Reorganization of myun health care service is one of the main issues in health care delivery in rural Korea. The fundamental, concept of the role and function of the myun health subcenter is that it is the basic unit of rural health care service and is to provide comprehensive health care service through the integration of curative and preventive services. The aim of this study is to analyze the patterns of curative activities in the myun health subcenter in terms of the most prevalent types of diseases, necessary diagnostic methods and required equipment, types of treatment, necessary drugs and materials, and finally the cost of curative services. The population on which this study was done was the 1596 patients who visited the two myun health subcenters (Sunwon Myun and Naega Myun) in Kang Hwa County, the area of the Yonsei University Community Health Teaching Project, during period from May 1, 1975 to June 10, 1976. For the patient's record in the clinic, problem oriented medical records were used. Decisions regarding the disease classification, the diagnostic methods used and selection of the most appropriate and adequate medical treatment were made by a group of three experienced physicians after reviewing the medical records which had been written by public physicians who were treating patients in the study area. The records were reviewed by resident staff members of the Department of Preventive Medicine, of Yonsei University College of Medicine. A brief summary of results of the study is as follow: 1. 29.9% of the patients who visited the clinics were ages between 0-4. No sex difference was observed among patients less than 20 years of age. However, among patients over 20 years old, females predominated. Thus it is evident that the majority of patients were either children or mothers and grandmothers. 2. The distance from the individual villages to the myun health subcenter was one of important factors in determining the ratio of clinic visits. However, other factors such as the activities of the health workers also affected the rates substantially. 3. The most common 25 diseases comprised 90.2% of all the diseases recorded. Acute respiratory infection (25.5), skin (12.7%), diarrheal diseases (6.8%), neuralgia and back pain (4.9%) and all other injuries (3.9%) were the five most common diseases. 4. Of all the diseases diagnosed and treated, 9.2% required simple laboratory tests for diagnosis, 6.5% required X-ray examination, and altogether 13.6% required either laboratory test of X-ray examination. 5. Treatment and management of 42.0% of the cases could be accomplished with simple, inexpensive drugs, 12.8% required the use of more expensive drugs (mostly antibiotics) and injections were required in 19.7% of the cases. Minor surgery and referral were necessary in 5% of the cases. 6. The cost for diagnosis and treatment was estimated with a standard which was set by general concensus. The average cost of diagnosis was 144 per case and the cost of treatment was 726 per case. The total average cost per visit was 870.
Ambulatory Care ; Back Pain ; Child ; Classification ; Comprehensive Health Care ; Delivery of Health Care ; Diagnosis ; Female ; Humans ; Korea ; Medical Records ; Medical Records, Problem-Oriented ; Mothers ; Neuralgia ; Preventive Medicine ; Referral and Consultation ; Rural Health ; Sex Characteristics ; Skin ; Surgical Procedures, Minor ; Young Adult

IVRO is one of the most common procedures to setback prognathic mandible. Since 1993 we have set-up our own protocol for functional physiotherapy(Park's protocol) after IVRO. This is a study on openbite and relapse tendency after IVRO followed by our protocol. We obtained lateral cephalograms of twenty-seven patients which were taken immediately after surgery, 3 months, 6 months and 1 year postoperatively. Changes in positions of each point were analyzed. The results were as follows: 1. No remarkable openbite occured during the first year after IVRO. Upper teeth, lower teeth and anterior mandible moved upward, it seems to show that post-op orthodontic treatment did not contribute to reduce openbite tendency during post-op period. Rater, the lower teeth and mandible moved with the upper teeth as the compensation mechanism. 2. Lower Incisal Edge moved anteriorly up to 6 months, so overjet decreased from 3.3mm to 2.9mm during the first six months. Skeletal changes in anterior mandible showed slight anterior movement, therefore showing slight relapse tendency, but it represented no statistical significance. 3. The physiotherapy according to our protocol was used for only a month after operation, but there was no openbite tendency, and the occlusion was stable over one year.
Compensation and Redress ; Humans ; Mandible ; Open Bite* ; Prognathism* ; Recurrence* ; Tooth

Clinical studies were performed that the patient with angina pectoris having no responses to Ca++ antagonist and beta-blocker had been taken nicorandil 5mg bid daily with, beta-blokade and Ca++ antagonists for 3 weeks. The results after the use of nicorandil were as follows; 1) The clinical symptoms after the use of nicorandil were improved in 20(80%) of 25 patients, specially marked improved in 16 of 25 patients. There was no significant changes of BP and heart rate after the use of nicorandil. 2) The results of CBC, urinalysis, serum chemistry exa. and chest P-A were within normal range before and after the use of nicorandil. 3) After the use of nicorandil, ST segments depressed in 13 of 25 patients before use of nicorandil was elevated in 8(61.6%) of 13 cases after the use of that. QT interval, P-R interval and T wave in 25 cases were within normal range before and after the use of that. The M mode echocardiography showed the decreased movement of ventricular septum in 19 of 25 patients before the use of Nicorandil, and there was no changes after the use of that. 4) The adverse effects after the use of nicorandil to 25 patients were as follows: headache in 3(12%), nausea and vomiting 2(8%), palpitation 1(4%), upper abdominal discomfort 1(4%), and facial flushing 1(4%).
Angina Pectoris* ; Chemistry ; Echocardiography ; Flushing ; Headache ; Heart Rate ; Humans ; Nausea ; Nicorandil* ; Reference Values ; Thorax ; Urinalysis ; Ventricular Septum ; Vomiting

