Background
: Fine needle aspiration biopsy is useful method to evaluate the mass lesion in primary care. But false negative result and insufficient specimen make it difficult to interpret the result and to manage the patients. Therefore, we should effort to decrease the frequency of false negative result and insurfficient specimen.

Methods : The medical records of twenty one patients were reviewed who had been examined with fine needle aspiration biopsy for the evaluation of thyroid nodule, cervical lymph node swelling and breast mass from January 1992 to October 1993 in the family practice outpatient department.

Results : Among 8 cases of the thyroid nodules, insufficient specimens were 3 cases, benign 4 and malignancy 1. Among 8 cases of the cervical lymph node swellings, insufficients 3, benign 4 and malignancy 1. Among 5 cases of the breast masses, insufficient 2 and benign 3. Total number of insufficient specimens were 8 cases(38% of all case), benign 10 and malignancy 2. Among the 8 cases of insufficient specimens, one thyroid nodule and two lymph node swellings were confirmed to adenomatous hyperplasia and tuberculosis, respectively by excisional biopsy. Another five cases were followed up and the lesion was reducted in size without any management in the cases of two thyroid nodules, the other was dropped out. One lymph node swelling was treated by anti-tuberculosis medication because chest film showed pulmonary tuberculosis concurrently. Two breast masses were not changed in size.

Conclusion : Our study had more insufficient speciment than others, but they are diagnosed by exicional biopsy or follow-up. We should improve the skill of fine needle aspiration biopsy to decrease the insurfficient specimen.

Background
: It is a recent trend that average life span prolonged according to the socioeconomic and scientific advance, therfore elderly patients are steadily increasing. The interest toward geriatrics raise earlier. Never the less, present epidemiologic study to geriatric patients is rare, in our country. This study purpoted to make basic epidemiologic data of geriatric in-patients.

Methods : The subjects were 65 years old patients and over that visited to small and medium hospital of Andong city from June 1991 to March 1992. Among them new in-patients of 65 years old and over hospitalized at March, June, October, December were selected and their charts were reviewed.

Results : Male and female ratio of 216 geriatric inpatients was 1:1.3 and average age was 72.5 years. The average numbers of diagnosis were 2.6 and the most common disease was hypertension, others were COPD, fractures, gastritis, malignant tumors, degenerative arthritis as in order and the average duration of hospitalization was 9.1days in geriatric in-patients. The average numbers of class of prescribed drugs in geriatric inpatients were 5.6 and the significant difference was not noticed in sex and age. The most common prescribed drug was antibiotics, The average of total cholesterol was 162.9mg/dl and dangerous group was 7.3%, borderline group was 11.8% by NCP guideline. The ratios of smokers and alcoholics were 50.0%, 34.4% respectively.

Conclusion : This study was concerned about common diseases, prescribed drugs and health risk factors in geriatric in-patients. But this study was limited to small area and one community. Therefore, this result can't represent the result of the total geriatric population. As this reason, I wish to more & more great epidemiologic study about geriatric inpatients will being done in the future.

Background
: Korea is an endemic area of viral hepatitis B, and the hepatitis B vaccine has been made and broadly prescibed since last decade. There have been a lof of studies and arguments to select proper indications, injection times, and interval for boaster injections. Among those, there have been arguments that it is better to test not only HBs antigen and anti-HBs, but also anti-HBc is more susceptible to viral hepatitis B and should be vaccinated. Previous studies have shown high rate of anti-HBs formation among only anti-HBc positive persons after three injections of hepatitis B vaccine. In this sutdy, authours selected persons with only anti-HBc positive, vaccinated once to the case group and compared the anti-HBs formation rate and titer ar more than 6 months after vaccination among the case and control groups.

Methods : Among the patients visited Department of Family Medicine in Kyung Hee Medical Center, we selected persons with no history of jaundice, hepatitis, blood transfusion, or heptitis B vaccination with normal AST, ALT and ALP level, and with only anti-HBc positive viral marker. The selected persons were divided by their opinion into case and control group. After then hepatitis B vaccine was injected to the case group and no vaccine was injected to the control group. More than six months later, the rate of anti-HBs formation, the titer of anti-HBs and the liver function test were checked and compared among the two groups.

Results : The anti-HBs formation rate in the case group was 68%(17 of 25 persons), and the rate in the control group was 9.5%(2 of 21 persons). So the former was significantly higher than the latter(P<0.01). Among the case group, the rate of nonresponder was 32%, low responder was 24%, intermediate responder was 28%, and high responder(anamnestic response) was 16%. There were no cases showing the positive conversion of HBsAg, the negative conversion of anti-HBc, or abnormal liver function test.

