Neonatal mortality rate (NMR) and infant mortality rate (IMR) are two of the most important indices reflecting the level of public health of a country. In this review, we investigated changes in NMR and IMR in Korea and compared the results with those of Japan, USA, and OECD nations. During the past 20 yr, NMR and IMR have lowered remarkably from 6.6 and 9.9 in 1993 to 1.7 and 3.2 in 2009, respectively, in Korea. It is an impressive finding that Korean IMR (3.2 in 2009) is lower than the average of OECD nations (4.7 in 2008), and USA (6.3 in 2009), although higher than Japanese IMR (2.8 in 2009). The proportion of NMR among the IMR calculation decreased from 66.7% in 1993 to 53.1% in 2009. The reason the value of Korea was higher than Japan but lower than USA was speculated to be an aspect of the health care service system. Several suggestions in perinatal, neonatal and infantile health care such as establishment of perinatal care center, research network system, regionalization, and new policies for care of pre-term and high risk pregnancy, are elucidated to achieve further improvement on NMR and IMR in Korea.
Female ; Health Services ; Humans ; Infant ; Infant Mortality/*trends ; Infant, Newborn ; Japan ; Perinatal Care ; Pregnancy ; Pregnancy, High-Risk ; Public Health ; Republic of Korea ; United States

PURPOSE: Because infants who have been hospitalized in the neonatal intensive care unit (NICU) are usually ill or premature, they are hospitalized repeatedly after their discharge. We intended to survey the frequencies and the medical costs of those rehospitalizations. METHODS: The NICUs of 7 major hospitals were included. The subjects were 3,451 infants that were admitted to the NICU from July 2005 to June 2006, and discharged to home. The frequency, causes, mean cost and distribution and proportion of National Health Insurance coverage and non covered costs were analyzed. RESULTS: The rate of rehospitalization after discharge from the NICU over 1 year was 14.8%. If multiple cases are considered as individual cases, it is 21.7%. The major causes of admission were pneumonia (15.8%), bronchiolitis (14.5%), gastroenteritis (10.4%), urinary tract infection (6.3%) and sepsis (6.3%). The mean cost for each admission was 1,652 thousand won. The mean cost of National Health Insurance coverage was 1,170 thousand won and non covered coat were 472 thousand won 70.9% and 28.6% respectively. CONCLUSION: The ratio of rehospitalization of infants after their discharge from the NICU over 1 year was approximately 20% and it means that follow-up management of these infants is very important and meticulous concerns after discharge should be given. However the rehospitalization and the non-coverage proportion of National Health Insurance cost is considerably high. It strongly implies that National Health Insurance should cover much more proportion, and personal cost exemption should be proceeded in case of rehospitalization of infants after discharge from the NICU.
Bronchiolitis ; Follow-Up Studies ; Gastroenteritis ; Humans ; Infant ; Infant, Newborn ; Intensive Care Units, Neonatal ; Intensive Care, Neonatal ; National Health Programs ; Pneumonia ; Sepsis ; Urinary Tract Infections

To produce bioactive compound enriched yeast using medicinal Gugiga (Lycium chinensis Mill), several edible Saccharomyces species were cultured in Gugija extracts added yeast extract, peptone and dextrose medium (GE - YEPD medium) at 30degrees C for 24 hr, and their growth were determined. Growth of Saccharomyces cerevisiae K-7 and Sacchromyces cerevisiae ACTC 7904 were better than those of the other yeasts. Two yeasts were selected and then determined their some physiological functionalities after cultivated the yeasts in the GE - YEPD medium and compared those grown on YEPD medium. Antihypertensive angiotensin I-converting enzyme (ACE) inhibitory activity of S. cerevisiae K-7 grown on GE - YEPD medium was about 20% higher than that grown on YEPD medium. Superoxide dismutase-like activity of S. cerevisiae ACTC 7904 was also about 12% more high. However, the other physiological functionalities were almost same or lower. Optimal addition concentration of Gugija extract was 10%, and maximally growth and ACE inhibitory activity of S. cerevisiae K-7 were shown when the strain was cultured in 10% Gugija extracts containing YEPD medium at 30degrees C for 12 hr.
Angiotensins ; Glucose ; Peptidyl-Dipeptidase A ; Peptones ; Saccharomyces ; Saccharomyces cerevisiae ; Sprains and Strains ; Superoxides ; Yeasts

