In order to reinforce the role of primary care physician and to improve doctor-patient relationship, the Korean government tried to introduce 'Family Doctor Registration Program' into Seocho-Gu in Seoul, Ansung-Gun and Paju city in Kyunggi-Do in Oct. 1996. Community residents and doctors in those area did not show much interest in this project because of low incentives. We have done this study to see how much people know 'Family Doctor Registration Program' and what is people's real needs about 'Family Doctor Registration Program. We selected l,800 telephone numbers in Seoul, Chongju city, and Ansung-Gun by multi-stage stratified random sampling. Three trained survey personnels called them and got answers to the premade questionnaire until they completed the questionnaires of 200 persons in each community. The calling time was 7-9 p.m. from Monday to Friday, 3-9 p.m. on Saturday, and 9 a.m. to 9 p.m. on Sunday. We dropped out the persons who did not respond 3 times. The subjects consisted of 222 male and 367 female residents. Their ages ranged from 20 to 78: 24.8% in their 30s, 23.4% in their 20s, 22.5% in their 40s in male, and 35.2% in their 30s, 22.5% in their 40s, 18.5% in their 20s in female. 9.9% of male and 13.2% of female had their Family Doctors. The specialties of their Family, Doctors were internists in 56.2%, general surgeons in ll.0%. The persons who did not have their family, doctors were asked which doctors they would prefer if they had choices of family doctor. The results were internists in 50.3%, family physicians in 13.0%, pediatricians in 4.8%. Only 16.0% residents knew that government tried to introduce Family Doctor Registration Program. The 'Family Doctor Registration Program' was not well known to people. The results of our study showed that more effective incentives and public notifications are needed to activate this program.
Female ; Gyeonggi-do ; Humans ; Male ; Motivation ; Physicians, Family ; Physicians, Primary Care ; Primary Health Care ; Surveys and Questionnaires ; Research Personnel ; Seoul ; Telephone*

PURPOSE: We describe 2 cases of bilateral acute myopia associated with topiramate, a drug that has recently been prescribed for epilepsy or weight reduction. CASE SUMMARY: A 24-year-old woman and a 25-year-old woman, both previously devoid of ocular problems, visited our hospital with blurry vision after taking topiramate for weight reduction. A thorough medical history review and ocular examinations, including a slit lamp examination, were performed. CONCLUSIONS: Slit-lamp examinations revealed forward displacement of the lens-iris diaphragm, which resulted in myopia and anterior chamber shallowing. Discontinuation of topiramate and the administration of cycloplegic agents successfully resolved the symptoms.
Adult ; Anterior Chamber ; Diaphragm ; Displacement (Psychology) ; Epilepsy ; Female ; Fructose ; Humans ; Myopia ; Vision, Ocular ; Weight Loss ; Young Adult

PURPOSE: To identify the normal range of factors which can be measured with Ocular Response Analyzer (ORA, Reichert Inc., Depew, NY, USA) in normal Korean, and to analyze factors affecting ORA by measuring intraocular pressure (IOP) of noncontact tonometer (NCT) and central corneal thickness (CCT). METHODS: Three hundred and one normal Korean subjects who did not have specific ophthalmological diseases and surgeries in the past were recruited for this study. Corneal hysteresis (CH), corneal response factor (CRF), corneal-compensated IOP (IOPcc), and Goldmann correlated IOP (IOPg) were measured using ORA. In addition, IOP of NCT and CCT were measured and the results and factors analyzed. RESULTS: The mean CH measured among normal Korean subjects in this study was 10.70 mmHg. The mean CRF was 10.40 mmHg. CH and CRF were significantly higher in the juvenile group. IOPcc and IOPg as measures of IOP using the ORA had significant correlation with IOP of NCT. In particular, IOPcc appeared to be independent of CCT. CONCLUSIONS: CH and CRF were different according to age, indicating a difference in biomechanical properties of the cornea. In particular, IOPcc is more important as it is independent of corneal thickness and should be compensated in general measurements of IOP reflecting biomechanical properties.
Cornea ; Intraocular Pressure ; Reference Values

