Journal of Yeungnam Medical Science

Volume 12(2); December 1995

Reviews

Magnetic Resonance Imaging of Uterine Mass.: Bok Hwan Park; Yeungnam Univ J Med. 1995;12(2):163-177. Published online December 31, 1995; DOI: https://doi.org/10.12701/yujm.1995.12.2.163

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Abstract PDF: No abstract available.

Ovum Donation.: Tae Hyung Lee; Yeungnam Univ J Med. 1995;12(2):178-190. Published online December 31, 1995; DOI: https://doi.org/10.12701/yujm.1995.12.2.178

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Abstract PDF: No abstract available.

Original Articles

Diagnostic Values of Abdominal Ultrasonograpy in Patients with Fever and Abdominal Symptoms.: Mi Kyung Lee, Chang Sung Im, Sun Mi Ahn, Chang Hi Kim, Dong Jin Lee, Joong Hyuck Kwan, Yong Hoon Park; Yeungnam Univ J Med. 1995;12(2):191-202. Published online December 31, 1995; DOI: https://doi.org/10.12701/yujm.1995.12.2.191

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Abstract PDF: PURPOSE: Acute febrile illness in children frequently accompanies with abdominal symptoms such as vomiting, diarrhea, and abdominal pain, even if its etiology is not occured from the gastrointestinal tract. If the etiology of fever was unknown and the fever was accompanied with abdominal symptoms, we should be concerned about whether the etiology of fever was originated from the gastrointestinal tract or interpretated from the abnormality in the gastrointestinal tract. This study was performed to evaluate the diagnostic value of abdominal ultrasonography in patients with fever and abdominal symptoms. METHODS: We reviewed retrospectively the medical records of abdominal ultrasonographic (US) findings of 60 cases of acute febrile illness with abdominal symptoms at department of Pediatrics, Ulsan Dongang General RESULTS: (100%), splenomegaly in 4 cases (66.7%), ileocecitis in 1 case (16.7%), enlarged mesenteric lymph nodes and splenomegaly in 4 cases (66.7%), enlarged mesenteric lymph nodes, splenomegaly and ileocecitis in 1 cases (16.7%). 6) The enlarged mesenteric lymph nodes and the abnormalities around the appendix were seen in 7 cases (11.7%), which were confirmed as appendicitis all. 7) The thickening of wall in urinary bladder was seen in 2 cases (3.3%) of acute cystitis and acute hemorrhagic cystitis. 8) The subtle thickening of wall in colon was seen in 1 cases (1.7%) of shigellosis. CONCLUSIONS: The enlarged mesenteric lymph nodes, splenomegaly and ileocolitis on the abdominal ultrasonography in patients with fever and abdominal symptoms aree suggestive findings of typhoid fever. The enlarged mesenteric lymph nodes and the abnormalities around the appendix on abdominal ultrasonography make the rapid diagnosis of acute appendicitis and its complications, when physical examination is difficult in small children and diagnosis of their illnesses is obscure in patients with fever and abdominal pain.

Treatment Planning Correction Using MRI in the Radiotherapy of Cervical Cancer.: Se One Shin, Kil Ho Cho, Chan Won Park; Yeungnam Univ J Med. 1995;12(2):203-209. Published online December 31, 1995; DOI: https://doi.org/10.12701/yujm.1995.12.2.203

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Abstract PDF: PURPOSE: To evaluate the role of MRI in the management of cervical cancer treated by conventional four-field whole pelvic irradiation. METHOD AND MATERIAL: Between 1993-march and 1994-february, 20 patients(4 Stage I B, 3 Stage U A, 13 Stage U B) with invasive cervical cancer were eligible for evaluation of accuracy of conventionally designed lateral treatment field without MRI determination. RESULTS: 5 out of 20 Patients had inadequate margin without MRI. The position of uterine fundus was more important than cervix in correction of field size and the center of treatment field. CONCLUSION: This Preliminary date show MRI determination of uterine position prior to radiotherapy planning is essential in the case of four-field whole pelvic irradiation technique.

