Medical licensing examination (uigwa) and the world of the physician officers (uigwan) in Korea's Joseon Dynasty / 보건의료교육평가

Physicians for ordinary people in Joseon Dynasty (1392-1910) do not need to pass national medical licensing examination. They had done their job after enough period of apprenticeship. Only physician officers were licensed as technical civil servants. These physician officers were middle class, located socially between the nobility and the commoner. They had to pass a national licensing examination to be considered for high-ranking physician officers, that is, those at the rank above the 6th level out of a total of 9 ranks, where the first rank was highest. Royal physicians also had to pass this examination before accepting responsibility for the King's healthcare. This article aims to describe the world of Physician officers during the Joseon Dynasty. Physician officers enjoyed considerable social status because they dealt with matters of life and death. Owing to the professional nature of their fields and a strong sense of group identity they came to compose a distinct social class. The physician officers' world was marked by strong group allegiances based on shared professional knowledge; the use of marriage to gain and maintain social status; and the establishment of hereditary technical posts within the medical profession that were handed down from one generation to the next. The medical licensing examination persisted until 1894 when the civil service examination agency, of which it was part, was abolished. Until that time, the testing agency, the number of candidates who were accepted, two-step test procedures, and the method of test item selection were maintained and enforced. These aspects of the test could be considered characteristic of the medical licensing examination.

A Case of Congenital Intramural Cyst of Uterus / 대한산부인과학회지

I experienced a case of a congenital intramural cyst of the uterine fundus. It was composed of a single layer of non-ciliated low cuboidal epithelium without associated with endometrial stroma and was found to be derived from the mesonephric duct. This case is presented with a brief review of the literature.

A Case of Carcinoid Tumor and Low Grade Mucinous Adenocarcinoma Arising in Ovarian Mature Cystic Teratoma / 대한산부인과학회잡지

Mature cystic teratoma of the ovary is the most common ovarian germ cell tumor and benign, but malignant transformation occurs in less than 2% of benign mature teratoma. Of the malignancies arising in teratomas, squamous cell carcinoma is the most common, however, carcinoid tumors or adenocarcinomas arising in mature cystic teratoma are uncommon, especially simultaneously. We present an unusual case of premenopausal woman having carcinoid tumor and mucinous adenocarcinoma simultaneously arising in ovarian muture cystic teratoma.

A Case Of Endometriosis At The Subcutaneous Tissue Of The Abdominal Scar After Cesarean Section / 대한산부인과학회잡지

Extrapelvic endometriosis is a fairly rare phenomenon. The majority of extrapelvic endometriosis involves scar tissue following obstetric/gynecologic procedures. Cesarean section scar endometriosis may be more common than reflected in the literature and has a distinct presentation and treatment. One patient with history of cesarean section presented with a painful, enlarging mass involving the cesarean section scar. The pain was cyclic and strongest just prior to menstruation. This patient was treated with surgical excision and specimens had endometriosis confirmed by histopathology. This case was reported with a brief review of the concerned literatures.

A Case Of Endometriosis At The Subcutaneous Tissue Of The Abdominal Scar After Cesarean Section / 대한산부인과학회잡지

Extrapelvic endometriosis is a fairly rare phenomenon. The majority of extrapelvic endometriosis involves scar tissue following obstetric/gynecologic procedures. Cesarean section scar endometriosis may be more common than reflected in the literature and has a distinct presentation and treatment. One patient with history of cesarean section presented with a painful, enlarging mass involving the cesarean section scar. The pain was cyclic and strongest just prior to menstruation. This patient was treated with surgical excision and specimens had endometriosis confirmed by histopathology. This case was reported with a brief review of the concerned literatures.

A Survey of Eating Behavior and Food Preferences of Children in Preschool Nursery Facilities / 대한지역사회영양학회지

This study was aimed at examine eating behavior and food preferences of children in preschool nursery facilities. A survey was conducted on parents using questionnaires including general characteristics, eating behavior, and food habits at home and food preferences of children in 6 nursery facilities. The children involved in this study were 150 boys and 154 girls, aged 1 to 7 years old. Sixty three percent(187 children) of the children were on 'regular' meal times, and 37.0%(110 children) were on 'irregular' meal times. The major reason for their irregular meal times were 'their' concentration on other tasks'(26.6%) and 'no appetite'(25.5%). The meal eaten best by children was 'dinner' while that eaten worst was 'breakfast'. The major type of their eating habit problem was 'unbalanced diet'(62.1%), and their mothers' response to the unbalanced diet was 'trying to persuade the child'(71.6%). The number of snacks at home was one or twice a day(97.3%), and 'preference'(67.8%) was the main reason for selecting particular snacks. Their preferred staple foods were 'cooked rice with meat & vegetables and Chinese noodles', and 'noodles with bean sauce', and their preferred soup was 'seaweed soup' Also, their most preferred meat dishes were 'fried chicken' and 'thin sliced barbecued beef. Children preferred side dishes with animal foods to those with vegetable foods. Since children liked mixed dishes, it seems desirable to introduce foods which children dislike as ingredients in mixed dishes.

Three Cases of Local Excision of Uterine Choriocarcinoma Lesion / 대한산부인과학회잡지

In treating young women for gestational trophoblastic tumor ( G.T.T. ), all efforts are made to preserve fertility and hysterectomy is avoided unless absolutely essential. However, in some cases the operation may be lifesaving. During the last 20 years among the 310 cases of G.T.T. treated at Il Sin Christian Hospital, there were 3 cases in which hysterectomy was avoided by the excision of a localized uterine lesion thus preserving fertility.

