The mobile medical service has been operated for many years by a number of medical schools and hospitals as a most convenient means of medical service delivery to the people residing in such area where the geographical and socioeconomic conditions are not good enough to enjoy modern medical care. Despite of official appraisal showing off simply with numbers of outpatients treated and medical persons participated, however, as well recognized, the capability (in respect of budget, equipment and time) of those mobile medical teams is so limited that it often discourages the recipients as well as medical participants themselves. In the midst of rising need to secure medical service of good quality to all parts of the country, and of developing concept of primary health care system, authors evaluated the effectiveness of and problems associated with mobile medical service program through the community diagnosis of a village (Ope-Myun, Kwangju-gun) to obtain the information which may be helpful for future improvement. 1. Owing to the nationwide Sae-Maul movement powerfully practiced during last several years, living environment of farm villages generally and remarkably improved including houses, water supply and wastes disposal etc. Nevertheless, due to limitations in budget, time and lack of knowledge (probably the most important), these improvements tend to keep up appearances only and are far from the goal which may being practical benefit in promoting the health of the community. 2. As a result of intensive population policy led by the government since 1962, there has been considerable advances in understanding and the rate of practicing family planning through out the villages and yet, one should see many things, especially education, to be done. Fifty eight per cent of mothers have not received prenatal check and the care for most(72%) delivery was offered by laymen at home. 3. Approximately seven per cent of the population was reported to have chronic illness but since only a few(practically none) of the people has had physical check up by doctors, the actual prevalence of chronic diseases may reach many times of the reported. The same fact was observed also in prevalence of tuberculosis; the patients registered at local health center totaled 31 comprising only 0.51% while the numbers in two neighboring villages (designated as demonstration area of tuberculosis control and mass examination was done recently) was 3.5 and 4.0% respectively. Prevalence rate of all diseases and injuries experienced during one month(July, 1977) was 15.8%. Only one tenth of those patients received treatment by physicians and one fifth was not treated at all. The situation was worse as for the chronic patients; 84% of all cases either have never been treated or discontinued therapy, and the main reasons were known to be financial difficulty and ignorance or indifference. 4. Among the patients treated by our mobile clinic, one third was chronic cases and 45% of all patients, by the opinion of doctors attended, were those who may be treated by specially trained nurses or other paramedics (objects of primary care). Besides, 20% of the cases required professional managements of level beyond the mobile team's capability and in this sense one may conclude that the effectiveness(performance) of present mobile medical team is quite limited. According to above findings, the authors would like to suggest following for mobile medical service and overall medicare program for the people living in remote country side. 1. Establishment of primary health care system secured with effective communication and evacuation (between villages and local medical center) measures. 2. Nationwide enforcement of medical insurance system. 3. Simple outpatient care which now constitutes the main part of the most mobile medical services should largely be yielded up to primary health care unit of the village and the mobile team itself should be assigned on new and more urgent missions such as mass screening health examination of the villagers, health education with modern and effective audiovisual aids, professional training and consultant services for the primary health care organization.
Allied Health Personnel ; Ambulatory Care ; Audiovisual Aids ; Budgets ; Chronic Disease ; Consultants ; Diagnosis ; Education ; Family Planning Services ; Health Education ; Humans ; Insurance ; Mass Screening ; Medicare ; Missions and Missionaries ; Mobile Health Units ; Mothers ; Outpatients ; Prevalence ; Primary Health Care ; Public Policy ; Schools, Medical ; Tuberculosis ; Water Supply

Endoscopic anterior cruciate ligament reconstruction using central one-third of bone-patellar tendon-bone autografts were performed on 76 consecutive patients. 36 patients out of them were reviewed and evaluated with subjective and functional rating scales according to the Lysholm knee scoring system, physical examination and instrumented anterior laxity test. The average follow-up was 2 years and 1 month, ranging from 1 year and 6 months to 3 years and 8 months and the everage age at operation was 31 years old, ranging from 20 to 49 years old. At follow-up, the average Lysholm knee score was 87.2 compared to the average score of 49.5 prior to reconstruction. Physical examination and instrumented anterior laxity test showed that excellent anterior stability was regained in all patients but two. There were 4 cases of complication, a fibrous nodule anterior to reconstructed ACL, an effusion of knee, a thrombophlebits, and an inadequate placement of screw fixation with protrusion of bone peg out of tibial hole. In summary, endoscopic ACL reconstruction using central 1/3 of bone-patellar tendon-bone seems to be a good procedure, which leaves less operative scar, takes short operation time and gives a constant good result as far as the surgeon is familiar with the technique.
Anterior Cruciate Ligament Reconstruction ; Autografts ; Cicatrix ; Follow-Up Studies ; Humans ; Knee ; Lysholm Knee Score ; Physical Examination ; Weights and Measures

