• Journal of Korean Neurosurgical Society
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• v.50 no.4
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• pp.392-395
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• 2011

Idiopathic hypertrophic spinal pachymeningitis (IHSP) is a rare inflammatory disease characterized by hypertrophic inflammation of the dura mater and various clinical courses that are from myelopathy. Although many associated diseases have been suggested, the etiology of IHSP is not well understood. The ideal treatment is controversial. In the first case, a 55-year-old woman presented back pain, progressive paraparesis, both leg numbness, and voiding difficulty. Initial magnetic resonance imaging (MRI) demonstrated an anterior epidural mass lesion involving from C6 to mid-thoracic spine area with low signal intensity on T1 and T2 weighted images. We performed decompressive laminectomy and lesional biopsy. After operation, she was subsequently treated with steroid and could walk unaided. In the second case, a 45-year-old woman presented with fever and quadriplegia after a spine fusion operation due to lumbar spinal stenosis and degenerative herniated lumbar disc. Initial MRI showed anterior and posterior epidural mass lesion from foramen magnum to C4 level. She underwent decompressive laminectomy and durotomy followed by steroid therapy. However, her conditions deteriorated gradually and medical complications occurred. In our cases, etiology was not found despite through investigations. Initial MRI showed dural thickening with mixed signal intensity on T1- and T2-weighted images. Pathologic examination revealed chronic nonspecific inflammation in both patients. Although one patient developed several complications, the other showed slow improvement of neurological symptoms with decompressive surgery and steroid therapy. In case of chronic compressive myelopathy due to the dural hypertrophic change, decompressive surgery such as laminectomy or laminoplasty may be helpful as well as postoperative steroid therapy.

• Korea Journal of Hospital Management
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• v.8 no.4
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• pp.149-181
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• 2003

It has been asserted that per diem payment system should be introduced, in place of the current fee-for-service system, for payment of the inpatient services of the geriatric hospitals, Based on the assentation, this study aims at calculating costs and profits per inpatient-day of the geriatric hospitals, and thereby at contributing to the managerial improvement from the both sides of the Government and the hospitals. Relevant data of the three months, May to August, 2002 were collected from the five geriatric hospitals, and per inpatient-day costs and profits were calculated for the three disease groups. Major results and conclusions are as follow : Firstly, total costs per insured inpatient-day of the geriatric hospitals are 65, 389 won for dementia (including optimal profit of 3,858 won), 69,730 won for stroke (including optimal profit of 4,117 won), and 70,085 won for other diseases (including optimal profit of 4,134 won). Secondly, the amount of the non-insured costs per inpatient-day occupies 34.5% of the total costs for dementia, 30.3% for stroke, and 30.1% for other diseases. Thirdly, the total amount of the per inpatient-day costs calculated including the optimal profits is, on the average, higher by 12% than the present price level calculated for the current fee-far-service system. This implies that the present price level should rise by 12% when the current fee-far-service payment system be maintained, and Finally, introduction of a sliding-scale payment system should be considered for the inpatient medical management fees for the length of stay over six months or more that are being cut in the claim examination process by the insurance corporation.

• Journal of Preventive Medicine and Public Health
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• v.41 no.1
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• pp.23-29
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• 2008

Objectives : We examined the association between alcohol consumption and incidence of colorectal cancer in elderly Koreans. Methods : The cohort members (n=14,304) consisted of 4,834 males and 9,470 females derived from the Korea Elderly Pharmacoepidemiologic Cohort (KEPEC), a population-based dynamic cohort. They were aged 65 years old or older and lived in Busan between 1993-1998; they were beneficiaries of the Korean Medical Insurance Corporation (KMIC). Baseline information was surveyed by a self-administered, mailed questionnaire. This study population was restricted to 14,304 participants who reported alcohol drinking habits on the questionnaire and had not been diagnosed with colorectal cancer at baseline. The adjusted hazard ratios (aHR) of status, type, frequency and daily average amount of alcohol consumption were computed with Cox's proportional hazard model, with the never-drinkers as a reference group and controlling for age and gender. Results : After 4.82 person-years of mean follow-up 112 cases of colorectal cancer occurred. The incidence densities of colorectal cancer were 161 (95% CI=123-200) for never-drinkers, 219 (95% CI=125-339) for ex-drinkers, and 137 (95% CI=84-189) for current-drinkers per 100,000 person-year. The status, type, frequency, and daily average amount of alcohol consumption were not significantly related to the incidence of colorectal cancer after controlling for age and gender. Conclusions : There was no significant association between alcohol consumption and colorectal cancer among elderly people after controlling for age and gender.

