• Health Policy and Management
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• v.4 no.1
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• pp.49-76
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• 1994

Small area variations in health care utilization have long been studied as an important issue related to boto cost containment and quality assurance. This study was conducted to investigate if variations in hospital services across small geographic areas in Korea existed. The claims data of the fiscal year 1992 obtained from the regional health insurance societies were used for the study. Main findings of the research can be summarized as follows : 1. Extremal Quotients(EQ) of hospital expenditure per capita and hospital days per capita varied among diagnosis types. The EQ ranged from 2.05(cataract) to 41.67(pneumonia) in hospital expenditure per capita and from 1.86(cataract) to 45.89(pneumonia) in hospital days per capita. The diagnosis groups which showed high variation were pneumonia, cephalo-pelvic disproportion, gastritis and duodenitis, fracture of rib, and acute bronchitis. Those which showed low variation were acute appendicitis and cataract. 2. The EQ level of admission rate was different in terms of diagnosis types, ranging from 2.57(catarct) to 44.45(pneumonia). The variations were high in medical disorders such as pneumonia, oephalo-pelvic disproportion, gastritis and duodenitis and acute bronchitis, while relatively low in surgical conditions such as acute appendicitis and cataract. 3. As an indicator of service intensity, the EQ of expenditure per admission ranged from 1.67(acute appendicitis) to 31.27(essential hypertension). The diagnoses which had high variation were essential hypertension, gastric ulcer, whereas those which had low variation were cephalopelvic disproportion and acute appendicitis. With regard to hospital days per admission, the EQ ranged from 1.55(acute appendicitis) to 28.13(gastric ulcer) by diagnosis types. The diagnosis groups with showed high variation were gastric ulcer, essential hypertension, and acute bronchitis, whereas those with low variation were cephalo-pelvic disproportion, intervertebral disc disorders, and acute appendicitis. Both the expenditure and hospital days per admission showed lewwer variations than the expenditure per capita, hospital days per capita and admission rate. 4. Comparing patterns of variation in utilization indices, diagnoses such as essential hypertension, gastric ulcer, fracture of rib showed higher variations in expenditure per admission than in admission rates, whereas diagnoses such as pneumonia, cephalo-pelvic disproportion and gastric ulcer showed higher variations in admission rate than expenditure per admission. These findings suggest that wide variations existed in several diagnoses groups across small areas in Korea. Further research should be performed to investigate factors related to small area variations including provider behavior.

• Geomechanics and Engineering
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• v.22 no.1
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• pp.1-9
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• 2020

This paper presents an investigation of the ground response of a gob-side gateroad suffering mining stress induced by a 21 m-thick coal seam extraction. A field observation, including entry convergence and stress changes monitoring, was first conducted in the tailgate 8209. The observation results of entry convergence showed that, during the adjacent panel 8210 retreating period, the deformation of the gob-side gateroad experienced a continuous increase stage, subsequently, an accelerating increase stage, and finally, a slow increase stage. However, strong ground response, including roof bending deflection, rib extrusion and floor heave, occurred during the current panel 8209 retreating period, and the maximum floor heave reached 1530 mm. The stress changes within coal mass of the two ribs demonstrated that the gateroad was always located in the stress concentrated area, which responsible for the strong response of the tailgate 8209. Subsequently, a hydraulic fracture technique was proposed to pre-fracture the two hard roofs above the tailgate 8209, thus decreasing the induced disturbance on the tailgate. The validity of the above roof treatment was verified via field application. The finding of this study could be a reference for understanding the stability control of the gob-side gateroad in extra thick coal seams mining.

