Korean Journal of Family Medicine

"Hee Cheol Kang"

Case Reports

A Patient with Neutropenia and Splenomegaly: A Case Report from Department of Family Medicine in Tertiary Hospital Center: Jaehee Cho, Youhyun Song, Jiyeon Lee, Daeun Lee, Yunsun Go, Hee Cheol Kang; Korean J Fam Med 2021;42(3):250-254. Published online May 22, 2020; DOI: https://doi.org/10.4082/kjfm.19.0130

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Pancytopenia represents a unique challenge for primary care doctors and its etiological causes encompass various specialties, including hematology and rheumatology. Despite the existence of effective tests such as bone marrow biopsy and immunoassays to rule out the potential causes of pancytopenia, it is often difficult to pinpoint the exact diagnosis. In this case report, we have described such a ‘gray zone’ patient, who presented with pancytopenia, neutropenia, and splenomegaly, and was being treated for fungal pneumonia before being transferred to Severance Hospital (department of family medicine). As the patient had a 10-year history of multiple, long-term hospital admissions that were having a severely debilitating impact on the quality of life, we performed a partial splenic embolization as a potential cure for the symptoms. Although this induced acute blood count recovery, it failed to prevent eventual mortality from septic shock.

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Malakoplakia of the Kidney Extending to the Descending Colon in a Patient with Secondary Adrenal Insufficiency: A Case Report: Soo Jin Jung, Hee Cheol Kang, Jun Jeong Choi; Korean J Fam Med 2011;32(6):367-372. Published online September 28, 2011; DOI: https://doi.org/10.4082/kjfm.2011.32.6.367

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Malakoplakia is an uncommon but distinctive type of chronic granulomatous inflammation that occurs most commonly in the genitourinary tract, especially the urinary bladder. Most patients have associated conditions characterized by some degree of immunosuppression, as seen in solid-organ transplants, autoimmune diseases requiring steroid use, chemotherapy, chronic systemic diseases, alcohol abuse and poorly controlled diabetes. We report an unusual case of the renal malakoplakia that involved the perirenal space, extending to the descending colon in a 65-year-old Korean woman with secondary adrenal insufficiency and diabetes mellitus.

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Multimodal imaging appearance including cinematic rendering of renal malakoplakia in a patient with E. coli bacteremia
Nicholas E. Henlon, Elliot K. Fishman, Erin N. Gomez
Radiology Case Reports.2023; 18(2): 709. CrossRef
Vaginal Malakoplakia
Deep B. Patel, Bradley Maller, Abel M. Abraham, Asha Ramsakal, Ardeshir Hakam, John N. Greene
Infectious Diseases in Clinical Practice.2021; 29(4): e230. CrossRef
Renal Parenchymal Malakoplakia with Acute Interstitial Nephritis Presented with Acute Kidney Injury
In Mee Han, Youn Kyung Kee, Eunyoung Lee, Choong-kun Lee, Seung Gyu Han, Su Jin Heo, Tae-Hyun Yoo
The Ewha Medical Journal.2015; 38(1): 36. CrossRef

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A Case Report of Superior Mesenteric Artery Syndrome after Acute Gastroenteritis.: Seung Beom Lee, Hee Cheol Kang, Yu Jung Yoon; Korean J Fam Med 2010;31(11):862-866. Published online November 20, 2010; DOI: https://doi.org/10.4082/kjfm.2010.31.11.862

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The most common cause of small bowel obstruction is postoperative adhesion, and besides a hernia, metastatic or primary cancer and small bowel tumors are possible causes. Superior mesenteric artery (SMA) syndrome is a rare cause of upper gastrointestinal obstruction and is associated with debilitating conditions with marked weight loss. SMA syndrome results from the compression of the third part of the duodenum due to the narrowing of the aortomesenteric angle. We report a 28-year-old woman with SMA syndrome after acute gastroenteritis. Her stomach was severely dilated due to the duodenal obstruction and computed tomography showed the compression of the third portion of the duodenum by SMA. She was conservatively cared for and thus favorably improved.

