ABSTRACT
Background@#Korea set up a new diagnosis-related group as a demonstration project in 2009. The new diagnosis-related group was reformed in 2016. The main purpose of the study is to identify the effect of reform on coverage of national health insurance. @*Methods@#This study collected inpatient data from a hospital that contains medical information and cost from 2015 July to 2016 June. The dependent variable was the coverage of national health insurance. The dependent variable was divided by total, internal medicine partition, surgical partition, and psychiatric partition. To analyze the effect of the reform, this study conducted an interrupted time series analysis. The final sample included 23,695. @*Results@#The health insurance coverage of internal medicine has the highest, followed by surgery and psychiatry. The health insurance coverage of bundle payment is higher than that of unbundled payment. The proportion of bundled payment and non-benefit decreased and the proportion of unbundled payment increased. The coverage of national health insurance significantly increased after policy reform in internal medicine partition (p-value=0.0356). @*Conclusion@#The results of the study imply that policy reform enhanced the coverage of national health insurance in internal medicine. The government needs to monitor side effects such as an increase of unbundled payment.
ABSTRACT
BACKGROUND/AIMS: Gastric schwannomas are rare benign mesenchymal tumors that are difficult to differentiate from other mesenchymal tumors with malignant potential, such as gastrointestinal stromal tumors. This study aimed to evaluate the characteristic findings of gastric schwannomas via endoscopic ultrasonography (EUS). METHODS: We retrospectively reviewed the EUS findings of 27 gastric schwannoma cases that underwent surgical excision at Pusan National University Hospital during 2007 to 2014. RESULTS: Gastric schwannomas were mainly located in the middle third of the stomach with a mean tumor size of 32 mm. All lesions exhibited hypoechoic echogenicity, and 24 lesions (88.9%) exhibited heterogeneous echogenicity. Seventeen lesions (63.0%) exhibited decreased echogenicity compared to the normal proper muscle layer. Distinct borders were observed in 24 lesions (88.9%), lobulated margins were observed in six lesions (22.2%), and marginal haloes were observed in 24 lesions (88.9%). Hyperechogenic spots were observed in 21 lesions (77.8%), calcifications were observed in one lesion (3.7%), and cystic changes were observed in two lesions (7.4%). CONCLUSIONS: During EUS, gastric schwannomas appear as heterogeneously hypoechoic lesions with decreased echogenicity compared to the normal proper muscle layer. These features may be helpful for differentiating gastric schwannomas from other mesenchymal tumors.
Subject(s)
Endosonography , Gastrointestinal Stromal Tumors , Neurilemmoma , Retrospective Studies , StomachABSTRACT
Enema has frequently been used for diagnostic or therapeutic purpose. However, cases of colitis from physical, chemical, and thermal injury due to enema have been reported. In severe cases, life threatening complications (perforation, rupture, peritonitis, etc.) may occasionally occur. Reports of ischemic colitis after enema is rare and there have been only 1 case of ischemic colitis after normal saline enema reported in South Korea. Sigmoidoscopy on a 58 year old female, presenting with sudden abdominal pain and hematochezia after glycerin enema, revealed ischemic injury of the rectosigmoid colon, which was improved after using antibiotics and conservative therapy.
Subject(s)
Female , Humans , Abdominal Pain , Anti-Bacterial Agents , Colitis , Colitis, Ischemic , Colon , Diarrhea , Enema , Gastrointestinal Hemorrhage , Glycerol , Peritonitis , Republic of Korea , Rupture , SigmoidoscopyABSTRACT
Russell body gastritis was first defined in 1998, but not many cases have been reported since then. The exact causes and process of this condition are unknown yet; however, considering the reported cases, it has been highly suggested to have correlation with Helicobacter pylori infection. Russell body gastritis has a non-specific clinical presentation of gastritis such as gastric mucosal edema in the macroscopic view. It can be mistaken as xanthoma, signet ring cell carcinoma, or a malignant lymphoma including mucosa-associated lymphoid tissue lymphoma and plasmocytoma. Russell body gastritis features polyclonal immunoglobulin and is differentiated from Mott cancer, of which immune globulin has monoclonal aspect. Authors report here two cases of Russell body gastritis with examined endoscopic findings as well as a review of related literature on the association of all reported cases of Russell body gastritis with H. pylori infection.
Subject(s)
Carcinoma, Signet Ring Cell , Edema , Gastritis , Helicobacter , Helicobacter pylori , Immunoglobulins , Lymphoma , Lymphoma, B-Cell, Marginal Zone , Plasmacytoma , XanthomatosisABSTRACT
Collision tumors of the colon are rare. A 54-year-old man was referred to our hospital for the evaluation of hematochezia. Colonoscopy demonstrated the presence of about 3 cm sized mass in the rectosigmoid junction. After surgical resection, the colonic lesion was histologically composed of two discrete lesions: adenocarcinoma in the superficial layer and poorly differentiated neuroendocrine carcinoma in the deeper layer. We report this case of colonic collision tumor (adenocarcinoma and neuroendocrine carcinoma) with a review of the literature.
