Background
: Hormone replacement therapy is effective for improvement of climacteric symptoms, and prevention of postmenopausal osteoporosis but patient compliance is very low. The aim of the study was to assess the comprarative effects on bone mineral density(BMD). lipid, mammographic finding, biochemical bone markers of tibolone and continuous combined hormone replacement therapy in postemeopusal women.

Methods : Body mass index, BMD in the spine and femur neck. lipid, alkaline phosphatase, serum osteocalcin, urine deoxypyridinolone were measured before and after 1 year therapy in 88 post - menopausal subjects. Of theses, 54 women received CEE 0.625 ㎎ and MPA 2.5 ㎎ (CEE/MPA) per oral, 34 tibolone alone for 1 year.

Results : Body mass index didn't changed in both groups. Significantly increased mammographic density in CEE/MPA groups(p<0.05). Total cholesterol was decreased in both group, but no significant differences between the different treatment groups. Triglyceride decreased in tibolone group and ther are significant difference between the two groups(p<0.01). HDL-cholesterol increased in CEE/MPA group(p<0.01) but decreased in tibolone group(p<0.01). There are significant difference in HDL- cholesterol response between two groups(p<0.01). LDL-cholesterol respone between two groups(p<0.05). Total alkaline phosphatase(TALP) and serum osteocalcin decreased in 새호 groups(p<0.01) but no differences between two groups. Urine deoxypyridinoline was not decreased in both groups and no differences between two groups. Spine bone mineral density(BMD) increased in both groups(p=0.0001) but no differences in treatment response between two groups. Femur neck BMD didn't not increased in both groups and no differenced of treatment responses between two groups. Urine deoxypyridinoline was not decreased in both groups and no differences between two groups.

Conclusion : Tibolone was effective on BMD of lumbar spine as much as CEE/MPA and may be safe in terms of mammographic changes in postmenopausal women.

Background
: The purpose of this study was to investigate the characteristics of and to analyze the factors related to the cost of the resolution of a medial dispute.

Methods : We have reviewed 2,346 cases reported to the Korean Medical Association(KMA) mutual-aid association from Nov.1. 1981 to Oct. 31, 1994.

Results : The percentage of reported cases of related field were as follows : obstetric-gynecology(OBGYN) 31.9%, general practitice 28.1%, general surgery 13.3%, orthopedics 6.9% and internal medicine 6.4%. 1,829 cases(80.0%) were settled out of court and without public intervention. 310 cases(13.2%) were settled by the police, the public procurator's office or the court. The mean settlement amount per cases was 9,340,000 won with annual growth rate 10.8%, and median settlement amount was 5,890,000 won. The mean settlement amount for OBGYN was 930,000 won, surgical group 8,900,000 won, medical group 7,710,000 won, and general practitice 7,490,000 won. The cases of medical dispute according to the types of medical care were : operation 21.1%, injection 18.0%, treatment and care 13.0%, artificial abortion 10.3%, Cesarian section 7.2% and anesthesia 2.5%. The mean settlement amount according to the types of medical care were : delivery and Cesarian section 15,190,000won, operation and anesthesia 9,500,000 won, others 6,610,000 won, and injection and medication 6,230,000 won. The mean settlement amount that was settled out of court without public intervention was 7,940,000 won. The mean settlement with public intervention in the court was 17,290,000 won. The cases of medical dispute according to the patient's status were : death 37.5%, complications 20.8%, disability 12.2% and others 28.9%. The mean settlement amount for death was 16,150,000 won, disability 9,430,000 won, others 4,850,000 won and complication 3,550,000 won. The mean settlement amount where doctors have asserted that the outcome was inevitable or have not agreed that it was their fault was higher than the cost of cases where they had admitted responsibility. The settlement amount where there was a misiagnosis present had not shown to be higher than when the misdiagnosis was absent. The mean settlement amount for cases where multiple doctors were involved was higher than for cases of single doctor. The mean settlement amount for disturbing the medical practice and suspension of are high. The mean settlement amount for complications was lower than others, and the mean settlement amount for disability and death presented were high. Concerning the types of care, the mean settlement amount for operation/anesthesia, delivery/Cesarian sections were higher than the injection/medication. Concerning the type of settlement, the mean settlement amount in the police and public procurator's office was higher than in out of court without public intervention.