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Superior Mesenteric Artery Syndrome: Where Do We Stand Today?
Tae Hee Lee, Joon Seong Lee, Yunju Jo, Kyung Sik Park, Jae Hee Cheon, Yong Sung Kim, Jae Young Jang, Young Woo Kang
Journal of Gastrointestinal Surgery.2012; 16(12): 2203. CrossRef

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A Case Report of Sepsis by Extended-Spectrum beta-Lactamase Producing Escherichia Coli.: Seung Beom Lee, Choon Ok Kim, Hee Cheol Kang; Korean J Fam Med 2010;31(5):384-389. Published online May 20, 2010; DOI: https://doi.org/10.4082/kjfm.2010.31.5.384

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The overall prognosis of acute pyelonephritis is good, but the infections by extended spectrum Ղ-lactamase (ESBL) producing Escherichia coli (E.coli) cause poor responses to empirical antibiotic treatment, and consequently increase mortality. ESBL can hydrolyze the antibiotics with a Ղ-lactam ring and confer resistance to oxyimino-cephalosporins and monobactams. If the patient shows poor responses to empirical antibiotics or severe septic conditions, physicians must switch the antibiotics to other antibiotics covering resistant strains without delay. We report a case of acute pyelonephritis by extended-spectrum Ղ-lactamase producing E.coli in a 29-year-old woman who was empirically treated with oral ciprofloxacin as an initial treatment, but progressed to sepsis.

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A Case Report of Anti-Neutrophil Cytoplasmic Antibodies Negative Churg-Strauss Syndrome.: Seung Beom Lee, Hee Cheol Kang, Jun Jeong Choi; Korean J Fam Med 2010;31(4):308-313. Published online April 20, 2010; DOI: https://doi.org/10.4082/kjfm.2010.31.4.308

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Churg-Strauss syndrome is a rare primary vasculitis called allergic granulomatosis angiitis. There is a substantial overlap of symptoms or signs between different vasculitides, so that a diagnosis of any vasculitis can be determined by a combination of clinical symptoms and laboratory tests. We report a case of a 54-year-old woman who had bronchial asthma, eosinophilia, peripheral polyneuropathy, pulmonary infiltrate, maxillary sinusitis, and extravascular eosinophilic infiltration on skin biopsy. So she was diagnosed as having Churg-Strauss syndrome, but she was antineutrophil cytoplasmic antibodies-negative on immunologic study. She had fever and showed cardiac involvement that was presented as cardiomegaly and pulmonary edema at chest radiography and left ventricular hypertrophy on electrocardiography. After steroid therapy, general condition and skin manifestation were rapidly improved.

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Clinical features and prognostic factors of Churg-Strauss syndrome
Mi-Yeong Kim, Kyoung-Hee Sohn, Woo-Jung Song, Heung-Woo Park, Sang-Heon Cho, Kyung-Up Min, Hye-Ryun Kang
The Korean Journal of Internal Medicine.2014; 29(1): 85. CrossRef

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Original Article

A Randomized Controlled Trial of SMS Text Messaging versus Postal Reminder to Improve Attendance after Lipid Lowering Therapy in Primary Care.: Sung Ja Cho, Young Sik Kim, Ho Cheol Shin, Eun Ju Sung, Dae Hyun Kim, Sangyeoup Lee, Tae Hee Jeon, Yun Jun Yang, Chung Hwan Cho, Hee Cheol Kang, Yoo Seock Cheong; Korean J Fam Med 2010;31(4):284-293. Published online April 20, 2010; DOI: https://doi.org/10.4082/kjfm.2010.31.4.284

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Background
In the primary care setting, compliance with lipid lowering therapy was relatively low. In order to compare the efficacy of a short messaging service (SMS) text messaging and postal reminder as means of improving attendance rates during the first 24 weeks of lipid-lowering therapy, a randomized controlled trial of 918 patients from 19 family practice clinics was conducted between February 2003 and June 2006. Methods: Patients were randomly assigned into 3 groups: SMS (327), postal (294),and control (297) group. To ascertain attendance rates, patients were followed up at 24 weeks after their treatment. Reminders were sent at 16 weeks from the coordinating center. Results: Overall attendance rate was 74.1%. This differed between groups, with 76.1% attendance for the SMS group, 73.5% for the postal group, and 72.4% for the control group. According to a multivariate analysis, the SMS group had a significantly higher attendance rate (Odds ratios [OR] 1.48; 95% confidence interval [CI], 1.01 to 2.16) than the control group, but the postal group (OR, 1.15; 95% CI, 0.79 to 1.69) did not. Moreover, the cost per attendance for the SMS reminder (155 Korean Won [KRW]) was much lower than that for the postal reminder (722 KRW). Conclusion: SMS reminder may be more cost saving method to improve the attendance rate compared with the postal reminder.