• Archives of Reconstructive Microsurgery
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• v.20 no.1
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• pp.8-13
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• 2011

Purpose: A palatal defect following maxillectomy can cause multiple problems like the rhinolalia, leakage of foods into the nasal cavity, and hypernasality. Use of a prosthetic is the preferred method for obturating a palate defect, but for rehabilitating palatal function, prosthetics have many shortcomings. In a small defect, local flap is a useful method, however, the size of flap which can be elevated is limited. In 12 cases of palatomaxillary defect, we used various microvascular free flaps in reconstructing the palate and obtained good functional results. Method: Between 1990 and 2004, 12 patients underwent free flap operation after head and neck cancer ablation, and were reviewed retrospectively. Among the 12 free flaps, 6 were latissimus dorsi myocutaneous flaps, 3 rectus abdominis myocutaneous flaps, and 3 radial forearm flaps. Result: All microvascular flap surgery was successful. Mean follow up time was 8 months and after the follow up time all patients reported satisfactory speech and swallowing. Wound dehiscence was observed in 4 cases, ptosis was in 1 case and fistula was in 1 case, however, rhinolalia, leakage of food, or swallowing difficultly was not reported in the 12 cases. Conclusion: We used various microvascular flaps for palatomaxillary reconstruction. For 3-dimensional flap needs, we used the latissimus dorsi myocutaneous flap to obtain enough volume for filling the defect. Two-dimensional flaps were designed with latissimus dorsi myocutaneous flap, rectus abdominis flap and radial forearm flap. For cases with palatal defect only, we used the radial forearm flap. In palatomaxillary reconstruction, we can choose various free flap techniques according to the number of skin paddles and flap volume needed.

• Archives of Plastic Surgery
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• v.33 no.4
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• pp.445-448
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• 2006

Purpose: The nose is the most prominent skeletal feature of the face and is thus prone to frequent injury. Closed reduction of nasal bone fractures can be performed under general or local anesthesia. However, the benefits and the drawbacks in either form of anesthesia chosen are seldom perceived by the surgeon. A retrospective study was performed to assess the differences in the outcome among the two groups subjected to surgery under different type of anesthesia and to introduce our method of local anesthesia and its adequacy. Methods: Two hundred and fifteen patients during a 2-year period were included in the study. 2% Lidocaine mixed with 1:100,000 epinephrine was injected on the anterior ethmoid nerve and the periosteum. Assessment factors included intra-operative adequacy of analgesia, post-operative analgesic requirement and functional and aesthetic outcome of surgery. Results: 19 patients were manipulated under general anesthesia and 196 patients were manipulated under local anesthesia on the anterior ethmoidal nerve and dorsal periosteum. No statistically signigicant variable in performance of surgery could be attributed to the mode of anesthesia employed(p > 0.05). Four patients experienced complications after reduction. One developed septal deviation and three nasal obstruction. But, no secondary operations were needed. Conclusion: Anterior ethmoidal nerve block and dorsal periosteal injection of 2% Xylocaine, combined with topical intranasal 4% lidocaine and epinephrine provided sufficient analgesia comparable to that of general anesthesia.

• Korean Journal of Social Welfare
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• v.57 no.2
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• pp.71-92
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• 2005

This study investigated social support, quality of life, and the impact of social support on quality of life among medicaid recipient with chronic illness such as hypertension, arthritis, diabetes, and stroke in Dec, 2003(N=221). Subjects were collected using stratified sampling by sex, age, diagnosis, and domicile on national data from National Health Insurance Corporation. Descriptive analysis and regression were performed. Results showed social support and quality of life was very low and social support was different in diagnosis and domicile, and social support, especially emotional support from family members, positively impacted on quality of life. The relationship of the two variables showed the differences in sex, diagnosis and domicile. This study will be used as theoretical bases for enhancing social support and quality of life among medicaid recipient with chronic illness.

• Journal of Korean Neurosurgical Society
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• v.29 no.12
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• pp.1600-1605
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• 2000

Objective : World Health Organization and International Labour Organization, in June 8, 1999, requested that working conditions should be reformed ethically right and economically solid for 2.7 billion world labour force. The purpose of this study is to request compensable surgical therapeutic options and to suggest the renewal in cognizance criteria for worker's compensation, especially in spondylolisthesis. Methods : Regarding spondylolisthesis, we obtained data from Korea Labor Welfare Corporation(KLWC). Spinal disease occurrence incidences and medical fees of National Federation of Medical Insurance(NFMI) were analysed. The compensated 122 spinal instrumented cases included 117 male and 5 female patients, aged from 23 to 72 years old(mean : $45{\pm}9.85$). We compared Korean and Foreign Workers Compensation Law. Results : Numbers of herniated nucleus pulpus(78 cases), spinal fractures(34 cases) and dislocations(4 cases) were claimed after spinal interbody fusion operation and were compensated. These compensated degenerative diseases, work related illness, occurred in the course of work. A case of 52-year old spondylolisthesis patient with Disability Grade 8 was compensated by KLWC, according to its occurrence at work by accident. With exception of trauma at work by accident, current cognizance criteria were too narrow to be compensable, especially in surgical therapeutic option, for worker's spondylolisthesis. Conclusion : Considering both worker's compensation law and clinical pathologic progress, we believe that spondylolisthesis should be regarded as a compensable occupation related disease if and when aggravates rapidly in the course of work. We suggest a new cognizance standard to KLWC for labour welfare and proper worker's compensation.

