intrauterine pregnancy (IUP) and repeat ectopic pregnancy (rEP) was 56.3% and 11.1% respectively. The occurrance rate of infertiity after treatment of EP was 32.6%. The mean time to IUP after treatment of EP was 16.5 months, and 79.0% of all IUP were conceived within 2 years after treatment. The mean time to repeat ectopic pregnancy was 15.9 months. With increasing maternal age, IUP rate was decreased and rEP rate was increased but they were statistically not signiTicant. Repeat EP rate was also increased in multiparous women but it was also statistically not significant. Overall PR (IUP and rEP) was decreased in women who have organic lesions (adhesions, endometriosis, PID etc.) in pelvic cavity(p=0.003). Patients who were treated with conservative surgery achieved a lower conception rate without statistical significance and it may be due to low cases. CONCLUSION: Future fertility rate was not significantly altered by EP itself, but rather affected by patient's age, organic lesions and previous history of pelvic surgery. Recently, the advent of assisted reproductive technology and its associated techniques improved the female fertility in women with such a problem.
Birth Rate ; Diagnosis ; Endometriosis ; Female ; Fertility* ; Fertilization ; Gynecology ; Humans ; Incidence ; Maternal Age ; Obstetrics ; Pregnancy ; Pregnancy, Ectopic* ; Reproductive Techniques, Assisted

OBJECTIVE: The prevalence of multifetal pregnancies has increased up to 30% as a result of the introduction of ovulation inducing agents for assisted reproductive teclmology(ART). An exttemely poor pognosis could be expected for viable pregnancies in multifetal gestation. So, to decrease the consequence of multiple pregnancies and prevent complications, especially premature baby irreversibly damaged, selective fetal reduction to the smaller number of fetuses should be considered in an early gestational period. METHODS: From May 1994 to Apr 1998, transvaginal selective fetal reduction in 13 pati including 9 triplet, 3 quadruplet and 1 quintuplet. Of the 13 patients, 4 were obtained by controlled ovarian hyperstimulation with intrauterine insemination (COH with IUI), 6 were by IVF-ET, 2 wae by controlled ovarian hyperstimulation with natural contact and 1 was by natural conception. Selective fetal reduction using intracardiac KC1 injection and aspiration of amniotic fluid carried out in 8-11 weeks of gestation. RESULTS: After procedures, 8 patients were remained as twin pregnancies, 5 patients as singleton pregnancies and 1 of the remaining twin embryos vanished after procedure. There have been 7 sets of twin delivery including 1 stillbirth and 3 singleton delivery. 1 cases are ongoing state. All of the singleton delivery were completed after 37 weeks of gestation. Of the twin delivery, 2 cases were delivered after 37 weeks of gestation, 2 cases in 35-37 weeks, and 3 cases before 35 weeks of gestation. Unfortunately, 1 stillbirth occurred in 20 weeks of gestation and 2 cases of singleton were aborted. As 3 losses(2 singleton, 1 twin) occurred, the delayed fetal loss rate in this selective fetal reduction was 25.0%(3/12). There was no fetal anomaly related to the procedure. CONCLUSION: Selective fetal reduction in multifetal pregnancies is a rather safe procedure and it may improve the outcome of multiple pregnancies.
Amniotic Fluid ; Embryonic Structures ; Female ; Fertilization ; Fetus ; Humans ; Insemination ; Ovulation ; Pregnancy Reduction, Multifetal* ; Pregnancy* ; Pregnancy, Multiple ; Pregnancy, Twin ; Prevalence ; Quadruplets ; Quintuplets ; Reproductive Techniques, Assisted* ; Stillbirth ; Triplets

The patellar tendon is known as the strongest material for the substitution of anterior cruciate ligament. There are many technical difficulties in reconstruction of the ligament with this tendon since patellar aponeurosis is weak, and the length of the tendon is restricted, and the adquate insertion in proper place is difficult. Authors harvested the middle 1/3 of patellar tendon c bone block of tibial tubercle and patella with the superficial layer of the quadriceps tendon left attached. The large triangular tibial tubercle piece was impacted into the femoral tunnel from distally to proximally, of which the orifice is the very place of the middle of the original anterior cruciate ligament. Two bundles of 0-dexon sutures made at the tibial tubercle portion, were pulled through to different outlet of femoral condyle during this procedure and were tied over the cortical bone of lateral supracondylar region. The tendon twisted 180°(clockwise for the right knee and counter-clockwise for the left knee) to adapt to screwhome movement. The patellar piece was fixed at the isometric point in full flexion and extension, which is usually the middle point of original tibial insertion c one or two barbed staples made at the original position of tibial insertion of the ligament. We tried this methods in 26 knees (12 vascularized grafts and 14 free grafts) and was followed for more than one year and the results was compared with those of 12 knees of original McIntosh operation (follow up period: 16-72 months, average 34.3 months). The instability were evaluated c Lachman test and OSI sagittal knee tester. The knee of negative Lachman test & pivot shift test was defined as "normal" The results were as follows;l. In modified McIntosh operation group negative Lachman test was noted only in 6 knees (50.0 % ) and there were 2 knees (16.7% ) of GI, II & III, respectively. 2. In vascularized bone block patellar tendon graft group II out of 12 knees (91.7%) showed negative Lachman test and only one knee (8.3%) revealed G II. 3. In free bone block patellar tendon graft 13 out of 14 knees (92.9%) showed negative Lachman test and the other one knee (7.1%) revealed GI. 4, The overall success rate (normal) of bone block patellar tendon graft was 92.3%. The success rate of patellar tendon bone block operation was significantly higher than that of modified McIntosh operation (χ²=6.48, df=1, P=0.0109) and there was no statististical difference between vascularized and free graft group (χ²=0.39, df=l, P=0.5322).
Anterior Cruciate Ligament ; Knee ; Ligaments ; Patella ; Patellar Ligament ; Sutures ; Tendons ; Transplants

