The household survey was performed in a urban slum and a rural Chonnam areas to measure the level of illness and medical care utilization and to find the determinants of physician utilization. The data revealed that age-adjusted prevalence rates of acute and chronic diseases were much the same in both areas ranged between 10.0 to 11.3%. But medical care utilization was more frequent in urban slum than in rural area. The facility of the first medical contact was also different. Some personal and disease related variables including disease severity and activity restricted day were significantly, but somewhat differently by area, associated with physician utilization pattern. When applying Anderson model, the medical need factors explained 42.2 and 40.4% of physician utilization in urban slum and in rural areas respectively, while the enabling factors explained 18.0 and 12.2% and the predisposing factors explained 17.1 and 8.9% correspondingly.
Causality ; Chronic Disease ; Family Characteristics ; Humans ; Jeollanam-do ; Poverty Areas ; Prevalence

To evaluate the possible functional role of serum during the process of parturition, 15 serum samples were collected and analyzed for the nickel concentrations in each 3 groups(Group 1 for the period during parturition, Group 2 for the period from delivery of fetus to delivery of placenta, and Group 3 for the period after delivery of placenta) of normal, uncomplicated full term vaginal delivery and one control group composed of healthy unmarried women in 3rd decades of age. Data revealed that average serum nickel concentration of Group 2(26.6 microgram/l) and Group 1(22.2 microgram/l) were significantly higher than that of Control group(13.7 microgram/l), but Group 3's(13.8 microgram/l) was almost same as Control group's. There were significant negative correlation between age and serum nickel concentration in group 2, and a tendency of higher nickel concentration in women who have no previous experiences of pregnancy than who have previous experiences of pregnancy, although it was not significant. These result could be indicative of close causal relationship between serum nickel concentration and the entire process of parturition.
Female ; Fetus ; Humans ; Nickel* ; Parturition ; Placenta ; Pregnancy ; Single Person

In Korea, slipped capital femoral epiphysis is a rare disease. In which the capital femoral epiphysis migrate posteriorly and inferiorly against the neck portion. Sometimes it should be differentiated from other conditions that separate the femoral capital epiphysis. We have experienced a rare case of separation of capital femoral epiphysis due to an osteosarcoma in the proximal femoral metaphysis in the 15 years of old girl.
Epiphyses ; Female ; Humans ; Korea ; Neck ; Osteosarcoma ; Rare Diseases ; Slipped Capital Femoral Epiphyses

Objectives : A diverse range of adverse effects has been linked to the application of antidepressants for the treatment of depressive disorder. Recently, evidence has been emerging of the adverse metabolic effects of antidepressants. This study investigated the effects of antidepressants on plasma glucose and other factors in the fat and muscle tissue relating to metabolism. METHODS : Long-Evans-Tokushima-Ostuka (LETO) rats were used to evaluate the effects of different antidepressants. Amitriptyline, fluoxetine, and mirtazapine were administered to each of three subgroups for 4 weeks, between 11 and 15 weeks old, while a fourth subgroup was administered no antidepressant during the same period. Changes of weight and daily intake were monitored. Tissues and blood were collected at 15 weeks. RESULTS : The fluoxetine subgroup showed lower weight gain and lower food efficacy ratio than did the other subgroups. Blood glucose and other circulating factors showed no significant differences among groups, except for the leptin levels of the fluoxetine subgroup. However, the amitriptyline and mirtazapine subgroups showed similar patterns in the response of mRNA expression of peroxisome proliferator-activated receptors gamma cofactor-1 and uncoupling protein-1, 2, 3. CONCLUSION : These results could indicate possible differences in metabolic response based on the kind of antidepressant used.
Amitriptyline ; Animals ; Antidepressive Agents ; Blood Glucose ; Depressive Disorder ; Energy Metabolism ; Fluoxetine ; Glucose ; Leptin ; Mianserin ; Muscles ; Peroxisome Proliferator-Activated Receptors ; Plasma ; Rats ; RNA, Messenger ; Weight Gain

No abstract available.

