OBJECTIVE: This study was designed to investigate automated pressure-controlled discography (APCD) findings, to calculate the elastance of intervertebral discs, and to assess the relationship between the calculated elastance and disc degeneration. METHODS: APCD was performed in 19 patients. There were a total of 49 intervertebral discs treated. Following intradiscal puncture, a dye was constantly injected and the intradiscal pressure was continuously measured. The elastance of the intervertebral disc was defined as unit change in intradiscal pressure per fractional change in injected dye volume. Disc degeneration was graded using a modified Dallas discogram scale. RESULTS: The mean elastance was 43.0 +/- 9.6 psi/mL in Grade 0, 39.5 +/- 8.3 psi/mL in Grade 1, 30.5 +/- 22.3 psi/mL in Grade 2, 30.5 +/- 22.3 psi/mL in Grade 3, 13.2 +/- 8.3 psi/mL in Grade 4 and 6.9 +/- 3.8 psi/mL in Grade 5. The elastance showed significant negative correlation with the degree of degeneration (R2 = 0.529, p = 0.000). CONCLUSION: APCD liberates the examiner from the data acquisition process during discography. This will likely improve the quality of data and the reliability of discography. Elastance could be used as an indicator of disc degeneration.
Humans ; Intervertebral Disc ; Intervertebral Disc Degeneration ; Low Back Pain ; Punctures

PURPOSE: This study is to identify factors associated with performance of occupational health services in small-sized workplaces in Korea. METHODS: The data were collected from a random sample of 1,158 occupational health managers working for small-sized workplaces across the nation in which occupational health services were supported by Korean Industrial Health Association. A structured questionnaire was self-administrated by occupational health managers about characteristics of workplaces, occupational health managers, and performance level of occupational health services. RESULTS: Stepwise multiple regression analyses revealed that factors associated with performance of occupational health services in small-sized workplaces included supervisor being designated, occupational health manager having received safety and health training, and employer's concern with activities of health management. CONCLUSION: Government should make efforts to raise the level of employer's concern to occupational health activities. And it is needed to promote health managing staff as a core personnel to self-management for occupational health system.
Occupational Health ; Occupational Health Services ; Surveys and Questionnaires ; Self Care ; Small Business

PURPOSE: This study is to identify factors associated with performance of occupational health services in small-sized workplaces in Korea. METHODS: The data were collected from a random sample of 1,158 occupational health managers working for small-sized workplaces across the nation in which occupational health services were supported by Korean Industrial Health Association. A structured questionnaire was self-administrated by occupational health managers about characteristics of workplaces, occupational health managers, and performance level of occupational health services. RESULTS: Stepwise multiple regression analyses revealed that factors associated with performance of occupational health services in small-sized workplaces included supervisor being designated, occupational health manager having received safety and health training, and employer's concern with activities of health management. CONCLUSION: Government should make efforts to raise the level of employer's concern to occupational health activities. And it is needed to promote health managing staff as a core personnel to self-management for occupational health system.
Occupational Health ; Occupational Health Services ; Surveys and Questionnaires ; Self Care ; Small Business

OBJECTIVES: A standardized questionnaire is not available for use as a screening tool to assess individuals with MCS/IEI in Korea. The QEESI(c), originally developed by Miller & Prihoda in 1998, helps researchers, doctors, and their patients identify individuals with MCS/IEI. Therefore, this study was conducted in order to create a Korean version of the QEESI(c) and evaluate whether this Korean version could be used as an effective MCS/IEI screening tool in Korea. METHODS: The Korean version of the QEESI(c) was developed using a six-step approach: permission, forward translation, the first quality control, backward translation, cognitive debriefing and the second quality control, final proof reading. In order to collect data, we have done a sample survey in certain parts of Korea. A household was used as the sampling unit; we extracted random samples in each survey cluster and then interviewed two adults over 19 years of age living in each sampled household. A total of 300 subjects were recruited from the general population in local community. The factor structure in the Korean version of the QEESI was analyzed with 40 items on four sub-scales except for the 10 items in masking index using principal components analysis with Varimax rotation. A convergent validity test two sub-scales: chemical intolerance and symptom severity. We carefully compared the chemical intolerance with Nordin's chemical sensitivity scale and the symptom severity with Cho's subjective symptom score. RESULTS: The results showed that the 40 items on the four sub-scales,' chemical intolerances',' symptom severity', 'life impact', and 'other intolerances', were consistent with those reported for the US population by Miller and Prihoda. The convergent validity wes very good (r=0.4; p<0.001, r=0.5; p<0.001, respectively). A good internal consistency (Cronbach' alpha=0.86~0.96) and test-retest reliability (r=0.87~0.90) were found in all scales, except for the internal consistency in the masking index. CONCLUSIONS: The Korean version QEESI(c) showed a good reliability and validity. It should be necessary to conduct a MCS/IEI study adopting Korean version QEESI(c).
Adult ; Environmental Exposure ; Family Characteristics ; Humans ; Korea ; Masks ; Mass Screening ; Multiple Chemical Sensitivity ; Quality Control ; Questionnaires ; Reproducibility of Results ; Weights and Measures