BACKGROUND: Beta-adrenergic receptor Kinase 1(betaARK1) is a serine/threonine kinase attached, which inhibits the coupling of beta-adrenergic receptor with G-protein. Myocardial betaARK1 level is usually elevated in heart failure and hypertrophy, but it is not known whether the circulating betaARK1 level is related with the degree of cardiac hypertrophy. This study was performed to evaluate the association of the betaARK1 level in circulating mononuclear leukocytes(MNL) in untreated hypertension with left ventricular mass in hypertensive patients. Method: Nineteen non-treated hypertensive patients were included for this study. High blood pressure was confirmed when systolic BP is over 150 mmHg or diastoli BP is over 95 mmHg. Echocardiography was performed to evaluate the degree of hypertrophy by measuring the left ventricular mass index(LVMI) and relative wall thickness(RWT), and test the LV function by measuring the ejection fraction(EF) according to ASE guideline. At the same time, blood was collected from each patient and MNL were isolated by gradient centrifuge with Ficoll-400. Total RNA was purified from MNL and semi-quantitative RT-PCR was performed. After reverse transcription, PCR was done with primers for human betaARK1 and GAPDH as external control. betaARK1 levels were expressed by ratio to GAPDH level and estimated the relations with clinical and Echocardiographic parameters. Result: We studied confirmed 19 hypertensive patients(10 men and 9 women, mean age of 50.6 years). Echocardiographically measured indices(mean+/-SD) were as follows; LVMI(137.3+/-30.6g/m2), PWT(0.53+/-0.09) and EF(54.6+/-8.5%). Ratio of betaARK1 levels to GAPDH was from 0.10 to 0.96 (0.62+/-0.25). betaARK1 levels were correlated with LVMI(correlation coefficient: r=.502, p=.029) and RWT(r=.627, p=.004). But Systolic BP(r=0.009, p=.93), diastolic BP(r=.07, p=.85) or EF(r=.045, p=.84) were not related to level of betaARK1. CONCLUSIONS: The betaARK1 level of circulating MNL was correlated well with the degree of the cardiac hypertrophy estimated by LVMI and RWT. This data suggests that activation of sympatho-adrenal system would exert a major role in developing cardiac hypertrophy and we can expect the decreased responsiveness to catecholamine in the heart of hypertensive patients. betaARK1 in circulating MNL might be used as a predictor or marker for LV hypertrophy in hypertensive patients.
beta-Adrenergic Receptor Kinases ; Cardiomegaly ; Echocardiography ; Female ; GTP-Binding Proteins ; Heart ; Heart Failure ; Humans ; Hypertension ; Hypertrophy ; Leukocytes, Mononuclear* ; Male ; Phosphotransferases ; Polymerase Chain Reaction ; Reverse Transcription ; RNA

Shoulder joint dislocation has the most common incidence rate compare compared to other joints. It is reported that shoulder Shoulder dislocation couldmay be associated with glenoid rim, greater tuberosity of humerus and coracoid process fracture. There were have only been 2 cases of anterior shoulder dislocation simultaneously combined with simultaneous glenoid rim, coracoid process, and humerus greater tuberosity fracture worldwide and no report reports in Korea. We present a case of quadruple fracture (glenoid rim, coracoid process, greater tuberosity, surgical neck of humerus) associated with anterior shoulder dislocation and treated successfully by open reduction. In addition, with we provide the injury mechanism, diagnosis, treatment procedure and discussion.
Diagnosis ; Dislocations ; Humerus ; Incidence ; Joints ; Korea ; Neck ; Shoulder Dislocation ; Shoulder Joint ; Shoulder

