Medical Tourism and the Future of Medical Practice in Korea

Medical tourism has emerged as a an increasingly relevant issue worldwide and its spread is gaining greater momentum. In 2008, 750,000 Americans went overseas for medical procedures and the number is expected to reach 6,000,000 by the year 2010. The Health Industry Development Institute of Korea announced that the number of medical tourists to Asia has seen an annual increase of 30%, to 1,590,000 from 950,000, between 2003 and 2005. Among Asian countries, Thailand, India and Malaysia have already established themselves as particularly attractive destinations for medical services thanks to low medical fees and/or tourism related prices. The number of foreign patients visiting these countries for medical services has increased rapidly as they had been from the very early days of medical tourism. Following the revision of its laws and regulations in medical practice, Korea will join the competition against existing leaders of medical tourism to gain a larger share of global medical shoppers. Some strength that Korea offers as a medical service destination are its plentiful supply of high quality physicians and medical facilities, relatively low medical fees compared to quality of service, excellent medical accessibility, and the geographical closeness to medically less developed countries. A vibrant medical tourism industry will not only create new jobs and generate a new source of income for medical professionals but also enhance the national image of Korea abroad. Another benefit of developing Korea as a destination for medical services is the maintenance of a better balance between medical supply and demand. The recent and rapid increase in the number of hospital beds and medical professionals in Korea has triggered a concern for a possible oversupply in medical services. Medical tourism is precisely the type of business that could help prevent the development of these situations. The patient's trust in medical professionals and their medical skills is a critical factor in medical decision-making. Therefore, to further develop Korea's medical tourism, policy support by the government along with meticulous preparation by health service providers would be required to build up a firm foundation. At the same time, active marketing promotions to heighten the awareness of Korea as a medical destination would be necessary to maximize the economic benefit of the nation from medical tourism.

The Effects of Acupuncture on Fibronectin, Collagens and Laminin in the Burn Wound Healing of Rats / 체질인류학회지

The present study was performed to examine whether acupuncture can regulate the expression of extracellular matrix proteins that play important roles in burn wound healing of rat, such as fibronectin, type I and IV collagens, and laminin. Sprague-Dawley rats weighing 250~300 g were divided into 4 groups such as normal control group (C), only acupuncture treatment group (Ca), burn treatment group (B), and a group for acupuncture treatment after burn (Ba). We burned 15x25 mm in size for 15~18 seconds at lumbar area of rats with special iron adapter and acupunctured at 5~7 mm in diameter and 1 cm in depth using 0.25 mm x 50 mm acupuncture needle for 20 minutes in wound area. Rats in group Ca were acupunctured once, and rats in group Ba were acupunctured every 12 hours 3 times. Rats sacrificed at days 1, 3, 7, 15 and 20 after burn treatment. Histological changes were examined by azan staining methods and expression profiles of fibronectin, type I and IV collagens, and laminin were detected by immunohistochemical staining methods. The results we obtained were as follows: 1. At day 1, fibers in epidermis, dermis and subcutaneous tissue in both groups B and Ba were not observed. However groups B and Ba exhibited fibers stained mildly and moderately, respectively, in muscle and connective tissues. At day 20 , the level of fiber in group B which was comparable to group C was less than that of in B group. 2. At day 3, fibronectin in group Ba was observed in the muscle. At days 15 and 20, fibronectin was increased in epidermis and dermis of group Ba compared with those of group B. 3. Type I collagen in subcutaneous tissue was observed at days 1, 3 and 7 in both groups B and Ba. However type I collagen was observed only in group Ba at day 15. In the epidermis of group Ba, type I collagen was observed at day 3 and maintained until day 20, while observing only at day 20 in group B. 4. For type IV collagen, both groups B and Ba showed similar results. 5. For laminin, both groups B and Ba showed similar results except the 7th day results. However after day 15, laminin was stained moderately and mildly in groups Ba and B, respectively. These results suggest that acupuncture may improve the burn wound healing by increasing fibronectin and type I collagen.

The Effects of Acupuncture on TGF-beta1, TGF-beta3, EGF, and IL-6 in the Burn Wound Healing of Rats / 체질인류학회지

The present study was performed to examine whether acupuncture can regulate the expression of cytokines that play important roles in wound healing and morphological changes in the burn wound healing of rats, such as transforming growth factor (TGF)-beta1, TGF-beta3, epidermal growth factor (EGF), and interleukin-6 (IL-6). Sprague-Dawley rats weighing 250~300 g were divided into two control groups and two experimental groups. Among the control groups, no-treatment group was classified as C and acupuntured group as Ca. Among the experimental groups, burned group (n = 6) was classified as B and acupunctured group after burn (n = 6) as Ba. The lumbar area of rats was burned 15 x 25 mm in size for 15~18 seconds with special small iron adapter and acupunctured at 5~7 mm in diameter and 1 cm in depth using 0.25 mm x 50 mm acupuncture needle for 20 minutes in wound area. Rats in group Ca were acupunctured once. Rats in group Ba were acupunctured every 12 hours 3 times. Rats were sacrificed at days 1, 3, 7, 15 and 20 after burn treatment. Morphological changes were examined by hematoxylin-eosin staining methods. The expression profiles of TGF-beta1, TGF-beta3, EGF and IL-6 were detected by immunohistochemical staining methods. The results we obtained were as follows: 1. In gross observation, the burn wounds were less odorous and cleaner in the acupunctured group (Ba) compared with those of no-acupuncture group (B). 2. Reepithelialization and formation of panniculus carnosus and granulation tissue were more prominent at days 3 and 7 in the acupunctured group Ba than group B. However, this difference was disappear at day 15. 3. In the muscle of group B, TGF-beta1 was observed after day7. However, in group Ba, TGF-beta1 was observed as early as days 1 and 3 and rapidly turnovered at day 7. 4. For TGF-beta3, both B and Ba groups showed similar results. 5. At day 3, EGF was observed in the subcutaneous tissue in both B and Ba groups. However, in day 7, EGF was rapidly decreased in Ba group compared with that of B. 6. For IL-6, both B and Ba groups showed similar results in epidermis, dermis, subcutaneous tissue and muscle. But, at day 3, IL-6 was rapidly decreased in theconnective tissue under the muscle in Ba group compared with that of B. These results suggest that acupuncture may improve the wound healing in the early stage by increasing the TGF-beta1 that is essential for the formation of extracellular matix and by decreasing EGF.

