Delirium in the Final Weeks of Terminally Ill Cancer Patients / 가정의학회지

BACKGROUNDS: In terminally ill cancer patients, delirium must be considered to be important clinically and for the quality of life. We reviewed cases of delirium in hospitalized cancer patients with the aim to recognize and treat delirium. METHODS: We reviewed retrospectively the medical records of patients admitted with terminal cancer from April 2003 to April 2004 in the department of family medicine, National Health Insurance Corporation Ilsan Hospital. A total of 71 patients were evaluated with age, sex, oncological diagnosis, metastases, morphine (oral morphine equivalents/day, OME) use and amount, sedatives use, duration from delirium to death, and laboratory fi ndings. Analysis was conducted to fi nd the characteristics of delirium patients and to quantify the relationship between delirium and predicting factors. RESULTS: Among 71 cases, those patients who developed delirium were 41 (57.7%). Among them, gastric cancer was the most common diagnosis with 10 patients (24.4%), followed by colon and lung cancers (9: 22%, 5: 12.2%). The patients receiving sedatives or morphines were 24 (58.5%) and 28 (68.3%), respectively. The mean amount of morphine was 168.6 +/- 125.5 mg OME/day. Hyperbilirubinemia (4.2 +/- 9.2 mg/dL) and hyponatremia (132.5 +/- 4.5 mM/L) were found. Not only bone metastasis and the use of morphine or sedatives but serum Na were significant (P = 0.047; P < 0.001; P = 0.069; P = 0.029). By logistic regression analyses, the occurrence of delirium was increased with decreased serum Na (odds ratio [95% CI] 0.798 [0.649-0.981]) and increased use of sedatives (5.955 [1.080-32.835]). CONCLUSION: In terminally ill cancer patients, the risk factors of delirium were bone metastasis, the use of morphine or sedatives, and serum Na level. Among these, the use of sedatives and serum Na level were independent risk factors.

Level of Understanding of Importance of Preventing and Treating Dermatophytoses in Diabetic Patients

BACKGROUND: Dermatophytoses tend to have a poorer outcome in diabetic patients than in non-diabetic patients. Therefore, diabetic patients need to pay a closer attention to the prevention and treatment of dermatophytoses. The aim of this study was to determine the level of understanding of the dermatophytoses in diabetic patients and to clarify the factors associated with the level of understanding. METHODS: A questionnaire survey was carried out from June to July, 2005, targeting 200 patients who had visited two hospitals in Seoul for the management of diabetes. There were 163 respondents (response rate 50.9%). The degree of understanding was calculated by giving 1 point to each question, with a maximum of 12 points. RESULTS: The average degree of understanding of dermatophytoses was 6.68 points (SD 1.79). Younger age (P= 0.0002), high education level (P=0.0035), and high income (P=0.0013) were the factors related to a better understanding of dermatophytoses. The patients who had obtained the information on dermatophytoses from the websites, broadcasts, newspapers, or magazines showed higher recognition points than others (P=0.0377). The body mass index, the duration of diabetes, the complications associated with diabetes did not affect the understanding of dermatophytoses. CONCLUSION: There are many diabetes patients who do not know enough about dermatophytoses. Diabetes itself is not related to the level of understanding of dermatophytoses. However, diabetic patients who are older, have a lower level of education, and a low income will need to be informed about prevention and treatment of dermatophytoses.

Level of Understanding of Importance of Preventing and Treating Dermatophytoses in Diabetic Patients

BACKGROUND: Dermatophytoses tend to have a poorer outcome in diabetic patients than in non-diabetic patients. Therefore, diabetic patients need to pay a closer attention to the prevention and treatment of dermatophytoses. The aim of this study was to determine the level of understanding of the dermatophytoses in diabetic patients and to clarify the factors associated with the level of understanding. METHODS: A questionnaire survey was carried out from June to July, 2005, targeting 200 patients who had visited two hospitals in Seoul for the management of diabetes. There were 163 respondents (response rate 50.9%). The degree of understanding was calculated by giving 1 point to each question, with a maximum of 12 points. RESULTS: The average degree of understanding of dermatophytoses was 6.68 points (SD 1.79). Younger age (P= 0.0002), high education level (P=0.0035), and high income (P=0.0013) were the factors related to a better understanding of dermatophytoses. The patients who had obtained the information on dermatophytoses from the websites, broadcasts, newspapers, or magazines showed higher recognition points than others (P=0.0377). The body mass index, the duration of diabetes, the complications associated with diabetes did not affect the understanding of dermatophytoses. CONCLUSION: There are many diabetes patients who do not know enough about dermatophytoses. Diabetes itself is not related to the level of understanding of dermatophytoses. However, diabetic patients who are older, have a lower level of education, and a low income will need to be informed about prevention and treatment of dermatophytoses.