OBJECTIVE: The aim of this study was to evaluate the clinicopathologic characteristics of granulosa cell tumor of the ovary (OGCT). METHODS: We retrospectively reviewed the medical records of 27 patients with OGCT at our hospitals from January 1995 to December 2003. RESULTS: The mean age was 48.3 years (24~70) and mean follow up period was 56.7 months (12~102). The most common symptom was vaginal bleeding (n=11, 40.7%). The tumors were ranging from 3 cm to 21 cm in diameter (mean: 9.9). Post-surgical FIGO stage was stage I in 20 (74.1%), stage II in 6 (22.2%), and stage III in 1 (3.7%). Endoemetrial samples were available in 21 patients and the results were endometrial carcinoma in 1 and endometrial hyperplasias in 5. Staging operation was performed in 17, unilateral salpingo-oophorectomy in 6, total hysterectomy and bilateral salpingo-oophorectomy in 2, and fertility sparing operation in 2. Postoperative chemotherapy was administered in 13 patients (48.2%). Two patients had recurred and recurrence rate was 7.4% (2/27). Two recurred patients finally died of the disease at 42 months and 103 months after first operation respectively. During follow-up period, 2 patients had 3 pregnancies and all of them delivered at term. CONCLUSION: These results shows that most OGCT is detected in early stage and have relatively excellent survival. However, because OGCT is a slow-growing tumor and has a late recurrence, long time follow-up is required.
Endometrial Hyperplasia ; Endometrial Neoplasms ; Female ; Fertility ; Follow-Up Studies ; Granulosa Cell Tumor ; Granulosa Cells ; Humans ; Hysterectomy ; Medical Records ; Ovary ; Pregnancy ; Recurrence ; Retrospective Studies ; Uterine Hemorrhage

OBJECTIVE: To evaluate the rates and clinical outcomes between abdominal hysterectomy (AH), laparoscopic hysterectomy (LH) and vaginal hysterectomy (VH). METHODS: Medical records of 236 patients who underwent hysterectomy (by one surgeon) for benign uterine pathology between march 2004 and april 2006 were reviewed. Primary outcome measure was the rate of each method of hysterectomy. Secondary outcome measures included perioperative and postoperative outcomes between groups. RESULTS: The mean age, weight, height, body mass index, and parity in three groups showed no difference. In two hundred and twenty two cases of hysterectomies, the rate of AH was 13.5%, LH 34.2%, and VH 52.3%. Perioperative outcomes of AH, LH and VH were as follows : operative time (83.2+/-27.1 min, 94.2+/-25.2 min, and 50.8+/-15.5 min, respectively), change in hemoglobin (2.3+/-1.5 g/dL, 2.0+/-0.9 g/dL, and 1.3+/-1.1 g/dL, respectively), duration of urinary catheterization (2.0+/-0.2 days, 1.0+/-0.0 days, and 1.0+/-0.4 days, respectively), postoperative hospitalization (5.7+/-1.2 days, 4.7+/-0.9 days, and 4.3+/-1.0 days, respectively), uterine weight (733+/-665 g, 340+/-213 g, and 300+/-156 g, respectively). Uterine weight in the AH group was significantly heavier than in the LH and VH. The benefits of LH versus AH were shorter duration of urinary catheterization and postoperative hospitalization (p<0.05). The benefits of VH versus AH were shorter operative time, a smaller drop in hemoglobin, shorter duration of urinary catheterization and postoperative hospitalization (p<0.05). The benefits of VH versus LH were shorter operative time, a smaller drop in hemoglobin, and postoperative hospitalization (p<0.05). There were no differences in complications of AH, LH and VH (13.3%, 10.5%, and 9.5%, respectively p=0.825). CONCLUSIONS: Eighty six point five percent of hysterectomy can be done vaginal or laparoscopic approach. When there is a concerted effort to increase laparoscopic or vaginal hysterectomy, abdominal hysterectomy can decrease without increasing complication rate.
Body Height ; Female ; Hospitalization ; Humans ; Hysterectomy* ; Hysterectomy, Vaginal ; Medical Records ; Operative Time ; Outcome Assessment (Health Care) ; Parity ; Pathology* ; Urinary Catheterization ; Urinary Catheters