Mucinous adenocarcinomas of the anal region constitute only 2% of anal cancer and adenocarcinoma developing in a chronic tuberculous anal fistula is extremely rare. In most cases, its origin is difficult to ascertain because the primary sites have already been destroyed before any diagnosis of malignancy is made. We experienced a case of perianal adcnocarcinoma developing in chronic tuberculous anal fistula, which was treated by abdominoperineal resection with preoperative chemo-irradiation. We reported a case and reviewed the related literatures.
Adenocarcinoma* ; Adenocarcinoma, Mucinous ; Anus Neoplasms ; Diagnosis ; Rectal Fistula*

PURPOSE: It is well known that duodenal ulcer disease does not relapse if H. pylori is cleared from the gastric mucosa. Little is known about the recurrence of duodenal ulcer in children. The purpose of this study was to evaluate the effect of the eradication of H. pylori in duodenal ulcer in children upon the duodenal ulcer recurrence. METHODS: 105 patients (M : F=78 : 27) diagnosed as duodenal ulcer by endoscopy in 1987~1995 were reviewed clinically, and were parted into two groups. The two treatment groups were ranitidine/antacid (RAN/ANT) and ranitidine/amoxicillin/denol (RAN/AMX/D). The latter was for H. pylori-positive children with duodenal ulcer who were diagnosed by serology and/or antral biopsies for histology, culture, and urease testing. The recurrence rates were compared between the two groups. RESULTS: 1) 30 patients with primary duodenal ulcer underwent endoscopy for H. pylori and 27 (90.0%) of them were positive for H. pylori. 2) 27 of H. pylori-positive children received RAN/AMX/D. 23(85.2%) of them showed cure of duodenal ulcer and eradication of H. pylori. 3) The duodenal ulcer recurrence rate in RAN/ANT group was 65.3% and the rate in RAN/AMX/D was 4.3% by a year. CONCLUSIONS: There is a strong correlation between the duodenal ulceration and H. pylori infection in children, and the eradication of H. pylori in duodenal ulcer patients reduces the recurrence of the ulcer. Because of the low incidence of duodenal ulcers in children, a multicenter prospective study is required to determine the effect of treating H. pylori infetion on the long term natural history of duodenal ulcer disease.
Biopsy ; Child* ; Duodenal Ulcer* ; Endoscopy ; Gastric Mucosa ; Helicobacter pylori* ; Helicobacter* ; Humans ; Incidence ; Natural History ; Recurrence* ; Ulcer ; Urease

Sheldon-Hall syndrome (SHS) is a rare autosomal dominant, inherited arthrogryposis syndrome characterized by multiple congenital contractures of the distal limbs. To date, four genes that encode the skeletal muscle fiber complex have been confirmed as the causative genes. Mutations in MYH3 have been identified most frequently and few cases of SHS caused by TPM2 mutations have been reported worldwide. This report describes, for the first time, a Korean family with two generations of SHS resulting from a rare TPM2 mutation, p.R133W. The affected mother and daughter manifested typical facial features of SHS including a triangular face with downslanting palpebral fissures, small mouth, high arched palate, and prominent nasolabial folds, and showed camptodactyly of fingers and deformities of feet with congenital vertical tali. Generalized myopathy with relative sparing of the slow-twitch muscle fibers was also revealed by electromyography in the affected mother.
Alleles ; Arthrogryposis/*genetics ; Asian Continental Ancestry Group/*genetics ; Exons ; Female ; Finger Phalanges/radiography ; Foot Bones/radiography ; Humans ; Infant, Newborn ; Mutation ; Pedigree ; Phenotype ; Republic of Korea ; Sequence Analysis, DNA ; Tropomyosin/*genetics