No abstract available.
Germ Cells* ; Neoplasms, Germ Cell and Embryonal*

The peripheral blood eosinophil and serum IgE level in 53 patients with atopic dermatitis (AD) were measured. The patients were divided into 2 groups by severity(mild and severe grous) and into 3 groups by the associated respiratory atopic deseases and/or their family history : respiratory group(patient, with both AD and respiratory atopy), family history group (patient with both AD and family history of respiratory atopy), and atopic group(patient with neither respiratory atopy nor family history of respiratorv atopy). We designed to study which factors are important in the elevation of serum IgE and peripheral blood eosinophil level in AD, and to know possible relationships between the serum eosinophil and IgE level and the several groups of AD. The results are as follows : 1. Peripheral eosinophil counts were higher in severe group(224.8/mm) than in mild group (180.0/mm)(p<0.05). 2. Peripheral eosinophil counts were 220.0/mm in atopic group, l65.0/mm in family history group, and 332.4/mm in respiratory group, but there was no stitistically significant difference among 3 groups. This suggests that concomitant respiatitiry atopy or a family history of respiratory atopy is not an important factor in the elvation of peripheral blood eosinophil counts in AD. 3. Serum IgE was higher in severe group(443.2IU/ml) than in mild group(231.5IU/ml)(p<0.05). 4. Serum IgE level in respiratory group(754.6IU/ml) were signifiiantlly higher than in atopic (286.6IU/ml) or family history group(342.0IU/ml)(p<0,01). But there was no significant. difference between family and atopic group. This result suggests that concomittent respiratory atopy is a potential factor in elevation of serurn Igi in AD. 5. Slightly high correlation between peripheral blood and IgE level appeared in all 53 patients (r=0.434) and severe group(r=0.480). But, respiratory group(r=0.060), family history group(r=0.111) and atopic group(r=0.202) showed poor relationships.
Dermatitis, Atopic* ; Eosinophils* ; Humans ; Immunoglobulin E*

Superior mesenteric artery (SMA) injuries remain a challenge to most trauma surgeons and continue to result in significant mortality despite aggressive management. We report successful management of a proximal SMA injury through endovascular treatment in a 56-year-old man. The patient presented with hypotension due to a stab wound after the epigastrium. He underwent emergency laparotomy and repair of the penetrated wall of the stomach. Right retroperitoneal hematoma at the initial laparotomy expanded and ruptured, requiring a massive transfusion. At the second laparotomy, we performed lateral arteriorrhaphy of the proximal SMA. Follow-up abdominal computed tomography angiography on post-injury day 7 showed a pseudoaneurysm on the left side of the SMA trunk. The patient was treated successfully with an endovascular stent graft.
Aneurysm, False* ; Angiography ; Blood Vessel Prosthesis ; Emergencies ; Endovascular Procedures ; Follow-Up Studies ; Hematoma ; Humans ; Hypotension ; Laparotomy ; Mesenteric Artery, Superior* ; Middle Aged ; Mortality ; Stomach ; Wounds, Stab

We report an unusual case of sebaceous hyperplasia in an 18-year-old male manifestated clinically as yellowish, grouped papules with a linear distribution, present on the right side of forehead since birth. Histopathologically, a large sebaceous gland composed of numerous lobules grouped around a centrally dilated duct was seen. The sebaceous lobules distributed in the upper dermis showed direct connection to the skin surface, which suggested a transepidermal elimination of sebaceous lobules.
Adolescent ; Dermis ; Forehead ; Humans ; Hyperplasia* ; Male ; Parturition ; Sebaceous Glands ; Skin