Supraspinatus outlet view and thirty-degree caudal tilt view have been used for the diagnosis of rotator cuff disease. Because scapula is moving on the thoracic cage, these two views are not always easy to take. The purposes of this study were to investigate the detectability of these views, to compare both views and to observe the interobserver reliability of these views. Supraspinatus outlet views and thirty-degree caudal tilt views were taken from 66 shoulders with clinically diagnosed rotator cuff disease. The shape of the acromions was examined on the supraspinatus outlet views and the size and shape of the acromions were analyzed on the thirty-degree caudal tilt views. An orthopaedic resident, an orthopaedic staff and a radiologic staff reviewed the all films without knowing the opinions of others. Suprapinatus outlet views were not-acceptable in average 43.9% and thirty-degree caudal tilt view were not-acceptable in average 12.6%. All of the three observes had same opinions in 43.9% for the supraspinatus outlet views, and in 45.5% for in thirty-degree caudal tilt views. Disagreement among all three observes was noticed in 13.6% for the supraspinatus outlet views and in 3.0% for in thirty-degree caudal tilt views. In the supraspinatus outlet views, the hooked acromions appeared in average 12.1%. In the thirty-degree caudal tilt view, acromial spurs appeared in average 27.3%. Only 2.5% in average showed hooked acromion on supraspinatus outlet view and acromial spur on thirty-degree caudal tilt view. Thirty-degree caudal tilt view is easier to take and more reliable than supraspinatus outlet view. In is better to take both supraspinatus outlet view and thirty-degree caudal tilt view for each patients with rotator cuff diseases. Radiologic findings should be judged on the base of clinical feature.
Acromion ; Diagnosis ; Humans ; Rotator Cuff ; Scapula ; Shoulder

In spite of highly advanced technology in orthopaedic field, management of femoral neck fracture presents difficult problems due to frequent non-union or avascular necrosis of femoral head even with adequate treatments. Intracapsular fracture of the femoral neck heals in the same way as other intra-articular fractures only by endosteal and not by periosteal repair. Avascular necrosis occurred in one-third of displaced fractures with more than a two-year follow-up and is the most serious remaining factor affecting the result. Many attempts have been made to achieve early diagnosis of nonunion and avascular necrosis of the femoral head. Yet, there is still no reliable clinical method of early detection of the union of femoral neck fracture and the viability of the femoral head. For the early detection of union and viability of femoral head, we performed femoral trochanteric intra-osseous venographic technique. Intraosseous venography was performed in 19 cases of femoral neck fractures in the orthopaedic department of National Medical Center during the period from Jan. 1979 to Dec. 1981. The results were as follows: l. 19 patients of femoral neck fracture were performed osteomedullography. Intra-osseous venous flow across the fracture line was seen in 11 cases from 19 patients. 2. Intra-osseous venous flow across the fracture line was seen between the 6th and 12th week following fracture treatment in rigid fixation and adequate reduction. 3. Osteomedullography is considered as very important study for the early diagnosis of the fracture healing and non-union.
Early Diagnosis ; Femoral Neck Fractures ; Femur ; Femur Neck ; Follow-Up Studies ; Fracture Healing ; Head ; Humans ; Intra-Articular Fractures ; Methods ; Necrosis ; Phlebography

