The systolic time intervals were measured on 388 normal chidren, ranging from 8 months to 15years of age by using simultaneous recordings of the electrocardiogram, phonocardiogram and carotid or axillary arterial pulse. The statistical methods were applied to study the influence of age, sex and heart rate(HR) on these intervals. The results were as follows. 1. The regression equation of QS2was -1. 60HR+480+/-16 msec in males and -1.68HR+492+/-15 msec in females, respectively. 2. The regression equation of LVET was -1. 13 HR+359+/-10 msec in males and -1.21 HR+369+/-13 msec in females, respectively. 3. The regression equation of PEP was -0.58 HR+133+/-9 msec in males and -0.58 HR+128+/-9 msec in females, respectively. 4. The PEP/IVET ratio was 0.29+/-0.04 in males and 0.30+/-0.06 in females. 5. There was no sex difference in various systolic time intervals, and age had a slight influence but it was negligible for clinical use. 6. According to the regression equations of QS2, LVET, and PEP to the heart rate, QS2, and LVET were found to be more inversely correlated with heart rate than PEP.
Child* ; Electrocardiography ; Female ; Heart ; Heart Rate ; Humans ; Male ; Sex Characteristics ; Systole*

This study was conducted to assess the referral patterns to specialist from general practitioners in health center and perceived needs of referred patients for specialist care in health center. The study subjects were 249 patients who visited to health centers and were referred to other medical facilities. The data were obtained from questionnaire survey which was conducted in Kyongjuu-city Health center, Seongju-Gun Health center and Koryong-Gun Health center in Kyongsangbuk-Do, from June 10 to october 17, 1995. The total referral rate was 2.7%. The proportion of patients who wished to be referred to medical specialists was 85.9%, and the proportion of patients referred by general practitioners in health centers was 14.1%. Among the patients who wished to be referred to medical specialists, 45.9% visited directly to health centers, 34.6% visited health centers via local clinics and 19.5% visited health centers to get referral permission only. The reasons for getting referral permission in health centers were easy geographical accessibility(34.6 %), easy to get referral permission in health centers(27.l%), and very difficult to get referral permission in local clinics(l6.4%). Among the diseases of referred patients, diseases of the musculoskeletal system and connective tissue were most prevalent on a whole, but diseases of nervous system and sensory organs were comparatively high among the patients who wished to be referred to medical specialists and infectious and parasitic diseases were comparatively high among the patients referred by general practitioners in health centers. The most favorable medical facility was general hospital including university hospital in both groups of patients who wished to be referred to medical specialist and the patient referred by general practitioners in health centers. Regarding the needs for specialist care in health center, 75.2% patients who wished to be referred to medical specialists and 74.3% of patients referred by general practitioners in health center wanted the specialist care. The most frequently requested speciality is internal medicine(47.1%), and then orthopedics and general surgery. Based on above results, this study revealed that the majority of patients referred from health center wished to be referred to medical specialists at their own will, so, referral system at health center level should be changed. And if specialist care in health center be provided, the medical care by internist could be provided first, and then that of orthopedics and general surgery could be provided. These kinds of medical cares could be covered by local clinicians as a part-time job on a voluntary basis.
Connective Tissue ; General Practitioners ; Gyeongsangbuk-do ; Hospitals, General ; Humans ; Musculoskeletal System ; Nervous System ; Orthopedics ; Parasitic Diseases ; Surveys and Questionnaires ; Referral and Consultation* ; Specialization*