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Effect of A Mobile-Phone Mediated Based Education on Self-Care Behaviors of Patients With Thalassemia Major
Fatemeh Gharaati, Teamur Aghamolaei, Zahra Hosseini, Sayed Hossein Davoodi, laleh Hassani, Razieh Mohamadi, Shokroallah Mohsseni, Moussa Soleimani-Ahmadi
Journal of Caring Sciences.2019; 8(3): 149. CrossRef
Self-management of Chronic Conditions Using mHealth Interventions in Korea: A Systematic Review
Jae Yoon Yi, Yujin Kim, Yoon-Min Cho, Hongsoo Kim
Healthcare Informatics Research.2018; 24(3): 187. CrossRef
The Effectiveness of SMS Reminders on Appointment Attendance: a Meta-Analysis
Nasim Boksmati, Kerryn Butler-Henderson, Kevin Anderson, Tony Sahama
Journal of Medical Systems.2016;[Epub] CrossRef
Using digital notifications to improve attendance in clinic: systematic review and meta-analysis
Dan Robotham, Safarina Satkunanathan, John Reynolds, Daniel Stahl, Til Wykes
BMJ Open.2016; 6(10): e012116. CrossRef
The effect of SMS messaging on the compliance with iron supplementation among pregnant women in Iran: a randomized controlled trial
Marzieh Rakhsh Khorshid, Poorandokht Afshari, Parvin Abedi
Journal of Telemedicine and Telecare.2014; 20(4): 201. CrossRef
Targeting the Use of Reminders and Notifications for Uptake by Populations (TURNUP): a systematic review and evidence synthesis
Sionnadh McLean, Melanie Gee, Andrew Booth, Sarah Salway, Susan Nancarrow, Mark Cobb, Sadiq Bhanbhro
Health Services and Delivery Research.2014; 2(34): 1. CrossRef
How Effective Are Short Message Service Reminders at Increasing Clinic Attendance? A Meta‐Analysis and Systematic Review
Rebecca Guy, Jane Hocking, Handan Wand, Sam Stott, Hammad Ali, John Kaldor
Health Services Research.2012; 47(2): 614. CrossRef

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Case Report

A Case Report of Kikuchi-Fujimoto Disease with Immune Thrombocytopenic Purpura.: Won Yong Kim, Seung Beom Lee, Jun Jeong Choi, Hee Cheol Kang; Korean J Fam Med 2010;31(1):51-55. Published online January 20, 2010; DOI: https://doi.org/10.4082/kjfm.2010.31.1.51

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Kikuchi-Fujimoto disease (histiocytic necrotizing lymphadenitis) is a rare disease characterized by lymphadenitis with fever. It is self-limited within one to four months, and is generally diagnosed by an excisional biopsy of the affected lymph node. Kikuchi-Fujimoto disease has a wide variety of nonspecifi c symptoms and it is sometimes misdiagnosed as malignant lymphoma, lymph node tuberculosis, or systemic lupus erythematosus. Because clinical course and treatment of this disease differ from those of others, Kikuchi-Fujimoto disease must be included in differential diagnosis of enlarged lymph node. In this report, we discribed a case of 24-year-old male patient who visited the clinic complaining of fever, petechiae, and enlarged lymph node. He was diagnosed as Kikuchi-Fujimoto disease and immune thrombocytopenic purpura.

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Kikuchi–Fujimoto disease: literature review and report of four cases
V. G. Potapenko, V. V. Baykov, А. Yu. Markova, N. B. Mikhailova, A. S. Ter‑Grigoryan, Yu. А. Krivolapov
Oncohematology.2022; 17(4): 48. CrossRef

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Original Article

Prevalence of Gallbladder Polyp in Adults in Korea.: Seung Beom Lee, Hee Cheol Kang, Young Tae Shin, Jung Hoon Lee, Sang In Choi, Choon Ok Kim, Hee Jin Whang; Korean J Fam Med 2009;30(1):39-45. Published online January 10, 2009; DOI: https://doi.org/10.4082/kjfm.2009.30.1.39