No abstract available.
Head* ; Necrosis*

Cybex evaluation of muscle strength was performed on 15 patients with chronic anterior cruciate ligament tears following arthroscopic reconstruction using central one-third patella tendon autograft. Cybex testing was done preoperatively and at 3, 6, 9, and 12 months postoperatively. Peak torque and total work of the quadriceps and hamstrings at the angular velocity of 60 degree/sec and 180 degree/sec were measured and analyzed. The results were as follows: l. At the angular velocity of 60 degree/sec, the muscle strength of the quadriceps showed 45.4% deficit in peak torque and 50.9% deficit in total work compared to the contralateral normal knee preoperatively, 48.2% and 49.0% deficit respectively at 3 months after operation, 40.3% and 37.7% deficit at 6 months, 30.6% and 32.5% deficit at 9 months and 23.4% and 24.7% deficit at 1 year after operation. 2. At the angular velocity of 60 degree/sec, the muscle strenggth of the hamstrings showed 32.3% deficit in peak torque and 42.9% deficit in total work compared to the contralateral normal knee preoperatively, 39.3% and 42.4% deficit respectively at 3 months after operation, 27.3% and 32.3% deficit at 6 months, 21.2% and 22.3% deficit at 9 months and 17.9% and 18.4% deficit at 1 year after operation. 3. At the angular velocity of 180 degree/sec, the muscle strength of the quadriceps showed 38.4% deficit in peak torque and 42.0% deficit in total work compared to the contralateral normal knee preoperatively, 41.1% and 47.54% deficit respectively at 3 months after operation, 34.4% and 33.7% deficit at 6 months, 28.5% and 28.6% deficit at 9 months and 21.0% and 22.1% at 1 year after operation. 4. At the angular velocity of 180 degree/sec, the muscle strength of the hamstrings showed 26.9% deficit in peak torque and 31.8% deficit in total work compared to the contralateral normal knee preoperatively, 41.2% and 45.2% deficit respectively at 3 months after operation, 32.3% and 36.0% deficit at 6 months, 21.4% and 25.1% deficit at 9 months and 16.1% and 15.7% at 1 year after operation.
Anterior Cruciate Ligament Reconstruction ; Anterior Cruciate Ligament ; Autografts ; Humans ; Knee ; Muscle Strength ; Patellar Ligament ; Tears ; Torque

One may sometimes complicated with non-union of the tibia with intact fibula or comparatively early united fibular fracture during the cause of treatment of crural fractures. So that the fibula is to strut the tibial fragment preventing effective contact. Several authors have sporadically reported the removal of a portion of fibula may increase potential compression force across the tibial fracture site and promote bony union of non-delayed union of the tibia. Partial fibulectomy was performed in 9 patients with established nonunion of the tibia at National Medical Center from 1975 to 1982. The results were as follows: 1. Healing occurred in 8 of the 9 cases, and average time to union was 7.4months after fibulectomy. 2. In one case performed B-K amputation due to intractable infection after partial fibulectomy. 3. The average shortening of the involved lower limb was about 1.9cm. 4. All cases did not have significant symptoms at the fibulectomy site after union. 5. Partial fibulectomy proved to be a relatively effective method for the treatment of nonunion of the tibia.
Amputation ; Fibula ; Humans ; Lower Extremity ; Methods ; Tibia ; Tibial Fractures

Parathyroid hormone(PTH), a major bone hormone, inhihits DNA and collagen syntheses in osteohlast-like cells in vitro, but increase the proliferation of osteoblast in vivo as secn in hyperparathyroidism. On the other hand, insulin is known to increase DNA and collagen syntheses and modify the effects of PTH in osteoblast-like cells. We have examined the effects of PTH and insulin in rat osteosarcoma UMR-l06-01 cells and whether PTH plays a role in the insulin-mediated bone formation. When 1 nM PTH and 10 nM insulin were administered to VMR-l06-01 ceils, the rates of DNA synthesis were 124% and 136% of the untreated control, respectively. When the two hormones were administered serially by exposing to 1 nM PTH for 7 days followed by 10 nM insulin lor 24h, the largest increase was observed. The protein synthesis was also increased remarkahly when the two hormones were aclministered serially: the[3H]-leucine incorporation rates, compared to the control group, were 75% and l62% with PTH ancl insulin administration, respectively, but the rate was 297% with the serial administration of the two. The collaeen synthesis, as measured by the (3H)-proline incorporation rates were 60% and l64% with PTH and insulin administration, respectively, but 351% with serial administration, again showing a dramatic effect. These results showed that 1 nM PTH decreased DNA and collagen syntheses in UMR-l06-01 cells after both a 24h and a more prolonged exposure. Similar exposures to insulin tended to increase the syntheses. The comhination of PTH and insulin tended to increase the syntheses. hut not beyond the effect of insulin alone. However, the sequential administration of PTH and insulin markedly increases ihose rales relative to the simultaneous adminstration of these two hormones. Thus, it is possihle that sequential stimulation of PTH and insulin in hone matrix exerts an synergistic effect on hone formation in vivo.
Animals ; Collagen ; DNA ; Hand ; Hyperparathyroidism ; Insulin* ; Osteoblasts ; Osteogenesis ; Osteosarcoma* ; Parathyroid Hormone* ; Rats ; Respiratory Sounds

The authors experienced a case of orbital neurilemoma, which is a rare benign tumor of the orbit, in a 31-year-old Korean female. At her first visit, she complained of decreased visual acuity for 3 years and protruded eyeball for 1.5 years in her left eye. After removal of mass, histopathologic examination confirmed neurilemoma.
Adult ; Female ; Humans ; Neurilemmoma ; Orbit* ; Visual Acuity