Validation of Scoring System for Survival Prediction in Terminal Cancer Patients in Korea

BACKGROUND: Accurate prediction of survival in terminal cancer patients is important for planning effective palliative care. But, the prediction of survival most often relies on the physicians' prediction. Recently, simple prognostic scores such as Palliative Prognostic Index and Palliative Prognostic Score have been developed to estimate duration of survival. The aim of this study was to validate these prognostic scores and physicians' prediction for terminally ill cancer patients in Korea to determine its value in clinical practice. METHODS: The subjects of this study were 40 terminal cancer inpatients of one hospital who died between March to May 2005. All patients' Palliative Prognostic Index, Palliative Prognostic Score, and physicians' prediction were recorded on admission by a physician. RESULTS: When a Palliative Prognostic Index of more than 6 was adopted as a cut-off point 3 weeks' survival was predicted with a sensitivity of 90% and a specificity of 60%. When the three groups were grouped by Palliative Prognostic Scores (group A: 11), the 30 day survival probability were 60% for group A, 16.7% for group B, and 4.3% for group C, respectively. Physicians' prediction showed moderate correlation (correlation coefficient=0.604) with actual survival and had a tendency to overestimate survival. CONCLUSION: Palliative Prognostic Index was proved to be a reliable survival prediction tool in Korea. Palliative Prognostic Score had a tendency to overestimate survival as compared with other studies. Physicians' prediction had a correlation with actual survival, and it was presumed to be more accurate when combined with other prognostic score.

Factors Attributing to Increasing Attempts at Central Venous Catheterization

BACKGROUND: Central venous catheterization allows the measurement of hemodynamic variables, the delivery of medications and nutritional support. It also has been used as a means to treat sepsis, cardiogenic and hemodynamic shocks. Arterial puncture, hematoma, and pneumo-hemothorax are the most common mechanical complications during the insertion of central venous catheters. This study was done to find out the factors attributing to the increase of puncture attempts in subclavian venous catheter insertion. METHODS: We have conducted surveys in residents who had previous experience with insertion of subclavian venous catheterization in Ilsan hospital from 01/09/2003 to 30/11/2003. A total of 40 cases were marked as two groups, those with less than three puncture attempts and those with more than or equal to three attempts. RESULTS: The incidence of three or less insertion attempts were 23, whereas in 17 cases three or more attempts were required. The results of the comparison between these two groups proved that the patient's hemoglobin level, skeletal deformity, the level of experience (more than 20), puncture site marking and insertion in the mid-clavicular line were significant factors (P<0.05). CONCLUSION: It seemed necessary to try three or less puncture attempts in order to decrease the incidence of mechanical complications. The operator factors such as previous experience with the procedure, puncture site marking prior to insertion, and insertion in the mid-clavicular line had affected the number of puncture attempts.

Effects on Weight Reduction and Safety of Short-Term Phentermine Administration in Korean Obese People

The phentermine, an appetite suppressant, has been widely applied in Korea since 2004. However, there have been relatively few reports about the efficacy and the safety of phentermine in Korea. The aim of this study is to verify the effect of phentermine on weight reduction and the safety in Korean patients. This randomized, double-blind, placebo- controlled study had been performed between February and July, 2005, in Seoul on 68 relatively healthy obese adults whose body mass index was 25 kg/m2 or greater. They received phentermine-HCl 37.5 mg or placebo once daily with behavioral therapy for obesity. The primary endpoints were the changes of body weight and waist circumference from the baseline in the intention-to-treat population. Mean decrease of both body weight and waist circumference in phentermine-treated subjects were significantly greater than that of placebo group (weight: -6.7 +/- 2.5 kg, p < 0.001; waist circumference: -6.2 +/- 3.5 cm, p < 0.001). Significant number of subjects in phentermine group accomplished weight reduction of 5% or greater from the baseline and 10% or more (p < 0.001). There were no significant differences in systolic and diastolic blood pressure between the groups (p = 0.122 for systolic BP; p = 0.219 for diastolic BP). Dry mouth and insomnia were the only statistically significant adverse events that occurred more frequently in phentermine group. Most side effects of phentermine were mild to moderate in intensity. Short-term phentermine administration induced significant weight reduction and reduction of waist circumference without clinically problematic adverse events on relatively healthy Korean obese people.

