Authors reviewed clinical records of 92 patients with tetanus from January 1974 to December 1983 at Severance Hospital and the following results wre obtained. 1) There were about 2.2 times more cases of neonatal tetanus than that of nonneonatal. The admitted cases of tetanus decreased in 1980's compared to those of 1970's. 2) The male versus female ratio was 3 : 1 not only in nonneonatal but also in neonatal teanus. 3) There was a tendency of higher mortality when the site of injury was on the central part of the body than on the distal. 4) Most cases of tetanus developed after the injury with bactrial contamination as expected, but a few cases are due to only trivial injury such as acupuncture or injection without overt contamination. 5) There was a close relationship between the incubation period and mortality in neonatal tetaus but no such definite relationship in nonneonatal tetaus. 6) The duraton of admission was about 3 weeks and the majority of deaths occureed in less than one week of admission. 7) There was no statistically significant difference in mortality between the group who used tetanus antitoxin from animal and that who used human tetanus immuneglobulin.
Acupuncture ; Animals ; Female ; Humans ; Male ; Mortality ; Tetanus Antitoxin ; Tetanus*

BACKGROUND: Family counseling is an essential part of family practice in which patients are cared in psychosocial dimension as will as in physical dimension and the family is dealt with as a whole unit. However, it is little applied in practice. The department of family medicine has made efforts to activate family counseling. This study was done to estimate the patients response on the effect of family counseling that we have performed, and to investigate what clinical problems counseling was held and in what situations the counseling was perceived to be useful by the patients. We hope this study will be useful to establish some useful data and ideas for the development of family counseling in family practice in Korea. METHODS: The subjects of this study are 53 households who received family counseling at the department of family medicine from Oct. 1, 1994 to May 31, 1995. 64 households received counseling during this peroid, but 11 persons who could not be reached by the phone were excluded. Patients demographic charateristics, patients chief complaints, physicians assessrnent on the complaints and major prolems presented in the counseling sessions were identified from the medical records. Patients own estimation of the effect of counseling and the reasons for termination of counseling were inquired through the telephone interview. Finally the association between the usefulness of counseling and some factors was statistically analyzed. RESULTS: Subjects were predominently women(84.9%), especially middle aged. The most common chief complaint was headache complained by 10 subjects (18.9%), and the second and the third were abdominal pain complained by 8 (15.1%) and chest discomfort complained by 7(13.2 %), respectively. The list of physicians assessment included depression(34.0%), physical symptom per se without any assessment(20.8%), family problem(15.1%), somatization(13.2%), and anxiety(9.45). More than half of the subjects(60.4%) had only one session, 26.4% two sessions and 7.5% more than 4 sessions. The most common problem presented in the counseling was marital conflict(28.3%), the second was trouble with in-laws(15.1%), and the third was chronic illness in the family(9.4%). 32.1% replied that the counseling was very helpful, 28.3% somewhat helpful, 17% little helpful, 20.8% never helpful, and 1.9% not sure. The session was experienced to be more useful in the group of duration of symptom less than 6 months, than in the group of longer duration(p<0.05), and in the group with motivation for counseling than in the group without motivation(p<0.05). CONCLUSIONS: About 60% of subjects replied the counseling was useful to them. Symptom duration and patients motivation to participate in counseling showed significant association with the effect of family counseling.
Abdominal Pain ; Chronic Disease ; Counseling* ; Family Characteristics ; Family Practice ; Headache ; Hope ; Humans ; Interviews as Topic ; Korea ; Medical Records ; Middle Aged ; Motivation ; Thorax

