Medical Service Utilization and Trends among Korean Elderly in the Last One Year of Life / 예방의학회지

OBJECTIVES: To analyze medical service utilization and trends among the elderly in the last year of life. METHOD: The subjects of this study were people that had died at the age sixty-five and above between January 1st and June 30th 2000 The names of the deceased and their dates of death were collected from the data of the funeral-expenses-receivers of the National Health Insurance Corporation (NHIC). This data was merged with that of the individual medical expenses of the NHIC. RESULTS: In the first half of 2000, 84.2% of the funeral-expenses-receivers (53, 063) utilized medical services during the year prior to their death; 51.0% (27, 042) were female and 49.0% (26, 021) male. In the last twelve months of life, the medical fees, the number of days receiving medical services and the number of days receiving medicine were 3, 107, 935 Won, 47.88 and 153.21, respectively, for each person. As the age of the groups increased, the level of medical service utilization decreased; the change was more obvious in female group. The level of medical service utilization during the twelve months prior to death drastically increased around the time of death. CONCLUSIONS: This study, from an analysis of the level of medical service utilization prior to death, shows a concentrated volume of medical services during a certain time period prior to death.

Nutritional Status of Mentally Retarded Children by Residence and by Degree of Handicap / 대한지역사회영양학회지

We studied the nutritional status of on mentally handicapped children living at home or in institutions since early teenage years are nutritionally important. The subjects of 7 to 12 year old mentally retarded children attending a special education school in Seoul were surveyed with questionnaires as well as 2-day dietary recall records, with the help of persons of their care-giver when needed. Among the 64 children, 54.7% are living in institutions and the rest of them are living at home. They were ranged from the trainable (64.1%), the educable (26.6%), and the non-trainable (9.4%). Their average daily intake of energy intakes (%RDA) was 2,070.1 kcal (94.1%), Ca 603.9 mg (75.5%), Fe 11.1 mg (92.5%), Vt.A 507.5 RE (84.6%), Vt. B2 1.1 g (88.2%), niacin 14.1 g (93.6%) and Vt. C 58.2 g (83.1%). Their average intakes of these nutrients were significantly higher in subjects of institutions than at home. The nutrients consumed at a much higher level than the RDA of the normal children were Vt. B1 (1.6 g, 146.8%) and protein (75.3g, 136.9%). The higher percentage of children at home were under consumed of several nutrients (< 75% RDA) than ones in institutions. When comparing the degree of handicap, energy and nutrient intakes except Vt. C were highest in educable children than trainable ones or Dawn's children. MAR of the diets of the subjects was 0.84. Children at home showed lower MAR as well as NAR of each nutrients, whereas children belonged to INQ < 1 were less at home. Handicapped children at home were snacking higher amount relative to their calorie intake and too frequently, that may lead to their poor nutrition. There was positive correlations between factors of nutrition and physical and dietary behaviors, but there were no correlations between factors of nutrition and health-related habits. Nutritional caring mentally handicapped children in institutions seemed to be more effectively managed.

Eating Behaviors and Food Preferences of Mentally Retarded Children according to the Degree of their Handicap / 대한지역사회영양학회지

The handicapped frequently suffer from inappropriate food intake often resulting in overweightness, malnutrition, and poor growth and development. Our study was done on 7 to 12 year old mentally retarded children attending a special education school in Seoul. We administered questionnaire surveys and 3-day dietary recalls of the subjects, with help when needed from their stay-at home or their care-giving teachers. The questionnaires covered the general characteristics and dietary behaviors of the subjects. The degrees of handicap of the 142 children ranged from the trainable (54.9%), the educable (31.0%), and the non-trainable (14.1%). Of the children studied, 70.4% had 'breakfast always', which was higher than normal. Appetites were highest in the Down's Syndrome group. We found that the more serious the handicap, the higher the breakfast eating ratio and appetite level. The main reason for their missing breakfast differed accroding to the handicap level: 'late rising' in the educable and non-trainable groups but 'no appetite' in the trainable group. Most of the children (52.2%) spent less than 20 minutes eating their meals, the parents described their children's dietary habit problems as a pica (22.3%) or overeating (17.3%), and they indicated that teaching the children how to use spoons and chopsticks (33.1%) was the most stressful. Actually more than 85% of the subjects could not use chopsticks, and skill of using cutlery was significantly different according to the degree of handicap. The food preference for milk products was the highest. It was interesting that the handicapped who had serious food pica didn't like food groups such as grains/starches, meats/fishes/eggs/beans or vegetables/fruits.