Primary Care Physicians' Attitudes to Community-Based Medical Education and the Wave Model as a New Teaching Method in Ambulatory Care Settings / 한국의학교육

PURPOSE: In order to expand and improve community-based medical education (CBME), we attempted to delineate the characters of the primary care physicians interested in medical education and their opinions on the new medical teaching method for ambulatory care settings, Wave model. METHODS: Through mailed questionnaires, we asked the Seoul members of the family physician association and the internal medicine physician association about their interest and opinions of CBME and the Wave model. RESULTS: We received 186 replies from the total 1088 questionnaires (17.1%) sent out. Many of the primary care physicians (141/186; 75.8%) had no experience with CBME. However, 127 (68.7%) were interested in CBME and 121 (65.4%) answered that they were interested in teaching students in their clinic. There were 128 (69.2%) affirmative responses to the Wave model, which was much higher than that to the observation-centered method, 53 (30.3%) (p < 0.0001). Primary care physicians who have affirmative attitudes to adopting the Wave model would select this model as their CBME program (p < 0.0001). Primary care physicians willing to teach students tend to be males (p=0.0085) and younger in age (p=0.0003), have examination rooms for student-patient contact (p < 0.0001), and possess positive attitude to adopting the Wave model (p= 0.0018). CONCLUSION: There are many primary care physicians eager to participate in CBME. They view the Wave model as an effective teaching method. Factors associated with the desire to work as a preceptor include being male and younger in age. having examination rooms for student-patient contact, and possessing a positive attitude to adopting the Wave model.

The Effects of the Acupuncture Treatment for Smoking Cessation in High School Student Smokers

The use of alternative medicine for smoking cessation have been increasing steadily in recent years. A series of clinical group studies was performed to clarify the effect, outcome and success rate of an acupuncture treatment for smoking cessation. This study was conducted for four weeks using 238 smoking students at 2 high schools. The subjects were separated into two groups: 159 students were treated with acupuncture on the anti-smoking acupoints of the ear, which is known to be effective for cessation of smoking (case group), and 79 students were treated at other sites of the ear (control group). The acupuncture treatment was alternately administered at each side of the ears on a weekly basis for 4 weeks. The smoking cessation success was only 1 case (0.6%) in the case group and none in the control group after 4 weeks. The change in the taste of tobacco and the intensity of the desire to smoke were not significantly different between the case and control groups, but the case group showed a tendency of reduction in the taste of tobacco and the intensity of the desire to smoke. In addition, the reduction in cigarette consumption was not significant, but the tendency of reduction in the study group was significant. It is believed that the site of auricular acupuncture for smoking cessation is not important. However, there was a significant tendency in terms of the reduction in cigarette consumption, the taste of tobacco and the intensity of the desire to smoke in the case group, indicating that auricular acupuncture in smoking cessation has some effect.

How Many Diabetes Patients Know the Name of Hypoglycemic Agents They Are Taking?

BACKGROUND: Numerous diabetes patients do not know the name of hypoglycemic agents that they are taking, even though they have taken them for a long time. The aim of this study was to find out the percentage of diabetes patients who recognize the name of their hypoglycemic agents and to clarify whether such recognition have effect on their glycemic control. METHODS: A cross-sectional questionnaire survey was done from March to May 2004, targeting in-patients and out-patients who had been taking oral hypoglycemic agents for diabetes treatment in 2 hospitals. RESULTS: 134 patients (89.3%) of 150 completed the questionnaire. Only 20 (14.9%) patients accurately knew the name of at least one of the hypoglycemic agents they were taking. Smoking (P=0.0086), recognition of the name of hypoglycemic agents (P<0.0001), history of change of prescribed hypoglycemic agents (P=0.0095), diet and exercise (P<0.0001), explanation of hypoglycemic agents (P=0.0231), and forgetting to toke medicine (P<0.0001) were significantly related to the HbA1c level. Among these factors, history of change of prescribed hypoglycemic agents (P=0.0006), diet and exercise (P=0.0002), and forgetting to take medicine (P<0.0001) were the independent related factors after adjustment. CONCLUSION: The recognition rate of the name of hypoglycemic agents was low. It may be associated with patients' HbA1c, but was not an independent related factor.