Conclusion : The persons with only anti-HBc positive viral marker with normal liver function were higher rate of anti-HBs formation in case gorup comparing to the control group after one hepatitis B vaccination, and so, they should be vaccinated with hepatitis B vaccine. The vaccination schedule for this group is to vaccination once and evaluate the titer of anti-HBs. If the anti-HBs titer shows anamnestic response, no more vaccination is needed and if the anti-HBs titer dosen't show anamnestic response, vaccination should be continued as usual schedule. But considering the cost-effectiveness, it would be better to vaccinate three times without the evaluation of anti-HBs titer.

Background
: It is well known that the ultrasonographic test is one of most commonly performed diagnostic tool nowadays. Also the fatty liver is one of the most frequent finding by this abdominal ultrasonographic examination. The purpose of this study is to determine the significance of this fatty liver and the possibility of application of ultrasonography to make diagrosis and follow up clinical course of fatty liver.

Methods : Obesity index, liver function tests, blood lipids, clinical features, related factors and age and sex distribution were analyzed with 237 fatty liver cases those were diagnosed by ultrasonography for the health care examination at Guro Hospital Korea University from April 1992 to March 1993. Fatty liver cases were classified according to Mittelstaedt's classification to group I(mild) an group II(moderate to severe). In this study, patients who were confirmed as hepatitis B or C were excluded.

Results : Fatigue(21.5%), indigestion(9.9%), epigastric pain(9.4%) were frequent complaints and asymptomatic was 54.1% in group I. In other hand, fatigue(28.6%), indigestion(14.3%), epigastric pain(8.9%) were prominent subjective finding and asymptomatic were only 39.3% is group II. The obesity index was statistically higher in group II than group I. And aspartate aminotransferase, alanine aminotransferase, ν-glutamyltranspeptidase, alkaline phosphatase were significantly higher in group II than in group I. Total cholesterol and triglyceride in group II were significantly elevated than group I.

Conclusion : The fatty liver cases classified by ultrasonographic finding revealed statistically significant differences in several biologic markers as indicated the above results. The author concluded that group II fatty liver needs more close and more frequent clinical traces individually as they have well known risk factors than group I.

Background
: The prevalence of DM has increased as a result of improved medical diagnostic technology, improvement of the quality of life, lengthened the life span. The basis in the treatment of DM is dietary management, exercise and medical treatment. And diabetics should control blood sugar continuously for their life. There are various DM management behaviors such as consulting a physician, self management, folk medicine, herb medicine, visiting drugstore in Korea. So, we investigated the management behaviors for DM in a rural area.

Methods : The study subjects were 899 diabetics in Kyungju county, who had proved in screening test for DM in the Kyungju Country Health Center from May, 1991 to Nov, 1991. The survey was carried out by direct interview by the health workers required and community nurse practitioners. Analysis of the data was done with 447 questionares which were available of the 485 questionares answered.

Results : 378(84.6%) diabetics tried for DM management and 69(15.4%) diabetics did not try. Management was used in 198 (52.4%) diabetics, combinations of 2 were 120(31.8%) patients, combinations of 3 were 50(13.2%) patients and combinations of 4 or more were 10(2.6%) patients. Just consulting a physician was most common(45.8%). In self management, dietary management was used in all and exercise was 13.3%, control of drinking was 6.1% and control of body weight was 10%, Contents of folk medicine were various. 259(83.1%) diabetics continued management and 51(16.9%) diabetics discontinued management.

Conclusion : Management behaviors for DM were various in a single or combinations of consulting a physician, self management, folk medicine, herb medicine and visiting a drugstore. And consulting a physician was most commonly used in a rural area.

Background
: TSH is of great use as screening test in health examination. Recently, new sensitive EIA has been developed. We calculated normal range of TSH and positive predictive value of TFT abnormality by this method. Also, this study was carried out for the purpose of presuming the prevalence of TFT abnormality in community screening test of our county.

Methods : TSH levels were measured in 4,708 subjects that participated in periodic health examination at department of family medicine, Hanil hospital. The subjects with TSH abnormality were carried out test of T3 and T4.

Results : There were 4,649 men and 59 women in study population. According to area, subjects were distributed to 1,935 in rural area, 1,651 in small and medium cities and 1,122 in large cities. The number of subjects with TSH abnormality was 123 (2.6%) and the number of subjects with TFT abnomality among male was 32(0.7%). There was no statistically difference by age and sex, there was revealed as statistically significant higher rate in small and medium cities by area. The TSH was revealed as left skewed distribution. The normal ragne of TSH was 0.34~3.28mIU/L after log transformation and positive predictive value was 26%. After supposing sensitivity was 100%, specificity was etimated as 98.1%.

Conclusion : The prevalence of T3, T4 abnormality in Korea as similar as other countries was 0.7% and positive predictive value of T3, T4 abnormality by EIA methods was 26% that was low. Therefore it seems that there are restrictions in cost effectiveness as community screening test, although sensitivity and specificity were high.