Background
: Determining the etiology of enlargement of the cervical lymph nodes is a common diagnostic challenge for clinicians. Necortizing lymphadenopathy was first described by Kikuchi in 1972, as a benign disease of which cervical lymphadenopathy with or without fever is characteristic. It has, on occasion, been misdiagnosed as tuberculosis lymphadenopathy or malignant lymphoma etc. It is resolved spontaneously without specific treatment within 1 to 4 months. So, we should consider this disease at the stage of presumptive diagnosis of the patient with cervical lymphadenopathy to avoid the unnecessary treatment of laboratory tests. Recently, in Korea, the cases with necrotizing lymphadenitis have been reported and studied, but the entity of this disease is not known to most of physicians of primary care. Therefore, we analyzed the clinical features of 39 cases which were diagnosed as necrotizing lymphadenitis by pathologist and reviewed the pertinent literature.

Methods : Thirty nine cases diagnosed as necrotizing lymphadenitis or subacute necrotizing lymphadenitis were selected from the files of the Department of Pathology, Kyung Hee University Medical Center, from 1985 through 1991.

Results : The age of 39 patients ranged form 5 to 58 years old with 89.7% below the 4th decades. Females were slightly more frequently encountered than males in the ratio of 22:17. The most common chief manifestations were neck mass only in 20 patients(51.3%). Cervical lymphadenopathy was multiple in 23 patients(60.5%) and tender in one half. The duration of the symptoms ranged from 1 week to 4 years and was within 3 months in the most of cases. At the first visit, the presumptive diagnosis were tuberculosis lymphadenitis in 23(59.0%), fever unknown origin in 6(15.4%), nonspecific lymphadenitis in 3(7.7%), malignant lymphomas in 3(7.7%), systemic lupus erythematosus in 1(2.6%), typhoid fever in 1(2.6%), lipoma in 1(2.6%), acute appendicitis 1 patient(2.6%). Three patients were relapsed.

Conclusion : At the diagnosis of cervical lymphadenopathy, the clinical and epidemiologic features of the enlarged lymph nodes are often useful in determining the diagnostic tests that are required and the type of initial therapy to be administered, also pathologic examination of excisional lymph node should be performed to prevent patients who have necrotizing lymphadenitis from unnecessary treatment or laboratory tests.

Background
: The causative effect of cigarette smoking on pulmonary diseases, coronary heart diseases and much variety of cancers is evident. But the rate of cigarette smoking in Korea is increasing and adequate smoking cessation intervention has not been done yet. this clinical trial evaluated the effect of antismoking intervention done by primary care physicians.

Methods : The subjects were 145 smokers who visited SNUH Family Medicine Model Clinic from April to early July, 1991. We randomized subjects by their chart number. We educated all smokers about the adverse effect of cigarette smoking with self-help material and recommended to quit smoking. We reeducated the intervention group every 3rd, 5th and 7th week by face-to-face interview or telephone call. Twelve weeks after the intervention, we attempted to contact every smoker for the number of cigarettes per day currently smoked.

Results : The rates of smoking cessation and reduction for control group and intervention group were 7.7% and 38.5% vs. 19.7% and 47.99%, respectively. They were statistically significant(P<0.05). Statistically significant differences between the case and control groups were in their change of smoking habit in the following subgroups ; greater than 40 years of age, greater than 12 years of education and having diseases associated to smoking.

Conclusion : In conclusion, personal intervention carried out by primary care physicians resulted in significant smoking reduction and cessation. history.

Background
: Knowing which patients will have a complicated delivery is crucial for family physician can make plans for adequate coverage or transfer to an appropriate facility. Therefore we need an easy-to-use reliable method to screen obstetric patients. The risk-scoring system described by Edwards was carried out for the study to determine the effectiveness and/or usefulness.

Methods : 199 pregnant women that visited for delivery during the period from July 1991 to September 1991, were classified high-risk-scoring system. And then their newborn babies were classified high-risk and low-risk group by definition. The maternal and infant morbidity was compared and evaluated, individually.

Results : The average age of the patients was 27 years(±3.97), the average gestational period was 39.48 weeks(±1.90), and the body’s average body weight was 3175gm(±463). The infants classified as high-risk group were 22 case(11%)(p<0.001) Neonatal morbidity was observed in 24.3% of infants of mothers classified as high risk compared to 3.8% of infants of mothers classified as low risk.