Electron Microscopic Studies on the Effects of Retinoic Acid on Palatogenesis in Fetal Rats / 체질인류학회지

Retinoic acid (RA) is widely used to treat the dermatologic disorders, such as acne and psoriasis, but its usage is limited because of teratogenic effects. Moreover, it is known that RA induces cleft palate by influencing epithelial differentiation and mesenchymal cells in palatine processes. We studied the ultrastructures of the epithelial and mesenchymal cells in rat palatine shelves treated with RA, in comparison with those of the normal developing rat. In this experiment, pregnant Sprague -Dawley rats were treated with 100 mg/kg of all -trans retinoic acid at day 10 of gestation. Pregnant rats were killed at 14 th and 16 th day of gestation. Fetuses were removed and palatine processes were dissected. The specimen were observed with a transmissiom electron microscope. The results were as follows. 1. Palatine epithelium of control rats was made up of two cell layers at day 14 of gestation, and that of RA treated rats consisted of multicellular layers. At the 16th day of gestation, many apoptotic bodies were observed in triangular area of the palatine epithelium of the control rat. In contrast, apoptotic cells were hardly observed in RA treated rats. 2. Mesenchymal cells of control rats contained cytoplasmic process, oval -shaped nucleus, well -developed rough endoplasmic reticulum, Golgi complex, and mitochondria. RA treated mesenchymal cells showed atrophied cisternae of Golgi complex, rough endoplasmic reticulum with sacculated, fragmented and ribosome detached cisternae, mitochondria with dissolved mitochondrial cristae, and multivesicular body. After RA exposure during palatogenesis, the frequency of apoptotic bodies was low in palatine epithelium, and mesenchymal cells were severely damaged. In conclusion, it is suggested the RA may induce direct cytotoxic effects on mesenchymal cells and influence normal apoptosis process in developing epithelium.

A Clinical Analysis for the Long Term Effect of the Epidural Injections with Steroid and Local Anesthetics in Low Back Pain Patients

OBJECTIVE: This study was designed to evaluate the long term effect of the epidural injections with steroid and local anesthetics in the low back pain patients by assessments of Visual Analog Scale (VAS) scores and several relating factors that influence good results. METHOD: Seventy two low back pain patients with or without sciatica were treated with epidural injections of weekly steroid (methylprednisolone acetate) and daily local anesthetics (lidocaine and bupivacaine) for 2 weeks via an epidural catheter. The efficacy of the epidural injections was assessed with Visual Analog Scale (VAS) score at the day of admission (VAS1), discharge (VAS2) and during the long term follow up period (VAS3)(mean : 14 months, 8~24 months). RESULTS: VAS1, VAS2 and VAS3 were 6.22+/-2.03, 3.36+/-1.49, and 3.39+/-1.45 respectively. VAS2 and VAS3 were significantly different with VAS1 (p<0.05). CONCLUSION: Epidural injections of steroid and local anesthetics are effective not only in the short term period, but also in the long term peroid for patients with low back pain with or without sciatica.

Segmental Ulnar Nerve Conduction Studies According to Elbow Position in Normal Subjects

OBJECTIVES: The current literature gives confusing advice on the position of the elbow in ulnar nerve conduction study. The purpose of this study was to determine the appropriate position of elbow flexion for a segmental ulnar nerve conduction study and to attain the basic information for an evaluation of ulnar neuropathy. METHODS: Segmental ulnar motor and sensory nerve conduction studies were performed bilaterally on 40 healthy korean adults(20 men and 20 women) with the age range from 19 to 56 years(mean age : 29.86). The ulnar nerve was stimulated at 7 cm & 10 cm proximal to the active recording electrode respectively and 5 cm distal, and poximal to the medial epicondyle of the humerus for motor and sensory nerves at each elbow flexion position of 0o, 45o, 90o, and 135o. The segmental distances were measured in each position. RESULTS: The segmental nerve conduction velocity(NCV) of the elbow segment increased with the degree of elbow flexion, and it was faster than the forearm segment at 90o and 135o of elbow flexion. The NCV showed no statistical difference in each elbow position. CONCLUSION: We conclude that the degree of elbow flexion should be maintained 90o or above in an ulnar nerve conduction study.