BACKGROUND: High-resolution ultrasonography has made the detection of asymptomatic small thyroid possible. Recent increases in the detection of incidentalomas have created a clinical dilemma on how to properly manage such incidental nodules. We investigated the prevalence, clinical and ultrasonographic characteristics, and optimal diagnostic approach toward incidentally detected benign and malignant thyroid nodules of less than 1.5 cm in size. METHODS: A retrospective review was undertaken on the 1,475 patients who had visited Samsung Medical Center, Seoul Korea between January 1999 and December 2000. The review consisted of a physical examination of the thyroid gland, thyroid function test, antithyroid antibodies, thyroid ultrasonography, fine-needle aspiration biopsy, pathology and TNM staging of the incidentally detected thyroid nodules of less than 1.5 cm in size. RESULTS: The prevalence of thyroid incidentalomas was 13.4% and the malignancy rate within them was 28.8%. There were no significant differences in age, sex, thyroid function test and size between the benign and malignant incidentalomas. Ultrasonographic characteristics showed meaningful diagnostic value for the detection of malignancy in incidentalomas. Most malignant incidentalomas were of a low stage. CONCLUSION: Occult thyroid cancers are fairly common finding. There are no clinical difference between benign and malignant thyroid nodules less than 1.5 cm ; however, ultrasonographic fingings can be used to decision of optimal management strategies.
Antibodies ; Biopsy, Fine-Needle ; Humans ; Korea ; Neoplasm Staging ; Pathology ; Physical Examination ; Pregnancy ; Prevalence ; Retrospective Studies ; Seoul ; Thyroid Function Tests ; Thyroid Gland* ; Thyroid Nodule ; Ultrasonography

BACKGROUND: Vasopressin has recently been recognized to have greater effect on improving blood flow to myocardium and brain during cardiac resuscitation than epinephrine and also improves rates of ROSC(return of spontaneous circulation) and survival in pre-hospital and in-hospital prolonged refractory cardiac angst patients who did not respond to the standard epinephrine treatment. This study was designed to investigate the effects of vasopressin on ROSC rates and survival rates in rat asphyxia arrest model. METHOD AND MATERIAL: Thirty male Sprague-Dawley rats were used. Anesthesia was induced with halothane and nitrous oxide and ventilatory cairo was maintained. EtCO2 was adjusted to 30-40mmHg and halothane was maintained. Right infernal carotid artery and right femoral vein were cannulated and EKG electrodes were attached. After 10 minutes of asphyxia, group 1 was treated with 1ml of saline, group 2 with 1ml(0.001mg/100g) of epinephrine and group 3 with 1ml(0.16u/100g) of vasopressin for resuscitation. Statistical significance was an analysed by SPSS with ANOVA and chi-square tests. RESULTS: No significant differences were seen in baseline measurements. Three ROSC and eight 60 minutes survivals were found in group 1, whereas nine ROSC and eight 60 minutes survivals were obtained in group 2 and all of the subjects in group 3 showed ROSC and 60 minutes survival, but no statistical differences were seen between group 2 and 3. CONCLUSION: Vasopressin seems to have similar effect on improving ROSC and survival rates compared to epinephrine in rat asphyxia models.
Anesthesia ; Animals ; Asphyxia* ; Brain ; Carotid Arteries ; Electrocardiography ; Electrodes ; Epinephrine* ; Femoral Vein ; Halothane ; Humans ; Male ; Myocardium ; Nitrous Oxide ; Rats* ; Rats, Sprague-Dawley ; Resuscitation* ; Survival Rate ; Vasopressins*

Overcrowding of emergency departments is a growing problem. Delays in admitting patients to inpatient units have been reported as a contributing factor to overcrowding. Overcrowding in ED results in many patients not receiving needed care and impairs the ability of the ED provider to meet the needs of those patients that are treated. The effect of the critically ill patients on the overcrowded emergency department make emergency physicians frustrated. So we created 'the special unit for observation' of critically ill patients and managed them continuously and closely. The special unit for observation have 4 physical beds and monitors and 2 ventilators. One nurse and senior ED residents were asigned to the management of the patients in the special unit. 160 patients(3.4% of all ED visits) admitted to special unit during the period of March 1, 1996 to May 31, 1996. we could continue assessment and management of critically ill patients without psychologic strain or burnout generated by overcrowding. We think that special unit for critically ill patients is a very effective alternative to overcrowded ED.
Critical Illness ; Emergencies ; Emergency Service, Hospital ; Humans ; Inpatients ; Ventilators, Mechanical