BACKGROUND: Family counseling is an essential part of family practice in which patients are cared in psychosocial dimension as will as in physical dimension and the family is dealt with as a whole unit. However, it is little applied in practice. The department of family medicine has made efforts to activate family counseling. This study was done to estimate the patients response on the effect of family counseling that we have performed, and to investigate what clinical problems counseling was held and in what situations the counseling was perceived to be useful by the patients. We hope this study will be useful to establish some useful data and ideas for the development of family counseling in family practice in Korea. METHODS: The subjects of this study are 53 households who received family counseling at the department of family medicine from Oct. 1, 1994 to May 31, 1995. 64 households received counseling during this peroid, but 11 persons who could not be reached by the phone were excluded. Patients demographic charateristics, patients chief complaints, physicians assessrnent on the complaints and major prolems presented in the counseling sessions were identified from the medical records. Patients own estimation of the effect of counseling and the reasons for termination of counseling were inquired through the telephone interview. Finally the association between the usefulness of counseling and some factors was statistically analyzed. RESULTS: Subjects were predominently women(84.9%), especially middle aged. The most common chief complaint was headache complained by 10 subjects (18.9%), and the second and the third were abdominal pain complained by 8 (15.1%) and chest discomfort complained by 7(13.2 %), respectively. The list of physicians assessment included depression(34.0%), physical symptom per se without any assessment(20.8%), family problem(15.1%), somatization(13.2%), and anxiety(9.45). More than half of the subjects(60.4%) had only one session, 26.4% two sessions and 7.5% more than 4 sessions. The most common problem presented in the counseling was marital conflict(28.3%), the second was trouble with in-laws(15.1%), and the third was chronic illness in the family(9.4%). 32.1% replied that the counseling was very helpful, 28.3% somewhat helpful, 17% little helpful, 20.8% never helpful, and 1.9% not sure. The session was experienced to be more useful in the group of duration of symptom less than 6 months, than in the group of longer duration(p<0.05), and in the group with motivation for counseling than in the group without motivation(p<0.05). CONCLUSIONS: About 60% of subjects replied the counseling was useful to them. Symptom duration and patients motivation to participate in counseling showed significant association with the effect of family counseling.
Abdominal Pain ; Chronic Disease ; Counseling* ; Family Characteristics ; Family Practice ; Headache ; Hope ; Humans ; Interviews as Topic ; Korea ; Medical Records ; Middle Aged ; Motivation ; Thorax

It is interested in examining treatment effect on a particular category of subjects or in comparing treatment effects among different subgroups as well as overall treatment effect due to heterogeneity of study subjects. Subgroup analyses are exceedingly common, but they are also often misleading. Conclusions based on subgroup analyses can do harm both when a particular category of people is denied effective treatment (a "false-negative" conclusion), and when ineffective or even harmful treatment is given to a subgroup of people (a "false-positive" conclusion). Because of the frequency and the importance of clinical application of subgroup analysis, researchers need to be cautious about doing subgroup analyses. This study presents guidelines to help conducting subgroup analyses correctly.
Population Characteristics

Confounding is the distortion of a disease/exposure association brought about by other factors which are not considered in the study design or the data analysis. These factors are called confounding factors. We should be cautious in data analysis of observational study of association of disease/exposure, since confounding often occurred in observational study. This study examines confounding effect according to data pattern (the ratio of controls to cases, the ratio of exposures to non-exposures for each level of confounding factor), criteria for treating a variable as a confounding variable, and some notes for the analysis in case-control study.
Case-Control Studies* ; Confounding Factors (Epidemiology) ; Observational Study ; Statistics as Topic

The goal of a clinical study is to determine the factors associated with a disease and to assess the efficacy and safety of an investigational drug, procedure, or device. Since clinical study designs vary due to unique requirements of individual studies, the aims of this report are to educate researchers on the different types of studies and to assist researchers in choosing the optimal study type to fulfill their individual requirements. Clinical studies are classified into the two main types, observational studies and clinical trials, depending on the presence or absence of an intervention. Observational studies include case-control studies, cohort studies, and cross-sectional studies. Case-control and cohort studies may be prospective or retrospective, and case-control studies may be nested or not. Clinical trials may be pragmatic and may be controlled or noncontrolled; randomized or nonrandomized; open label or blinded; and parallel, crossover, or factorial. These observational and clinical trial designs are reviewed. Each type of clinical study has advantages and disadvantages. Therefore, researchers must consider these in choosing the design best suited for achieving their study objectives.