Conclusion : The risk-scoring system described by Edwards is an easy-to-use reliable method to screen obstetric patients. Implementation of this scoring system can be of help to family physicians in determining which patients will be likely to have complicated deliveries.
physicians should take more active role in extending cervical screening corverage.

Background
: Chest P-A interpretation is very important because chest P-A is one of the important diagnostic tools in primary care. Primary care physicians often make decision of patient management based on clinical impression and radiologic findings. This study assessed the accuracy of family physicians in interpretationg radiographs taken in the seven family practice offices.

Methods : This study compared the interpretation of family physicians with those of one radiologist on 183 office radiographs using a uniform protocol. Nine family physicians participated in the study along with one radiologist. A total of 183 chest P-Ad were evaluated.

Results : The results were as follows 1) the family physicians' discordancy rate with the radiologist was 19.6% 2) 80% of the discordant films were clinically significant misses of those were read as "normal" by one radiologist 4) only 5% of chest P-As which were read as "normal" by family physicians were read as "abnormal" by radiologist 5) The sensitivity of family physician's interpretation compared with radiologist was 90%, the specificity was 86%, and the positive predictability was 71%.

Conclusion : This result suggest that it is not necessary to consult radiologist for interpretation of Chest PAs which were read as "normal" by family physician, because 95% of Chest PAs which were read as "normal" by family physicians were read as "normal" by radiologist. Radiologically abnormal films may need to be consulted with clinical information. Physicians should take more active role in extending cervical screening corverage.

Background
: In order to make accurate diagnosis and to avoid unnecessary use of medications in UTI, family physicians require sensitive & rapid diagnostic methods. In this study we analyzed the relationship between symptoms and the results of microscopic examination of urine with the results of urine cultures in order to identify predictors of cultures result in the diagnosis of UTI.

Methods : Usual symptoms, signs, and urinalysis (including microscopy of urinary sediment) as predictors of UTPs in patients were evaluated in 65 primary care visits in two community based hospitals, using a positive urine culture as gold standard (which was defined by colony count≥10).

Results : 1) The overall culture positivity rate was 26.2%(17 out of 65 cases). The 17 isolated was 26.2%(17 out of 65 cases). The 17 isolated bacteria were E.coli (11), Serratia species(4), G(+) Bacilli(1), Acinetobacter species(1), in order of decreasing frequency. 2) A difference was not found between sexes(p=,206), but was among age groups(p=.046). 3) The presenting features with the higher efficacy were dysuria, frequency, generalized symptoms, and no history of previous antibiotic use. A positive nitrite test, albuminuria, and ketonuria had relatively high specificities, but relatively low sensitivities. 4) The sensitivity and specificity of microscopic bacteriuria were 41.2% and 85.4%, respectively. At the maximal cutoff point for microscopic leukocytes(10/HPF) and erythrocyte(2/HPF), the sensitivity and specificity were 94.1% and 64.6%, 70.6% and 54.2%, respectively. 5) In cases of symptoms and signs consisting of dysuria, urgency, abdominal pain, or costovertebral angle tenderness, and microscopic findings of WBC≥(10/HPF), the sensitivity and the specificity were 94.1% and 64.6%, and the positive and negative predictive values were 48.5% and 96.9%, respectively. 6) In cases of any symptoms and signs consisting of dysuria, urgency, abdominal pain, or costovertebral angle tenderness, and urine tests consisting of a positive nitrite test, microscopic bacteriuria, microscopic WBC≥20/HPF, the sensitivity, specificity, positive and negative predictive values were 88.2%, 70.8%, 51.4%, and 91.4%, respectively, and were the most predictive values in our study.

Conclusion : Among some diagnostic methods, the finding of at least 10 WBC/HPF was found to have the highest correlation with positive urine culture. Specificity of WBC result is increased by symptoms & signs of patients and microscopic examinations of organism & RBC. This is further enhanced by addition of a nitrite test. The combination of these diagnostic methods yield the highest validity in the prediction of urine culture result.