BACKGROUND/AIMS: The aim of this study was to characterize the spectrum of esophageal motor dysfunction after repair of an esophageal atresia with a tracheoesophageal fistula (EATEF). METHODS: This study included 16 patients, aged 0.8 to 13.3 years, who were diagnosed with Gross Type C esophageal atresia and underwent a fistula repair and end to end anastomosis. Esophageal function was evaluated with manometry, 24 hour esophageal pH monitoring, a barium esophagogram, and an endoscopy. RESULTS: Symptoms were present in 8 patients (dysphagia for solid food in 2; frequent vomiting in 6; and poor weight gain in 4). Anastomotic stricture was present in 6 patients. An esophageal manometric study showed that the reflex relaxation of the lower esophageal sphincter (LES) was incomplete or absent in 9 patients (56%). The upper esophageal sphincter (UES) was completely relaxed in all 16 patients. In 14 patients (88%), a normal peristaltic wave was present in the proximal esophagus, but absent below the anastomotic site. Simultaneous contractions were observed in 2 patients (12%). Seven (64%) of 11 patients who underwent 24 hour esophageal pH monitoring presented gastroesophageal reflux. CONCLUSION: Most of the patients after the repair of an EATEF developed motor dysfunction of the esophagus. Poor transmission of the peristaltic waves beyond the anastomotic site and abnormal reflex relaxation of the LES were present.
Barium ; Constriction, Pathologic ; Endoscopy ; Esophageal Atresia* ; Esophageal pH Monitoring ; Esophageal Sphincter, Lower ; Esophageal Sphincter, Upper ; Esophagus* ; Fistula ; Gastroesophageal Reflux ; Humans ; Manometry ; Reflex ; Reflex, Abnormal ; Relaxation ; Tracheoesophageal Fistula* ; Vomiting ; Weight Gain

BACKGROUND: Primary lymphoma of the gastrointestinal tract is an unusual disease for which the optimal management strategy has not been clearly defined. The role of surgery in the management of primary gastrointestinal lymphoma remains controversial. METHODS: We retrospectively reviewed the management and the outcome of 55 patients a diagnosis of gastrointestinal lymphoma who were treated at Kyung-Hee University Medical Center during the period 1986-1997. Thirty-seven of them underwent a resection for cure, and 23 patients of them underwent chemotherapy. 18 patients underwent chemotherapy only. Radiation therapy was excluded due to the small number of patients. Surgery consisted of wide local resection of the primary tumor (curative for stages I and II, and palliative for stages III and IV), and regional lymph nodes, with re-establishment of bowel continuity. Chemotherapy involved 6-10 courses of CHOP-B (cyclophosphamide, adriamicin, vincristine, prednisone, and bleomycin). Survival curves were calculated by using the Kaplan and Meier method. RESULTS: The mean age was 51 years (range: 3-82), the peak incidence of age was the fifth decades (34%), and the male-to-female ratio was 1.3:1. Common signs and symptoms at presentation were abdo minal pain (n=46), palpable mass (n=28), nausea/vomiting (n=26), and weight loss (n=18). The diagnostic sensitivities of ultrasound, contrast radiography, endoscopic biopsy, and computed tomography were 52%, 57%, 76%, and 78%, respectively. The primary tumor sites were the stomach (n=18), the terminal ileum & cecum (n=15), the small bowel (n=13), and the large bowel (n=9). The respective cumulative overall 5-year survival rates for stage I, II, III tumors were 89%, 74%, and 43% (p<0.05). The respective overall 5-year survival rate for resection only, resection with chemotherapy, and chemotherapy only were 100%, 78%, and 40% (p<0.05). By the Kaplan-Meier method, the prognostic factors of survival were stage and curative resection (p<0.05). CONCLUSION: A curative resection in a stage I, II lymphoma confined to the gastrointestinal tract and to regional involvement may improve patient survival.
Academic Medical Centers ; Biopsy ; Cecum ; Diagnosis ; Drug Therapy ; Gastrointestinal Tract* ; Humans ; Ileum ; Incidence ; Lymph Nodes ; Lymphoma* ; Prednisone ; Radiography ; Retrospective Studies ; Stomach ; Survival Rate ; Ultrasonography ; Vincristine ; Weight Loss