Background
: Acute abdominal pain is one of the most common problems in the family practice but the differential diagnosis of acute abdominal pain is difficult in first encounter. When family physicians are encountered whit patients with acute abdominal pain in the ambulatory care settings, they have to make a decision for management of acute abdominal pain such as admission, referral, discharge or follow-up without any definite diagnosis. If it is possible to predict the course or prognosis of acute abdominal pain by using certain data about patients, it will be helpful to make a decision for the management of acute abdominal pain. So we tested the hypothesis that acute abdominal pain with intermittent pain nature and normal simple abdomen X-ray finding is not serious and shows favorable outcome.

Methods : 126 patients with acute abdominal pain were enrolled from Feb. to Aug. in 1995 at the emergency department of Kyungju hospital, Dongkuk University. 116 patients showed normal simple abdomen X-ray finding and among them 94 patients were discharged and 21 patients were admitted. 92 patients were contacted in 1 week by phone call and they reported the outcome of their acute abdominal pain.

Results : Among 92 study populations, 44 patients were male and 48patients were female. 72 patients complained intermittent abdominal pain and 21 patients complained continous abdominal pain. Frequencies of tentative diagnosis at emergency department were 45 acute gastroenteritis, 26 unknown, 14 functional gastointestinal disorders, 4 acute gastritis, 2 pelvic inflammatory diseases, and 1 ureter stone. Outcomes of patients with intermittent abdominal pain were more favorable than those with continous abdominal pain.

Conclusion : If the patients with acute abdominal pain have intermittent pain nature and normal simple abdomen x-ray finding, they will show favorable outcome and can be managed at ambulatory care settings.

Background
: The Helicobacter pylori(H. pylori) is associated with chronic gastritis and is now recognized to be the main factor in the pathogenesis of peptic ulcer disease. The eradication treatment of H. pylori significantly lowers ulcer relapse rate, which is accompanied by important histological change. We evaluated the prevalence of H. pylori infection in upper gastrointestinal diseases.

Methods : Total 491 patients(274 with chronic gastritis, 134 with gastric ulcer, 57 with duodenal ulcer, and 26 with gastrointestinal ulcer) were tested for H. pylori infection by the CLO test, hematoxylin-eosin stain and Giemsa stain.

Results : The prevalence of H. pylori infection was 74.0% in male and 58.6% in female. The prevalence of H. pylori infection was 73.2% in 30-59 year-old group and 60.2% in older age group. The sex and age adjusted prevalence of H. pylori infection was 64.7% in chronic gastritis, 69.4% in gastric ulcer, 84.5% in duodenal ulcer and 87.8% in gastroduodenal ulcer.

Conclusion : The prevalence of H. pylori infection of upper gastrointestinal diseases is significantly higher in male, 30-59 year-old group, peptic ulcer and duodenal ulcer than in female, older age group(over 60), chronic gastritis and gastric ulcer, respectively.

Background
: The elderly is known to have many different clinical laboratory data compared with the young adults. But, in Korea, such study is lacking.

Methods : We gathered 98 healthy elderly cases and 98 healthy young adult controls who have taken periodic heath examination from January 1993 to May 1996 at one hospital and we compared the mean of various clinical laboratory data between the two groups.

Results : In both sexes, cholesterol, ESR, glucose were significantly higher in the elderly than in the controls and direct bilirubin was significantly lower in the elderly than in the controls(P<0.05). In men, albumin, calcium, hemoglobin were significantly lower in the elderly than in the controls and MCV was significantly higher in the elderly than in the controls(P<0.05). In women, alkaline phosphatase, LDH, triglyceride, GOT, GPT, T₃, TSH, phosphate were significantly higher in the elderly than in the controls and total bilirubin, protein, uric acid were significantly lover in the elderly than in the controls(P<0.05).
WBC count, platelet count, neutrophil count(%), lymphocyte count(%), eosinohpil count(%), monocyte count(%), MCH, MCHC, BUN, creatinine, HDL were not significantly different between two groups.

Conclusion : Many clinical laboratory data are different between the elderly and the young adults, and some clinical laboratory data have sexual differences.

Background
: The red cell distribution width(RDW) has been reported to be of value in discriminating iron deficiency anemia(IDA) from the anemia of the other causes(non-IDA). The combination of a low MCV and a high RDW may indicate iron deficiency anemia. The purpose of this study was to discriminate IDA form anemia, using automated blood cell count alone.

Methods : We collected 139 cases of anemia in outpatients, with 80 cases of IDA and 59 case of anemia due to other causes, from July 1995 to September 1996 in department of family medicine, Pusan Paik hospital.

