Background
: The adequate and appropriate pain control for the terminal cancer patients which should have heen given is not simple matters to be accomplished. Because there was not enough accumulated experiences for the most of medical doctors through their residency training and they are not comfortable to give analgesics to terminally illed patients, particularly narcotics.
Therefore the author attempt to make actual method to use in paractive with analyzing the requirement of analgesics, the method how th give analgesics, the side reaction from narcotic analgesics and the cahracteristics of terminally illed cancer patients in order to make a suggest how th approach to the terminally illed patients, particularly narcotics.
Therefore the author attempt to make actual method to use in paractive with analyzing the requirement of analgesics, the method how th give analgesics, the side reaction from narcotic analgesics and the cahracteristics of terminally illed cancer patients in order to make a suggest how th approach to the terminally illed patient successfully.

Methods : A retrospective chart audit of analgesic type and amount was performed on the medical records of 100 terminal cancer patients who had been expired in the Holy Welfare Hospital from July 1991 through August 1993. Different typers and amounts of analgesics were converted to a common standard, and oral morphine equivalent(OME) relative to 1mg of oral morphine. Descriptive statistics were used to characterize patient analgesic use during the last 30 days and the last 5 days of life. Associations between analgesic use and select patient characteristics(age, sex, cancer site, metastasis, family life cycle, family type and pain intersity at the last 5 days of life) were explored.

Results : 1. The number of patients was 110, male, 60 cases(54.5%) and the female was 50 cases(45.5%) respectively.
2. 90% of 110 subjects had required analgesics to given at some time during terminal care. The 11 patients did not need any analgesics at all, 2 other patients did not need any analgesics during the last 5 days of life. However, 84.5% out of the all patients received narcotic analgesics at some time during the terminal course.
3. Most of the patients in this study used the long-acting form of oral morphine in regular basis and talwin was most frequently given alalgesics on an as-needed-basis. 61.7% of 99 subjects had been received analgesics by mouth during the last 30 days to the end of life and during the last 4 days, the requirement of pain killer by mouth had been decreased markedly to 54.6%. Parenteral and rectal route were prefered route of drug admistration as reach to the end of life.
4. The range of mean daily analgesics used was between 17.3 and 397.5 OMEs. The proportion of patients using analgesics increased while reach to death. The mean of daily requirement of analgesics longer than a month in duration was 73.6%mg(OME1) and the median was 58.0mg OMEs. During the last 5 days of life, the mean daily analgesic requirement was 79.5mg(OME2) and the midian was 61.5 OMEs. There was significant difference between OME1 and OME2(P<0.05).
5. OME2 was positively related with pain intensity at the last 5 days(P<0.05)/
6. OME2 was inversely related to age(r=-0.2978, P<0.01).
7. There were no statistically significant difference in OME2 by sex, staging, bone metastasis, family life cycle and family type.

Conclusion : The most of all terminally illed cancer patients acquired analgesics to take care of their terminal stage of life although there was some individual differences in the requirement of pain medication. Large and enormous doses of analgesics may sometimes be required to control cancer pain. To control apin properly was the one of important method th take care of terminally illed patient as breaking vicious cycle to pain-fear to death-depression, and preventing anxiety, hopelessness and give up dignity as a human being.
The side reactions from the analgesics ware not prominent as to avoid to give medication and those could be ignored.

Background
: Hypertension is the most frequent disease of chronic circulatory disease, and compliance is very important because the hypertensive patients should receive antihypertensive treatment as long as the condition exists. We studied the dropout reasons in hypertensive patients for better compliance.

Methods : We studied 85 dropout patients from 142 hypertensive patients registered to Department of Kyung Hee University family practice from June 1, 1992 to Dec 31, 1993. Dropout patients were difined the patient who didn't have any evidence of referral to another physician and the patient had not returned within 3 months after the expected date. The telephone survery was done to 73 patient among 85 patients for about 10 minutes and we used SPSS for Windows for statistical analysis.

Results : The general characteristics of subjects were as follows : 31.5% were male and 68.5% were female ; the most frequent age was age 41 to 60 and the mean age was 53.5±10.8 ; the patients had stage 1 hypertension(27.4%), stage2 hypertension(39.7%), stage 3 hypertension(26.0%), and stage 4 hypertension(6.8%). The mean period since the diagnosis of the disease were about 2 years and the most common complication was left ventricular hypertrophy. The total dropout rate was 59.9% and the dropout reasons by multiple response were as follows, the symptom is absent or improved(35.6%), long waiting time(35.6%), change to neiberhood pharmacy(26.0%), normalized blood pressure after treatment(24.7%), and busy daily life(20.5%)

Conclusion : To reduce the dropout of patients, we should develope multiple methods to achieve better compliance of hypertensive patients, especially to correct wrong attitude toward disease. Also, we should shorten the waiting time for outpatient visit, and make special consultation hours for the hypertensive patients.

Background
: As the average lifespan in human increases, women's concerns about osteoporosis and health promotion in post menopausal are increased. Osteoporosis causes the serious health problem in postmenopausal women. In order to investigate the women'sgnition about postmenopausal osteoporosis, we carried out this study.

