Background
: The previous studies suggested that the rate of the people who reported having sensitivity to cold and Raynaud's disease were 12% and 5∼10% of general population respectively. There are surprisingly few data on 'cold hands and feet syndrome', the conventional circulatory disorder in far-eastern Asia in spite of the assumption that it is a common disorder among Korean population. Besides, the prevalence of Raynaud's disease has not been studied for Korean complaint of the syndrome. Therefore, we conducted the survey regarding the frequency of Baynaud's disease and phenomenon among the people appealed abnormal sensory symptoms on hands and feet, and 'cold hands and feet syndrome'.

Methods : The questionnaires were asked to 1,008 out- patients who complained abnormal sensory symptoms on hands and feet. The subjects were screened among the patients who visited the clinics, mainly department of family medicine in Uijongbu St. Mary's hospital from January to July 2003.

Results : The most common abnormal sensory symptoms were tingling feeling and coldness, pain in the descending order. The mean age of the patients is 47 years, the average age at the onset of the symptoms is 40 years, and the mean duration they had been suffered by the symptoms is 7 years. During interview, 289 patients voluntarily appealed 'cold hands and feet syndrome' in expression of "I have cold extremities" or "I have the syndrome". Among the screened patients, 510 patients answered, "yes" to the question "Are your fingers unusually sensitive to cold?" Two hundred and nineteen patients (43%) of them showed Raynaud's phenomenon. One hundred and sixty patients were diagnosed as Raynaud's disease among 219 patients who had Raynaud's phenomenon. The rest 59 patients were diagnosed as secondary Raynaud's phenomenon. Eighty-seven patients (30%) of 289 patients who voluntarily reported 'cold hands and feet syndrome' were diagnosed as Raynaud's disease. The average age of Raynaud's disease patients is 37 years old, average first attack age is 24 years, and average suffering period is 14 years. Only 10% of cases experienced the first attacks after 40 years old. The attack rates are different by gender. The ratio is 2.3 and higher in female. Only six patients (4%) of Raynaud's disease had been diagnosed accurately. Fifty-three patients (33%) have family history and 41 of them are the first-degree relatives. The causes of secondary Raynaud's phenomenon (59 patients) are connective tissue disorders, neurologic diseases, carpal tunnel syndrome, hypothyroidism, vascular disorders, etc. The statistically significant factors that influence on Raynaud's disease are female, below 40 years old, stress, family history, hypertension, diabetes, etc. The statistical analysis in this study does not prove the association between the disease and the factors such as physical labor, manual labor using hands heavily, smoking, drinking, thyroid diseases, joint disorders, ischemic heart disease, depression.

Conclusion : Raynaud's disease has been underlooked even though it is not uncommon and can be easily diagnosed and treated. In conclusion, the result of our study suggests that abnormal sensory symptoms on hands and feet, especially 'cold hands and feet syndrome', the conventional circulatory disorder, are the medical condition where special concern on Raynaud's disease is required.

Background
: Most recently, there is an increased use of EGD (esophagogastroduodenoscopy) for primary care among family physicians, which tends to promote EGD training programs in the course of Family Practice Residency. This study determined to survey current status of EGD training programs among residents in family medicine, identify relevant problems, and present some suggestions for their improvement.

Methods : The subjects were residents selected among family medicine training hospitals, which were registered in the KAFM (Korean Academy of Family Medicine). The residents were in their 3rd year of training or had already completed the EGD training program. Surveys were sent out to those hospitals by mail and electronic mail surveys were performed by researchers.

Results : Among 66 subject hospitals a total of 27 surveys (40.9%) were returned. Most EGD training were performed in the department of internal medicine. The mean duration of training period was 8 weeks. The averale number of hands on experience of the procedure was 62. It was found that most residents thought that EGD training period and the number of hands on experience of the procedure were insufficient. The longer period of actual experience of the procedure and the more number of EGD caseloads they had, the more they were satisfied with their EGD training programs. It was also found that there was a high demand for a follow-up learning opportunities for EGD (p＜.05), because the residents who had already had many EGD caseloads further wanted to receive continuous education even, after they acquired license. There were no relationships observation period, period of actual experience of the procedure, and number of EGD caseloads during residency with demand for follow-up learning opportunities.

Conclusion : In summary, there was insufficient EGD training period and actual experience of the EGD procedure in family practice residency. There was low satisfaction of EGD training programs and high demand for continuous education. Therefore, it is recommended to establish EGD training program, proper practice training, and regular continuing education after completing residency.

Background
: The burden of cardiac complications during endoscopy are growing due to increasing proportion of elderly in the endoscopy target population. This study was conducted to examine the blood pressure changes before and after the endoscopy and to seek better pre-treatments in minimizing cardiac complications.

Methods : One hundred subjects were chosen by consecutive sampling who visited a general hospital for physical examination. Basal, pre-endoscopic, immediate post-endoscopic blood pressure and blood pressure after 10 and 30 minutes were measured utilizing manual BP cuffs and recorded.