Spinal pain is a common symptom that motivates visiting a physician. However, the natural course is usually benign and few patients need invasive treatment. Even though history taking, neurological examination, and imaging studies provide useful information for understanding the etiology of spinal pain, the pain chart is the most important tool for decision making regarding spinal interventions. Invasive treatments for chronic spinal pain refractory to conservative management include surgery as well as established interventions such as medial branch blocks, nerve root blocks, the sacroiliac joint block, and radiofrequency neurotomy, as well as emerging procedures such as pressure-controlled discography and percutaneous epidural adhesiolysis. Surgery should be considered for patients with a progressive neurologic deficit including significant radiculopathy, failure of spinal interventions, or an uncertain or serious diagnosis.
Decision Making ; Diagnosis ; Humans ; Nerve Block ; Neurologic Examination ; Neurologic Manifestations ; Pain Management ; Radiculopathy ; Sacroiliac Joint ; Spine

The findings of special medical examinations are not infrequently summarized in the form of health classification. This procedure seems valuable for the protection of workers'health from personal health as well as public health point of view, because health classification of workers provides occupations health workers with birds eye view informations in terms of medical, placement and educational procedures, which are to be followed after medical examinations. In this study, the authors have reviewed the existing systems of special medical examinations and Health classifications in different countries and those recommended by international organizations for the purpose of improving the current system in Korea. The important issues covered in this review in relation to health classification of workers included the categories of diseases, the examination and laboratory tests, the criteria for health level classification and the health instructions to be given at each health levels. It was found that the current health classification system in Korea could be featurea as follows : 1. Special medical examinations are always carried out in combination with general medical examinations, contributing to the detection of risk factors of occupational diseases. 2. The selection of examinees is always made on the basis of work environment monitoring, often resulting in the underdetection of exposed workers. 3. Even if the test items are properly selected according to the principles of occupational medicine, further review is required in the light of recent advances in the pathogenesis as well as early changes of occupational diseases and epidemiologic principles. 4. The criteria for the classfication of health levels are to be reviewed on the basis of clinical epidemiology. 5. The health instructions covered only medical and placement aspects, failing to introduce the concept of health promotion.
Birds ; Classification* ; Epidemiology ; Health Promotion ; Health Status ; Humans ; Korea ; Occupational Diseases ; Occupational Medicine ; Occupations ; Public Health ; Risk Factors