Expression of Oncogene Product in the Colorectal Carcinoma.: Young Ran Shim, Woo Young Jang, Kyoung Chan Choi, Joon Hyuk Choi, Won Hee Choi, Min Chul Shim; Yeungnam Univ J Med. 1995;12(2):210-225. Published online December 31, 1995; DOI: https://doi.org/10.12701/yujm.1995.12.2.210

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Abstract PDF: The expression of p62"' and p2l can be seen in many solid tumor, but the pattern and incidence of expression were different according to organ, countries, and examiners, thus it is not definitely defined. Total 67 colorectal carcinoma in paraffin sections are analysed by immunohistochemically for evaluation of the p62and p21- expression according to the age, sex, chief complaints, location, differentiation, modified Dukes stage, using the specific monoclonal antibodies. The results were summarized as follows : The age of patients ranged from 32 years to 82 years. The mean age was 57.6 years. The expression of p 62y' and p21 was not correlated with age. Male was 29 cases(43.3%) and female was 38 cases(56.7%). The male to female ratio was 1:1.31. The and 95.0% in moderately differentiated adenocarcinoma, 90.0% and 90.0% in poorly differentiated <,;, adenocarcmoma, 100.0% and 100.0% in mucinous carcinoma. The positive rate of p62!and and p2l' was 94.1% and 88.2% in Dukes stage B,, 96.0% and 96.0% in Dukes stage B,, 100.0% and 100.0% in Dukes stage C,, 100.0% and 88.9% in Dukes stage C, and 100.0% and 100. o% in Dukes stage D. The expression of p62 y' in metastatic colorectal carcinoma showed diffuse and strongly positive reaction than primary colorectal carcinoma. The expression of p21 in primary colorectal carcinoma showed diffuse and strongly positive reaction than metastatic colorectal carcinoma.

CT Findings of Bronchogenic Cyst: Hyun Cheol Cho, Yong Woo Lee, Mi Soo Hwang, Kil Ho Cho, Woo Mok Byun, Jae Ho Cho, Jae Chun Chang; Yeungnam Univ J Med. 1995;12(2):226-236. Published online December 31, 1995; DOI: https://doi.org/10.12701/yujm.1995.12.2.226

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Abstract PDF: We studied to evaluate CT characteristics of bronchogenic cysts. We retrospectively evaluated CT of 11 patients with pathologically proved bronchogenic cyst. Precontrast and postcontrast CT scan was performed in all. We analyzed CT with viewpoints of location, size, attenuation on pre- and postcontrast scan, and calcification. Three of 11 bronchogenic cysts were intrapulmonary in location and eight were located in the mediastinum. Two of 3 intrapulmonary bronchogenic cysts were located in the right lower lobe, and the remaining one was left lower lobe. Intrapulmonary bronchogenic cysts ranged from 6cm to 12cm in diameter (average, 9.7 cm). On Cr, intrapulmonary bronchogenic cysts appeared as thin-wall air cyst, homogenous water attenuation and soft tissue attenuation with air bubble respectively. Mediastinal bronchogenic cysts were located in posterior mediastinum (n=5), superior mediastinum (n=2), middle mediastinum (n=1) respectively. These cysts ranged in size from 3cm to 8cm in diameter (average 5.0 cm). On CT, five showed homogenous water attenuation, two soft tissue attenuation similar to that of muscle, one air-fluid level. Calcification or contrast enhancement was not detected in any cases. On operative findings, all of intrapulmonary bronchogenic cysts contained dirty pus-like material and all of mediastinal bronchogenic cysts contained whitish or yellowish mucus material. Bronchogenic cysts showed homogenous water density in many cases, homogenous soft tissue density, air-fluid level and air-filled cyst. The constellation of CT findings may be helpful in the diagnosis and Differentiation of bronchogenic cyst.

Cloning and Sequencing of the phoA Gene which is Regulated by the phoP-phoQ operon in Pathogenic Enteric Bacteria.: Sung Kwang Kim, Tae Yoon Lee; Yeungnam Univ J Med. 1995;12(2):237-245. Published online December 31, 1995; DOI: https://doi.org/10.12701/yujm.1995.12.2.237

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Abstract PDF: The DNA fragment containing the phoA of Klebsiella pneumoniae was cloned into pACYC184. The size of the insert. was 4.0 kb and the restriction map showed it contained 3 Pstl sites and 4 PvuLI sites. The nucleotide sequence of the phoA region was determined, which showed strong (80%) sequence similarity with that of Escherichia coli. This suggested that these two species are phylogenetically very close to each other.