Results : The subjects included 34 hypertensive patients. Twelve subjects were on anti hypertensive medication. In 5 consecutive measurements, significant variations on blood pressure was noted (P＜0.01). Blood pressure kept increasing until immediately after the procedure, followed by a gradual reduction. These changes were observed in both the normotensive and the hypertensive group, but the degree of changes were more pronounced in the hypertrensive group than the normotensive group (P＜0.01). The difference between basal and after procedure was 17.6 mmHg for systolic, 13.5 mmHg for diastolic in the normotensive group. However in the hypertensive group, the difference was 21.4 mmHg for systolic, 14.8 mmHg for diastolic. In comparison of medicated and non-medicated group in the hypertensive patients, the degree of changes were marginally, but significantly lower in the treatment group than in the non-treatment group (systolic P=0.056, diastolic P=0.049).

Conclusion : The stress during endoscopy resulted in blood pressure changes, and the degree of changes was higher in the hypertensive group than the normotensive group. In the hypertensive group, the degree of changes was lower in patients treated with anti hypertensives than the non-treated patients. This sample size, however, was small.

Background
: The purpose of this research was to compare one hospital family practise residents' diagnostic and therapeutic behavior with a Dupont et al¹⁾ described Guidelines on acute infectious diarrhea in adults and HARRISON'S PRINCIPLES OF INTERNAL MEDICINE 15th edition's algorithm for the management of acute diarrheal patients.²⁾

Methods : From March 1, 2003 to April 30, 2003, we reviewed 82 acute diarrheal patients (3.19% of the total patients) who had visited one hospital's emergency room which was located in Jeonju district. Doctor's diagnostic and therapeutic approaches were reviewed on the basis of history and physical exam. Then we compared with the standard algorithm referred above.

Results : Inpatients were 36.6% (30 patients) among the total of 82 and 63.4% (52 patients) returned home after symptomatic treatment. Among the 52 return home patients, doctors did not entirely conduct stool exam. Among the 30 hospitalized patients, doctors conducted stool exam in 25% among 4 of 16 high fever patients, in 25% among 2 of 8 moderately dehydrated who had diarrhea more than 10 times per day, and in 60% among 6 of 10 patients whose symptom duration was more than 48 hours. Doctors did not use antibiotics in 76.9% (40 patients) of 52 return home patients. Quinolone and Augmentin tablets were administered to each 6 patients of 12 return home patients. Among the 30 inpatients, Augmentin injection were given to 80% (24 patients) and second-generation cephalosporin with aminoglycoside combination injection to 13.3% (4 patients) and quinolone injection to 6.7% (2 patients).

Conclusion : Compared with standard algorithm, doctors neglected testing stool examination that may be the most important way to diagnose the specific etiology of acute diarrhea. If we actively utilize the stool exam, it may help in providing the correct diagnosis and suitable treatment.

Background
: There are conflicting reports on the effect of subclinical hypothyroidism on plasma lipid concentrations and blood pressure. This may be due to lack of consideration for menopause status or hormone replacement therapy (HRT) in selecting the study subjects. Also, the reason may be that many subjects with transient abnormality were included in those studies. Therefore, we intended to include the subjects who satisfied the definition of subclinical hypothyroidism on repeated measures. Then, we investigated the difference of plasma lipid concentrations and blood pressure between subclinical hypothyroidism and normal control subjects.

Methods : This study involved the women above age 18, who visited a health promotion center in a general hospital and measured their serum TSH and free T4, from January 1997 to May 2003. The number patients who satisfied the definition of subclinical hypothyroidism on repeated measures, and who had no history of thyroid disease, herb medication or HRT, diabetes, abnormalities of liver and renal function were 30. Age, menopause, body mass index-matched people of 65 were selected as normal controls. Serum TSH, free T4 and plasma lipid concentrations were measured by chemiluminescent assay and enzyme method, respectively. Dyslipidemia were defined according to NCEP ATPIII guidelines.

Results : There was no significant difference of blood pressure and plasma lipid concentrations between subclinical hypothyroidism patients and normal controls irrespective of menopause. There was no significant difference of percentage of dyslipidemia and hypertension between the two groups.

Conclusion : There were no significant increase in plasma lipid concentrations and blood pressure in subclinical hypothyroidism patients despite more strict inclusion.

In foreign country, lots of studies were reported about the relationship between heart rate variability (HRV) and cardiac mortality. Lower HRV has been identified as a independent risk factor for sudden death. By the time, the study of HRV is confined to physically diseased state such as myocardial infarction or diabetic neuropathy. However recently the tendency of HRV has been toward to make clear the relationship of HRV and psychological problem. It is well known that depressed person is affected frequently by cardiovascular disease compared with normal people. However the mechanism that depression increases cardiovascular disease is not definitely found even though the autonomic dysfunction measured in HRV is suggested a factor for this mechanism. Depressed person has decreased HRV, decreased low frequency which reflects sympathetic activity, decreased high frequency which reflects parasympathetic activity. It means they have lower autonomic activity, so they have high cardiac mortality.

Few physician knows about the utility of heart rate variability and in my thought, especially short time analysis and frequency domain method is first introduced in Korea.

So we introduce this case for as many as physician know the utility of HRV.