This study was conducted to assess the effects of implementation of the patient referral system started July 1st, 1989. A comparison on the pattern of outpatient services of the Departments of Internal Medicine, General Surgery, and Pediatrics at the Yeungnam University Hospital was conducted for each one year period before and after implementation of the patient referral system. The pre-implementation period was from July 1. 1988 to June 30, 1989 and the post-implementation period was from July 1. 1989 to June 30, 1990. The information used for this study was obtained from official forms, prepared by the Yeungnam University Hospital, and submitted to the Korean Medical Insurance Cooperatives. After implementation of the patient referral system, the number of outpatient cases in the Department of Internal Medicine decreased 36.1% from 9,669 cases to 6,181 cases a year. Cases in the Department of General Surgery decreased 23.7% from 1,864 cases to 1,422 cases a year. The number of cases in the Department of General Surgery decreased 23.7% from 1,864 cases to 1,422 cases a year. The number of cases in the Department of Pediatrics decreased 36.9% from 3,372 cases to 2,128 cases a year. After implementation of the patient referral system, the average age of cases in the Departments of Internal Medicine and General Surgery was 52.5 and 49.7 years old, respcetively. This was a significant increase in comparison with the pre-implementation period. After implementation of patient referral system, the proportion of new outpatients in the Department of Internal Medicine decreased form 24.1% to 14.6%, the Department of General Surgery from 36.0% to 23.4%, and the Department of Pediatrics from 15.5% to 8.3%. The number of visits per case decreased significantly in the Department of Internal Medicine(from 1.74 to 1.61), but there was no significant change in the Department of General Surgery and Pediatrics. The length of treatment per case increased significantly in all three departments (form 16.1 days to 19.3 days in the Department of Internal Medicine, from 12.0 days to 15.2 days in the Department General Surgery, and 8.9 days to 11.2 days in the Department of Pediatrics). The number of clinical tests per case increased significantly in the Department of Internal Medicine (from 22. to 2.5), in the Department of Pediatrics(from 0.8 to 1.1) and increased in the Department of General Surgery(from 6.4 to 6.6). The average medical cost per case decreased form 43,900 Won to 42,500 Won in the Department of Internal Medicine, while the cost increased from 75,900 Won to 78,500 Won in the Department of General Surgery and from 12,700 Won to 13,500 Won in the Department of Pediatrics. In case-mix, the chronic degenerative disease(i. e. hypertension, diabetes mellitus, angina pectoris, malignant neoplasm, and pulmonary tuberculosis) ranked higher and acute infectious diseases and simple cases(i. e. gastritis and duodenitis, haemorrhoids, anal fissure, carbuncle, acute URI, and bronchitis) ranked lower after implementation of the patient referral system compared to before implementation.
Angina Pectoris ; Carbuncle ; Communicable Diseases ; Diabetes Mellitus ; Duodenitis ; Fissure in Ano ; Gastritis ; Humans ; Hypertension ; Insurance ; Internal Medicine ; Outpatients* ; Pediatrics ; Referral and Consultation*

Most fractures of the proximal humerus are managed well to simple conservative treatment. But open reduction and interhal fixation of the fragment is definitely indicated in certain types of displaced fractures. Thirty eight cases of fractures of the proximal humerus which were treated at Inje Medical College from January 1980 to December 1985 were analyzed both clinically and radiologically accordingto Neer's classification and the following results were obtained. l. Among the 38 patients, the ratio of male and female was 2.2:1 and the highest incidence was in the fifth decades. 2. The main cause of fracture was traffic accident, 20 cases (52. 6%) and the the next one was falling from a height. 3. According to the classification of Neer, one part acture(52.6%) was the most common type. 4. The common associated injuries were fracture of the lower extremities and forearms. 5. Thirty two cases(84.2%) were treated by conservative treatment and six cases by operative treatment. 6. Thirty eight cases were followed form 6 months to 5 years and 6 months, average 14.3 months, and the results were analyzed according to Neers criteria and 26 cases (68. 6%) showed excellent results. 7. Two cases of limitation of shoulder motion were observed as a complication and one cases of paralysis of deltoid muscle by axillary nerve injury was observed. Excellent functional result could be obtained by a simple external support with early motion in a minimal displacement of proximal humeral fracture. Satisfactory functional result could be obtained by a open reduction and internal fixation with early motion in a severely displaced fracture. But long term immobilization of shoulder could have a poor functional result.
Accidental Falls ; Accidents, Traffic ; Classification ; Clinical Study ; Deltoid Muscle ; Female ; Forearm ; Humans ; Humerus ; Immobilization ; Incidence ; Lower Extremity ; Male ; Paralysis ; Shoulder ; Shoulder Fractures

With the expending use of sublaminar segmental instrumentation, various complication, including paraplegia, paresis, dysesthesia and dural tears, have been reported. These findings suggest that the displacement of sublaminar wires toward the spinal eord during extraction followed by spinal cord damage. The cut surface of Luque sublaminar wire is sharp and has a barb and it may cause damage to the spinal cord. The cut end of Luque wire was inserted into the Intracath (a kind of angiocatheter) 16 gauge and pulled parallel to the lamina. And we found the Intracath followed by Lugue wire in the operating field. Lateral view of spine roentgenogram revealed that the radioopaque Intracath was passed under the lamina in 3 mm in depth. When the Luque wire is removed with inserting into the Intracath 16 gauge and pulled parallel to the lamina, the dura can be protected by the cut end of Luque wire.
Paraplegia ; Paresis ; Paresthesia ; Spinal Cord ; Spine ; Tears