No abstract available.
Animals ; Blastocyst* ; Embryonic Structures* ; Glucose* ; Mice*

OBJECTIVES: To determine the effect of increased plasma Progesterone(P) level on the day of hCG administration on oocyte /embryo development and implantation after blastocyst transfer in controlled ovarian hyperstimulation (COH) cycle with premature progesterone elevation for IVF-ET. METHODS: Seventy controlled ovarian hyperstimulation cycles for IVF-ET were underwent with GnRH agonist and hMG/FSH in 70 women. Embryos were cocultured up to the blastocyst stage and transferred into the uterine cavity. The cycles were devided into two groups depending on the levels of plasma P on the day of hCG administration, and the clinical results in both groups were analysed and compared each other. High P group was defined when the level of plasma P was higher than 0.9 ng/mL. RESULTS: Fertilization rates, cleavage rates and blastulation rates were similar in the low and high P groups. Blastulation rates were increased in high quality (morphological characteristics) D 2-3 preembryo regardless of the P levels during the late follicular phase(p <0.001). However, clinical pregnancy rate, ongoing pregnancy rate and implantation rate were higher in low P group compared with high P group(p <0.01). CONCLUSIONS: Premature P elevation did not deteriorate the developmental potential of oocyte, but had a harmful effect on pregnancy rate and implantation rate. So we suggest that early ET on the day 2-3 (after ovum pick-up) without delaying another several days to avoid the advanced maturation of secretory endometrium might be better than blastocyst transfer in patients with premature P elevation.
Blastocyst* ; Embryo Transfer* ; Embryonic Structures ; Endometrium ; Female ; Fertilization ; Gonadotropin-Releasing Hormone ; Humans ; Oocytes ; Ovum ; Plasma ; Pregnancy Rate ; Progesterone*

No abstract available.
Neck*

Heart transplantation is an accepted procedure for treatment of end-staged cardiac failure. A return to near-normal quality on life can be expected in many patients with a nonrejecting cardiac allograft, and many of these patients will return to the operating room for noncardiac surgical procedures. Anesthesiologists should be alert to recognizing problems caused by the presence of infection in immunosuppressed patients, modes of presentation of rejection phenomena and how transplanted organs, notably significantly denervated ones, may behave and respond under the pathophysiologic circumstance that arise during surgery, resuscitation and intensive care. The use of regional techniques require adequate preloading to avoid exaggerated hypotension and aseptic technique to avoid infection. Hypobaric spinal anesthesia has some benefit. It does not depress cardiovascular and respiratory system and keep adequate venous return by trendelenberg position. We report herein a case of successfully undergone total hip replacement in a patient who had previously undergone orthotopic heart transplantation under hypobaric spinal anesthesia.
Allografts ; Anesthesia, Spinal* ; Arthroplasty, Replacement, Hip ; Heart Failure ; Heart Transplantation ; Heart* ; Humans ; Hypotension ; Critical Care ; Operating Rooms ; Respiratory System ; Resuscitation

Platelet-derived growth factor(PDGF) is known to accelerate soft tissue fracture and periodontal bone healing, but little information is available for characterizing the healing of articualr cartilage. This study was designed to demonstrate the regeneration potential of pasteurized autogeneous osteochondral graft when PDFG was applied locally in vivo. Eighteen rabbits in two groups were used in the experiment. The free osteochondral fragment(1x1x1 cm) were taken from distal femur. The fragment were pasteurized in 65degrees C for 5 minutes. In experimental group(group II), the fragment were soaked in 0.25 mg/ml of recombinant human PDGF mixed 5 ml normal saline and reimplanted to the resected site, and followed with local administration of 0.25 mg/ml PDGF to knee joint. In control group(group I), the pasteurized fragment were reimplanted in the resected site without any treatments. The histologic characteristics of the transplanted autografts for three rabbits in each group were observed at 3, 5 and 7 weeks postoperatively. The results were as follows; Group II revealed the more favorable regeneration of articular cartilage, less arthritic changes and more mature arrangement of chondrocytes than group I. Even thought the cartilage is avascular and the regeneration capacity of pasteurized cartilage is severely limited, the regeneration of grafted articular cartilage is thought to be accellerated by increased newly formed blood vessels and soft tissues due to the diffusion of PDGF on grafted cartilage, and probably also by differentiation of mesenchymal cells in the initial stage of experiment. The results of this study suggest that local administration of PDGF could be used for the treatment of posttraumatic or degenerative arthritis and various cartilage damages.
Autografts ; Blood Vessels ; Cartilage ; Cartilage, Articular ; Chondrocytes ; Diffusion ; Femur ; Humans ; Knee Joint ; Osteoarthritis ; Platelet-Derived Growth Factor* ; Rabbits* ; Regeneration* ; Transplants*