Changes in Patients Who Receive Coverage for Positive Airway Pressure Therapy According to Alterations in National Health Insurance Benefit Standards for Mild Obstructive Sleep Apnea / 대한이비인후과학회지

Background and Objectives@#The aim of this study was to identify the frequency of indicators of National Health Insurance (NHI) coverage for positive airway pressure (PAP) therapy and to investigate the changes in patients receiving coverage for PAP therapy after the alterations were made in the insurance benefit standards for mild obstructive sleep apnea (OSA).Subjects and Method We divided the mild OSA patients into two groups according to altered categorization in insurance benefit standards (Mild1: 5≤AHI<10; Mild2: 10≤AHI<15). Eight indicators related to the NHI coverage were identified: four symptoms, three complications, and the minimal blood oxygen saturation during polysomnography (min SpO2) of ≤85% during polysomnography. We also investigated the change in the number of patients receiving insurance benefits under the altered insurance benefit standards. @*Results@#Of the 233 OSA patients, 66, 57, and 110 patients were diagnosed as mild, moderate and severe OSA, respectively. For all of them, the most common indicator related to NHI coverage for PAP therapy was the minimum SpO2 of less than 85% during polysomnography, and the second most common indicator was daytime sleepiness. In the mild OSA group, however, daytime sleepiness was found to be the most common indicator, found in 46 (70%) patients, followed by 38 (58%) patients with min SpO2 of less than 85%. In this group, 59 (89.4%) would have been benefited before the change in the insurance benefit standards whereas 51 patients (77.3%) would now be benefited under the changed insurance benefit standards. @*Conclusion@#Daytime sleepiness was the most commonly observed indicator in the mild OSA patients. The number of patients receiving insurance benefits for PAP therapy significantly decreased after the change was made in the NHI benefit standards for mild OSA

Epicardial Fat Thickness and Neutrophil to Lymphocyte Ratio are Increased in Non-Dipper Hypertensive Patients

BACKGROUND: In this study, we aimed to investigate the relationship between echocardiographic epicardial fat thickness (EFT), neutrophil to lymphocyte ratio (NLR; an important inflammatory marker), and diurnal blood pressure (BP) changes in patients with recently diagnosed essential hypertension. METHODS: A total of 647 patients underwent echocardiography and 24 hours of ambulatory BP monitoring. EFT was measured by echocardiography, while NLR was measured by dividing the neutrophil count by the lymphocyte count. Patients were categorized into three groups according to BP pattern: the normotensive group, the dipper group, and the non-dipper group. RESULTS: The mean EFT was highest in the non-dipper group (non-dipper group, 7.3 ± 3.0 mm; dipper group, 6.1 ± 2.0 mm; control group, 5.6 ± 2.0 mm; p < 0.001). NLR was also highest in the non-dipper group (non-dipper, 2.75 ± 2.81; dipper, 2.01 ± 1.32; control, 1.92 ± 1.11; p < 0.001). EFT was significantly correlated with age (r = 0.160, p < 0.001) and NLR (r = 0.353, p < 0.001). Furthermore, an EFT ≥ 7.0 mm was associated with the non-dipper BP pattern with 51.3% sensitivity and 71.6% specificity [95% confidence interval (CI) = 0.56–0.65, p < 0.001]. In a multivariate analysis, EFT [adjusted odds ratio (OR) = 3.99, 95% CI = 1.22–13.10, p = 0.022] and NLR (OR = 1.34, 95% CI = 1.05–1.71, p = 0.018) were independent parameters that distinguished a non-dipper pattern after adjustment for cardiovascular risk factors. CONCLUSION: EFT and NLR are independently associated with impaired diurnal BP profiles in hypertensive individuals. EFT (as measured by echocardiography) and NLR appear to be helpful in stratifying cardiometabolic risk.

A Case of Pulmonary Hypertension Recurred by Graves' Disease / 고신대학교의과대학학술지

A few cases of severe pulmonary hypertension with right heart failure associated with Graves' disease were reported in the literature. However, cases of pulmonary hypertension with right heart failure recurred by Graves' disease is very rare. We describe the case of a 60-year old woman who had been treated pulmonary hypertension caused by right pulmonary artery thromboembolism seven years ago. Recently, her pulmonary hypertension with right heart failure was recurred by Graves' disease. The patient's symptoms of pulmonary hypertension was resolved after treatment of Graves' disease.

