Background
: It has been recognized that acute appendicitis in children is very difficult to diagnose, early diagnosis remains in the most challenging clinical issue in acute appendicitis in children. The very high incidence of perforation particularly in preschool children and the enormously increased morbidity in the perforated cases emphasize the importance of the problem.

Methods : This study is a clinical analysis of 49 cases with acute appendicitis under age 15 treated at the Keimyung University Dongsan Hospital, Taegu from 8.1, 1990 to 7.31, 1991.

Results : The incidence of acute appendicitis was increased as the age increased. The male to female ratio was 2:1(male 33, female 16) and there were 25 non-perforated case and 24 perforated cases. Bacterial culture from the peritoneal contented case and 24 perforated cases. Bacterial culture from the peritoneal contents in the perforated group was positive in 54.1% and E. coli was the most common organism.

Conclusion : There were much differences in clinical aspects between the perforated group and non-perforated group. Therefore, early diagnosis and operation of acute appendicitis in children is very important in clinical practice.

Background
: Hepatitis B virus infection is one of the important health problems in Korea. But high cost of hepatitis B vaccine interfered the introduciton of the nationwide vaccination programme. The immunogenectiy of hepatitis B vaccination with reduced dose proved to be comparable with usual dose vaccination in many studies. So we performed comparatived study of immunogenecity of hepatitis B vaccination between low-dose intradermal(ID) group and ususal-dose intramuscular(IM) group.

Methods : The number of vaccines of ID and IM group is 43(mean age : 41.5 years) and 40(mean age : 35.4 years) respectively. In ID group, Hepavax 0.1ml was adminstered intradermally on forearm volar side at 0,1,2 months. In IM group, Hepavax 1.0ml was adminstered intramuscularly on deltoid muscle at 0,1,2 months. HBsAg, anti-HBs, and anti-HBc were examined at 1 month after 3rd adminstration.

Results : The seroconversion rate of anti-HBs in ID group(90.7%) is not significantly different from that of IM group(85.0%). The geometric mean of anti-HBs titer in ID group(562 RIA units;95% CI:339-933) is not signifincatly different from that of IM group(240 RIA units; 95% CI:115-501). The side reactions in ID group are local skin reactions such as pain and pigmentation and they are disappeared spontaneously.

Conclusion : As a preventive measure of hepatitis B virus infection in adults, the low-dose intradermal method is comparable with usual-dose intradermal method is comparable with usual-dose intramuscular method in anti-HBs seroconversion rate and anti-HBs titer.

Background
: Acute hepatitis B can often induce chronic liver diseases, which cause serious complications. Korea is an endemic area where HBsAg positive rate is reported to be 5~10% of whole population. Therefore hepatitis B vaccination is essential to prevent disease transmission and it is important to assess the factors that after vaccination.

Methods : The study was carried out in 1,006 subjects among 2,870 adults that became candidates for hepatitis B vaccination. the subjects received a dose of Hepavax 1.0ml. The second and third doses were given one month and six months after the first dose. Al blood samples were tested for HBsAg and anti-HBs by EIA method. Chi-square test was performed for statistical analysis of the results by SPSS.

Results : Four years after hepatitis B vaccination, the subjects that negative HBsAg and negative anti-HBs were 33% and that negative HBsAg and positive anti-HBs were 66.4% Anti-HBs positive rate was significantly associated with vaccination doses. In the 975 subjects who received and dose or more, there was no statistically significant relationship between anti-HBs positive rate and the subject's age or sex. Two years after vaccination, 779 subjects had anti-HBs and 18.6% of these subjects converted to negative anti-HBs status two years later. And this negative conversion did not show statistically significant correlation with vaccination doses, subject's age or sex.

Conclusion : Four years after vaccination, anti-HBs positive rate was significantly associated with vaccination doses but it was not associated with the subject's age or sex. After 3 doses vaccination, the anti-HBs positive rate was 77.5% and 68.1% at 2 years and 4 years respectively. This negative conversion rate of 10.4% was not associated with vaccination doses and subject's sex or age. These facts don't support the necessity of booster vaccination after 5 years from initial vaccination.

Background
: Most women have regular menstruation since their menarche. According to a regular menstrual cycle, the hormone levels change. Also physical and mental impairments occur before menstruation. However. only recently have the interests and interest of the medical community in PMS increased. Therefore we gathered information concerning the frequency, and type of PMS in these study.

Methods : In this research, 277 first and second-year high school students and 65 Margaret Pritchard Nursing college students were surveyed during the period from July 1991 to August 1991.

Results : Of the 330 subjects, 26(7.9%) suffered from PMS. According to the Dawood's classification, the degree of the disease was as follows : 19(73.1%), mild ; 2(7.7%), moderate ; 5(19.2%), severe. Of the symptoms, fatigue is the most often experienced(88%). 11 subjects have taken medication for relief.

Conclusion : We gathered information concerning the frequency and type of PMS. The purpose of this research is informed and aid young women through counseling and treatment of problem.

Background
: Abnormal liver function test is relatively common findings in medical practice. The causative diseases are viral hepatitis, alcoholic or toxic hepatitis, fatty liver and etc. Recently many numbers of hepatitis of which causes were unknown in the past were revealed the association with hepatitis C virus. This study was designed for evaluation of positive rate and causative distribution of patients with abnormal liver function test.