Predictors of High Peak Serum CK Levels in Doxylamine Intoxication

BACKGROUND: Because doxylamine succinate (DS) is an over-the-counter medicine, it can be obtained easily and is frequently used in suicidal attempts. Patients usually recover without serious complications, but occasionally rhabdomyolysis and even death can occur in DS intoxication. In this study, the authors tried to find out the independent predictors of high peak serum CK levels, i.e. probable rhabdomyolysis in DS intoxication. METHODS: The medical records of 41 patients who visited a hospital for DS intoxication from January 1, 2002 to April 30, 2003, were reviewed retrospectively. RESULTS: In the group of DS only, initial occult blood of urine (P=0.003), initial WBC count (P=0.003) and confusion (P=0.007) were the best predictors of the peak serum CK level (2=0.724). In the group of DS with other drugs intoxication, initial creatinine level (P=0.003) and initial occult blood of urine (P=0.007) were the best predictors of the peak serum CK level (r2=0.784). In the cases of rhabdomyolysis patients, the time taken for the CK level to be increased over 1,000 IU/L was 1.9level to be increased over 1,000 IU/L was 1.9+/-0.6 days. CONCLUSION: In DS only intoxication, occult blood in initial urine analysis, initial high WBC count and confusion can be thought of as useful clinical predictors for high peak serum CK level case. In DS with other drugs intoxication, initial creatinine level and initial occult blood of urine can be considered as the best predictors. More than 2 days will be needed for the observation of serious complications in DS intoxication.

Do Patients Want Physicians to Inquire about Their Religion?

BACKGROUND: In Korea, there has been a few medical studies on the relationship between religion and health. In future, active research is anticipated in this area. However, the validity and methods of performing religious inquiry should be tested beforehand. This study was designed to look into the attitudes of patients about religious inquiries by their physicians and to suggest better methods of religious approach to aid future researches on the effect of religion on health. METHODS: A survey was performed on the religious attitude among 177 patients among which 92 were randomly selected from an outpatient clinic of tertiary teaching hospitals and 85 from two local family practice offices on August, 2002. x2 test was used to verify the difference of results between the subgroups. RESULTS: As a whole, more than half of patients disagreed with religious inquiries by their physicians regardless of medical situation; however, there was a trend that a critical health reasons produced a higher percentage of patients accepting religious inquiry than in ordinary patients. There was no significant difference in answer between the two practice settings but a significant difference among the subgroups with strong religious belief and among those with a particular type of religion existed. CONCLUSION: The results of this study may be used as data on the method of approaching patients with religious inquiries for future studies on the relationship between religion and health, and also should encourage active researches on this subject.

A Study on Hair Mineral Concentrations in Diabetic Patients

BACKGROUND: Minerals are essential nutrients of human body and related with various diseases. Some minerals may be associated with endocrine function. Especially, chromium is known to enhance the action of insulin. The correlation of minerals with DM has not been studied in Korea yet. Therefore, to know whether there is any significant difference of minerals concentration and component between DM patient and non-DM patient, the quantity of each mineral in the hair of patients and controls was measured. If there is any significance, a guideline of nutritional therapy with minerals could be proposed and recommended. METHOD: An analysis of hair was performed on the type II diabetic patients and non-diabetic patients who visited Severance hospital outpatient clinic from April, 2001 to January, 2002. Hairs were obtained from each subject and were analyzed into the concentration of mineral using an atomic absorption spectrophotometer. The concentration of each element between the two groups was compared by t-test analysis. RESULTS: The concentration of copper, sodium, chromium, sulfur, and antimony was significantly different; the level of copper was significantly lower in the diabetic group (P=0.013). On the other hand, the levels of sodium, chromium, sulfur, and antimony were significantly higher in the diabetic group (P=0.013, 0.0001, 0.010, 0.0001). CONCLUSION: Previous studies have suggested that the concentration of chromium in diabetic patients' blood was lower than those in normal population. However, this study showed that the measured amount of chromium in hair was significantly higher in the diabetic group. This result warrants a study on the correlation between the concentration of chromium in blood and hair, and also, on the mutual relationship of other minerals (copper, sodium, sulfur, and antimony) which also showed significant difference in this study.