Methods : We selected the patients who visited to Department of Family Medicine in Asan Medical Center from April to Septemer 1994. The questionnaire included demographic characteristics, sociocultural factors and questionnaire that are constructed to know the women's recognition of osteoporosis. At this study, the respondents were 300 women in this period, we excluded ambigeous data, we analyzed 232 questionnaires.

Results : The mean age of investigated 232 subjects is 40 years old. They were composed of 78(33.6%) postmenopausal womens and 154(66.4%) premenopausal women. Both groups answered subjectively recognition of osteoporosis. Among them, twelve women answered "wellknown" the osteoporosis(6%), and seventy three cases answered "unknown" the osteoporosis(37%), "moderately known" (59%).There were significant association between recognition of osteoporosis and their educational level. There were association between recognition of osteoporosis and economical level also. The respondents were asked whether thdy would be taking hormone replcement therapy to prevent and treat osteoporosis if they were recommended to do so. Twenty seven cases answered they would not take the hormone replacement therapy. The most common cause of refusal the hormone replacement theraapy is cancer or side effect of hormone replacement therapy(29.6%). The studied subjects were significantly less likely to be interested in taking hormone replacement therapy than non-hormonal therapy.(such as exercise, calcium, diet, vitamine agent)

Conclusion : We found that recognition level of postmenopausal osteoporosis is low and studied subjects prefer to non-hormonal agent than hormonal agent to prevent and treat of osteoporosis. The most common cause of refusal the hormone replacement therapy is that they worried about cancer or side effect of hormonal replacement therapy. We concluded that correct patient education for prevention and treatment of osteoporosis is needed.

Background
: MRI, being the latest diagnostic technique, is drawing interest from radiologists and clinical physicians. Its use is increasing day by day. In Korea MRI is usually useful in a general hospital. It is recently reported that primary physicians are increasing usefulness of MRI. This trend affect significantly Health Care System. Especially, cost and effectiveness is a matter of concern. In Korea it is absent report of usefulness pattern of Magnetic Resonance Imaging by primary care physicians. This paper examines primary care physicians knowledge, attitudes, and patterns of utilization about MRI.

Methods : From January 1,1994 to May 30,1994, of the registered 338 members of the Korean Association of Family Medicine Physicians in the Pusan, We choose 240 doctors of private clinics to be a part of our study. Questionaires were mailed to family medicine physicians. Our questionaires included 10 items of family medicine physicians kowledge, attitudes, and patterns of utilization about MRI.

Results : In or study 43.8% replied, and of those that replied 93 were men(88.6%), 12 were women(11.4%) and the mean age was 56.5 years old. 41.9% of the respondents cited that cost was the greatest factor that caused hesistancy to order an MRI as a diagnostic tool for patients. 42.5% of the respondents cited that are well known about MRI. 39% of the respondents cited that my unfamiliarity affects ordering of MRI. 41% of respondents felt that the usefulness of MRI was very important in their practice. Many respondents are not commentted about cost of estimates of MRI. 10.5% of respondents cited that 100,000won per MRI was the most reasonable price. 58.1% of respondents had MRI scans in medical practice and referred patients for MRI. The head region especially, 39.3%, the most number of scans had been taken.

Conclusion : About half of respondents of this paper indicated that MRI was useful to their practice. The cost problem causes hesistency of the ordering of an MRI. It is exhibited that family medicine physicians who made greater use of MRI are more well known about MRI and have positive attitude.

Background
: Low back pain ranks second only to upper respiratory illness as symptomatic reason for office visits to physicians. About 70% to 80% of adults have low back pain at some time. Plain lumber roentgenogram is ordered for diagnostic evaluation in most low back pain patients. This study was attempted to evaluation the effectiveness of plain lumbar roentgenogram in low back pain patient comparison with control group.

Methods : We gathered 210 patient cases as control group who have taken medical examination for complaints of low back pain from January 1992 to June 1994 at orthopedic department of Dong-A university hospital. There were excluded who have transferral or diagnosis or treatment from other hospital, Previous history of direct trauma, cancer, spine disease. The control group was 124 cases who have taken health examination during same time. We analized the medical records and results of L-spine series and analized physical findings in patient group additionally.

Results : The selected subjects were composed 89 male, 121 female in patient group and 69 male, 55 female in control group by sex. 4th decade and 5th decade of patient and 5th decade of control group are most common age group. Disc space narrowing of 4th decade and spondylolysis of 5th decade of patient group are significantly higher than the control group only. Osteophyte and posterial ridging of patient group was higher than the control group but statistically not significant. Scoliosis, straightening, demineralization, sclerosis, spina bifida between two group. Osteophyte and sclerosis was more frequent in old age. According to physical findings comparison with radiologic findings, claudication was significantly higher in who hvae osteophyte. Neurologic abnormalities of lower legs and positive SLRT were significantly higher in who have disc space narrowing. Claudication was significantly higher in who have demineralization. Postitive SLRT and claudication was significantly higher in who have sclerosis. Positive SLRT and claudication was significantly higher in who have poste ridging.