OBJECTIVES: This study was undertaken to evaluate correlation between the levels of hippuric acid in blood plasma (HAP) and those of toluene concentration in the workplace air. METHODS: Study subjects were composed of two groups; 21 workers who were occupationally exposed to toluene and 25 rural-area residents who were not exposed to any known occupational toluene source, as an exposed group and a reference group, respectively. Mean age and work duration of the exposed was 42 years and five years, respectively. Mean age of the reference was 42 years. To determine toluene concentrations in the workplace air, air sampling has been conducted for more than six hours using a personal sampler, and analyzed by a gas chromatography-flame ionization detector. Concentrations of hippuric acid in biological samples were determined by a high performance liquid chromatography-ultraviolet detector. RESULTS: Geometric mean(geometric standard deviation) of HAP and hippuric acid in urine(HAU) for the exposed was 1.39(2.21) mg/L and 2.77(1.46) g/L, respectively, which were significantly different from those of the reference [HAP, 0.45(2.94); HAU, 0.37(0.45)]. Toluene concentration in the workplace air was 86.92(range: 45.18~151.23) ppm. The level of HAP or HAU was significantly correlated (r=0.70 and r=0.63, respectively) with that of toluene in the workplace air. The estimated regression equation was logHAP(mg/L)=-3.60+1.93 log(toluene, ppm) or logHAU(g/L)=-0.85+0.67 log(toluene, ppm). The magnitude of correlation was further enhanced when analyzing relationship between toluene concentrations lower than 100 ppm and its corresponding HAP levels. CONCLUSION: Overall, plasma hippuric acid levels were well correlated with toluene concentrations in the workplace air, and a statistically significant correlation was observed for the samples with toluene concentration lower than 100 ppm.
Chromatography, High Pressure Liquid ; Humans ; Occupations ; Plasma* ; Toluene*

PURPOSES: The authors derived two forecasting models which can be used as objective tools for detecting epidemics and predicting the future frequencies of communicable diseases. METHODS: In this study, regression analysis using trigonometric functions, Box and Jenkins's seasonal ARIMA model were applied to the monthly accumulated data of five nationally notifiable communicable diseases from January 1987 to December 1998 in Korea. RESULTS: Between two forecasting models, seasonal ARIMA model gives more precise predicted frequencies than regression model in the neighborhood of the current time points and future time, but the regression model is better in overall agreement between the predicted and observed frequencies during 7 years(1992-1998). CONCLUSIONS: These forecasting models can be usefully applied in deciding and carrying out a national policy in preventing epidemics in the future, and graphic program is much helpful to understand the present status of disease occurrence.
Communicable Diseases* ; Forecasting* ; Korea* ; Moclobemide ; Residence Characteristics ; Seasons

Lumbo-sacral junction is a transition zone between the mobile lumbar spine and immobile pelvis. Lumbosacral junction has been considered to be the most troublesome portion of the spine to be fused because of the difference in anatomical and biomechanical factors between spine and pelvis. A metastatic sacral tumor in a 57-year-old man was resected, followed by unilateral lumbo-iliac fixation across lumbosacral junction using modified Galveston technique. Rigid fixation was successfully achieved. Detailed anatomy and surgical techniques are presented.
Arthrodesis ; Humans ; Middle Aged ; Pelvis ; Spine

OBJECTIVE: Vertebral distraction is routinely performed during anterior cervical discectomy and fusion (ACDF). Overdistraction can injure the facet joints and may cause postoperative neck pain consequently. The purpose of this study was to investigate the clinical relevance of distraction force during ACDF. METHODS: This study included 24 consecutive patients with single level cervical disc disease undergoing single level ACDF. We measure the maximum torque just before the the arm of the Caspar retractor was suspended by the rachet mechanism by turning the lever on the movable arm using a torque meter. In order to turn the lever using the torque driver, we made a linear groove on the top of the lever. We compared the neck disability index (NDI) and visual analogue scale (VAS) scores between the high torque group (distraction force>6 kgf.cm) and the low torque group (distraction force< or =6 kgf.cm) at routine postoperative intervals of 1, 3, 5 days and 1, 3, 6 months. RESULTS: The VAS scores for posterior neck pain had a linear correlation with torque at postoperative 1st and 3rd days (y=0.99x-1.1, r2=0.82; y=0.77x-0.63, r2=0.73, respectively). VAS scores for posterior neck pain were lower in the low torque group than in the high torque group on both 1 and 3 days postoperatively (3.1+/-1.3, 2.6+/-1.0 compared with 6.0+/-0.6, 4.9+/-0.8, p<0.01). However, the difference in NDI scores was not statistically significant in all postoperative periods. CONCLUSION: Vertebral distraction may cause posterior neck pain in the immediate postoperative days. We recommend not to distract the intervertebral disc space excessively with a force of more than 6.0 kgf.cm.
Arm ; Diskectomy ; Humans ; Intervertebral Disc ; Neck ; Neck Pain ; Pain, Postoperative ; Spinal Fusion ; Torque ; Zygapophyseal Joint