The Combination Therapy with Peg-interferon Alfa and Ribavirin for Chronic Hepatitis C in Korea as an Initial Treatment / 고신대학교의과대학학술지

OBJECTIVES: The combination therapy with peginterferon and ribavirin has been used to treat chronic hepatitis C for several years in Korea but there is a few report about the results of the treatment. We evaluated safety and efficacy of the combination therapy with Peg-interferon and ribavirin and analyzed factors that may affect treatment. METHODS: Total 72 untreated chronic hepatitis C patients were administered pegylated interferon alfa-2a (180microg/week) or alfa-2b (1.5microg/kg/week) and ribavirin (800 mg/day in genotype 2, 1000-1200 mg/day in genotype 1). Duration of the treatment was 24 weeks in genotype 2 and 48 weeks in genotype 1. Response of the treatment was evaluated by rapid virologic response (RVR), early virologic response (EVR), end treatment virologic response (ETR), sustained virologic response (SVR) and adverse event. RESULTS: The RVR, EVR, ETR, SVR were 61.8%, 82.5%, 88.9% and 80.5% retrospectively. The SVR of genotype 1 was 63.4% and non-genotype 1 was 96.7%. Genotype (Odds ratio: 14.92) was an independent predictor of the SVR. Leukocytopenia, flu-like symptoms, itching, rash and anemia were common adverse events of the combination therapy and if then we reduced dose and there was one case of cessation. CONCLUSIONS: The combination therapy with Peg-interferon and ribavirin shows efficacy to the Korean patients with chronic hepatitis C as an initial treatment. Genotypes 2 and 3 were more likely to have a sustained virologic response.

A Case of Thyrotoxic Periodic Paralysis Associated with Transient Thyrotoxicosis / 고신대학교의과대학학술지

Thyrotoxic periodic paralysis is an acute muscle weakness of the limbs associated with hypokalemia. It can occur with any form of thyrotoxicosis. Thyrotoxic periodic paralysis associated with transient thyrotoxicosis due to thyroiditis is very rare. We experienced a case of thyrotoxic periodic paralysis associated with transient thyrotoxicosis. A 39-yr-old man was referred to our hospital because of paralysis of upper and lower extremity. The laboratory results were hypokalemia and mild thyrotoxicosis. A thyroid scan with Tc-99m revealed decreased uptake in the thyroid area compatible with destructive thyroiditis. The paralytic attack did not recur after the patient recovered to euthyroid state.

A Case of Localized Castleman's Disease in a Patient with Rheumatoid Arthritis

Castleman's disease is an atypical lymphoproliferative disorder of unknown origin. It has three histologic types (hyaline vascular, plasma-cell, and mixed) and two clinical types (localized and multicentric). Some systemic diseases may be accompanied with Castleman's disease, but it is unclear if Castleman's disease is relevant to rheumatoid arthritis. We experienced a case of Castleman's disease suffering from rheumatoid arthritis. A 25-year-old female with rheumatoid arthritis was referred to our hospital with a palpable mass lesion in the left upper arm. Excisional biopsy of the mass and arthroscopic synovectomy were performed, and the histological finding was compatible with hyaline-vascular type of Castleman's disease. Herein, we report this case along with brief review of relevant literature.

Detection for demineralization of dental hard tissues using index-sequenced radiographs / 대한구강악안면방사선학회지

PURPOSE : The purpose of this study was to develop the radiographic technique for detecting the demineralization which is known as indication of dental caries MATERIALS AND METHODS : This technique was based on the comparing of multiple radiographs which was irradiated by multiple X-ray spectra. For the meaningful comparing, the multiple radiographs were reconstructed to the dosimetrically consistent images using a standard material. The difference of resulting images of same target with multiple spectra represents the difference of response of material as regards the spectra. RESULTS : We have found about 10% of demineralization of dental hard tissues particularly in the proximal region through the analyzing of differences. CONCLUSION : Most intriguing thing in this investigation was that the method to analyze difference shows us to an anatomic structure of dental hard tissues even if absolute values of optical density were excluded during the procedures.

Patient Specific Quality Assurance of IMRT: Quantitative Approach Using Film Dosimetry and Optimization / 대한방사선종양학회지

PURPOSE: Film dosimetry as a part of patient specific intensity modulated radiation therapy quality assurance (IMRT QA) was performed to develop a new optimization method of film isocenter offset and to then suggest new quantitative criteria for film dosimetry. MATERIALS AND METHODS: Film dosimetry was performed on 14 IMRT patients with head and neck cancers. An optimization method for obtaining the local minimum was developed to adjust for the error in the film isocenter offset, which is the largest part of the systemic errors. RESULTS: The adjust value of the film isocenter offset under optimization was 1 mm in 12 patients, while only two patients showed 2 mm translation. The means of absolute average dose difference before and after optimization were 2.36 and 1.56%, respectively, and the mean ratios over a 5% tolerance were 9.67 and 2.88%. After optimization, the differences in the dose decreased dramatically. A low dose range cutoff (L-Cutoff) has been suggested for clinical application. New quantitative criteria of a ratio of over a 5%, but less than 10% tolerance, and for an absolute average dose difference less than 3% have been suggested for the verification of film dosimetry. CONCLUSION: The new optimization method was effective in adjusting for the film dosimetry error, and the newly quantitative criteria suggested in this research are believed to be sufficiently accurate and clinically useful.