Nutrient Intakes and Health-related Behaviors of the Elderly in Rural Area / 대한지역사회영양학회지

A study about health status of the elderly in rural area was performed with 110 home-bound elderly. The results obtained by questionaires and personal interviews recall were as follows. 1) Subjects were 68.6 years of age on average. They revealed the physical tendency of not overweight but high blood pressure. 2) We found that seniors who live alone in rural area were more than in urban area. 3) Average daily intakes of energy and protein of rural elderly were lower than the Korean RDA and the intakes of Ca, riboflavin and niacin in female were also lower. 4) Nutrient intakes were related to family income, food expense, smoking amount, drinking frequency and duration of exercrse, which suggested the needs of nutrition education for the seniors and meal services especially for the low-income elderly.

Normal Anatomy of the Anal Wall and Perianal Spaces: An EUS, MRI and Cadaveric Correlative Study

PURPOSE: To understand the normal endosonographic anatomy of the perianal spaces, and to evaluate the diagnostic efficacy and limitation of endorectal sonography(EUS), correlative study with MRI, cadaveric sectional image and cadaveric MRI were performed. MATERIALS AND METHODS: EUS images of the normal 6 perianal spaces (pelvirectal, ischiorectal, intersphincteric, subcutaneous, central, submucous space) which were bounded by internal and external anal sphincters, rectal wall and levator ani muscle were correlated with MRI in 10 normal persons, cadaveric sectional images and cadaveric MRI in 2 cadavers. RESULTS: Pelvirectal space located superior to levator ani muscle could be demonstrable only on anterior wall scan but could not be visualized on lateral or posterior wall scan on EUS. Five perianal spaces located inferior to levator ani muscle were well seen on anterior, lateral, and posterior wall EUS. MRI was superior to EUS in the evaluation of pelvirectal and ischiorectal spaces but equal or inferior to EUS in the evaluation of intersphincteric, subcutaneous, central and submucous spaces. CONCLUSION: EUS was valuable in the evaluation of perianal spaces inferior to levator ani muscle but was limited in the evaluation of perianal spaces superior to levator ani muscle.

Doppler-Ultrasonographic Finding of Air in the Portal Vein: A Case Report

PURPOSE: Classically air in the portal vein has been detected on plain radiography, but computed tomography and ultrasonography have been shown to be more sensitive. We report a case of air in the PV in a 10-day-old infant with pneumatosis intestinalis with its ultrasonographic and Doppler findings. MATERIAL AND METHODS: The patient was a 10-day-old infant born by cesarean section at 41 weeks. Simple abdomen film revealed branching pattern of radiolucent air shadows within the contour of liver, gas distention of bowel loops and thickenod bowel walls with lincar intraluminal air shadows in abdomcn, suggesting neerotizing enterocolitis. So we performed Doppler ultrasonography. RESULTS: Ultrasonography showed branching pattern of hyperechogenic dots along the lumen of left portal vein. The color Doppler study revcaled an aliasing duo to increased velocity and whirling pattern of blood flow, and the Duplex Doppler spectral display showed sharp, vertical bidirectional spikes by air in portal vein. CONCLUSION: Air in the portal voin can be easily diagnosed by the followign signs:hyperechogenic dots in the portal vein on ultrasonography and vertical, sharp bidirectional spikes superimposod on the usual Doppler tracing of the portal vein on Duplex ultrasonography.

Acute Respiratory Failure Caused by Aspiration of High Density Barium: A Case Report

Accidental aspiration of barium contrast medium during the upper gastrointestinal study can occur in patients with swallowing disorder, especially in the elderly patients. We experienced a case of respiratory failure followed by death within a few hours in a 85 year-old patient after barium aspiration.

Sclerosing lymphangitis of the penis: a case report

Sclerosing lymphangitis of the penis occurs as a skin-colored or dusty red, cord-like thickening of tissue at the corona or within the coronal sulcus. The thickened, elongated lesion is firm and relatively nontender. The cause is unknown: because it occurs primarily in those who are sexually very active, however, it is likely that chronic trauma plays an important etiologic role. We experienced a case of pathologically proven sclerosing lymphangitis in a 31 year-old man. Ultrasonographic finding showed circumferential cord like hypoechoic band with irregular, but well demarcated margin.

The Mayer-Rokitansky syndrome misled to pelvic abscess

No abstract available.