Subject(s)
Humans , Male , Middle Aged , Adenocarcinoma/diagnosis , Antigens, CD/metabolism , Antigens, Differentiation, T-Lymphocyte/metabolism , Carcinoma, Neuroendocrine/diagnosis , Colonic Neoplasms/diagnosis , Colonoscopy , Positron Emission Tomography Computed Tomography , Synaptophysin/metabolism , Tomography, X-Ray ComputedABSTRACT
The incidence of gastrointestinal complications has increased as endoscopic biopsy has become a standard diagnostic technique. However, esophageal dissection is a rare complication. A 71-year-old man suffered retrosternal pain for 15 days. Fifteen days previously, he had undergone an endoscopic gastrointestinal examination at a local clinic and an esophageal biopsy to obtain microscopic confirmation of esophageal candidiasis. The patient then underwent a subsequent endoscopic examination, which showed features specific to esophageal submucosal dissection. The predisposing conditions for esophageal dissection are coagulopathy, iatrogenic trauma (variceal sclerotherapy), drugs (thrombolytic agents, aspirin), foreign bodies/certain foods (fish, chicken bones), and emesis. However, endoscopic biopsy is a rare predisposing condition. Here, we report a case of esophageal submucosal dissection that developed after esophageal biopsy. We observed the healing process of this lesion with a series of endoscopies as part of a conservative treatment plan.
Subject(s)
Aged , Humans , Biopsy , Candidiasis , Chickens , Endoscopy , Esophageal Diseases , Incidence , VomitingABSTRACT
The incidence of gastrointestinal complications has increased as endoscopic biopsy has become a standard diagnostic technique. However, esophageal dissection is a rare complication. A 71-year-old man suffered retrosternal pain for 15 days. Fifteen days previously, he had undergone an endoscopic gastrointestinal examination at a local clinic and an esophageal biopsy to obtain microscopic confirmation of esophageal candidiasis. The patient then underwent a subsequent endoscopic examination, which showed features specific to esophageal submucosal dissection. The predisposing conditions for esophageal dissection are coagulopathy, iatrogenic trauma (variceal sclerotherapy), drugs (thrombolytic agents, aspirin), foreign bodies/certain foods (fish, chicken bones), and emesis. However, endoscopic biopsy is a rare predisposing condition. Here, we report a case of esophageal submucosal dissection that developed after esophageal biopsy. We observed the healing process of this lesion with a series of endoscopies as part of a conservative treatment plan.
Subject(s)
Aged , Humans , Biopsy , Candidiasis , Chickens , Endoscopy , Esophageal Diseases , Incidence , VomitingABSTRACT
PURPOSE: The serum immunosuppressive acidic protein (IAP) has been reported to be a useful tumor marker for renal cell carcinoma. In a previous study, the serum levels of IAP were shown to be related to the TNM stages and the nuclear grades in patients with renal cell carcinoma. The effectiveness of the IAP as a follow-up marker for renal cell carcinoma was evaluated. MATERIALS AND METHODS: In 135 patients who underwent a radical or partial nephrectomy for renal cell carcinoma, the serum concentrations of the IAP were measured by radial immunodiffusion preoperatively and postoperatively every 3 months. The changes in the serum IAP levels in the follow-up were recorded, and the change in the recurrence group was compared with that of the non-recurrence group. RESULTS: The mean age of 135 patients (male 87, female 48) was 52.2 12.3 (18-86) years. At follow-up, metastatic recurrences were observed in 8 patients an average of 18.4 months after surgery. The metastatic lesions were found in the bone in 3 patients, the liver in 2, the lung in 2 and the spleen in 1. In patients with an increased serum IAP preoperatively, the IAP levels were significantly lower 7-9 months postoperatively (p<0.05) (from 752.4 296.8microgram/ml to 465.9 88.9microgram/ml). With the metastatic recurrence, the serum IAP level was continuously higher. CONCLUSIONS: The serum IAP might be a valuable tool in following up a renal cell carcinoma for a postoperative recurrence.
Subject(s)
Female , Humans , Carcinoma, Renal Cell , Follow-Up Studies , Immunodiffusion , Liver , Lung , Nephrectomy , Recurrence , SpleenABSTRACT
PURPOSE: It has been reported that renal cell carcinoma patients with microscopic vascular invasion showed poor treatment outcome. We analysed the association between microscopic vascular invasion and other variable pathologic and clinical parameters, which are known as poor prognostic factors, to evaluate the significance of microscopic vascular invasion as a prognostic factor. MATERIALS AND METHODS: 157 patients (108 men and 49 women, mean age 53 years) who had received radical nephrectomy (153 patients) or partial nephrectomy (4 patients) for the treatment of renal cell carcinoma were evaluated. Microscopic vascular invasion was compared with Fuhrman's nuclear grade, TNM stage, tumor diameter, lymph node involvement, p53 point mutation, result of flow cytometry, and recurrence. RESULTS: Microscopic vascular invasion was found in 51 of 157 patients (32.5%). Microscopic vascular invasion showed significant relationship with Fuhrman's nuclear grade, T stage, and tumor diameter (p<0.05). Microscopic vascular invasion was observed more frequently in patients with lymph node involvement, DNA aneupolid tumor, and recurrence (p<0.05). CONCLUSIONS: Microscopic vascular invasion was related to higher T stage, higher grade, larger tumor diameter, lymph node involvement, DNA aneuploid tumor, and recurrence. Microscopic vascular invasion might be another important finding to predict prognosis not to be overlooked. And since there is a higher possibility of lymph node metastasis and tumor recurrence in cases with microscopic vascular invasion, localized renal cell carcinoma patients with microscopic vascular invasion should be followed closely for metastatic disease.