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Background
Incidentally discovered gallbladder polyp in health check-up has been increasing in numbers due to extended use of ultrasonography. Past researches have reported on the relationship between body mass index and gallbladder (GB) polyp. As there has been a recent rise in the prevalence of obesity, this research attempted to study GB polyp prevalence and the trend according to time elapse in Korea. Methods: Retrospective cross sectional research was carried out with the data of Korean Association of Health Promotion, between 2nd. Jauary. 2003 to 3rd. Aug. 2007, for subjects who received abdominal ultrasonography. Those excluded were,below 20 years of age, non-asian and who have received cholecystectomy. The number of eligible subjects were 137,135, where 69,493 were male and 67,642 were female. Results: Out of 137,135 subjects, the number of subjects with GB polyp were 5,278, where 3,163 were male and 2,115 were female. According to 2005 census, the age adjusted prevalence was 3.7% (3,656 per 100,000). The prevalence for men was 4,403 per 100,000 (4.4%) and for women 2,943 per 100,000 (2.9%). The prevalence has been increasing for the past five years. Conclusion: The prevalence of GB polyp in Korea is found to be higher than the pre-existing reports and the prevalence is higher in male than female. The prevalence is on the increase and there is a need to be more attentive to the issue in the future.

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Are there modifiable risk factors affecting the prevalence of gallbladder polyps or those 5 mm or larger? A retrospective cross-sectional study
Oh-Sung Kwon, Young-Kyu Kim
Medicine.2021; 100(35): e27115. CrossRef
Factors Affecting Smoking Cessation Success during 4-week Smoking Cessation Program for University Students
Sang Mee Koo, Jeong Hee Kang
Journal of Korean Academy of Community Health Nursing.2017; 28(2): 165. CrossRef
Shifting Prevalence of Gallbladder Polyps in Korea
Yoo Jin Lee, Kyung Sik Park, Kwang Bum Cho, Eun Soo Kim, Byoung Kuk Jang, Woo Jin Chung, Jae Seok Hwang
Journal of Korean Medical Science.2014; 29(9): 1247. CrossRef

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Case Report

One Case of Tetanus after Taking Acupuncture .: In Cheol Hwang, Rae Jun Jung, Sul Hui Chee, Hee Cheol Kang; J Korean Acad Fam Med 2008;29(12):948-951. Published online December 10, 2008

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Tetanus is a neurologic disease which features the muscle spasm as the hallmark. It is an infectious disease with high mortality rate triggered by tetanospasmin produced by Clostridium tetani. This report concerns incidence of tetanus consequent to oriental medical care such as acupuncture and moxibustion. Although the tetanus occurrence has shown a remarkable decline since nationwide vaccinations in some of the developed countries, including Korea, it still remains to be an important issue, to be dealt within Korea, as the majority of the patients are old aged and Korean population is rapidly becoming an aging society. Furthermore, since more elders are coming to rely on Oriental medicine in Korea, the Korean elders are at a higher risk than elsewhere. The lack of medical experiences, including those in oriental medical field, has been hindering early diagnosis of Tetanus. This study aims to encourage rapid and accurate decisions in diagnosis and treatment through reviewing symptoms particularly specific to tetanus, and also to arouse attention to the riskiness of invasive procedures involving skin puncture. (J Korean Acad Fam Med 2008;29:948-951)

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Original Articles

The Relation of Coronary Artery Calcium Scores with Framingham Risk Scores.: Youngsang Kim, Incheol Hwang, Hee Cheol Kang; J Korean Acad Fam Med 2008;29(10):762-767. Published online October 10, 2008

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Background: Atherosclerosis of the coronary artery is related to the obstructive coronary artery disease. The coronary artery calcium score test is a non-invasive and useful indicator of atherosclerosis. The Framingham risk scoring system is a traditional indicator of the cardiovascular risk. This cross-sectional study was performed to evaluate the relation of the coronary artery calcium scores with Framingham risk scores. Methods: We evaluated 135 patients who visited the Department of Family Medicine in Severance Hospital and had a test of the coronary artery calcium scores from January 5th, 2005, to August 12th, 2006. The Framingham risk scores were calculated. We analyzed the correlation between the coronary artery calcium scores and the Framingham risk scores and tested the difference between the groups divided by categorization of the calcium scores. Results: The coronary artery calcium scores were significantly correlated with the Framingham risk scores (r=0.282, P<0.01). There was a significant correlation in case of women (r=0.349, P<0.01), but not in case of men. There was a significant difference between the group whose calcium score was 0 and the group whose calcium scores were above 0 (P<0.001). Conclusion: There was a positive correlation between the coronary artery calcium scores and the Framingham risk scores. The coronary artery calcium score seems to be a significant factor to assess the cardiovascular risk. (J Korean Acad Fam Med 2008;29:762-767)