Effect of Baclofen on the Cholinergic Nerve Stimulation in Isolated Rat Detrusor: Kwang Youn Lee, Keun Mi Lee, Eun Mee Choi, Hyoung Chul Choi, Jeoung Hee Ha, Won Joon Kim; Yeungnam Univ J Med. 1995;12(2):246-259. Published online December 31, 1995; DOI: https://doi.org/10.12701/yujm.1995.12.2.246

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Abstract PDF: This study aimed to investigate the mechanism of action of baclofen on the detrusor muscle isolated from rat. Rats (Sprague-Dawley) were sacrificed by decapitation and exsanguination. Horizontal muscle strips of 2 mm × 15 mm were prepared for isometric myography in isolated muscle chamber bubbled with 95% / 5%-OZ / CO2 at 371C, and the pH was maintained at 7.4. Detrusor strips contracted responding to the electrical field stimulation (EFS) by 2 Hz, 20 msec, monophasic square wave of 60 VDC. The initial peak of EFS-Induced contraction was tended to be suppresed by α,β-methylene-adenosine 5'-triphosphate (mATP), a partial agonist of purinergic receptor, and baclofen, a GABAB receptor agonist (statistically nonsignificant). The late sustained contraction by EFS was suppressed significantly (p<0.05) by additions of atropine, a cholinergic muscarinic receptor antagonist and baclofen. The adenosine 5'-triphosphate-induced contraction was completely abolished by mA TP but not by baclofen. In the presence of atropine, the subsequent addition of acetylcholine could not contract the muscle strips: but the addition of acetylcholine in the presence of baclofen evoked a contraction to a remarkable extent. These results suggest that in the condition of present study, the cholinergic innervation may play a more important role than the purinergic one, and baclofen suppresses the contractility of rat detrusor by the stimulation of the GABA receptors to inhibit the release of neurotransmitter from the cholinergic nerve ending

Effect of Intracarotid Cold Saline Infusion during Cerebral ischemia on Brain Edema in the Rabbit: Sae Yeon Kim, Kyu Taek Choi; Yeungnam Univ J Med. 1995;12(2):260-268. Published online December 31, 1995; DOI: https://doi.org/10.12701/yujm.1995.12.2.260

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Abstract PDF: Ischemia results when the decrease in tissue perfusion exceeds the tissues ability to increase an oxygen extraction from the blood. Brain edema has been defined as an abnormal accumulation of fluid within brain parenchyma associated with a volumetric enlargement of the brain tissue. In most instances, the labelling of edema as vasogenic or cytotoxic is only relative. For cerebral protection, there were many possible techniques which could increase or maintain cerebral perfusion and reduce cerebral metabolic demand for oxygen. This study was carried out the effect of mild Brain hypothermia which was induced by infusion with cold saline into the carotid artery, during brief episodes of transient global ischemia on postischemic brain edema in rabbit. Eight rabbits were anesthetized with halothane and mechanically ventilated with oxygen. For isolated cerebral perfusion, polyethylene catheter was inserted left carotid artery for infusion of cold saline, external carotid artery was ligated, vertebral arteries were cauterized, right carotid artery was snared for ischemia and femoral artery and vein were also cannulated for monitoring and drug treatment. At 3 hours after transient global ischemia, specific gravity of cerebral cortex and hippocampus was compared with no-perfusion group, perfusion with cold saline group and normal group. There was no significant differences in physiologic variables among the groups before transient global ischemia. But during transient global ischemia, brain temperature of perfusion group was decreased when compared to no perfusion group. Specific gravity of cerebral cortex and hippocampus of no-perfusion group and perfusion group was statistically significant when compared to normal group (p<0.01). The results of this study suggested that mild brain hypothermia with intracarotid cold saline infusion during brief episodes of transient global ischemia had decreased postischemic brain edema in rabbit.