A study on the normal position of articular disk of the temporomandibular joint on MRI

To evaluate the normal range of articular disk postion, MRIs of 25 temporomandibular joints(TMJs) in 19 asymptomatic volunteers were analysed. On the closed mouth sagittal T1 weighted MRI the junction of the posterior band and bilaminar zone was within 10°anterior from the vertical line through the apex of condylar head in 19 (76%) lad within 20°in 23 (92%) TMJs. The intermediate zone of the articular disk was located between the posterior surface of articular eminence and the anterior surface of condylar head in 22 (88%) TMJs. We suggest that on the closed mouth sagittal MRI the junction of the posterior band and the bilaminar zone could be within 10°anterior from the vertical line through the apex of condylar head in asymptomatic Korean persons. If the junction is located more than 20°anterior from the vertical line or the intermediate zone is anterior to the anterior surface of condylar head it is suggested that the disk is anteriorly displaced. Further studies are needed to evaluate the clinical significance of mild anterior displacement of the articular disk(11°-20°) in asymptomatic persons.

Endorectal sonography in the evaluation of anal canal, rectum and anorectal disease

No abstract available.

T-cell non-Hodgkim lymphoma associated with chronic tuberculous empyema: case report

Malignant neoplasm associated with long-standing pleuritis or empyema is rare but a critical complication. Among 67 cases which were reported in English and Japanese literatures the cause of empyema was considered tobe tuberculosis in 51 cases. The most common malignant disease associated with the long-standing pleural disease was non-Hodgkin lymphoma (NHL), and the majority of the malignant lymphomas were B-cell type. Detection of the malignancy combined with an empyema is difficult, however, chest radiograph or CT may show the evidence of malignant pleural disease. We report a case of pathologically proven T-cell type malignant NHL associated with chronic tuberculous empyema in a 66-year-old male patient.

T-cell non-Hodgkim lymphoma associated with chronic tuberculous empyema: case report

Malignant neoplasm associated with long-standing pleuritis or empyema is rare but a critical complication. Among 67 cases which were reported in English and Japanese literatures the cause of empyema was considered tobe tuberculosis in 51 cases. The most common malignant disease associated with the long-standing pleural disease was non-Hodgkin lymphoma (NHL), and the majority of the malignant lymphomas were B-cell type. Detection of the malignancy combined with an empyema is difficult, however, chest radiograph or CT may show the evidence of malignant pleural disease. We report a case of pathologically proven T-cell type malignant NHL associated with chronic tuberculous empyema in a 66-year-old male patient.

Soft tissue sparganosis

Sparganosis is a rare tissue-parasitic infestation caused by a plerocercoid tapeworm larva(sparganum), genus Spirometra. The most common clinical presentation of sparganosis is a palpable subcutaneous mass or masses. Fifteen simple radiographs and 10 ultrasonograms of 17 patients with operatively verified subcutaneous sparganosis were retrospectively analyzed to find its radiologic characteristics for preoperative diagnosis of sparganosis. The locations of the subcutaneous sparganosis were lower extremity, abdominal wall, breast, inguinal region and scrotum in order of frequency. The simple radiographs showed linear or elongated calcification with or without nodular elongated shaped soft tissue mass shadows in 8 patients, soft tissue mass shadow only in 2 patients and lateral abdominal wall thickening in 1 patient. But no specific findings was noted in 4 patients with small abdominal and inguinal masses. We could classify the subcutaneous sparganosis by ultrasound into 2 types: one is long band-like hypoechoic structures, corresponding to the subcutaneous tunnel-like tracks formed by migration of sparganum larva and the other is elongated or ovoid hypoechoic nodules, representing granulomas. Long band-like hypoechoic structures within or associated with mixed echoic granulomatous masses were noted in 6 patients and elongated or ovoid hypoechoic mass or masses were noted in 4 patients. In conclusion, sparganosis should be considered when these radiologic findings-irregular linear calcifications on simple radiograph and long ban-like hypoechoic structures on ultrasonography, corresponding to the subcutaneous tunnel-like tracks formed by migration of sparganum larva-are noted in the patients who have subcutaneous palpable mass or masses. And radiologic examination especially ultrasonography is very helpful to diagnose sparganosis.

Too many ducts sign: a characteristic cholangiographic finding of clonorchiasis?