Results : The sex distribution was 39(28.1%) in male, 100(71.9%) in female. The age distribution was 15 to 79 year. The hemoglobin level and MCV in IDA(9.5±1.6g/dl, 77.5±8.9fl) was significantly lower than those in non-IDA(10.1±1.5g/dl, 87.6±10.5fl)(P=0.042, P<0.001, respectively). And mean RDW in IDA(16.9±3.3%) was significantly higher than that in non-IDA(15.1±3.2%)(P<0.001).
In discriminating IDA from anemia, we drew receiver operating characteristic curves(ROC curves) with each value of MCV and RDW. The cut-off value of MCV was 83fl, and in that value, the sensitivity and specificity were 75.9% and 72.9%, respectively. The cut-off value of RDW was 14.3%, and the sensitivity and specificity were 78.2% and 57.6%, respectively. We combined each value of MCV with RDW, the cut-off value were 83fl of MCV and 14.3% of RDW, and the sensitivity and specificity were 76.3% and 71.3%, respectively.

Conclusion : The sensitivity and specificity of MCV, RDW and combination of MCV and RDW were not so high in discriminating IDA from the anemia of the other causes in ambulatory patients.

Background
: Otitis media with effusion(OME) is a very common disease in pediatric age, However, a few literatures on epidemiologic study of otitis media with effusion are available in Korea due to the great variability of its diagnostic criteria and clinical features. The aim of this study is to provide the estimate of silent otitis media prevalence for preschool age.

Methods : The study population includes 329 children enrolled in 6 kindergartens in Kunsan city from April 1 to 10, 1995. Silent otitis media was diagnosed with otoscopy, pneumatic otoscopy and impedance audiometry by DANAC 40 model impedance audiometer from DANA JAPAN Co.

Results : The prevalence of silent otitis media with effusion was 14.5% and peak at 6 years of age(17.8%). The prevalence of silent otitis media with effusion according to sex were 11.8% in boys group, 17.9% in girls group. Nine cases(11.8%) involved bilaterally. Forty-three cases(89.6%) were asymptomatic cases.

Conclusion : Among 329 preschool children, the prevalence of silent otitis media with effusion was 14.5%. The prevalence by sex showed slightly higher in girls group than boys group. OME involved unilateral site mostly and subjective symptoms were rare.

Background
: Primary hepatocellular carcinoma(HCC) is the second cause of cancer death in our country. Hepatitis B virus(HBV) and hepatitis C virus(HCV) are important risk factors for hepatocellular carcinoma. The mechanism of HCC development and the epidemiology in HCV- infected individuals are still unclear. In this study, we investigated the epidemiolgical and chilnical features of HCC in relation to viral infection.

Methods : We reviewde the medical records of 160 HCC patients retrspectively who had been admitted to one University Hospital located in Seoul between January 1991 and December 1995. Among theses patients, 113 patients were positive for HBsAg(B group, 24 for anti-HCV(C group). We compared epidemiological and clinical data between B group and C group.

Results : Anti-HCV positivity was significantly higher in HBsAg negative patients than in HBsAg positive patients(53.3:17%, p<0.01). The mean age of patients in B group was significantly lower than that in C group(52:62yr, p<0.01). In C group, the proportion of Child-Pugh class B and C was significantly larger than that of B group(35.4:75.0%, p<0.01). In C group, the proportion of transfusion history was significantly larger than that in B group(4.4:16.7%, p<0.05), and the proportion of drug abuse hestory was significantly larger than that in B group(31.0:62.5%, p<0.01). In C group, the albumin, cholesterol, Gamma-glutamyl transferase leves were significantly lower than those in B group. In B group, the proportion of metastasis was significantly larger than that in C group(31.9:4.2%, p<0.01). Alpha fetoprotein levels greater than 400ng/ml are much more prevalent in group B significantly(67:39.1%, p<0.05). No significant differences in cumulative survival rate(1yr, 2yr) and median survival time were observed between the two groups.

Conclusion : We ascertain that the HBV and HCV are inportant factors in HCC. In epidemiology and clinical features of HCC, there were some difference between the HBsAg and anti HCV positive group. Therefore, on primary health care settings, it is necessary to test for hepatitis C as well as hepatitis B in order to prevent and manage HCC and chronic liver desease.

Background
: Majority of hypertension is essential in type, so its clear cue usually is not found , and the patients are tend to be persisted of psychopathy such as emotional tension, depression, anger, anxiety and psychologic conflict, also not to be adapted to stressful event. So we decide to survey the personality characteristics of essential hypertensive patients and factors of psychopathology.