Effect of Persistent Mild Hyperglycemic Hyperinsulinemia on Development of Insulin Resistance in Rats: Yong Woon Kim, Jin Hyun Park, So Young Park, Jong Yeon Kim, Suck Kang Lee; Yeungnam Univ J Med. 1995;12(2):269-281. Published online December 31, 1995; DOI: https://doi.org/10.12701/yujm.1995.12.2.269

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Abstract PDF: The effect of persistant mild hyperglycemic hyperinsulinemia on the development of the insulin resistance in rats was studied in vivo. Also, the characteristics of the insulin resistance compared with the insulin resistance of STZ diabetic rats. Persistant mild hyperglycemic hyperinsulinemic rat model was produced by ingestion of glucose polymer for 8 days. The glucose disappearance and infusion rate was measured by hyperinsulinemic euglycemic clamp to"Imique at steady state of blood glucose and insulin levels. The clamped level of blood glucose was 100 mg/dl, and the clamped levels of insulin were 70 pU/ml (physiologic condition) and 3000 pU/ml (supramaximal condition). Hepatic glucose producticon rate was calculated using measured data. And the glycogen synthetic capacity of skeletal muscle (soleus) and liver was measured after 2 hours of hyperinsulinemic euglycemic clamp study. The glucose disappearance and glucose infusion rate in glucose polymer group was decreased in the both physiological and supramaximal insulin level compared to the rate of the normal control group. The rate of STZ diabetic group was lowest at supramaximal insulin level among two another experimental groups. The hepatic glucose production rate of glucose polymer group was decreased compared to normal control but increased in STZ diabetic group. The glycogen synthetic capacity of skeletal muscle and liver of glucose polymer group was not significantly different from normal control group, but it was markedly decreased in STZ diabetic group. These results suggest that persistant mild hyperglycemic hyperinsulinemia may induce insulin resistance, but glycogen synthetic capacity is intact.

Comparision of Heoatitis B Virus Markers in the Serum and the Cerebrospinal Fluid: Sang Dug Suh, Seong Min Kim, Jun Lee, Gun Ju Park, Hyun Cheol Do, Yeung Ju Byun; Yeungnam Univ J Med. 1995;12(2):282-291. Published online December 31, 1995; DOI: https://doi.org/10.12701/yujm.1995.12.2.282

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Abstract PDF: We investigated HBV markers in serum and cerebrospinal fluid of 50 subjects with neurologic disorders or other disorders, who visited Dept. of neurology, college of medicine, Yeungnam University, from April-1 to August-31 1994 and were performed cerebrospinal fluid analysis to investigate the detection rate of HBV markers in cerebrospinal fluid and the possibility of neurologic disorders associated with HBV infection. The results were as follows. The positivity of HBsAg and. HBV prevalence rate in serum were 6 (12.04) and 37 (74.0%). Thf, number of patient with HBsAg, only anti-HBV and no markers were 6 (12.0%), 31 (62.0%) and 13 (26.0%), respectively. The positivity of HBsAg and HBV prevalence rate in cerebrospinal fluid were 3 (6%) and 18 (36.0%). The number of patient with HBsAg, only anti-HBV and no markers were 6 (100.0%), 12 (38.7%) and 0 (0.0%) respectively. The number of patient with virus associated diseases (VAD) and non virus associated diseases (NVAD) were 26 (52%) and 24 (48%). The HBV prevalence rate in serum of VAD and NVAD groups were 88.5% and 58.3% (p<0.05). The HBV prevalence rate in CSF of VAD and NVAD groups were 53.8% and 16.7% (p<0.05). The HBV prevalence rate in serum and CSF of VAD and NVAD groups were 60.9% and 28.6%. As a conclusion, the HBV markers in the CSF were partially detected at the presence of the HBV markers in serum. The prevalence rate of HBV in the CSF was increased at the HBsAg positive in the serum and the CSF was significantly increased at the VAD group than the NVAD group

Development of the Korean Form of Zung's Self-Rating Depression Scale.: Jung Hoon Lee; Yeungnam Univ J Med. 1995;12(2):292-305. Published online December 31, 1995; DOI: https://doi.org/10.12701/yujm.1995.12.2.292

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Abstract PDF

This study was carried out to develop a Korean language version of Zung's self-rating depression scale (SDS). The subjects consisted of 173 males and 161 females drawn from various groups of the general population by a cluster of sampling methods. In order to analyze the data on depression scores, Pearson's product moment correlation coefficient method was carried .out, as well as reliability and factor analysis, by the SPSS/PC+ program. The results obtained were as follows: The mean average of the total depression scores were 40.60. 8.66 for the subjects. Thirty-seven subjects (11.1%) showed high depression scores of 50 or over. Test-retest reliability(coefficient r=0.82, p <0.001), internal consistency(coefficient r=0.84, p <0.001) were satisfactory. Factor analysis using oblique technique rotation yielded five factors. The items of confusion, indecisiveness, decreased libido, diurnal variation, and psychomotor retardation were scored higher by the subjects. The items of suicidal rumination, psychomotor agitation, constipation, irritability, and weight loss were scored lower.