Patient Specific Quality Assurance of IMRT: Quantitative Approach Using Film Dosimetry and Optimization / 대한방사선종양학회지

PURPOSE: Film dosimetry as a part of patient specific intensity modulated radiation therapy quality assurance (IMRT QA) was performed to develop a new optimization method of film isocenter offset and to then suggest new quantitative criteria for film dosimetry. MATERIALS AND METHODS: Film dosimetry was performed on 14 IMRT patients with head and neck cancers. An optimization method for obtaining the local minimum was developed to adjust for the error in the film isocenter offset, which is the largest part of the systemic errors. RESULTS: The adjust value of the film isocenter offset under optimization was 1 mm in 12 patients, while only two patients showed 2 mm translation. The means of absolute average dose difference before and after optimization were 2.36 and 1.56%, respectively, and the mean ratios over a 5% tolerance were 9.67 and 2.88%. After optimization, the differences in the dose decreased dramatically. A low dose range cutoff (L-Cutoff) has been suggested for clinical application. New quantitative criteria of a ratio of over a 5%, but less than 10% tolerance, and for an absolute average dose difference less than 3% have been suggested for the verification of film dosimetry. CONCLUSION: The new optimization method was effective in adjusting for the film dosimetry error, and the newly quantitative criteria suggested in this research are believed to be sufficiently accurate and clinically useful.

The Prevalence and Ergonomic Analysis of Cumulative Trauma Disorders in the Paper Reviewing Workers

OBJECTIVE: To survey the prevalence of cumulative trauma disorders (CTDs) and to analyze the ergonomic factors in the paper reviewing workers. METHOD: Five hundreds and twenty subjects of paper reviewers were collected from 'National Medical Insurance Association' who had been exposed to risky working environment regarding CTDs. The subjects were first screened by occupational medicine specialists and confirmed by physiatrist. The subjects were also examined by serologic test, radiologic imaging, and electro diagnostic study. Ergonomists analyzed the job element to identify the risk factors by baseline checklist of CTDs. RESULTS: Among the workers, 51 (9.8%) of 520 were confirmed to CTDs, the prevalance of myofascial pain syndrome was 22 (43.1%), that of medial epicondylitis was 13 (25.5)%, lateral epicondylitis 8 (15.7%) and others. Pain scale of National Industrial Occupational Safety Health Institute symtoms criteria was highest in the shoulder girdle and the next was in the neck, in the wirst and fingers. The ergonomic risk score was highest 2.56 in the 'verifying' job, and the next 2.20 in 'the 2nd examination' job and 'the 1st examination' job, 1.72 in 'correcting' job. CONCLUSION: The result would be helpful for the prevention and management of CTDs in the paper reviewing workers.

The Prevalence and Ergonomic Analysis of Cumulative Trauma Disorders in the Bank Worker and Post Officer

OBJECTIVE: To survey the prevalence of Cumulative trauma disorders (CTDs) and to analyze the ergonomic factors among the bank workers and post officers. METHOD: Seventy seven subjects were collected from bank workers (50) and post officers (27) from the multiple areas of country who had been exposed to risky working environment regarding CTDs. The subjects were first screened by occupational medicine specialists and confirmed by rehabilitation medicine specialist. The serologic test, radiologic imaging, electrodiagnostic study were performed in all the subjects. Ergonomists analyzed the job element to identify the risk factors by baseline checklist of CTDs. RESULTS: Among bank workers, 30 (60%) of 50 were confirmed as having CTDs. MPS was present in 30 patients (60%), latenl epicondylitis in 5 (10%), medial epicondylitis in 3 (6.0%), tendinitis 3 (6.0%), and other disease in 3 (6.0%). Among post officers, 14 (51.9%) of 27 were confirmed as having CTDs. MPS present in 10 (37.0%), cervical disc disease in 4 (14.8%), others in 4 (14.8%). The ergonomic risk score was highest 1.87 in the 'package deviding' job, and 1.82 in 'bagging to cart', 1.62 in 'initial devision'. CONCLUSION: The result would be helpful for the prevention and management of CTDs in the bank workers and post officers.

