Impact of Continuous Care on Health Outcomes and Cost for Type 2 Diabetes Mellitus: Analysis Using National Health Insurance Cohort Database

BACKGROUND: The objective of the study was to determine the impact of continuous care on health outcomes and cost of type 2 diabetes mellitus (T2DM) in Korea.METHODS: A nationwide retrospective, observational case-control study was conducted. Continuity of treatment was measured using Continuity of Care (COC) score. Information of all patients newly diagnosed with T2DM in 2004 was retrieved from the National Health Insurance database for the period of 2002 to 2013. The study examined 2,373 patients after applying exclusion criteria, such as for patients who died from conditions not related to T2DM. Statistical analyses were performed using frequency distribution, simple analysis (t-test and chi-squared test), and multi-method analysis (simple linear regression, logistic regression, and survival analysis).RESULTS: The overall COC score was 0.8±0.24. The average incidence of diabetic complications was 0.39 per patient with a higher COC score, whereas it was 0.49 per patient with a lower COC score. In both survival and logistic analyses, patients who had high COC score were significantly less likely to have diabetic complications (hazard ratio, 0.69; 95% confidence interval, 0.54 to 0.88). The average medical cost was approximately 3,496 United States dollar (USD) per patient for patients with a higher COC score, whereas it was 3,973 USD per patient for patients with a lower COC score during the 2006 to 2013 period, with a difference of around 477 USD, which is statistically significant after adjusting for other factors (β=−0.152).CONCLUSION: Continuity of care for diabetes significantly reduced health complications and medical costs from patients with T2DM.

Electrophysiological Changes after Botulinum Toxin Type A in Children with Cerebral Palsy

OBJECTIVE: To investigate the electrophysiological changes after botulinum toxin type A injection in children with cerebral palsy. METHOD: Sixteen children with spastic cerebral palsy enrolled in the study. Botulinum toxin type A (Dysport(R)) was injected into gastrocnemius muscles. Electrophysiological assessments included the compound motor action potential of the tibial nerve, the sensory nerve action potential of the sural nerve, the H-reflex and the T-reflex before injection, and at 2 weeks and 4 weeks after the injection. Modified Ashworth scale was used to evaluate spasticity before, 2 weeks and 4 weeks after the injection. RESULTS: Modified Ashworth scale of the ankle decreased at 2 weeks and 4 weeks after injection. The amplitude of the H-reflex and H(max)/M(max) ratio decreased significantly at 4 weeks. The amplitude of the T-reflex decreased at 2 weeks and 4 weeks. The correlation between changes in modified Ashworth scale of the ankle and the changes in electrophysiological parameters at 4 weeks after injection were not significant. CONCLUSION: The change in T-reflex is faster than the change of H-reflex and H(max)/M(max) ratio after botulinum toxin A injection in children with cerebral palsy. Electrophysiological tests could quantify the change in spasticity after botulinum toxin injection.

The Analysis of Relationship among the Anthropometric Index, the Foot Types and Dynamic Plantar Pressure in Normal Teenagers

OBJECTIVE: To investigate the possible relationship between the anthropometric data, the foot types, sex and the dynamic plantar pressure of normally developed teenagers. METHOD: The height, weight, body mass index and dynamic plantar pressure were measured from 98 teenagers. Foot types were classified to high arch, normal and flat foot groups depending on the value derived by dividing the minimal length of mid foot area by the maximal length of the rear foot area. RESULTS: The area with the highest plantar pressure was the middle metatarsal area at both feet. However the plantar pressure of the right medial metatarsal and lateral calcaneal areas was greater than the left, while the plantar pressure of the left lateral metatarsal and medial calcaneal areas was greater than the right. Therefore, supinating and pronating forces were applied to the right and left feet. There were statistically significant differences in body weight and BMI among three groups. The comparison between men and women in plantar pressure measurements and foot type determinations showed that the number of pronated feet group and plantar pressures was greater in males than in females. CONCLUSION: The dynamic plantar pressure of teenagers showed high correlation to weight and BMI. Just like the hands, there was lateral dominance at the feet, and analysis of dynamic plantar pressure of each foot showed asymmetry and asymmetrical turning forces.

Emotional and Psychosocial Development in Siblings of Children with Cerebral Palsy