Folk remedies in Korean rheumatoid arthritis patients

BACKGROUD: A lot of "Folk Remedies" on rheumatoid arthritis treatment prevail in Korea, but they have never been evaluated or investigated systemically. Therefore we studied folk remedies used in rheumatoid arthritis patients. METHODS: We delivered 12 questionnaires to 106 rheumatoid arthritis out -patients of family medicine, internal medicine, and orthopedics, located in Seoul and Kyungki area. These questionnaires addressed to demographic characteristics, duration of rheumatoid arthritis, current treatments, kind of folk remedies experienced, decision to choose folk remedies and its subjective effects, and volition to try new folk remedies. RESULTS: There were up to 27 kinds of folk remedies used by 77 people (72.8% of total). Lower education level was proved to be correlated with folk remedies experience. Most patients began their remedies introduced by relatives or close friends (83.1%) . Many Patients on folk remedies were skeptical about its effect, but they were still willing to try new folk medicine (80.6%). Many rheumatoid arthritis patients experienced folk remedies and were skeptical about its effects, but they were still willing to try new folk medicine. Therefore, education on folk remedies is needed.

The relationship of BDI and education

BACKGROUND: Individual propensity towards depressive mood has been influenced by various socio-demographic factors. Studies on the relationship between socio -demographic variables and degree of individual depressive mood in korea do not seem sufficient. In order to see the correlation of education level with the degree of depressive mood we surveyed to provide available data which are useful in the treatment of depression. METHODS: We randomly sampled 315 out of 452 patients based on the availability of chart record and questionnaire sheet. They were admitted to the department of family medicine in one university medical center in Seoul between Jan. 3. 1999 and Mar. 31. 2000. Out of 315 patients. we chose 271 patients between 30 and 80 years of age according to socio - demographic variables. Korean Beck Depression Index (BDI) questionnaire sheet method with 21 questions was used to collect the data for the degree of individual depression. The study group was subdivided into three (Group 1: group less educated than high school level, Group 2: group educated in high school, Group 3: group educated in college or above) BDI of each group was compared using ANOVA test. RESULTS: Age and sex among the three groups showed a significant difference. Other socio-demographic variables were not significantly different. The average of BDI was as follows : Group 1(19.6), Group 2(15.2), Group 3(13.2). After controlling for the socio-demographic variables, the BDI revealed significant difference among the groups according to education level. When Tukey method was applied to see the inter-group difference, Group1 BDI was higher than Group2 and Group3 BDls. No significant difference was found between Group2 and Group3. CONCLUSIONS: People educated below high school level revealed more propensity towards depressive mood with a statistical significance. Such result implies that education leved be considered in the treatment of depressive patients.

A report on the high frequency beam in hemorrhoid management based on patients' satisfaction

BACKGROUND: The most frequent disease seen in the anal area is hemorrhoid. The main therapeutic approach has been surgical treatment. However, in case of first degree and second degree hemorroids, the high frequency therapy is available. It can be applied on the OPD basis by the family pratitioners. Method: The data have been collected between Nov. 1997 and Apr. 1999, 464 cases are surveyed on the basis of sex, age, symptom duration, main symptom, location and duration of hemorrhoid, associated anal disease, therapeutic complication, and patients subjective satisfaction. Only 220 out of the 464 cases were available for the patients satisfaction study because of limited follow up study. RESULT: The sex ratio is 1.18:1 (252 in male, 212 in female). Age distribution shows a clustering pattern around the middle age(158 cases in the 30s, and 142 in the 40s respectively). Symptom duration before their first hospital visit reveals 118 cases(25.4%). under 5 years, 105 cases(22.6%) over 10 years, 102 cases(22.1%) 5 to 10 years orderly. The main symptom includes hemorrhoidal mass, bleeding, and pain. 146 cases(31.5%) had all the symptom descrived above. Patients with mass and bleeding were 122 patients(26.3%). In case of the degee of internal hemorrhoid, the second degree of hemorrhoid was the most common(386 cases: 83.2%) followed by the first degree(43 cases: 9.3%), the third degree (24 cases: 5.1%) and the forth degree(11 cases:2.4%). Total number of the patients with therapeutic complication were 99 cases. The complications were acute urinary retension (46cases: 46.5%), perianal edema (30 cases: 30.3%), bleeding (18cases: 18.2%) and anal stricture (5 cases: 5.0%). Satisfaction survey was based on the 220 follow up case study. 125 cases revealed very satisfied.(56.8%), 66 slightly satisfied (30.0%) and 29 unsatisfied.(13.2%). CONCLUSION: As shown in the study above, the high frequency therapy provided the patients with the high level of satisfaction. Based on the this fact, it is suggested to the family practitioners.