The Prevalence and Characteristics of Cumulative Traumatic Disorders

OBJECTIVE: To investigate the current status and the basic information of cumulative traumatic disorder among workers. METHOD: The subjects were 198 workers, consisted of 100 shipspublisher workers, 155 telephone operators and 43 light workers. Workers were surveyed with a standardized self- administered questionnaire and examed by the occupational medicine doctors and physiatrists for the cumulative traumatic disorders. Laboratory tests, nerve conduction studies and X-rays of the C-spine and shoulders were performed in all subjects. RESULT AND CONCLUSION: Myofascial pain syndrome was the most frequent problem in the shipspublisher and telephone operators. As a result of the multiple logistic regression analysis, cycle time, palm pinch, lumbar and neck flexion were the significant variables accounting for the musculoskeletal symptoms.

A Study on Risk Prediction and Prevention Guidelines for CTDs / 대한산업의학회지

CTDs have been a growing problems for US and European industries with higher incidence rate every year. In our country, we have just Started to recognize and to work on the problems in industry. In this respect, this would be the first ergonomic-based CTD study with medical data. Two automobile part plants were ergonomically and clinically surveyed for this study. Specifically,' 25 jobs from A industry and 51 jobs from B industry were matched with the clinical data. Two types of analysis were conducted. First, ergonomic job evaluation using CTD checklist was done for both industries to figure out the relative risks for each jobs. Second, comprehensive analysis for risk factors regarding CTDs was conducted. It produced mainly two results. First, multiple regression analysis of both worker and work-related factors on total scores based on the results of the'physical examination showed that there was no statistically significant relationships between total scores based on physical examinations and either worker or work-related risk factors. Second, logistic analyses for both factors were done. An user-friendly logistic program was developed for this analysis and for the future analysis of CTD study in the long-run. The program would have even non-expert in statistical package easily manipulate logistic analysis. Based on the logistic analysis, there was no significant relationships between worker related risk factors and all CTD types except marital status. However, there was some significant results in terms of work-related factors. Lateral pinch and ulnar deviations had significant relationship with both all CTD types and CTS. Power grip was associated with all types of CTDs, Tendinitis and Carpal Tunnel Syndrome. The cycle time had significant effects only on Carpal Tunnel Syndrome. In conclusion, the first ergonomic-based CTD study has been initiated in Korea. However, it was realized that good overall situation for CTD study in Korea has been before the right time yet. Therefore, futher research on the basis of the framework of this study is strongly suggested to have a complete CTD guidelines in the near future.

A Study on Risk Prediction and Prevention Guidelines for CTDs / 대한산업의학회지

CTDs have been a growing problems for US and European industries with higher incidence rate every year. In our country, we have just Started to recognize and to work on the problems in industry. In this respect, this would be the first ergonomic-based CTD study with medical data. Two automobile part plants were ergonomically and clinically surveyed for this study. Specifically,' 25 jobs from A industry and 51 jobs from B industry were matched with the clinical data. Two types of analysis were conducted. First, ergonomic job evaluation using CTD checklist was done for both industries to figure out the relative risks for each jobs. Second, comprehensive analysis for risk factors regarding CTDs was conducted. It produced mainly two results. First, multiple regression analysis of both worker and work-related factors on total scores based on the results of the'physical examination showed that there was no statistically significant relationships between total scores based on physical examinations and either worker or work-related risk factors. Second, logistic analyses for both factors were done. An user-friendly logistic program was developed for this analysis and for the future analysis of CTD study in the long-run. The program would have even non-expert in statistical package easily manipulate logistic analysis. Based on the logistic analysis, there was no significant relationships between worker related risk factors and all CTD types except marital status. However, there was some significant results in terms of work-related factors. Lateral pinch and ulnar deviations had significant relationship with both all CTD types and CTS. Power grip was associated with all types of CTDs, Tendinitis and Carpal Tunnel Syndrome. The cycle time had significant effects only on Carpal Tunnel Syndrome. In conclusion, the first ergonomic-based CTD study has been initiated in Korea. However, it was realized that good overall situation for CTD study in Korea has been before the right time yet. Therefore, futher research on the basis of the framework of this study is strongly suggested to have a complete CTD guidelines in the near future.

Cumulative Trauman Disorders: Their recognition and ergonomic intervention / 대한산업의학회지

No abstract available.