As the arthroscopic surgery of the knee joint has taken rapid strides recently, the knowledge of the structure and deveIopment of the joint are getting needed more and more. An embryological study about the development of the human knee joint was carried out using a total of 23 knees of human embryos. Serial sections of 23 embryos aged 5-8 postovulatory weeks (12-31 mm C.R.) and 3-dimensional reconstruction were examined. The embryos have been staged according to Carnegie's 'developmental stages'. The femur, tibia and fibula had begun to undergo chondrification by stage 18. The patella had commenced chondrification at stages 23. As the mesenchymal model began to chondrify, concomitant changes occurred in the region of the presumptive knee joint to create the interzone (stage 19-20). The following structures became condensed successively: patellar tendon (18-19), lateral collateral ligament and popliteus tendon (19-20), cruciate ligaments (20-22), meniscus (21-22). In summary, the differentiation from a generalized cellular blastema to a joint resembling the adult in form and arrangement occurred in only a relatively few days. By the end of the embryonic period proper (stage 23, 8 postovulatory weeks), all the elements of the knee joint were present in a form and arrangement closely resembling those of the adult. It seems that the embryological studies are more required to clarify the structures having many variants such as synovial plica, meniscus, and the development of the joint cavity through this study.
Adult ; Arthroscopy ; Embryonic Structures ; Femur ; Fibula ; Humans* ; Joints ; Knee Joint* ; Knee* ; Lateral Ligament, Ankle ; Ligaments ; Patella ; Patellar Ligament ; Tendons ; Tibia

We experienced the 17 hands of 11 patients with Dupuytren disease, which was known as relatively rare in orientals. Retrospectively, we analyse it and the results were followings; l. Among 11 patients, 10 patients were male and average age was 62.5 years (49 to 77 years) 2. Most (15 hands, 88%) of patients had symptoms of flexion contracture, nodule and contracted cord, simultaneously. 3. Occupation of patients was agricultural laborer in 9 patients (82%). 4. In 9 patients(82%); individual habit of alcoholic drinking, more than 3 times per week, and smoking, 1 package per day, over 20 years more, was observed. 5. In 15 hands (88%), ulnar side of fingers (4th+5th, 5th only or 3rd+4th+5th)was involved. 6. Surgical treatment was performed in 9 hands of 7 patients, with results of excellent in 6 hands (67%) and no recurrence, in average follow up 2.6 years (1.5 year to 3.7 year)
Alcoholics ; Clinical Study ; Contracture ; Drinking ; Dupuytren Contracture ; Fingers ; Follow-Up Studies ; Hand ; Humans ; Male ; Occupations ; Recurrence ; Retrospective Studies ; Smoke ; Smoking

It is generally accepted that fractures should be treated by closed methods, however for certain femoral fractures in adults, closed methods yields an unacceptable high incidence of nounlon, malunion, delayed unlon, and disability. For these fractures various methods of open reduction and internal fixation have been recommended, but unfortunately, there are frequent reports of complications and failures. The recently developed association for study of Internal fixation (ASIF) compression plating apparatus, seems to satisfy the basic objectives of internal flxatlons: namely
Adult ; Femoral Fractures ; Femur ; Follow-Up Studies ; Humans ; Incidence ; Joints ; Walking

The onset of systemic scleroderma in the first. decade of lif occurs in less than 1.5% of instances. Systemic sclerodrma in childhood have been characterized by less severe visceral involvement and a benign course We report a boy, aged 7 years, with a history of Raynaid; phenomenon and dysphagia. He had a mask-like face, flexion contracture of hands and knee joints, digital pitting scars, ichthyosiform skin change on leg and hyperpigrnented induration on all extremities and trunk. Antinuclear antibodies were positive in nucleolar type and Scl-70 antiocy was also present. On radiologie study, the pattern of reflux esophagitis and resorption of the listal ends of all phalanges were nated. Histopathological findings were compatible with sclerodma. He was treated with Penicillamine-D and oral corticosteroic with good improvernent.
Antibodies, Antinuclear ; Cicatrix ; Contracture ; Deglutition Disorders ; Esophagitis, Peptic ; Extremities ; Hand ; Humans ; Knee Joint ; Leg ; Male ; Scleroderma, Systemic* ; Skin