• Journal of Korean Neurosurgical Society
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• v.46 no.4
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• pp.328-332
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• 2009

Objective : The purpose of this study was to establish new fusion criteria to complement existing Brantigan-Steffee fusion criteria. The primary purpose of intervertebral cage placement is to create a proper biomechanical environment through successful fusion. The existence of a traction spur is an essential predictable radiologic factor which shows that there is instability of a fusion segment. We studied the relationship between the existence of a traction spur and fusion after a posterior lumbar interbody fusion (PLIF) procedure. Methods : This study was conducted using retrospective radiological findings from patients who underwent a PLIF procedure with the use of a cage without posterior fixation between 1993 and 1997 at a single institution. We enrolled 183 patients who were followed for a minimum of five years after the procedure, and used the Brantigan-Steffee classification to confirm the fusion. These criteria include a denser and more mature bone fusion area than originally achieved during surgery, no interspace between the cage and the vertebral body, and mature bony trabeculae bridging the fusion area. We also confirmed the existence of traction spurs on fusion segments and non-fusion segments. Results : The PLIF procedure was done on a total of 251 segments in 183 patients (71 men and 112 women). The average follow-up period was $80.4{\pm}12.7$ months. The mean age at the time of surgery was $48.3{\pm}11.3$ years (range, 25 to 84 years). Among the 251 segments, 213 segments (84.9%) were fused after five years. The remaining 38 segments (15.1%) were not fused. An analysis of the 38 segments that were not fused found traction spur formation in 20 of those segments (52.6%). No segments had traction spur formation with fusion. Conclusion : A new parameter should be added to the fusion criteria. These criteria should be referred to as 'no traction spur formation' and should be used to confirm fusion after a PLIF procedure.

• Journal of Preventive Medicine and Public Health
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• v.35 no.1
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• pp.41-48
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• 2002

Objectives : To review the drug prescription pattern of antiulcerative agents for elderly inpatients, Methods : The study population comprised inpatients of community hospitals who were members of the Korean Elderly Pharmacoepidemiologic Cohort (KEPEC), aged 65 years or over, beneficiaries of the Korea Medical Insurance Corporation (KMIC) and residing in Busan city in 1993. The drug prescription information was collected from the claims data of hospitals where the cohort members received medical care between January 1993 and December 1594. The information included personal identification, age, gender, diagnosis, drug dosage, date of hospital admission and name of medical institutions where the study subjects received drug prescriptions. The data analysis produced outcomes in terms of distribution of antiulcerative agents by class and by medical institution and trend of relative prescription, Analysis was also performed in terms of combined prescriptions of antiulceratives and drugs that could induce risk from drug interaction with antiulceratives. Results : The number of patients prescribed antiulcerative agents was 1,059 (64,9%) male and 1,724 (65.5%) female among the total inpatients. An antacid and composite agent was the most frequently prescribed antiulcerative agent (70.8%), followed by $H_2$ antagonist (16.0%), Among the potential drugs that could induce risk from drug interaction with the antiulcerative agents, diazepam was the most frequently prescribed. The proportion of diazepam co-prescription was 22.5% of the total cimetidine prescriptions and 14.5% of the fetal omeprazole prescriptions. Conclusions : Antiulcerative drugs were frequently prescribed in the elderly inpatients. The adverse drug reaction could possibly be due to drug interaction. The study results could be used as fundamental data for further drug utilization review of antiulceratiye agents.

• Journal of Digital Convergence
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• v.14 no.2
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• pp.501-507
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• 2016

We obtained medical test data of 150 male from National Health Insurance Corporation, that included physique, blood chemistry, and lifestyle. ${\chi}^2-test$ and logistic regression, and multiple regression were done to verify how CAD risks and/or lifestyle are different between obese and non-obese person. SPSS(version 18) was used for statistical procedures and p-value of .05 was regarded as good through. ${\chi}^2-test$ showed the frequency of hypertension, htperglycemia, hyperlipidemia were higher in obese person than in non-obese This result told us that lifestyle modification could be a key to prevent cardiovascular disease by controlling and managing body composition, especially abdominal obesity.