No abstract available.
Tricuspid Atresia*

BACKGROUND: Transforming growth factor-beta(TGF-beta) has multiple regulatory effects on cells of the immune system, and it has been suggested that differentiation of lymphoid cells is influenced by low concentra tions of this cytokine. OBJECTIVES: The aim or this study was to investigate the role of TGF-beta in regulation of T cell growth and differentiation, and to compare this effect with that of other cell signals known to be important in T cell ontogeny. METHODS: We used the CTLL-2 cell line in the presence of IL-2. Surface phenotype expression was analysed to see whether these cells could be switched to the other subtype of cells. RESULT: Treatment of CTLL-2 cells with TGF-beta resulted in dose dependent growth inhibition and morphological changes. Curing routine passage, less than 5% of cells were CD8alpha positive, whereas 38% of cells expressed CD8alpha when treated with IL-2 plus TGF-beta. However, TPA plus calcium ionophore, IFN-gamma, or TNF-alpha caused no significant changes in the proportion of CD8 cells. CONCLUSION: Our results show that this experiment can be a useful model for investigating CD8 precursor potentials in populations of CD4-CD8-(double negative) cells, and such a model may offer a way to study the molecular regulation of CD8 gene expression.
Calcium ; Cell Line* ; Gene Expression ; Immune System ; Interleukin-2 ; Lymphocytes ; Phenotype ; Transforming Growth Factor beta ; Tumor Necrosis Factor-alpha

Keratoacanthoma is a benign neoplasm that develops as a protruding mass especially on the central part of face, We experienced a case of keratoacanthoma that developed on the nasal vestibule after the eradication of verruca vulgaris on the same site by surgical intervention 3 months before. We treated it with total excision and skin graft.
Keratoacanthoma* ; Skin ; Transplants ; Warts*

Patients with severe congestive heart failure due to rheumatic heart disease generally have both reduced cardiac output and increased pulmonary and systemic venous pressures. A study was therefore made of the use of vasodilator therapy with orally administered hydralazine, which acts on arteriolar resistance vessels and thus reduces afterload. 55 children aged from 4 years old to 15 year old were divided into two groups. Group I received oral hydralazine(4mg/kg/kay in 4 divided doses) in addition to digoxin therapy for mean duration of 10.5 months. Group II received oral digoxin only. The hemodynamic results using M-mode echocardiography, chest X-ray, and EKG between two groups were analyzed. 1) 4(78%) of 55 patients had only mitral valve involvement and another 12 patients had double valve involvement and all the patients belonged to functional class III or IV fo New York heart Association. 2) Left venticular end-diastolic dimensions and the height of R in V6 on EKG were not changed significantly in both groups. 3) Shortening fraction, LPEP/LVET, and RPEP/RVET were markedly improved in both groups, but the degree of improvement in group I was more significant than in group II. 4) 21(80%) of 26 patients in group I showed significant improvement in functional class(t=1.92, 0.05 Adolescent ; Cardiac Output ; Child* ; Child, Preschool ; Digoxin ; Echocardiography ; Electrocardiography ; Estrogens, Conjugated (USP)* ; Heart ; Heart Failure* ; Hemodynamics ; Humans ; Hydralazine ; Mitral Valve ; Rheumatic Heart Disease ; Thorax ; Venous Pressure

Thirty-six cases of paroxysmal supraventricular tachycardia which were observed at the Department of Pediatrics, Seoul National University Hospital from 1976 till October 1982, were analyzed. 1. The sex ratio was 1.8:1, male predominance. Sixteen cases (44.4%) were under 1 year of age and 11 cases (30.6%) were under 4 months of age. 2. Cases without known heart disease were 22(61.6%). Among Known etiology, most frequent one was 7 cases(19.4%) of W-P-W syndrome. 3. The sex ratio of group without known heart disease was 2.1:1, and that of group with known heart disease was 1.3:1. Under 4 months of age, there were more cases without known heart disease(72.7%) and after 4 months of age number of cases with and without known heart disease were similar. 4. Most frequent clinical manifestation was tachydyspnea. hepatomegly, irritability, palipitation, cyanosis and pallor, vomiting, chest pain, edema, abdominal pain, and fever were followed in order of frequency. 5. Congestive heart failure occurred in 22 cases(61%). The incidence was related to the duration of attack of tachycardia, age of patients, and heart rate. The longer the duration of attack and the younger the age of patients and the faster the heart rate, the higher incidence of heart failure was observed. 6. As treatment, vagal reflex stimulation was almost ineffective, and digitalization was effective in most of the cases. Verapamil and electrical cardioversion were tried in small number of cases and proved to be effective. 7. One case (2.8%) expired becase of the supraventricular tachycardia. 8. Eight cases (30.8%) had recurrence. In younger age group, recurrence rate was lower. 9. Digoxin was given in 15 cases for prevention of recurrence and was effective in 12 cases.
Abdominal Pain ; Chest Pain ; Child* ; Cyanosis ; Digoxin ; Edema ; Electric Countershock ; Fever ; Heart ; Heart Diseases ; Heart Failure ; Heart Rate ; Humans ; Incidence ; Infant* ; Male ; Pallor ; Pediatrics ; Recurrence ; Reflex ; Seoul ; Sex Ratio ; Tachycardia ; Tachycardia, Supraventricular* ; Verapamil ; Vomiting