Conclusion : Plain lumbar roentgenogram was few informations about cause and diagnosis of most simple low back pain patiens who have never exprienced direct trauma, cancer, spine disease, especially. Careful physical examination is needed for diagnostic appraoch of low back pain patients.

Background
: Alcoholics have been increased realistically, but the cause of withdrawal symptoms is not established. The role of magnesium has been claimed, therefore, we intends to see the relation of serum magnesium with alcohol withdrawal symptoms in this study.

Methods : The one hundred fifteen patients were cohsen, who were diagnosed as alcohol dependence in Alcohol clinic department of Dae Jeon Hani I1 Hospital from 1993. 10. 1 to 1994. 9. 30. The symptoms of selected patients were classified by DSM Ⅳ classification of alcohol withdrawal, and then compared with serum magnesium concentration at admission.

Results : The mean serum magnesium concentration of total 115 patients was 1.99±0.39 eEq/L. Among them, 61(53%) patients show sweating, 6(55.7%) tremor, 25(21.7%) delirium tremens, 26(22.6%) hallucination, 64(55.7%) agitation, and 24 patients(20.9%) have no withdrawal symptom. According as existence and/or nonexistence of withdrawal symptom, the difference of serum magnesium concentration was noted. The mean magnesium concentration of withdrawal symptom group is 1.90±0.31mEq/L, on the other hand, nonwithdrawal symptom group is 2.34±0.32eEq/L. As to magnesium concentration of each withdrawal symptom, sweating group is 1.79±0.27mEq/L, tremor group 1.84±0.36mEq/L, delirium tremens group 1.74±022mEq/L, hallucination group 1.83±0.39mEq/L. agitation group 1.89±0.38mEq/L, and so, the significant difference between symptom and nonsymptom group was seen.

Conclusion : The relation of serum magnesium concentration with alcohol withdrawal symptoms was observed, therefore, we guess the role of magnesium for alcohol withdrawal. Our study suggests that the active study and application of magnesium for the treatment of alcohol withdrawal may be required.

Background
: Aseptic meningits is caused, for the most part, from viruses. Reports say that over 85% of its cause is from enterovirus and some of the rest from arbovirus, mumpsvirus, herpes simplexvirus, etc. Due to well-developed antibiotics, most recently, the proportion of aseptic meningitis to all meningitis has showed a rise trend, so that high contrat rate still has been proved epidemic in accrdence with causative viruses. Thereupon, we experienced 120 cases diagnosed aseptic meningitis among the patients who were hospitalized at the pediatric deparment, Jeong Eup Hospital, Asan Foundation, Jeon Ra Peuk Do in the middle of 1993, so we report the clinical observation and the literature on the subject.

Methods : While working as the pediatric chief physician, We wrote examination reports and medical affairs records about the 120 cases diagnosed aseptic meningitis based on clinical findings and negative fidings on CSF Gram & AFB stain & culture with sensitive test among the patients hospitalized numerously in this area. Age and sex distribution, attack frequency in date, duration between onset of symptom and admission, duration of fever and admission, laboratory findings, clinical prognosis, and therapeutic result were analized based on the above mentioned examination reports and medical affairs records.

Results : Aseptic meningitis in this area broke out numerously to be bimodel during the middle third and the last third of May and during the middle third and the last third of June. The rate of concurrent attack in family was 8 famillies among 112 families(7.1%). The rate of male to female was 1.7:1, so male was found to be vulnerable. Most common age was 1~5 years(46.7%h, main clinical ymtom was fever(98.3%), headache(47.5%), nausea(46.7%), pain on lower extremity(24.2%), pain on neck(22.5%), and skin rash(17.5%) in order. With peripheral blood laboratory findings, 52% of 120 cases had 10,000/mm³ or more of WBC which is called leukocytosis. 50% were found to keep 60% or more of neutrophils on percentage of WBC, 54.2% kept 40% or less of lympocytes, 74.2% showed 20 mm/hr or more of ESR, and 27.5% showed positive in CRP. In addition, with CSF, 44.2% showed 500/mm³ or more of WBC, to our suprise, 17.5% showed 1,000/mm³ or more of WBC, 90% of former example showed lymphocytosis. 15% showed 40mg/dl or more of protein which was increased level, only 2.5% showed 40mg/dl or less of sugar with which almost all were normal. The average duration between onset of initial symptom in which fever is primary symptom and admission was 3.8days. Becasuse the average duration of hospitalization was 13.5 days, we estimated that the average febile duration of aseptic meningitis is about 8 dyas and therapeutic duration is about 17 days.

Conclusion : Almost all aseptic meningitis patients who had clinical symptom of fever, headache, vomiting, abdominal pain, etc and showed WBC(especially lymphocyte) increment on CSF, proved normal in sugar, but protein was increased with 15%, With fluid replacement and bed rest using symptomatic care, antipyretics and antibiotics to prevent secondary infection, the patients were cured completely without complication.