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The Factors Related to Intractability in Patients with Partial Epilepsy.: Yeung Ki Lee, Yeing Ju Byun, Mee Yeong Park, Jung Sang Hah, Se Jin Lee; Yeungnam Univ J Med. 1995;12(2):306-318. Published online December 31, 1995; DOI: https://doi.org/10.12701/yujm.1995.12.2.306

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Abstract PDF: To evaluate the intractability of partial epileptic patients by variables, the author studied 113 patients (uncontrolled: 45, controlled: 68) who were admitted to the Department of Neurology, College of Medicine, Yeungnam University from January, 1991 to August, 1993. The results were as follows. The items related to complex partial seizures, multiple seizure types and a histories of status epilepticus or clusters of seizures were significantly associated with drug-refractoriness (p<0.01). A high frequency of seizures before evaluation was associated with a poor outcome(p<0.01). The presences of known etiology of seizures, neurologic abnormalities and psychiatric disturbance were associated with limited treatment responses(p<0.01, p<0.05, p<0.01). An abnormal EEG findings such as background slowing, focal slowing, epileptiform discharges or secondarily bilateral synchrony were statistically significant (p<0.01). Age at onset, sex, distribution of epileptic foci, duration of seizure before evaluation, family history and abnormal neuroradiologic findings were not statistically significant. By these results, it was suggested that having at least four factors of the above variables were associated with limited treatment response.

Insulin Resistance in Late Pregnant Rats.: Myung Heup Chun, Yong Woon Kim, So Young Park, Jong Yeon Kim, Suck Kang Lee; Yeungnam Univ J Med. 1995;12(2):319-330. Published online December 31, 1995; DOI: https://doi.org/10.12701/yujm.1995.12.2.319

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Abstract PDF: The influence of normal late pregnancy on insulin action and insulin secretion was studied in the Sprague-Dawley female rats. On 20th day after mating, intravenous glucose tolerance test(IVGTI) was performed in non pregnant control and pregnant rats. As results of IVGTT, glucose disappearance rate was not significantly different in both groups, but secretory response of insulin was significantly(p<0.05) increased in pregnant rat. And the ratio of insulin/ .glucose was significantly higher in pregnant rats, which means existence of insulin resistance. These insulin resistance was overcomed by increased secretory response of pancreatic insulin. Insulinogenic index( A insulin/glucose - 5 min) was highly significantly (r=0.62, p<0.01) correlated with progesterone concentration. Glycogen level and amounts of "C-glucose incorporated into glycogen after IVGTT were significantly(p<0. 05) decreased in the liver, but were not changed significantly in soleus. Glycogen synthase activity of soleus and liver was not differ significantly in the both groups. Insulin binding at varying concentrations of insulin to crude membrane of pregnant liver was not significantly different from control. In conclusions, although these pregnant rats were normal glucose tolerance due to increased secretory response of insulin, that was correlated with progesterone concentration, pregnant rat had insulin resistance. The mechanisms of insulin resistance were not related to defect of insulin binding phase and glycogen synthase, but suggest pre-receptor and/or postreceptor phase.