BACKGROUND AND OBJECTIVES: The protective effect of angiotensin converting enzyme (ACE) inhibitor against ischemia/reperfusion injury has been demonstrated in animal models, however the effect of AT1 receptor antagonist is contradictory. The present study was designed to investigate the myocardial protective effects of the AT1 receptor antagonist irbesartan during myocardial ischemia/reperfusion in vivo. MATERIALS AND METHODS: Sprague-Dawley rats were subjected to a 45-minute left coronary artery ligation followed by a 2-hour re-perfusion. An inert vehicle (group I:n=14) or irbesartan (50 mg/kg/day:group II, n=12) was administered for 3 days before coronary occlusion. The ratio of the myocardial infarct area to the ischemic area at risk was assessed through triphenyltetrazolium chloride staining. Apoptosis was evaluated by analyzing DNA fragmentation and TdT-mediated dUDP nick end labeling staining. Western blot analysis was performed for MAP Kinases (ERK1/2 and p38) and Bcl-2 and Bax. RESULTS: The ratio of the infarct area to the ischemic area at risk of group II was smaller than that of group I (42.6+/-2.7% vs. 64.1+/-4.6%;p<0.005). Agarose gel electrophoresis revealed discrete DNA laddering in the ischemic zone of group I, however DNA ladder formation was attenuated in group II. The expressions of ERK1 MAPK and Bcl-2 were increased in the ischemic area of group II compared to that of group I. CONCLUSION: AT1 receptor antagonist was effective in reducing myocardial reperfusion injury in vivo. This effect can at least be partially attributed to the attenuation of cardiomyocyte apoptosis, and this anti-apoptotic effect appears to be related to the increased expression of Bcl-2 and alterations in MAP kinase signaling.
Angiotensin II* ; Angiotensins* ; Animals ; Apoptosis ; Blotting, Western ; Coronary Occlusion ; Coronary Vessels ; DNA ; DNA Fragmentation ; Electrophoresis, Agar Gel ; Ligation ; MAP Kinase Signaling System ; Models, Animal ; Myocardial Infarction ; Myocardial Ischemia* ; Myocardial Reperfusion Injury ; Myocytes, Cardiac ; Peptidyl-Dipeptidase A ; Phosphotransferases ; Rats* ; Rats, Sprague-Dawley ; Receptors, Angiotensin ; Reperfusion Injury* ; Reperfusion*

BACKGROUND: To assess the myocardial perfusion state after myocardial infarction, Tl-201 SPECT (Thallium-201 Single Photon Emission Computed Tomography) with a repeated "booster" injection before the acquisition of delayed redistribution image is more sensitive and more effective than conventional 4 hour redistribution image. However, this protocol has several disadvantages such as patient inconvenience, additional Tl-201 dose and compromised quantitative analysis. In this study, we compared 4 hour nitrate-augmented redistribution protocol with standard 24 hour delayed redistribution protocol with reinjection to evaluate the usefulness of sublingual nitrate to augment myocardial perfusion and the effectiveness of myocardial assessment for each protocol. METHODS: In 20 myocardial infarction patients, stress-redistribution Tl-201 SPECT was performed. Immediately after resting redistribution image was taken, each patient was administered 0.6 mg of nitroglycerin sublingually without additional Tl-201 and nitrate-augmented SPECT was taken after 30 minutes. Each patient then returned the next day and was injected with a booster dose of Tl-201 30 minutes before the delayed redistribution SPECT acquisition. For the analysis of SPECT study, the myocardium was divided into 22 segments, and the perfusion to each segment was scored on a four-point scale by consensus. An overall cardiac perfusion score was derived by summing the perfusion score for each segment. RESULTS: Reduced stress perfusion was identified in 258 segment among total 440 segments: 61 (23.6%) had improved perfusion after rest redistribution; 145 (56.2%) had improved perfusion after nitrate-augmented redistribution; 140 (54.2%) had improved perfusion after 24 hour delayed redistribution after Tl-201 reinjection. The cardiac perfusion score after stress was 38.2+/-13.1. The score increased to 41.5+/-13.1 after rest redistribution. The perfusion score were improved to 46.3+/-10.4 (p< or =0.05 vs. rest redistribution) after nitrate augmentation. The cardiac perfusion score, 46.2+/-10.8, did not improve further after delayed redistribution. CONCLUSION: Tl-201 SPECT with sublingual nitrate-augmented redistribution is as same or better than 24-hour delayed redistribution with reinjection to detect viable myocardium. Therefore, Tl-201 SPECT with sublingual nitrate-augmented redistribution has economic and time sparing advantage over traditional 24 hour delayed redistribution with reinjection.
Consensus ; Humans ; Myocardial Infarction ; Myocardium* ; Nitroglycerin ; Perfusion* ; Tomography, Emission-Computed, Single-Photon*