A Comparison of Misoprostol and Dinoprostone Vaginal Tablet for Labor Induction at Full Term Pregnancy / 대한산부인과학회잡지

Our purpose was to compare the safety and efficacy of intravaginal misoprostol versus dinoprostone vaginal tablet for induction of labor at term pregnancies. Two hundred three patients with indications for induction of labor at term were randomly assigned to receive either intravaginal misoprostol or dinoprostone vaginal tablet. Fifty micrograms of misoprostol was placed in the posterior vaginal fornix every six hours, with a potential maximum of four doses. 3 milligrams of dinoprostone vaginal tablet was placed in the posterior vaginal fornix every eight hours, with a potential maximum of three doses. Further medication was withheld with the occurrence of spontaneous rupture of membrane, entry into adequate contraction pattern(twenty second sustained with two or more frequent uterine contraction in 10 minutes), nonreassuring FHR tracing, or delivery. Artificial membrane rupture with both study protocol was done at the discretion of the attending physician. After membrane rupture, in the cases of failure of active labor or arrest of dilation, oxytocin was administerated. Among those evaluated, 100 received misoprostol and 102 received dinoprostone. The average interval from start of induction to vaginal delivery was shorter in the misoprostol group(784.7 +/- 389.3 min) than in the dinoprostone group(988.3 +/- 369.5 min)(p<0.01). There was no significant difference in change of Bishop score between the two groups. No statistically significant differences were noted between two groups in case of need for oxytocin and oxytocin total dose, but significant difference was noted between two groups in case of indication for oxytocin augmentation. There were no significant differences in the routes of delivery. Intravaginal administration of misoprostol appears to be as effective as dinoprostone vaginal tablet for labor induction at full term pregnancies. Complications associated with prostaglndin administration were not statistically different between the two treatment groups.

Transabdominal Selective Fetal Reduction in Multifetal Pregnancy / 대한산부인과학회잡지

Over the past 30 years, there has been an increase in the incidence of multifetal pregna-ncies, primarily because of the introduction of ovarian stimulants for ovulation induction and assisted reproductive technology ( ART ) in infertile patients. It is well established that multifetal pregnancies are associated with an increased frequency of the maternal complications and gre-ater perinatal morbidity and mortyality. The adverse outcome of multifetal pregnancies is dire-ctly proportional to the number of fetuses, primarily as an consequence of prterm delivery. Re-duction in the number of fetuses in multifetal pregnancies has been proposed as a way to impr-ove the perinatal outcome in this situation. Therefore, selective fetal reduction ( SFR ) is sugges-ted as a therapeutic option for continuation of pregnancy with fetuses mature enough to survi-ve. In this paper, we report our infertility clinic experiences with 6 patients who carried mult- ifetal pregnancies including 1 quintuplet, 1 quadruplet, and 4 triplets. from January, 1991 to May, 1996, transabdominal SFR was accomplished by fetal intrathoracic KCl injection at 9~10 weeks of gestation. After the prcedure, 4 patients remained as twin pregnancies, and 2 patients as single pregnancy. There have been 3 sets of twin deliveries and the 2 sets of single delivery. One case was aborted. Two patients were delivered after 37 weeks of gestation, 2 patients were at 35 weeks, and 1 patient at 24 weeks. All babies have been healthy after birth in patients after 35 weeks gestation. There was no fetal anomaly related to the procedure in the 6 cases. We concluded that transabdominal SFR is a rather safe and useful procedure that may improve the outcome of multifetal pregnancies.

The Relationship between Occupational Lead Exposure and Minor Hearing Impairment / 대한산업의학회지

In this study the relationship between occupational lead exposure and minor hearing impairment was investigated in a cross-sectional design with 50 lead exposed workers from January to April 1994, The data were collected from the interview with the structured questionnaire which included sociodemographic variables and medical histories especially ear disease and occupational histories. Lead exposure indices which were blood lead, urine lead, zinc protoporphyrin in urine, and delta-aminolevulinic acid in urine were analyzed, Also study subjects were examined pure-tone hearing test. The results were as follows ; 1. There were significant differences in lead indices between lead-exposed workers and non-exposed workers. 2. The duration of lead exposure did not affect the hearing impairment among lead exposed workers. 3. Minor hearing impairment were higher in lead-exposed workers than non-exposed workers, but there were not statisticatly significant. The result from this study indicated that lead exposed workers should be monitored to prevent hearing impairment and would be needed health education.

The diagnostic value of ultrasound-guided fine-needle aspiration biopsy in breast masses

Real-time ultrasound-guided fine-needle aspiration biopsy in 137 solid breast masses was performed. Sonographic findings were categorized into three group and aspirates were categorized into three cytologic groups. The cytologic result was reported benign masses (cytologic group 1) in 71 cases (52%), malignant masses (cytologic group 2 and 3) in 44 cases (32%) and insufficient specimens in 22 cases (16%). Insufficient specimens were treated as benign masses. Excisional biopsy in 44 malignant masses and 3 benigh masses according to cytologic results, clinical findings and follow up study was performed. The result was reported 41 malignant masses and 6 benign masses. Based on cytologic criteria, sensitivity for detection of malignancy was 93% and specificity was 94%. In conclusion, the high specificity provided by ultrasound-guided fine-needle aspiration biopsy could markedly reduce unnecessary surgical excisions for benign masses and it should be routinely performed, since it can give physical and emotional benefits to patients and lead to earlier and cost effective diagnosis of breast cancer.