Laserthermia Induced Histological Changes in Different Thermal Condition.: Sang Woo Kim, Kyung Yup Lee, Seong Ho Kim, Jang Ho Bae, Oh Lyong Kim, Byung Yearn Choi, Soo Ho Cho; Yeungnam Univ J Med. 1995;12(2):331-338. Published online December 31, 1995; DOI: https://doi.org/10.12701/yujm.1995.12.2.331

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Abstract PDF: Laserthermia is a new method of local hyperthermia using fiber optic guided probe with computer controlled Nd-YAG laser system. We used a synthetic sapphire probe and allowed irradiation with contolled low power laser energy (less than 5W), in different thermal condition (temprature:38.5-50 degrees C) for 10 minutes, in the normal brain tissue of 18 rabbits. In results, the histological changes of brain tissue was variable (myelin condensation, chromatin condensation, nuclear waving and palisading, RBC discoloration, cell necrosis) in microscopic findings after laser irradiation, but changing area was not occured proportionally in thermal condition level. Cell necrosis appears to over 44.5 degrees C and the distance was about 1.25 mm. This study, using computer controlled laserthermia system for interstitial local hyperthermia, may offer many advantages in the experimental treatment and clinical management of tumor. Minimizing normal tissue damage is now being developed.

Prevalence of HBV DNA in Packed Red Blood Cells.: Chae Hoon Lee, Chung Sook Kim, Dal Ho Song; Yeungnam Univ J Med. 1995;12(2):339-346. Published online December 31, 1995; DOI: https://doi.org/10.12701/yujm.1995.12.2.339

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Abstract PDF: Assays for HBsAg, HBV DNA, anti-HBc and anti-HBs of 285 units of packed red blood cells supplied by Taegu Red Cross Blood Center were performed to evaluate the correlation between the prevalence of HBV DNA and the serologic markers for hepatitis B virus. None of 285 plasma samples was positive for HBsAg, however, HBV DNA were detected by polymerase chain reaction in 2 samples which both presented only with anti-HBc positivity.. Of 204 samples tested for anti-HBs, 96 samples(47.1%) were positive and among 216 samples tested for anti-HBc, 80 samples(37.0%) were positive. Of 193 samples tested for both anti-HBs and anti-HBc, 80(41.1%) were all negative and 48(24.9%) were positive on both tests. Those samples which showed positivity only to anti-HBc were 25(13.0%). Considering the above results, transfusion-transmitted hepatitis B virus infection could be prevented by discarding anti-HBc positive blood, however, that may bring insufficient supply of donor bloods in the country like Korea where the prevalence of anti-HBc is high. Anti-HBc positive blood unequivocally positive for anti-HBs should be considered noninfectious for HBV and should be allowed to be transfused. It would reduce the amount of discarding donor blood as the routine blood donor screening tests presently used at Korea Red Cross Blood Center supplemented by anti-HBs and anti-HBc testing.

A Study on Preception and Attitudes of Health Workers Towards the Organization and Activies of Urban Health Centers.: Jae Mu Lee, Pock Soo Kang, Kyeong Soo Lee, Cheon Tae Kim; Yeungnam Univ J Med. 1995;12(2):347-365. Published online December 31, 1995; DOI: https://doi.org/10.12701/yujm.1995.12.2.347

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Abstract PDF: A survey was conducted to study perception and attitudes of health workers towards health centers activities and organization of health services, from August 15 to September 30, 1994. The study population was 310 health workers engaged in seven urban health centers in Taegu City area. A questionnaire method was used to collect data and response rate was 81.3 percent or 252 respondents. The following are summaries of findings: Profiles of study population: Health workers were predomina1itly female(62.3%); had college education(60. 3%); 'and held medical and nursing positions(39.6%), technicians(30.6%) and. public health/administrativc positions(29.8%). Perceptions on health center's resources: Slightly more than a half(51.1%) of respondents expressed that physical facilities of the centers are inadequate; equipments needed are short(39.0%); human resource is inadequate(44.8%); and health budget allocated is insufficient(38.5%) to support the performance of health center's activities. Decentralization and health services: The majority revealed that the decentralization of government system would affect the future activities of health centers(51.9%) which may have to change. However, only one quarter of respondents(25.4%) seemed to view the decentralization positively as they expect that it would help perform health activities more effectively. The majority of the respondents(78.6%) insisted that the function and organization of the urban health centers should be changed. Target workload and job satisfaction: A large proportion (43.3%) of respondents felt that present target setting systems for various health activities are unrealistic in terms of community needs and health center's situation while only 11.1 percent responded it positively; the majority(57.5%) revealed that they need further training in professional fields to perform their job more effectively; more than one third(35.7%) expressed that they enjoy their professional autonomy in their job performance; and a considerable proportion (39.3%) said they are satisfied with their present work. Regarding the personnel management, more worker (47.3%) perceived it negatively than positive(11.5%) as most of workers seemed to think the personnel management practiced at the health centers is not fair or justly done. Health services rendered: Among health services rendered, health workers perceived the following services are most successfully delivered; they are, in order of importance, Th controi, curative services, and maternal and child health care. Such areas as health education, oral health, environmental sanitation, and integrated health services are needed to be strengthening. Regarding the community attitudes towards health workers, 41.3 percent of respondents think they are trusted by the community they serve. New areas of concern identified which must be included in future activities of health centers are, in order of priority, health care of elderly population, home health care, rehabilitation services, and such chronic diseases control programs as diabetes, hypertension, school health and mental health care. In conclusion, the study revealed that health workers seemed to have more negative perceptions and attitudes than positive ones towards organization and management of health services and activities performed by the .urban health centers where they are engaged. More specifically, the majority of health workers studied revealed to have the following areas of health center's organization and management inadequate or insufficient to support effective performance of their health activities: Namely, physical facilities and equipments required are inadequate; human and financial resources are insufficient; pefsonnel management is unsatisfactory; setting of service target system is unrealistic in terms of the community needs. However, respondents displayed a number of positive 'perceptions, particularly' to those areas as further training needs 'and implementation of decentralization of government system which will bring more autonomy of local government as they perceived these change would bring the necessary changes to future activities of the health center. They also displayed positive perceptions in their job autonomy and have job satisfactions.