Conclusion : The mean settlement amount depended on the patient's status, the type of settlement, and the disturbance of medical practice regardless of the doctor's misdiagnosis, fault, and standard care. Therefore, a reasonable method of resolution for medical dispute is needed.

Background
: Medical dispute is increasing and its effect on society is serious, but reasonable settlement system is absent. Nevertheless patients and families choose medical dispute. But there is little research on patients and their families who choose to settle by medical dispute. Therefore this study examines the impact of medical malpractice to patients and their families and their reasons for choosing medical dispute after mishap.

Methods : Data were collected from 234 subjects who inquired of Medical Malpractice Family Association about malpractice suit. Questionnaire was composed of demographic characteristics, characteristics of hospital, characteristics of medical malpractice, degree of satisfaction with explanation and attitude of the treating doctor, effect of medical malpractice on patients' life and reasons that patients and their families choose to settle by medical dispute. Factor analysis with varimax rotation was carried out to reduce the reasons to a smaller number of clearly interpretable factors. Multiple regression analysis was carried out to identify the variables relevant to these main themes.

Results : Degree of satisfaction with doctor's explanation and attitude was less than 10%. Over 60% of respondents stated that medical malpractice seriously affected their lives. Four main themes emerged from the factor analysis of reasons for dispute which includes dissatisfaction with doctor's attitude, wanting to prevent similar incident in the future, call to account, and compensation. The relative importance in the order of frequency was wanting to prevent similar incident in the future, dissatisfaction with doctor's attitude, call to account, followed by compensation. Multiple regression analysis was used to identify the variables relevant to these four main themes. Clinical specialty group and degree of satisfaction on attitude were significantly associated with the dissatisfaction with doctor's attitude. Clinical specialty group, patient's condition, effect of medical malpractice on life and degree of satisfaction on attitude were significantly associated with the call to account. Academic career, clinical speciality group, patient's condition, effect of medical malpractice on life and degree of satisfaction on attitude were significantly associated with the compensation.

Conclusion : From the above results, the reasons patients and their families choose to settle by medical dispute were diverse and associated with demographic characteristics, doctor's attitude, effect of mishap on life, et. al.

Background
: The breast cancer is the fifth common tumor in statistics in mortality rate. The aim of this study is to evaluate the diagnostic efficacy of mammography and ultrasonography to dectect the breast cancer.

Methods : This retrospective study was carried out in 266 subjects who visited Youngdong Servrance Hospital due to breast disorders from March, 1992 to July, 1993. They were confirmed by pathology and preoperative mammography and/or ultrasonography.

Results : Among the 266 cases, breast cancer were 66 cases(24.8%) and benign breast disorder were 200 cases(75.2%). The cases which performed mammography were 207 cases, and the cases which performed ultrasonography were 164 cases. Among total 266 cases, the cases which performed both mammography and ultrasonography were 176 cases.
Mean age was 45.03 years in breast cancer group but mean age was 38.73 years in benign disorder group(P<0.01). In breast cancer group, chief complaints on admission were palpable msss(90.3%), breast pain(7.6%), abnormal finding in periodic health examination(7.6%). But in benign disorder group, chief complaints were palpable mass(53.5%), abnormal finding in periodic health examination(21.5%), nipple discharge(8.5%) The efficacy of film mammography to detect breast cancer was as followed : sensitivity was 87.7%, specificity was 66.7% and positive predictive value was 54.8%. The efficacy of ultrasonography to detect breast cancer was as followed : sensitivity was 82.8%, specificity was 66.7% and positive predictive value was 45.2%.

Conclusion : Film mammography is useful for mass screening because of high sensitivity, and ultrasonography is useful as additional study to detect breast cancer.