Sampling of appropriate specimen at or near the squamocolumnar junction is necessary to increase sensitivity of cervical smear. The presence of endocervical cells or squamous metaplasia is currently considered to be an important factor in assessing the adequacy of a cervical smear. One of the purposes of this study is to assess capture rate of endocervical element of the current Pap smear method in Korea which is performed by using only dry cotton swab. The other purpose is to compare effectiveness of two combinations of instrument when performing Pap smear, (Milex spatula+moistened cotton swab, Milex spatula+Cytobrush) This study was performed for 277 patients visiting family practice clinic at Seoul National University Hospital to take Pap smear test form Nov 1, 1991 to Jan 25, 1992. For 114 patients (group C) only dry cotton swabs were used to collect specimen. 78 patients' specimens were taken by combination instrument of Milex spatula and moistened cotton swab. (group A) Combination instrument of Milex spatula and Cytobrush were used for 85 patients. (group B) The endocervical cell capture rate was 62.8% for group A, 80.0% for group B, 56.5% for group C. The difference of endocervical cell capture rates among groups was significant statistically (X²=13.2, p<0.05). This difference among groups was more marked in the older age group over 45. In conclusion, combination instrument of Milex spatula and Cytobrush is considered as a more effective method for collection of endocervical cells compared with other two methods.
Physicians should take more active role in extending cervical screening corverage.

Background
: This study was performed in order to investigate the pattern of health behaviors and total health behavior risk.

Methods : The analysis and interpretation was done about health behavior of the whole persons who consulted Family Practice of the Dongguk University Medical College, Kyeong-Ju Hospital for comprehensive health check-up, from Now. 1991 to May, 1992 via questionnaire.

Results : The total number of collected data was 215. About obesity, 62.6% are normal-ranged, 25.1% overweight, 12.3% obese. Among men, 20.2% are non-smoker, 16.1% ex-smoker and 63.7% are current smoker. Among women, 79.5% are nonsmoker, 4.5% ex-smoker and 15.9% are current smoker. About regular exercise, 12.9% exercise regularly, but 87.1% don't exercise regularly. Among men, 39.7% hardly drink, 29.8% drink less than 3 times a week, and 30.5% drink more than 3 times a week. Among women, 82.4% hardly drink, 16.5% drink less than 3 times a week and 1.1% drink more than 3 times a week. About eating habit, 47.6% eat regularly, 52.4% eat irregularly. About salt intake, 14.5% take little salt, 49.5% take moderate, 36% take much. About safety belt, 56.6% always take, 22.9% often take, 20.5% rarely take. Among men, 63.1% sleep 7 to 8 hours a day on the average and 36.9% sleep less than 6 hours or more than 9 hours. Among women. 47.3% sleep 7 to 8 hours and 52.7% sleep less than 6 hours or more than hours. About total health behavior risk, 23.7% consist in low risk group, 65.1% consist in moderate risk group, and 11.2% consist in high risk group.

Conclusion : On the whole, two thirds of person consist in moderate health behavior risk group and a tenth consists in high health behavior risk group. Both smoking and drinking of men, and irregular eating habit and no regular exercise of men and women, contribute very much to total health behavior risk.

Background
: Still in Korea, the incidence of cervical cancer is so high that it comprise the majority of female malignant neoplasm. In addition, the mortality due to cervical cancer is higher than the mortality due to any other female neoplasm. however cervical cancer can be detected early by the Pap smear, and early treatment can prevent its spread. Thus, it is very impartment for the primary physician to conduct periodical follow-up evaluations of the patient. Therefore, in this study, we would investigate the extent to which using a reminder is effective, including the female's periodical evaluation.

Methods : We have used letters and phone calls to remind 315 patients, chosen randomly from 1,280 patients who had taken Pap smears at a certain out patient department of university hospital located in Seoul.

Results : Although there was no significant difference from a statistical perspective, reminding the patient was deemed useful. Compliance rate was 31.9% in the letter-receiving group, compared to 25.7% in the control group. Furthermore, the experience of having taken the Pap smear within the past 3 years has a significant relationship with the compliance rate(p<0.05). In addition, the compliance rate of the patient who has not taken a Pap smear was 0% in the control group, 8.0% in the letter-receiving group. However, the compliance was not associated with patient's age, educational level, parity, and age of 1st delivery. frequency of abortion, accompanied chronic medical illness, obtaining other screening test.

Conclusion : The compliance was strongly related with the patient's recent Pap smear experience, and the compliance can be increased by using the reminder in the non-examination group. Thus it is advisable that the family physician remind the female patient taking the Pap smear to retake it frequently.