Genomic analysis of Mycobacterium foruitum by pulsed-filed gel electrophoresis.: Tae Yoon Lee, In A Do, Sung Kwang Kim; Yeungnam Univ J Med. 1995;12(2):366-385. Published online December 31, 1995; DOI: https://doi.org/10.12701/yujm.1995.12.2.366

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Abstract PDF: Epidemiological studies are important in both the prevention and treatment of mycobacterial infections. This study was initiated to establish the pulsed-field gel electrophoresis (PFGE) method, which are not yet extensively studied. The most apprpriate restriction endonucleases included Dral, AsnI, and XbaI. The optimal PFGE condition was different according to the enzymes used. Two stage PFGE was performed, in case of DraI first stage was performed with 10 seconds of initial pulse and 15 seconds of findA pulse, while the second stage was performed with 60 seconds of initial pulse and 70 seconds of final pu',se. The electrophoresis time for DraI-PFGE was 14 hours for each stage. Electrophoresis was performed for 22 hours, in case of XbaI, with 3 seconds of initial pulse and 12 seconds of final pulse. Electrophoresis was performed for 22 hours, in case of AsnI, with 5 seconds of initial pulse and 25 seconds of final pulse. In all cases the voltage of the electrophoresis was maintained constantly at 200 voltage. Standard mycobacterial strains, which included Mycobacterium bovis BCG, M. tuberculosis, and M. fortuitum, could not be differentiated by PFGE analysis. PFGE analysis was performed to differentiate 9 clinically isolated M. fortuitum strains using AsnI. All M. fortuitum strains showed different genotypes except 2 strains. Cluster analysis divided M. fortuitum strains into 2 large groups. PFGE analysis was performed to further differentiate M. fortuitum isolates using XbaI. The undifferentiated 2 M. fortuitum strains showed different PFGE patterns with Xba I. Cluster analysis of the XbaI-PFGE patterns showed more complex grouping than AsnI-PFGE patterns, which showed that XbaI-PFGE analysis was better than AsnI-PFGE in M. fortuitum genotyping. The top dissimilarity values of AsnI-PFGE and XbaI-PFGE were 0.74 and 0.75, respectively. This value was higher than that of arbitrarily primed polymerase chain reaction (AP-PCR) analysis and lower than that of restriction fragment length polymorphism (RFLP) analysis. This suggested that PFGE can be used as a supportive or alternative genotyping method to RFLP analysis.