Clonorchiasis procucts diffuse dilatation of the small and medium sized intrahepatic bile ducts and its cholangiogram shows visualization of many bile ducts, especially, tertiary, quaternary, and more peripheral tributaries up to the 6th tributaries. In an attempt to clarify this cholangiographic sign quantitively, we counted the visualized smaller bile ducts in clonorchiasis and compared the number of visualized ducts in normal cholangiogram, recurrent pyogenic chlangitis and carcinoma of the extrahepatic ducts. In clonorchiasis the number of visualized smaller bile ducts was considerably geater than in normal subjects and recurrent pyogenic cholangitis, but there was no singnificant statistical differences in the number of visualized bile duct tributaries between clonorchiasis and carcinoma of the bile ducts. Thus it is considered that too many ducts sign is not a unique cholangiographic finding of clonorchiasis, but we believe that in the presence of this sign with other we l known cholangiographic findings, diagnosis of clonorchiasis is very easy.

Circumscribed breast carcinoma: mammographic and sonographic findings

No abstract available in English.

A study on renal damage in rats induced by different concentrations and osmolarities of diatrizoate

There has been few papers regarding the pathologic changes of kidney induced by contrast media, especially in terms of iodine concentration or osmolarity. In order to evaluate histopathologic changes, a series of rat kidneys, after injection of iodinated contrast media, were examined. A total of 220 rats were divided into two groups: those given Urografin-60% by 6.3 ml/Kg(1840mg/6.3ml):those given Urografin-76% by 5ml/Kg(1850mg/5ml). (the same amount of iodine but at different iodine concentration). The kidneys were removed and microscopically examined on 1, 2, 3, 5, 7, 10th days, 2nd, 3rd, 4th, 6th and 12th weeks after injection of contrast media, respectively. The results were as follows: Renal pathologic changes induced by contrast media were congestion and ectatic change of the interstitial vessels, epithelial degeneration and necrosis of the collectiong ducts. Congestion of interstitial vessels and epithelial degeneration and necrosis of the collecting ducts were severe in the higher iodine concentration Urografin-76% group(2100 Osm/Kg H2O) than the Urografin-60% group(1500 Osm/Kg H2O). And above pathological changes persisted for 12weeks without significant interval changes. The authors conclude that the renal damage induced by ionic contrast media becomes more severe in higher concentrations or osmolarities in spite of the same amount of iodine and that the pathologic changes persisted until 12 weeks without improvement.

Computed tomographic findings of cervical tuberculous lymphadenitis

Computed tomographic findings of 24 cases of cervical tuberculous lymphadenitis were retrospectively analyzed. We classified the CT findings as 4 types: type 1(homogeneous soft tissue density mass), type 2(central low density with peripheral rim enhancement and with preservation of surrounding fat plane), type 3(central low density with peripheral rim enhancement and with obliteration of surrounding fat plane), type 4(large confluent low density mass, so called "cold abscess") As a result, there were 2 cases(8.3%) of type 1, 7 cases(29.2%) of type 2, 9 cases(37.5%) of type 3, 3 cases(12.5%) of type 4, 1 cases(4.2%) of type 1 combined with type 3, and 2 cases(8.3%) of type 2 combined with type 4. So 22 cases(91.7%) revealed central low density and peripheral rim enhancement, which suggest necrosis. The maximum thickness of enhancing rim was above 2mm in all of 64 definable necrotic lymph nodes and above 4mm in 42(65.5%) lymph nodes, suggesting that the wall of necrotic tuberculous lymphadenitis tends to be thick. We conclude that CT is useful not only for the diagnosis but also for the evaluation of the extent and the status of cervical tuberculous lymphadenitis.

Breast tumors associated with nipple discharge: US findings with galactographic correlation

To compare the specific information of each imaging modality of US (7.5MHz, water path system) and galactography, and to appreciate clinical applicability of US as a primary diagnostic method in breast tumor causing nipple discharge, we performed a comparative study of each method in 15 cases of the ductal tumor of breast. To evaluate the demonstrable smallest anatomic unit of the lactiferous system by US, 30 normal lactating breasts were examined prospectively. The visible smallest lactating unit in the normal lactating breast by US is terminal duct lobular unit(TDLU). US is superior to galactography for detection of the mass less than 0.5cm in size with proximal ductal dilatation, and for evaluation of the multiple ductal lesions, in contrast, inferior to galactography for systemic visualization of involving ducts and for the detection of microcalcification. Sonographic diagnosis is limited in detection of small retromammillary masses, peripheral small masses without ductal dilatation and masses in excessively fatty breast. In conclusion US can be a primary diagnostic tool in suspicious breast tumor causing nipple discharge as a non-invasive method but galactography should be combined in the indicated cases.

Radiologic findings of liver infarction

No abstract available.