A survey on change of perception and satisfaction of family medicine (From patients add in one general hospital in seoul)

BACKGROUND: The author surveyed and analyzed the changes of perception and satisfaction about family medicine. So that the outcome may bring us a reference to advance family medicine more. METHODS: 247 in and out patients in one general hospital in Seoul were surveyed by the questionnaire from July 26, 2000 to June 20. The date was analyzed statistically by SAS program. RESULTS: As for the knowledge of family medicine, 61.5% of the patients answered that they knew what it is, and the most of them, 54%, via medical institution. The office workers, married , and highly educated people tend to know more about family medicine (P<0.05). As for attitude, 68% of the group answered that family medicine is necessary, because "family medicine doctors give proper advice and consult through out all fields of medicine"(58.8%). As for the preference so prirate doctor, 56.7% of the group answered that they would register for family medicine clinic, and students and office workers are fond of family medicine(P<0.05). As for the satisfaction, 34.4% were ever been to family medicine clinic, and 35.5% out of them were dissatisfied, mainly due to the lack of knowledge of physicians about their diseases(70.1%). CONCLUSION: The perception of family medicine are still scanty compared to the old studies.

A study on family function of the patients with psychiatric disorders

BACKGROUND: Psychiatric disorders have been known to occur by the interaction of biologic, psychologic and social factors. A family can affect the occurrence of psychiatric disorders as a primary social factor. On the other hand, psychiatric disorders can affect family function. There fore, we studied to compare family function between the families of psychiatric inpatients and those of normal persons, using Family APGAR and FACES III. METHODS: Between July 1, 1999 and August 31, 1999, we examined the subject group as 40 relatives to visit psychiatric inpatient and the control group as 40 persons whose family members did not have chronic diseases or psychiatric disorders, using questionnaire of socio-demographic factors and family function. RESULTS: Family APGAR scores in subject group were lower than those of control group, but not statistically different. But the degrees of 'Partnership' of the Family APGAR in subject group were significantly lower than those of control group.(P<0.05) Adaptability scores of FACES III in two groups were not different. Cohesion scores of FACES III in subject group were lower than those of control group but not statistically different. The Family APGAR scores in the families of the schizophrenics were significantly lower than those of control group. The duration of psychiatric disorders did not affect family function. CONCLUSION: The family function of subject group was worsened but not statistically different. But in the families of the schizophrenics, the Family APGAR scores were significantly lower than those of control group. Therefore, we should consider serious family dysfunction in the families of schizophrenics.

Measurement of Myocardial Perfusion with Electron Beam Tomography: Comparison with 99m Tc-MIBI Scan

PURPOSE: To compare the accuracy with which electron beam tomography (EBT) and 99m Tc-MIBI scanning measure myocardial perfusion valve. MATERIALS AND METHODS: Twenty-two subjects [normal volunteers (n = 6), patients in whom ischemic heart disease was diagnosed (n = 5), and those in whom ischemic heart disease was suspected but who were found to be normal (n = 11)] were involved in this study. EBT was performed after bolus injection of contrast media (50 ml of Iopamiro 370 or Optiray 350, 3 ml/sec). The myocardium was divided into 16 segments according to the classification devised by the American Society of Echocardiography, and each myocardial perfusion value was calculated by post-image processing. A pharmacologic stress test was performed in all subjects except four patients with acute myocardial infarction, and myocardial perfusion reserve ratios were assessed. Single photon emission computed tomography (SPECT) was performed after the injection of 20 mCi of 99m Tc-MIBI. Any segments with moderate to severe photon defect on visual analysis of SPECT were identified and perfusion values determined by EBT in normal and ischemic segments were compared. RESULTS: No difference in myocardial perfusion was found between volunteers and the suspected group. Their perfusion values were 0.71 +/-0.14 ml/g/min in the resting state and 1.16 +/-0.24 ml/g/min on the stress test and the myocardial perfusion reserve ratio was, therefore, 1:1.68 +/-0.38. In ischemic patients, 99m Tc-MIBI scanning revealed a perfusion defect in 28 segments, and on EBT the measurement obtained was 0.54 +/-0.19 ml/g/min. The remaining 324 perfusion segments shown by SPECT to be normal showed a perfusion value of 0.79 +/-0.22 ml/g/min on EBT. CONCLUSION: Compared with 99mTc-MIBI scanning, the measurement of myocardial perfusion by EBT provides absolute quantification of perfusion value and more detailed anatomic information.