OBJECTIVE: To investigate the psychological development such as emotional and social aspects of typically developing siblings of children with cerebral palsy. METHOD: Eighteen siblings of children with cerebral palsy aged 5 to 12 years and their mothers were included and the interview and psychological assessment were administered by developmental psychologist. All children were asked to complete the Children's Depression Inventory (CDI), State- Trait Anxiety Inventory (STAI), Piers-Harris Children's Self- Concept Scale, Korea Child Behavior Checklist and Korean Educational Developmental Institute-Wechsler Intelligence Scale for Children (KEDI-WISC). All participating mother were asked to complete Minnesota Multiphasic Personality Inventory (MMPI), Beck's Depression Inventory (BDI). For control group, eighteen children with healthy sibling and their mothers were enrolled. RESULTS: Siblings of children with cerebral palsy showed higher mean score of CDI and STAI. And there were no differences in the CDI and STAI according to frequency of treatment, duration of treatment of children with cerebral palsy. There were no significant difference in Piers-Harris children's Self-Concept Scale and Korea Child Behavior Checklist between study group and control group. More than half of mothers of children with cerebral palsy showed depression in BDI and higher score of psychopathic Deviate and psychasthenia in MMPI. Children of mothers with depression in BDI showed higher mean score of CDI and STAI. CONCLUSION: It is necessary to consider extended service to promote psychosocial well-being of children with cerebral palsy and siblings in community-based service organizations.

A Case of Ischemic Colitis Presenting as Bloody Diarrhea after Normal Saline Enema / 대한소화기학회지

Ischemic colitis is a frequent disorder of large bowel in elderly persons or in debilitated patients with a variable underlying medical problems. Ischemic colitis may result from alterations in the systemic circulation or anatomic or functional changes in the local mesenteric vasculature. In most cases, no specific cause for the ischemic colitis is identified. Cases of ischemic colitis after enema for bowel cleansing have been rarely reported, but there has been no case report after normal saline enema. We report a case of ischemic colitis in a 72-year old patient with well-controlled hypertension, presenting as bloody diarrhea which developed after normal saline enema for preoperative bowel cleansing.

A Case of Granular Cell Tumor of the Colon Treated by Colonoscopy / 대한소화기내시경학회지

Granular cell tumor (GCT) is a relatively rare benign tumor that can be located anywhere throughout the body, but it is uncommon in the gastrointestinal tract, and especially in the colon and rectum. A 41-year-old man visited our hospital with a three-month history of intermittent abdominal discomfort at the left lower quadrant area. Colonoscopic examination revealed a hemispheric, submucosal lesion, about 1.5 x 1.2 cm in size, on the opposite side of the ileocecal valve in the proximal ascending colon. The tumor was removed by an endoscopic snare without any immediate complication. The pathologic findings revealed spindled or polygonal large cells that were positive for S-100, neuron-specific enolase and vimentin, and they were negative for smooth muscle actin and desmin, which was consistent with granular cell tumor. We report here on a case of granular cell tumor of the colon that was successfully treated with endoscopic polypectomy.

A family of multiple endocrine neoplasia type 2A associated with a C618R mutation in RET proto-oncogene / 대한내과학회지

Medullary thyroid carcinoma (MTC) is a relatively rare malignant thyroid disease that accounts for approximately 1% to 5% of all thyroid carcinomas. MTC occurs as a sporadic disease and as an inherited disease with the multiple endocrine neoplasia type 2A (MEN2A), MEN2B, and familial non-MEN medullary carcinoma (FMTC). MEN2A is characterized by MTC, pheochromocytoma, and parathyroid adenoma. The mutation of RET proto-oncogene plays an important role in MEN2A syndromes. Recently the authors diagnosed MEN2A patient and screened his family with thyroid ultrasonogram and RET proto-oncogene analysis. A genetic analysis of the peripheral leukocyte showed a codon 618 mutation (Cys618Arg) at exon 10 of the RET proto-oncogene in a family presenting third generations from age 7 to age 56 years. We report this case of MEN2A with a review of the related literatures.

A Case of Synchronous Esophageal Basaloid Squamous Carcinoma and Cancer of the Base of Tongue / 대한소화기내시경학회지

Basaloid squamous cell carcinoma occurs in various organs including the upper respiratory tract, the base of the tongue, pharynx, larynx, breast, uterine cervix and anus. It is a rare tumor, but it must be distinguished from other malignancies because of its aggressive clinical behavior. Many cases present in the advanced stage at the time of diagnosis. We present here a case of esophageal basaloid squamous cancer that was diagnosed in 75-year-old male patient who had dysphagia and throat pain, and this was accompanied by squamous cell cancer of the tongue base, as was determined by laryngoscopic and esophagogastroscopic examination.

A Case of Gastrojejunocolic Fistula as a Complication after Gastrojejunostomy / 대한소화기내시경학회지

Gastrocolic and gastrojejunocolic fistula are well-recongnized but rare complications of a variety of diseases, and surgical or endoscopic procedures We had a case of gastrojejunocolic fistulae associated with marginal ulcer following gastrectomy with Billroth II gastrojejunostomy for recurrent peptic ulcer disease. He had chronic watery diarrhea, weight loss and fecal eructation and gastrojejunocolic fistula was dignosed by gastroscopy, barium enema, upper gastrointestinal series and abdominal CT scan. He underwent subtotal gastrectomy with Roux-en-Y gastrojejunal anastomosis and en-bloc resection including the fistula and surrounding colon, jejunum and gastric segments. Hereafter, he showed disappearance of diarrhea, along with slow rate of weight gain.