Case Reports

CT findings of Desmoid tumor arising at Abdominai Wall.: Dae Hyoun Cho, Jae Ho Cho, Jae Chun Chang; Yeungnam Univ J Med. 1995;12(2):386-392. Published online December 31, 1995; DOI: https://doi.org/10.12701/yujm.1995.12.2.386

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Abstract PDF: Desmoid tumor is a type of fibromatosis usually arise in deep musculo-aponeurotic structures, primarily of the trunk and extremities. It is characterized by proliferation of fibroblastic tissue and does not metastasize but may be locally aggressive. Eventhough the surgical margin reveals clean, recurrence often occurs. To analyze the extent of the tumor and homodynamic characteristics exactly, we performed IV bolus CT. Desmoid tumors show peripheral rim enhancement on early phase scan and more strong, central enhancement on late phase IV bolus CT, which reflects abundant fibroblastic components of the tumor. We report two cases of pathologically confirmed desmoid tumor performed IV bolus CT.

A Case reports of a Surgical Correctiona of the Mandibular Retrusion.: Nan Hee Im, Jin Ho Park, Byung Rho Chin, Hee Kyung Lee; Yeungnam Univ J Med. 1995;12(2):393-399. Published online December 31, 1995; DOI: https://doi.org/10.12701/yujm.1995.12.2.393

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Abstract PDF: Mandibular retrusion showing the facial problem with a marked maxillarry incisors protrusion and chin deficiency, resulting in a highly convex profile is uncommon in Korea.. The large incisor overjet and deep-bite create functional limitations and unpleasing esthetic result. The majority of theses cases are susceptible to correction by orthodontic therapeutic methods. But severe Class II retrognathic cases in which orthodontic treatment alone has not been capable of achieving good results. Orthognathic surgery offers several approaches. In this case, mandibular advancement by bilateral sagittal split ramus osteotomy and augmentation genioplasty has a special surgical problems. The suprahyoid muscle gorup are lengthened if the body of the mandible is surgically repositioned anteriorly. Instability of results and relapse return to original position shoud predicted during post-surgical muscular readjustment.. To maintain maximum correction with this technique, it is suggested that the mandibular body be well rotated forward at time of surgical intervention and overcorrected anteriory as much as possible. So, the authors report the case with review of concerned literature.

Focal Nodular Hyperplasis in Liver.: Ki Ho Seong, Jae Ho Cho, Jae Chun Chang; Yeungnam Univ J Med. 1995;12(2):400-404. Published online December 31, 1995; DOI: https://doi.org/10.12701/yujm.1995.12.2.400

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Abstract PDF: Focal nodular hyperplasia is a benign hepatic tumor mainly composed of nodules of hepatocytes and Kupffer cells separated by fibrous septa. In general, it is difficult to differentiate focal nodular hyperplasia and hepatocellular carcinoma on ultrasonography, conventional CT(computerized tomography), and angiography. But IV bolus CT is of particular value in the diagnosis of focal nodular hyperplasia because it can divide enhanced CT into early and late phase and can characterize tumor vascularity and analyze any intratumoral elements. In our case, it was seen as a hypoechoic mass lesion on ultrasonograpl'hy and hyperdense mass lesion on early-phase IV bolus CF and isodense mass, lesion on late-phase IV bolus CT. On angiography, hypertrophy of the feeding artery and tumor staining were well visualized. The patient underwent operation and the mass was pathologically confirmed to a focal nodular hyperplasia. We report the first case of focal nodular hyperplasia on IV bolus CT in Korea.

A Case of Lichenoid Drug Eruption Caused by Antituberculosis Drug.: Soo Keoung Lee, Jong Soo Choi, Ki Hong Kim; Yeungnam Univ J Med. 1995;12(2):405-411. Published online December 31, 1995; DOI: https://doi.org/10.12701/yujm.1995.12.2.405

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Abstract PDF: Lichenoid drug eruption is lichenoid skin eruptions caused by certain drugs and compounds, and can be identical or similiar to lichen planus. A 75-year-old woman who had taken antituberculosis medication(INH, ethambutol, rifampin) for 4 months developed pruritic generalized erythematous papular eruptions on the trunk and extremities, alopecia and nail dystropy. Histopathologic findings were hyperkeratosis, hypergranulosis, hyc rophic degenaration of basal layer, band like lymphohistiocytic infiltration in the upper dermis and perivascular lymphohistiocytic infiltration in the deep dermis. She was treated with systemic corticosteroid, and then skin lesion were slightly improved. After termination of antituberculosis medication, skin lesions were markedly improved with residual hyperpigmentation. Alopecia and nail dystrophy were also improved.

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