• Journal of Trauma and Injury
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• v.27 no.4
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• pp.229-232
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• 2014

A 55 year-old man hit a vehicle while riding a bicycle. He was diagnosed as left hemopneumothorax, multiple rib fracture, cerebral hemorrhage, and skull fracture. Initially he suffered from hypoxia requiring 100% oxygen with a mechanical ventilator. Finally he became hypotensive. Venovenous extracorporeal membrane oxygenation (ECMO) was initiated to support patient's gas exchange. Because hypotension and left ventricular dysfuction persisted, we converted the mode of support to veno-arterio-venous ECMO. Over four days of intensive care, we could wean off ECMO. The patient went to rehabilitation facility after 45 days of hospitalization. Although trauma and bleeding are considered as relative contraindication of ECMO, careful decision making and management may enable us to use ECMO for trauma-related refractory heart and/or lung failure.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.31 no.1
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• pp.74-81
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• 2005

In 1974, Casson et. al. reported midfacial degloving approach to repair the midfacial bone fracture. After then, this approach has been used frequently to treat the lesions on nasal cavity, nasopharynx, facial plastic surgery and midfacial trauma. Midfacial degloving approach consists of 1) bilateral sublabial incision 2) complete transfixion incision/ septocolumellar incision 3) bilateral intercartilaginous incision 4) bilateral pyriform aperature incision. This approach provides proper access for midfacial bone structure without facial scar but has post-operative complications such as transient epistaxis, infraorbital nerve paresthesia and nasal crust. We treated three patients using midfacial degloving approach to correct traumatic deformity in midface area. In two patients, rhinoplasty with autogenous rib graft was done simultaneously. So we report these cases with review of literatures.

• Journal of Trauma and Injury
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• v.34 no.2
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• pp.130-135
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• 2021

Celiac artery compression is a rare condition in which the celiac artery is compressed by the median arcuate ligament. Case reports of compression after trauma are hard to find. Blunt traumatic pericardium rupture is also a rare condition. We report a single patient who experienced both rare conditions from a single blunt injury. An 18-year-old woman was brought to the trauma center after a fatal motorcycle accident, in which she was a passenger. The driver was found dead. Her vital signs were stable, but she complained of mild abdominal pain, chest wall pain, and severe back pain. There were no definite neurologic deficits. Her initial computed tomography (CT) scan revealed multiple rib fractures, moderate lung contusions with hemothorax, moderate liver injury, and severe lumbar spine fracture and dislocation. She was brought to the angiography room to check for active bleeding in the liver, which was not apparent. However, the guide wire was not able to pass through the celiac trunk. A review of the initial CT revealed kinking of the celiac trunk, which was assumed to be due to altered anatomy of the median arcuate ligament caused by spine fractures. Immediate fixation of the vertebrae was performed. During recovery, her hemothorax remained loculated. Suspecting empyema, thoracotomy was performed at 3 weeks after admission, revealing organized hematoma without pus formation, as well as rupture of the pericardium, which was immediately sutured, and decortication was carried out. Five weeks after admission, she had recovered without complications and was discharged home.

• Journal of Chest Surgery
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• v.10 no.1
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• pp.38-43
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• 1977

With the adevance of widespread mechanization and high-speed era, the incidence of traumatic rupture of the tracheobronchial tree has been increased considerably. We have experienced these diseased of the 3 cases in our department. The first case was a 25 year old male who was severe dyspneic and subcutaneous emphysema, hemoptysis, and hemopneumothorax of both side were noted. During tracheostomy, it was found that the 2net ring of the trachea was ruptured. No definitive procedure was made on admission. Corrective surgery was performed with end-to-end anastomosis on 31 post-traumatic day. The second case was a 43 year old female who received multiple stab wounds on the anterior neck and it was found that the cricoid cartilage was transected partially. The injured cartilage was approximated with interrupted suture of No. 600 wire. The third case was a 19 year old male who had sustained a compression chest injury without external wound or rib fracture. At five days after trauma, he had suffered from dyspnea, and obstruction of the left main bronchus due to traumatic bronchial rupture was confirmed by means of bronchoscopy and bronchography at two weeks after the trauma. End-to-end anastomosis of the bronchus was performed and the left lung was aerated well. Mild postoperative stenosis of trachea was remained in the first case. Others were uneventful.