An analysis of fatigue among outpatients

BACKGROUND: Up to the present, there has been little study on chronic fatigue or chronic fatigue syndrome, and there is equally sparse relevant statistical data For this reason, we attempted to investigate the present status of fatigue, particularly its incidence and actual conditions. METHODS: The study subjects were 12,152 outpatients who visited family practice in hospitals all over Korea between July 24 and September 21, 1997. They were given a questionnaire which included questions reflecting the (U.S.) Center for Disease Control criteria defining chronic fatigue syndrome. RESULTS: Among the subjects, 861 people complained of fatigue in their response to the questionnaire and they became the focus of the study. Of this fatigue group, 426 people(49.4%) had rnanifested fatigue for more than 6 manths, and the male/female ratio was 54%/46%, respectively. People who re ported that fatigue impaired their ability to function on a daily basis made up 35.8% of the fatigue group and the percentage of people who had considered visiting a clinic duen to fatigue wasa unexpectedly high 52.8%. The reported causes of fatigue, in decreasing order, were. social interactio(mals 68.5%/ femals 45.1%); sleep disturbance(mals 26.8%/ femals 21.8%); and physical maladies(mals 24.2%/femals 26.5%). There were significant gender differences in social interaction relating to domestic problems(mals 4.7%/femals 16.7%) and emotional problems(mals 12.2%/femals 21.4%). Among 33 chronic fatigue syndrome patients who indicated what they thought were the causes of their problems, 68.8% reported physical maladies, 65.6% social life, 31.3% emotional problems, 21.9% sleep disturbance, and 21.9 % domestic problems. The associated symptoms of fatigue reported in both males and females, in decreasing order, included: myalgia, headache and neurologic symptoms. The prevalence of chronic fatigue was 0.27%. CONCLUSIONS: Our study showed that 7.1% of family practice outpatients complained of fatigue and that their daily activities or occupational life were disturbed as a result. This group demanstrates is serious need for medical assistance. Therefore, doctors should have more interest in fatigue, particularly in chronic fatigue syndrome, so as to provide real and versatile care.

The effects of acupuncture treatment for smoking cessation: Preliminary study for high school student

BACKGROUND: Smoking is the single most considerable factor, which may likely affect one's health most adversely. Therefore, an effective control upon smoking has been the most important issue for all of the practitioners. Furthermore, the latters concern an the alternative medicine has been steadily mounting these days. Accordingly, a series of clinical group study has been mapped aut in order to clarify the effect and the outcome of acupuncture treatment and its rate of success. METHODS: The survey has been conducted fram April 7th, 1998 for six months with the voluntary help of 130 students as our study objects, who were the 1st, 2nd and 3rd graders at two metropolitan high-schools in Seoul A basic questionnaire has been prepared and collected at the first interview. The acupuncture treatment has been alternately administered at each side of ears once a week for the respective object-students and the information had been questioned in the survey. When 5 months lapsed with no treatment after the initial four weeks of intensive application, a further follow-up survey was repeated all over again(once every week for 4weeks and another after 6 months). For the analysis of our finding, the SAS V6.12 has been used together with the one way ANOVA test, t-test, and Cochran-Armitage trend test. RESULTS: Those who managed to stop smoking after the acupuncture treatment of one week, four weeks and six months respectively were found as follows; 2 students(61%), 12 students(37.5%), and 8 students(25%), proving that the success rate for smoking cessation after six months was 25%. Those who decreased their number of smoking more than half were; 13 students(39.4%), 15 students(46.9%), 25 students(75%). The number of withdrawal symptom and the smoking cessation as well as the smoking reduction rate were not found co-related each other. The frequency of their smoking, the frequency of the smoking attempt, the period of their abstinence from smoking, the facts whether their family-members of relatives smoked or not, the FTQ(Fagerstrom Tolerance Questionnaire), the frequency of their drinking and the motivation types of smoking(Why test) were found not influential upon the change of smoking tastes and their intensity of smoking wish by the treatment of the auricular acupuncture. CONCLUSIONS: The change of smoking taste and the change on the intensity of smoking wish as the outcome of acupuncture treatment for the stop-smoking has been statistically siganificant.