Methods : One hundred and twenty-three patients with abnormal liver function test were participated in this study and interviewed by preliminary questionnaires at their first visit. Liver function test including aspartate transaminase and alanine transaminase, hepatitis B viral markers(HBs Ag, anti-HBs, anti-HBc IgG), antibody to hepatitis C virus (anti-HCV) (ELISA, Abbott) and abdominal ultrasonography were done in all patients.

Results : Among 123 patients, positive rate of anti-HCV was 19.5% of 24 patients. The positive rate increased with age significantly, but was no relationship between anti-HCV positivity and the levels of enzyme(P<0.05), X² for trend). Anyone positive cases in HBV-marker were 108 patients with 33 patients of HBsAg positive and there was no relationship between anti-HCV positivity and anti-HBc positivity. Among 123 patients, fatty liver were diagnosed in 42 patients who had diabetes, obesity or history of drinking alcohols over than ethanol 60gm/day. To present the possible risk factors of hepatitis C infection, 48 patients were compared as control group with 24 patients were compared as control group with 24 patients of anti-HCV positive cases about the transfusion, operation, drug etc. But there was no significant correlation between anti-HCV positivity and possible risk factors.

Conclusion : The positive rates of anti-HCV are about 20% in patients with abnormal aminotransferase. In patients with abnormal liver function test, it is common to reveal the combined causes more than two.

Background
: Delirium tremens is alcoholic withdrawal symptom that developed with psychiatric disorder and epilepsy. Delirium tremens is prevalent in rural area of the country and social problem. There is psychiatric approach of the disease reported, but medical and biochemical approach is rare. Therefore we carried out this study to determine the relationship between medical, biochemical change and delirium tremens.

Methods : 55 delirium tremens cases, classified by DSM Ⅲ criteria were gathered during the period from April, 1985 to June, 1990. Data were analyzed on epidemiologic status such as withdrawal period, maintenance time, other withdrawal symptoms, laboratory exam, liver function change in epilepsy and mortality cases.

Results : There was no significant correlation between the duration of abstinence and severity of the diseases in DSM-Ⅲ classification. Most of patients presented with typical symptoms and signs of delirium tremens, the symptom of the disease were agitated behavior(95%), delusion, ALT over 100 IU/L was seen in 71% of the seizure patients. Severity of the disease was not related to mortality.

Conclusion : There was no laboratory marker of delirium tremens ; the increased ratio of ALT / AST and increase of r-GTP, which are frequently seen in alcoholic liver disease are thought to suggest the presence of delirium tremens.

Background
: Chronic liver dysfunction, especially fatty liver and chronic hepatitis, is a common problem in primary care. In such case, physicians diagnosed the liver disease through the history and physical examination, blood chemistry, hepatitis viral markers, and radiologic study. We carried out this study to determine the clinical association between noninvasive diagnostic methods and liver biopsy.

Methods : Age and sex distribution, blood chemistry, hepatitis viral markers, sonographic finding and pathologic diagnosis were evaluated in 93 patients with chronically abnormal liver function test who were admitted for liver biopsy to Guro Hospital Korea University form July 1990 to June 1991.

Results : The AST level, 140.7 U/L and ALT level, 227.6 U/L in chronic hepatitis group were more elevated with statistical significance than 90.8 U/L, 98.1 U/L in fatty liver group(p<0.05). But the AST/ALT ratio, 1.14 in fatty liver group was more elevated with statistical significance than 0.74 in chronic hepatitis group(p<0.01). At pathologic diagnosis compared with sonographic finding, diagnosis accuracy of fatty liver was 52.5% and chronic hepatitis was 42.4%. Normal finding on sonography in fatty liver group or chronic hepatitis group by pathologic diagnosis were 44.0%.

Conclusion : The blood chemistry including AST, ALT, AST/ALT ratio, γ-GTP and hepatitis viral markers, sonography all are available diagnostic method in the chronic liver dysfunction. But we should be considering that liver biopsy was needed for more accurate diagnosis of liver disease.

Background
: There have been a number of researches of hepatitis and parenterally infected NANB viral hepatitis where clonization was successful. Viral hepatitis C would be named by this process, and enzymatic-immunologic tests and serologic tests to diagnose viral hepatitis C were developed.

Methods : Seventy nine patients were selected from those whose HBsAg tests were negative and transaminase levels were abnormal from Jan. 1 to Sep. 30, 1991. We assessed the prevalence and clinical aspects of viral hepatitis C. We divided all patients into anti-HCV positive and negative groups and compared them with regard to symptoms of hepatitis, transaminase level and transfusion history.

Results : 22(27.8%) out of 79 patients showed positive anti-HCV, and the positive rate was highest in the group aged 60~69 years in men and 50~59 years in women. There was no sex difference. The positive rates of anti-HCV in the groups of positive and negative anti-HBc were 28.6% and 25.8%, respectively.

Conclusion : A positive rate of anti-HCV was higher(27.8%) in the patients with negative HBsAg & increased transaminase levels than in normal subjects. But, the number of case is small, so total morbidity is difficult to analyze.