Methods : Patient group-50 persons(male 23, female 27) are selected in the course of antihypertensive medication, being in or outpatient treatment at the dept. of F.M. or I.M. in Kae-jung, Dae-sung or Jung-ang Hospital from August 1, 1995 to July 31, 1996.
Control group- 52 persons(male 25, female 27) are selected. Exclusision criteria are any clinical disease hystory, over 140/90mmHg of BP, under 20-year-old age or no cooperation. We assessment of the MMPI, BDI and STAI results about both group.

Results : Comparing hypertensive group with normal control group, significantly higher F, Hs, D, Hy, Pd, Pt, and Sc scales of MMPI and BDI(p<0.01), and anxiety scale of STAI(p<0.05). There were no significant differences in all scales comparing between both sexs in the hypertensive and control groups, except comparing hypertensive male with hypertensive female in Pt scale(p<0.05) and control female with control male in Hy scale(p<0.05).

Conclusion : Comparing essential hypertensive group with normal control group, significant higher score was found in scales of Hypochondriasis, Depression, Hysteria, Psychopathic deviate, Psychasthenia, Schizophrenia and anxiety.
And in the treatment of hypertensive patient with antihypertensive drugs, appropriate additive psychotherapy appears useful in the case of revealing psychopathy.

Background
: In Korea, doctors are tend to prescribe digestive system drugs to the patients who have no digestive symptoms. The purpose of this study was to describe the prescription tendency toward digestive system drugs among residents of family practice.

Methods : Among outpatients who were consulted by residents of family practice in S hospital form Jan. 1995 to Jul. 1996, the patients without digestive symptoms were selected and their medical records were reviewed about prescribed drugs.

Results : The total number of eligible patients were 308. The number of residents who examined the eligible patients were 25 and they consulted average 12.3(S.D 5.1, range 5-21) patients. The proportion of patints who were given digestive system drugs was 43.2%. The proportions were 48.3%, 35.4% and 54.8% in patients who were examined by 1st, 2nd and 3rd grade reridents, respectively. There were no differences in the proportions between patients & sex groups, among patients & age groups, and also among groups of number of major drugs. The proportion was 58.6% in patients with common cold, 39.4% in patients with respiratory diseases other than common cold, 70.2% in patients with musculoskeletal diseases, 50.5% in patients with headache, 45.0% in patients with neurosis. The three most common categories of digestive system drugs were enzyme digestives, motility regulators and antacids. The proportion of total prices of digestive system drugs to total price of prescribed drugs was 19.8% in all patients and 36.3% in patients who were given digestive system drugs.

Conclusion : Residents of family practice in S hospital were tend to prescribe digestive system drugs to the patients who have no digestive symptoms and therefore there need more efforts to improve prescription behavior.

Background
: Pap smear is well known as a useful method for early detection of the cervical cancer and known to be widely performed by women. But the cervical cancer is the most common cancer in Korean women until now. So we surveyed to find out the status of women's practice and the result of Pap smear.

Methods : A questionnaire was filled up by the 270 women who had taken Pap smear from Jun to July in 1994 at the department of family medicine of Kyung Hee Medical Center. The family physician's gynecological findings at Pap smear and the results of Pap smear were obtained. After then we analyzed the data by SAS(Statistical Analysis System). The data which were not answered at each item were excluded in the analysis of each item.

Results : Among the 270 women, thirties were 98 persons(36.3%), forties were 115 persons(42.6%). The women who had never been taken Pap smear before were 34.6%. At the age performed Pap smear first, 30-39 years old was most common as of 39.8%. In the interval of Pap smear among the performed, 2 years interval was 36.8%, The medical facility usually being performed Pap smear was obstetrics and gynecological clinic as of 49.7%. At the opinion of interval which they think they should take Pap smear, the women answered that 1 year interval was appropriate were 50.7% and the opinions of the experienced group were statistically different from those of the non-experienced group(P<0.01). Gynecological findings showed normal in 74.8%, the cytological results of Pap smear showed class I as of 88.9%, class II 6.3%, class III 4.4% and class IV 0.4%.

Conclusion : Almost of them knew correctly the appropriate interval of Pap smear they should take, but the practice rate was very low. They had good results in the final cytological results of Pap smear, but the cervical cancer is the most common cause of cancer death in Korean women until now. So they should continuously get public informations and be educated to take Pap smear at the appropriate interval for the reduction of death due to cervical cancer.