• Journal of Korean Foot and Ankle Society
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• v.19 no.1
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• pp.27-31
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• 2015

Intraosseous lipoma is a benign tumor that originates from proliferating mature lipocytes. It often occurs in the metaphysis of long bones of the lower extremity, and also in the calcaneus, humerus, mandible, sacrum, and rib bones. Frequently, it involutes spontaneously through a process of infarction, calcification, and cyst formation. It can either present as pain, or be asymptomatic and only discovered through an incidental radiological finding. In our case, the patient presented with heel pain. Intraoperatively, it was found that the intraosseous cavity was filled with fat along with an adjacent but separate area of cystic degeneration. There was also a cortical perforation at the cystic lesion which was communicating with the subtalar joint. This cortical breach is most likely the cause of diffuse lateral heel pain experienced by our patient, and such a pathological fracture due to intraosseous lipoma has never been reported.

• Journal of Veterinary Clinics
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• v.15 no.1
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• pp.188-192
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• 1998

A 3-month old female Holstein calf was presented with about a month history of intermittent dyspnea, exercise intolerance and cough despite antibiotic therapy. Auscultation revealed prominent inspiratory and exploratory crackles and wheezes over the causal cervical trachea which were heard equally over both side of the chest.4 modest amount of forced exercise caused severe respiratory distress with stertorous noise and occasional honkinglike cough. Pasteurella spp. was isolated on the nasal swabs and a hemogram showed mild leucocytosis with a mature neutrophilia and mild monocytosis. Lateral radiographs of the neck and thorax revealed a marked narrowing of the tracheal lumen extending from the level of the fifth cervical to the second thoracic vertebra, and the lung field was judged to be within normal limitsi except very mild peribronchial thickening. The hypertrophic non-union fractures of the first pair of ribs were noted with a well delineatedr redundant callus formations and also the completely healed fractures were found on the next seven pairs of ribs. A diagnosis of tracheal collapse was made, which is thought to be a traumatic origin.4 poor prognosis was given. The calf was euthanatized and necropsied. The tracheal rings from 19th to 41s1 were collapsed dorsoventrally. Histologically, there was no difference between the collapsed and normal areas of the tracheae except the folding mucosal layer in the collapsed area. This report details a case of tracheal collapse in a calli and the literature is reviewed.

• Journal of Veterinary Clinics
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• v.41 no.1
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• pp.60-64
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• 2024

This case report documents the rescue, clinical presentation, treatment, and recovery of pneumothorax in a female Korean water deer (Hydropotes inermis argyropus) following a vehicular collision. Severe injuries, including a confirmed rib fracture, prompted an extensive treatment plan. Computed tomography imaging confirmed pneumothorax, particularly in the left lung, necessitating thoracocentesis to alleviate the accumulated air. Post-procedural monitoring demonstrated gradual recovery, with the water deer exhibiting restored appetite after the 2nd day of thoracocentesis. Successful recovery marked by natural pneumothorax resolution allowed for treatment cessation on the 13th day after injury.

• Journal of Veterinary Clinics
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• v.22 no.1
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• pp.60-64
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• 2005

A 6year-old intact male hound cross dog, weighing 23 kg, was presented to the Teaching Animal Hospital, Chonbuk National University with the history of gunshot wound at the left elbow joint. Survey radiographs of the affected elbow revealed the presence of a metallic bullet caudal to the olecranon processes and comminuted fracture of the proximal radius and ulna. The first treatment strategy included removal of the bullet and fixation of the radius and ulna using separate bone plates, bone screw, K-wire and surgical wire, was failed. The second treatment strategy included olecranon osteotomy and rigid immobilization of the elbow joint with a bone plate applied to the caudal aspect of the humerus and ulna along with autogenous bone grafts collected from the 13th rib. The optimal angle of the joint following arthrodesis of this case appeared to be 130°. This resulted in improving the case but after 60 weeks the plate was bent and there was exudation from the wound. The third treatment strategy was the same with the second except for that the bone autografts were collected from the proximal metaphyses of the ipsilateral humerus. This resulted in a successful arthrodesis 6 weeks after the surgery. Elbow arthrodesis with bone autograft resulted in acceptable function, but abnormal gait remained in the dog due to mechanical interference with the movement of the joint.