Vasculo-Behcet's Disease Developing in a Patient with Ebstein Anomaly / 대한류마티스학회지

Behcet's disease (BD) is a chronic inflammatory disease, involving several organs. It is well known that there are the marked regional differences in the disease expression of BD. In case of the vascular involvement in BD, the frequency rate has been described in 25~30% among the patients from the MiddLe East, whereas it has been noted in 5~15% in our country. In general, BD associated with large vessel lesions is named vasculo-BD. On the other hand, the cardiac involvement in BD has rarely been reported in the literature. Ebstein anomaly is a kind of malformation that is characterized by a downward displacement of the tricuspid valve into the right ventricle. We reported a 54-year-old male patient with vasculo-BD who had inferior vena cava obstruction and Ebstein anomaly. The association of Ebstein anomaly with vasculo-BD is considered to be coincidental. To the best of our knowledge, this is the first case of Ebstein anomaly associated with BD.

Comparison of the medical counseling by PC communication between family medicine and internal medicine according to ICPC

BACKGROUND: The purpose of this survey was to assess knowledge of the public on family medicine through the analysis of medical counseling by PC communication and to compare them with that of internal medicine. METHODS: This survey analyzed the contents of medical counseling by PC communication according to ICPC from Oct. 1996 to Jun. 1998. The survey was done by means of E-mail in Nownuri eyes and the selected medical departments were those of those of family medicine and internal medicine in Pusan National University Hospital. RESULTS: The total number of questions was 342, including 181 in the department of family medicine and 161 in internal medicine. In the analysis of medical counseling according to ICPC, there was a significant difference between family medicine and internal medicine in the reasons for questions by components(P<0.001). In family medicine, the reasons were symptoms, complaints(66.9%), diagnoses, diseases(18.8%), treatment, procedure, medication(17.2%), and diagnostic, screening, prevention(5.5%). In internal medicine, the reasons for questions were symptoms, complaints(64.6%), diagnoses, diseases(21.1%), treatment, procedure, medication(9.3%), and test results(4.3%). There was a significant difference between family medicine and internal medicine in the questions by chapters(P<0.05). In family medicine, the questions about digestive system were 28 cases(15.5%), neurological system were 26 cases(14.4%), skin were 26 cases(14.4%), musculoskeletal system were 25 cases(13.8%), and unspecified were 25 cases(13.8%). In internal medicine, the questions about digestive system were 76 cases(47.2%), circulatory system were 21 cases(13.0%), and respiratory system were 15 cases(9.3%). The most common symptom was headache in family medicine and generalized abdominal pain in internal medicine. CONCLUSIONS: There were significant differences in the age distribution, the reasons for questions, and the contents of questions between family medicine and internal medicine.

The differences of opinion on Boramae incident between physiscians and common people

BACKGROUND: Without available medical policy, up until now discharges against medical advice have occurred in th field of medicine in Korea. Seoul district court had convicted two physicians of crime because they had allowed a patient to discharge against medical advice, referred to as the Boramae incident in May of 1998. This shocked people in medical field as well as people and appeared in almost all newspapers and created a debate especially to physicians. The purpose of this study was to evaluate the differences of opinion of this incident between physicians and common people. METHODS: Ninety-nine physicians and ninety-nine common people were questioned from September 1 to September 30, 1998 about sociodemographic characteristics and opinion of this event. RESULTS: The mean age of the physician group, the non-physician group was 38.12+/-11.2, 38.5+/-11.1, respectively. Each group consisted of 87.9 percent, men and 12.1 percent, women. There were no differences between physicians and common people in experiences of discharges against medical advice in their families, decisions on Boramae-like incidents that could occur in the near future, and causes of discharges against medical advice. The physician group had more awareness rate of this incident than the non-physician group, and insisted more on the needs of methods to prevent recurrence. In opinion of the judgement, 5.1 percent of non-physician group agreed to conviction of Seoul district court. 22.2 percent of the non-physician group was of the opinion that this incident will affect patient care positively, about patient wifes decision, 21.2 precent of non-physician group considered that she made an imprudent decision. CONCLUSION: There were significant, differences between physicians and common people in the awareness of this incident, opinion on th judgement, needs of methods to prevent recurrence, the influence of this incident on patient care in the future, opinion of patient wifes decision, exceptional experiences of discharges against medical advice in a family, decisions on Boramae-like incidents that can occur in the near future, and causes of discharges against medical advice.

The effect of urine-holding on blood pressure

BACKGROUND: For diagnosis of hypertension, prompt blood pressure measurement is necessary. In a clinical setting, increased blood pressure is often recorded during urine-holding. The aim of this study was to assess the effect of urine-holding on blood pressure. METHODS: We analyzed 172 subjets who visited a hospital in Pusan for examinafion of pelvic ultrasonography. We measured urine holding time, blood pressure in a urine-holding state, and blood pressure immediately after urination when pelvic ultrasonography was examined. Paired t-test was performed to compare the pre-voiding blood pressure. The relationship between urineholding time and difference in blood pressure were assessed by Pearsons's correlatian coefficients. RESULTS: In subjects who held urine for no less than 3 hours, mean pre-voiding systolic blood pressure was 124.2+/-20.8 mmHg, mean pre-voiding diastolic blood pressure was 78.3+/-13.3 mmHg, post-voiding systolic blood pressure was 120.0+/-21.0 mmHg, and post-voiding diastolic blood pressure was 75.4+/-12.3 mmHg. Mean difference in systolic bload pressure was 4.2+/-10.7mmHg, and mean difference in diastolic blood pressure was 2.8+/-7.7 mmHg(p0.05) CONCLUSION: Urine-holding for no less than 3 hours made systolic and diastolic blood pressure rise. However, the rise in blood pressure was not proportianal to urine-holding time.

What do residents of family medicine discuss after outpatient care?

BACKGROUND: Physicians who provide primary care should be trained specifically to manage the problems encountered in a primary care practice. This study was carried out to know the resident's concerns and problems during outpstient care by analysing case discussions as an outpatient teaching. METHODS: We used 533 records discussed by 3 resident's teams for 1 year. Of discussion contents, symptoms or diseases were classified into codes and chapters using the ICPC(lnternational Classification of Primary Care) coding system and the main topics of discussion into 12 types. We compared data among 3 resident's teams and also between the discussed contents and the diseases of patients who visited a family practice for 1 year. We used relative discussion ratio to compare data. RESULTS: Of 533 discussed records, 106 kinds of symptoms or diseases were used and the 20 most common kinds accounted for 61.7%. Contents about menopausal sympto/complaint were 47 records(8.8%) and was the most frequent. Digestive part was the most frequent chapter(22.0%). Distribution of discussed main topics were diagnosis(35.5%), medication(26.8%), other treatment(11.6 %), follow-up(5.8%), etc. There was some difference among 3 resident's teams by chapters and topics. Visiting patients were 3,436 persons with 79 kinds of symptoms and diseases and prior 20 kinds accounted for 86.6%. Visited patients were some what different with the discussed contents by chapters. CONCLUSIONS: Contents of case discussion in ambulatory setting were some what different among each teams and more diverse than the visiting patients The residents could exchange many informations and find problems during ambulatory care. We think case discussion can be a good method for outpatient teaching.