BACKGROUND: Idiopathic left ventricular tachycardia (ILVT), one of common idiopathic ventricular tachycardias which develop without structural abnormality of the heart. It has been reported that ILVT has a typical QRS morphology of right bundle branch block and left axis and unique clinical and electrophysiological characteristics. Intravenous verapamil is shown to be very effective in acute termination. However, radio-frequency catheter ablation is now recommended as the treatment of choice for long-term managemnt. This study was performed to determine the clinical and electrophysiological characteristics of ILVT and to evaluate the effects of radiofrequency catheter ablation (RFCA) of ILVT. METHODS: Seventeen patients (12 men, 5 women:mean age : 39+/-15 years) with ILVT were included in this study. ILVT was diagnosed based on the results of electrocardiogram, echocardiogram, cardiac catheterization, and electrophysiology study (EPS). EPS was performed with the standard technique in fasting state for more than 6 hours. In patients with their clinical VTs reproducibly induced during EPS, RFCA was attempted using endocardial activation mapping and pace-mapping. The mode of induction and termination, response to verapamil, and site of origin of the ILVT were evaluated. The local electrogram chacteristics at the sites of successful catheter ablation were also evaluated in patients undergoing RFCA. RESULTS: All 17 patients presented with recurrent palpitation but none with syncope or sudden cardiac death. None had a significant heart disease. The spontaneous ventricular tachycardias were of right bundle branch block morphology with left superior axis in 11 cases, right inferior axis in 1, and northwest axis in 5. The VTs were terminated with intravenous verapamil in all of 14 patients receiving IV verapamil. VT of same morphology as the clinical VT was induced with programmed electrical stimulation in 13 cases (76.4%), of whom 2 cases required isoproterenol infusion. The most frequent mode of induction was single ventricular extrastimulation (7 cases). Mean cycle length of the induced VTs was 320+/-59 ms. RFCA was attempted in 11 cases and successful in 9 (82%). The successful ablation sites were and central mid septum (3 cases), posterior mid septum (3 cases), posterior apical septum (3 patients) of the left ventricle (3 patients). At the successful ablation sites, the local ventricular activation preceded the onset of QRS complex by 34+/-15 ms (range : 10-58) and the paced QRS complexes during pace-mapping were identical to those of the induced or spontaneous VTs in 11.7+/-0.4 leads (range : 11-12). However, Purkinje potential was recorded only in 2 cases. There were no complications associated with EPS and RFCA. CONCLUSIONS: The present study suggests that ILVT is mild in symptoms, highly sensitive to verapamil, mostly caused by reentry, and can be cured by radiofrequency catheter ablation guided by pace-mapping and activation mapping.
Axis, Cervical Vertebra ; Bundle-Branch Block ; Cardiac Catheterization ; Cardiac Catheters ; Catheter Ablation* ; Catheters* ; Death, Sudden, Cardiac ; Electric Stimulation ; Electrocardiography ; Electrophysiology ; Fasting ; Heart ; Heart Diseases ; Heart Ventricles ; Humans ; Isoproterenol ; Male ; Syncope ; Tachycardia, Ventricular* ; Verapamil