Clinical Study on the Management of Lower Ureteral Stone / 대한비뇨기과학회지

We had been managed on 44 cases of lower ureteral stone in 42 patients who were admitted to the Department of Urology, Han Il Hospital during the period from January 1979 to December 1980. The results were as follows; 1. among 24 cases (below 4 mm in size)of lower ureteral stone, 11 cases were delivered spontaneously with conservative management and 9 cases were extracted immediately with cystoscopic manipulation and 4 case were delivered spontaneously after cystoscopic manipulation. 2. Among 14 cases (from 5 mm to 7 mm in size)of lower ureteral stone, 2 cases were delivered spontaneously with consecutive management and 4 cases were delivered spontaneously after cystoscopic manipulation and 8 cases were removed with ureterolithotomy. 3. All of 3 cases (from 8 mm to 10 mm in size)of lower ureteral stone were removed with ureterolithotomy. 4. Among 3 cases (over 11 mm in size)of lower ureteral stone, 2 cases were removed with ureterolithotomy but 1 case was extracted immediately with cystoscopic manipulation.

A Clinical Study on Intrascrotal Mass / 대한비뇨기과학회지

A clinical study was made on 57 patients (61 cases)of intrascrotal mass in the Department of Urology, Han Il Hospital, during the period from January, 1978 to December, 1981. The results were follows: 1. The incidence of intrascrotal mass was 11.5% of total admitted patients. 2. The most common population was 20-29 year of age giving the rate of 36.4% (18 patients). 3. 29 patients were affected in the right side, 24 patients in the left and 4 patients in both. 4. 39 cases were painless intrascrotal mass and 22 cases were painful. 5. The most common disease was hydrocele giving the rate of 45.9% (28 cases). Acute epididymitis was 23.0% (14 cases), tuberculous epididymitis 9.8% (6 cases), varicocele 6.6% (4 cases), others 14.7% (9 cases). 6. Of 61 cases, operation was performed in 43 cases and conservative management in 18 cases.

Clinical Evaluation of Sterile Intermittent Catheterization in Spinal Cord Injury Patients on Indwelling Catheter Drainage / 대한비뇨기과학회지

Sterile intermittent catheterization was used in spinal cord injury patients who had indwelling catheters. This study included 17 men who had indwelling catheters for from 6 months to 5 years, an average of 22 months. Incidence of achieving catheter-free state was 12 cases among 17 cases (70.6%) and the mean period of intermittent catheterization of successful trials was 31 days. Among successful 12 patients follow-up studies up to 1 year, 9 patients (53.0%) were complete catheter-free state and 3 patients (17.6%) needed alternative intermittent catheterization. For the period of 1 year follow-up studies, there were not been any urologic complications except 2 cases of acute pyelonephritis and some trivial urinary tract infections. As these results, sterile intermittent catheterization was the useful method for management of neurologic bladder due to spinal cord injury and eliminating indwelling catheter.

Clinical Evaluation of the Urinary Tract Infection in Spinal Cord Injury Patient / 대한비뇨기과학회지

81 spinal cord injury Patients divided to 4 groups; The 1st. group was 12 patients with vesicostomy, the 2nd. group was 27 Patients with urethral indwelling catheterization, the 3fd. group was 15 Patients with intermittent catheterization and the 4th. group was 27 Patients with self voiding state. In 81 spinal cord injury Patients of 4 groups, urine culture, colony count and drug susceptible test were done from the department of Urology, Veterans Hospital during the period from Mar. 1983 up to Jun. 1983. 1. The incidence of bacteriuria was totally 54 cases (66.7%) among 81 cases, 10 cases (83.3%) among 27 cases in 2rid. group, 8 cases (53.3%) among 15 cases in 3rd. group and 12 cases (44.4%) among 27 cases in 4th. group. 2. The frequency of isolate organisms by culture were as followings; Pseudomonas: 34.8%, Proteus: 17.4%, Serratia: 14.5%, Providence: 13.0%, Acinetobacter: 5.8%, E. coli. 4.3% Alkaligenes: 2.9%. 3. Mixed infection of 2 different organisms was 12 cases (30.8%)among 39cases in 1st. and 2nd. groups and 2 cases (4.8%) among 42 cases in 3rd. and 4th. groups. 4. On the whole, all isolated organisms showed considerable susceptibility to Amikacin (73.9%) and then frequency of susceptible drugs were Tobramycin and Velocef. The incidence of resistance for all drugs was 13 cases (18.8%) among 69 cases.

A Giant Hydronephrosis Associated with Staghorn Calculus / 대한비뇨기과학회지

One case of giant hydronephrosis associated with staghorn calculus was presented in 65 year old man. It`s containing fluid was about 4,000ml in amount. We reported this cases with a brief review of the literature.