This is a case report of the familial olivo-ponto-cerebellar atrophy (Menzel type OPCA, OPCA III with retinal degeneration). The patient is a 37 year-old male with 5 years history of slowly progressive cerebellar ataxia, dysarthria, visual change, horizontal nystagmus and signs of pyramidal dysfunction. The CT brain scan shows significant atrophy of brain stem and cerebellum with dilatation of cisterns. His younger sister, also, has similar clinical manifestations and radiological abnormalities, but mild. By history, his mother who died at 47 years of her age looked like to have same kind of chronic disease.
Adult ; Atrophy ; Brain ; Brain Stem ; Cerebellar Ataxia ; Cerebellum ; Chronic Disease ; Dilatation ; Dysarthria ; Humans ; Male ; Mothers ; Nystagmus, Pathologic ; Olivopontocerebellar Atrophies* ; Retinaldehyde* ; Siblings

This is a case report of pernicious anemia with neurologic deficits. The patient is a 69 years old male with generalized tingling sense. On examination, slight pale conjunctiva and beefy red tongue are noted. Laboratory stud show megaloblastic anemia with low serum vitamin B12 level, positive Schilling test, gastric achlorhydria and mild gastric atrophy. Neurologic examination reveals cerebral, spinal and peripheral involovement and EEG and EMG study support those things. On parenteral vitamin B12, the hematologic and neurological abnormalities are improved dramatically.
Achlorhydria ; Aged ; Anemia, Megaloblastic ; Anemia, Pernicious* ; Atrophy ; Conjunctiva ; Electroencephalography ; Humans ; Male ; Neurologic Examination ; Neurologic Manifestations ; Schilling Test ; Tongue ; Vitamin B 12

The purpose of this study is to establish the criteria to discriminate whether the difference of the optic disc parameters compared actually reflects the progress of the disease or it is merely caused by the intraexaminer or interexaminer error. Using the confocal scanning laser ophthalmoscope (TopSS), one eye of each of 20 healthy adults were exmained by the same examiner and one eye of each of 10 adults were examined by different examiners for two consecutive days. The results out of these repeated examinations were analysed to obtain 95%confidence intervals by analysis of the change of the 12 optic disc parameters, and to determine whether the results have been influenced by the disc size or the disc tilt. The criteria to differentiate actual progression of disease from potential errors of the test were obtained. In addition, it was confirmed that changes in the parameters were not influenced by the disc size or the contour tilt. In conclusion,the outcomes of this study can be utilized as a guiding criteria when judging the relevance of the parameter changes to the progress of the disease.
Adult ; Humans ; Ophthalmoscopes

OBJECTIVE: The aim of this study is to investigate the effects of cooperative training on the pretreatment assessment of the feasibility to perform Ultrasonography (US) guided percutaneous radiofrequency ablation for patients afflicted with hepatocellular carcinoma. MATERIALS AND METHODS: In our prospective study, 146 patients with 200 hepatocellular carcinomas were referred for radiofrequency ablation after triage by hepatologists. Three radiologists with different levels of experience performed the planning US before (group I) and after (group II) cooperative training, to evaluate whether radiofrequency ablation was feasible. The feasibility rates considered eligible according to our criteria were evaluated. In addition, we analyzed the reasons for the lack of feasibility were analyzed. The interobserver agreement for the assessment of feasibility before and after training was also calculated. RESULTS: The overall feasibility rates for both groups was 73%. No significant difference in the feasibility rates was observed. The feasibility rates of each observer for group I were 71% (observer 1), 77% (observer 2) and 70% (observer 3) and those for group II were 73%, 76% and 69%, respectively. In the tumors (n = 164) considered ineligible, the two most common causes for refraining from performing radiofrequency ablation included non-visualization of the tumor (62%) and the absence of a safe route for the percutaneous approach (38%). We found moderate interobserver agreement for all observers before cooperative training and a good agreement after training. CONCLUSION: Although the cooperative training did not affect the feasibility rate of each observer, it improved the interobserver agreement for assessing the feasibility of performing US guided radiofrequency ablation, which may reduce unnecessary admission or delayed treatment.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular/*surgery/ultrasonography ; *Catheter Ablation ; Clinical Competence ; Feasibility Studies ; Humans ; Inservice Training ; Liver Neoplasms/*surgery/ultrasonography ; Male ; Middle Aged ; Prospective Studies ; Reproducibility of Results ; *Ultrasonography, Interventional