BACKGROUND: Upper respiratory infections account for many of the visits in primary care. As most URIs are caused by viruses, antibiotic therapy is not desirable. However, for URI treatment antibiotic therapy is commonly used, which causes many public health problems such as drug resistant bacteria and high medical cost. This paper examines patient knowledge of the normal presentation of a URI, beliefs in the effectiveness of antibiotics and health care utilization. METHODS: A survey of 200 outpatients or their families was conducted in one university hospital from March to April, 1998. Two URI conditions were given for the survey:(1) a condition of 5 days' duration with a cough, sore throat, and clear nasal discharge (question 1), (2) a condition of the same symptom as (1) except a discolored nasal discharge (question 2). For various questions in each of these conditions they were to answer in 5 point Likert type scale. Statistical softwares of SAS 8.0 and GAUSS 3.21 were used for analyzing the survey data. RESULTS: For question 1, 61 % of the sample reported that they would seek care from a physician while for question 2, 75 % of the sample reported that they would do so (p<.01). The health service suppliers, in the order of visiting frequencies, were pharmacy (58 %), hospital (38 %), no visit (2.5 %), public health center (0.5 %), and Chinese medicine clinic (0.5 %) for question 1 and pharmacy (54 %), hospital (42 %), no visit (2 %), Chinese medicine clinic (0.5 %) and public health center (0.0 %) for question 2. For question 1, 54 % of the sample and for question 2, 63 % reported that they believe antibiotics were effective (p=.068). For question 1, 79.5 % and for question 2, 89.5 % of the subjects reported that they had complied to prescriptions of doctors or pharmacists (p<0.05). Out of those subjects, only 19.5 % for question 1 and 21.2 % for question 2 reported that they checked the presence of antibiotics in the prescriptions. A multivariate analysis shows that older people, normally used antibiotics and current smokers had higher tendency of seeking care and stronger beliefs in the effectiveness of antibiotics. CONCLUSION: There is a lack in patient understanding of normal presentation of a URI and the effectiveness of antibiotics as a treatment. A confusion about the meaning ofa discolored nasal discharge is particularly evident. The patients visited pharmacies more often than hospitals, and majority of them (80 %) did not know the details of their prescriptions.
Anti-Bacterial Agents* ; Asian Continental Ancestry Group ; Bacteria ; Cough ; Delivery of Health Care ; Health Services ; Humans ; Multivariate Analysis ; Outpatients ; Pharmacies ; Pharmacists ; Pharmacy ; Pharyngitis ; Prescriptions ; Primary Health Care ; Public Health ; Respiratory Tract Infections*

We experienced a Korean patient with complete form of pachydermoperiostosis. He presented with typical features consisting of clubbing with spade like enlargement of the hand and feet, thickening of facial skin and scalp, irregular thickening of cortex with periosteal new bone formation involving radii, ulnae, tibiae, and fibulae. Classically, pachydermoperiostosis is characterized by a triad of finger clubbing, periostitis, skin and soft tissue changes, giving an acromegaloid look. A variety of associated abnormalities have been described such as cranial suture defects, female escutcheon, bone marrow failure. There are a few reports documenting gastric ulcer, hypertrophic gastropathy and Crohn's disease as accompanying diseases. The patient had upper gastrointestinal bleeding caused by hemorrhagic gastritis and duodenal ulcer. A case is herein reported of pachydermoperiostosis accompanied by peptic ulcer disease.
Acromegaly ; Bone Marrow ; Cranial Sutures ; Crohn Disease ; Duodenal Ulcer ; Female ; Fibula ; Fingers ; Foot ; Gastritis ; Hand ; Hemorrhage ; Humans ; Osteoarthropathy, Primary Hypertrophic* ; Osteogenesis ; Peptic Ulcer* ; Periostitis ; Scalp ; Skin ; Stomach Ulcer ; Tibia ; Ulna

Congenital hepatic fibrosis (CHF) is a rare developemental abnormality, which is characterized pathologically by periportal fibrosis with irregularly shaped proliferating bile ducts. In most, if not all, cases CHF is associated with autosomal recessive polycystic kidney disease. Recently, we experienced two cases, confirmed by percutaneous needle liver biopsy, of CHF with polycystic kidney disease. The first patient was a 19-year-old man and presented with hematemesis and hepatosplenomegaly. Esophageal varix was noted by an endoscopic examination and an endoscopic variceal ligation was performed. Abdominal CT scanning revealed innumerable cysts of both kidneys. The pateint also had cystic dilation of subarchnoid space in the basal cistern and posterior fossa detected through brain MRI. The second patient was a 24-year-old man admitted for an evaluation of splenomegaly. He had no esophageal varix but, splenic varix and splenorenal shunt were detected through an abdominal CT scanning. Innumerable renal cysts were also present. The diagnosis of CHF was confirmed in both cases by its typical histologic features. We report these cases with a review of the relevant literatures.
Bile Ducts ; Biopsy ; Brain ; Diagnosis ; Esophageal and Gastric Varices ; Fibrosis* ; Hematemesis ; Humans ; Hypertension, Portal ; Kidney ; Ligation ; Liver ; Magnetic Resonance Imaging ; Needles ; Polycystic Kidney Diseases* ; Polycystic Kidney, Autosomal Recessive ; Splenomegaly ; Splenorenal Shunt, Surgical ; Tomography, X-Ray Computed ; Varicose Veins ; Young Adult