BACKGROUND: Idiopathic left ventricular tachycardia (ILVT), one of common idiopathic ventricular tachycardias which develop without structural abnormality of the heart. It has been reported that ILVT has a typical QRS morphology of right bundle branch block and left axis and unique clinical and electrophysiological characteristics. Intravenous verapamil is shown to be very effective in acute termination. However, radio-frequency catheter ablation is now recommended as the treatment of choice for long-term managemnt. This study was performed to determine the clinical and electrophysiological characteristics of ILVT and to evaluate the effects of radiofrequency catheter ablation (RFCA) of ILVT. METHODS: Seventeen patients (12 men, 5 women:mean age : 39+/-15 years) with ILVT were included in this study. ILVT was diagnosed based on the results of electrocardiogram, echocardiogram, cardiac catheterization, and electrophysiology study (EPS). EPS was performed with the standard technique in fasting state for more than 6 hours. In patients with their clinical VTs reproducibly induced during EPS, RFCA was attempted using endocardial activation mapping and pace-mapping. The mode of induction and termination, response to verapamil, and site of origin of the ILVT were evaluated. The local electrogram chacteristics at the sites of successful catheter ablation were also evaluated in patients undergoing RFCA. RESULTS: All 17 patients presented with recurrent palpitation but none with syncope or sudden cardiac death. None had a significant heart disease. The spontaneous ventricular tachycardias were of right bundle branch block morphology with left superior axis in 11 cases, right inferior axis in 1, and northwest axis in 5. The VTs were terminated with intravenous verapamil in all of 14 patients receiving IV verapamil. VT of same morphology as the clinical VT was induced with programmed electrical stimulation in 13 cases (76.4%), of whom 2 cases required isoproterenol infusion. The most frequent mode of induction was single ventricular extrastimulation (7 cases). Mean cycle length of the induced VTs was 320+/-59 ms. RFCA was attempted in 11 cases and successful in 9 (82%). The successful ablation sites were and central mid septum (3 cases), posterior mid septum (3 cases), posterior apical septum (3 patients) of the left ventricle (3 patients). At the successful ablation sites, the local ventricular activation preceded the onset of QRS complex by 34+/-15 ms (range : 10-58) and the paced QRS complexes during pace-mapping were identical to those of the induced or spontaneous VTs in 11.7+/-0.4 leads (range : 11-12). However, Purkinje potential was recorded only in 2 cases. There were no complications associated with EPS and RFCA. CONCLUSIONS: The present study suggests that ILVT is mild in symptoms, highly sensitive to verapamil, mostly caused by reentry, and can be cured by radiofrequency catheter ablation guided by pace-mapping and activation mapping.
Axis, Cervical Vertebra ; Bundle-Branch Block ; Cardiac Catheterization ; Cardiac Catheters ; Catheter Ablation* ; Catheters* ; Death, Sudden, Cardiac ; Electric Stimulation ; Electrocardiography ; Electrophysiology ; Fasting ; Heart ; Heart Diseases ; Heart Ventricles ; Humans ; Isoproterenol ; Male ; Syncope ; Tachycardia, Ventricular* ; Verapamil

Rapidly progressive glomerulonephritis (RPGN) in Wegener's granulomatosis patients typically has been characterized by pauci-immune glomerulonephritis (PIGN). In some patients, however, significant amount of glomerular immune deposits was detected and reported that they may have poor prognosis. A 30 year-old-female visited due to the skin rash of both lower extremities, arthralgia and nasal stiffness. She had sinusitis, lung opacity, and proteinuria. Serologic PR-3 ANCA was positive and histologic findings of nasal cavity and lung also showed necrotizing vasculitis and granuloma. Thus we could diagnose Wegener's granulomatosis. However, gross hematuria developed and renal function worsened in spite of treatment with high dose prednisolone and oral cyclophosphamide. Therefore we performed a kidney biopsy. The kidney biopsy showed crescentic glomerulonephritis with Ig A deposition in the mesangium. We experienced a case of Wegener's granulomatosis patient with significant IgA deposition in glomeruli. We report this case with brief review of the literature.
Antibodies, Antineutrophil Cytoplasmic ; Arthralgia ; Biopsy ; Cyclophosphamide ; Exanthema ; Glomerulonephritis ; Granuloma ; Hematuria ; Humans ; Immunoglobulin A ; Kidney ; Lower Extremity ; Lung ; Nasal Cavity ; Prednisolone ; Prognosis ; Proteinuria ; Sinusitis ; Vasculitis ; Wegener Granulomatosis