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Validation of Scoring System for Survival Prediction in Terminal Cancer Patients in Korea.: In Chul Lee, Chan Kyong Kim, Sang Yeon Suh, Young Sung Kim, Kyung Hee Cho, Hee Cheol Kang, Bang Bu Youn; J Korean Acad Fam Med 2007;28(9):682-689. Published online September 10, 2007

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Background
Accurate prediction of survival in terminal cancer patients is important for planning effective palliative care. But, the prediction of survival most often relies on the physicians' prediction. Recently, simple prognostic scores such as Palliative Prognostic Index and Palliative Prognostic Score have been developed to estimate duration of survival. The aim of this study was to validate these prognostic scores and physicians' prediction for terminally ill cancer patients in Korea to determine its value in clinical practice. Methods: The subjects of this study were 40 terminal cancer inpatients of one hospital who died between March to May 2005. All patients' Palliative Prognostic Index, Palliative Prognostic Score, and physicians' prediction were recorded on admission by a physician. Results: When a Palliative Prognostic Index of more than 6 was adopted as a cut-off point 3 weeks' survival was predicted with a sensitivity of 90% and a specificity of 60%. When the three groups were grouped by Palliative Prognostic Scores (group A: ≤5.5, group B: 5.6∼11, group C: ＞11), the 30 day survival probability were 60% for group A, 16.7% for group B, and 4.3% for group C, respectively. Physicians' prediction showed moderate correlation (correlation coefficient=0.604) with actual survival and had a tendency to overestimate survival. Conclusion: Palliative Prognostic Index was proved to be a reliable survival prediction tool in Korea. Palliative Prognostic Score had a tendency to overestimate survival as compared with other studies. Physicians' prediction had a correlation with actual survival, and it was presumed to be more accurate when combined with other prognostic score. (J Korean Acad Fam Med 2007;28: 682-689)

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Level of Understanding of Importance of Preventing and Treating Dermatophytoses in Diabetic Patients.: Bong Wu Wu, Sung Kyung Je, Kyoung Kon Kim, Hee Cheol Kang, Bang Bu Youn; J Korean Acad Fam Med 2007;28(5):359-366. Published online May 10, 2007

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Background
Dermatophytoses tend to have a poorer outcome in diabetic patients than in non-diabetic patients. Therefore, diabetic patients need to pay a closer attention to the prevention and treatment of dermatophytoses. The aim of this study was to determine the level of understanding of the dermatophytoses in diabetic patients and to clarify the factors associated with the level of understanding. Methods: A questionnaire survey was carried out from June to July, 2005, targeting 200 patients who had visited two hospitals in Seoul for the management of diabetes. There were 163 respondents (response rate 50.9%). The degree of understanding was calculated by giving 1 point to each question, with a maximum of 12 points. Results: The average degree of understanding of dermatophytoses was 6.68 points (SD 1.79). Younger age (P= 0.0002), high education level (P=0.0035), and high income (P=0.0013) were the factors related to a better understanding of dermatophytoses. The patients who had obtained the information on dermatophytoses from the websites, broadcasts, newspapers, or magazines showed higher recognition points than others (P=0.0377). The body mass index, the duration of diabetes, the complications associated with diabetes did not affect the understanding of dermatophytoses. Conclusion: There are many diabetes patients who do not know enough about dermatophytoses. Diabetes itself is not related to the level of understanding of dermatophytoses. However, diabetic patients who are older, have a lower level of education, and a low income will need to be informed about prevention and treatment of dermatophytoses. (J Korean Acad Fam Med 2007;28: 359-366)

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Factors Attributing to Increasing Attempts at Central Venous Catheterization.: Dong Hoon Suh, Dong Hee Oh, Hee Sun Seo, Kyung Hee Cho, Kyoung Kon Kim, Hee Cheol Kang, Bang Bu Youn; J Korean Acad Fam Med 2006;27(4):288-293. Published online April 10, 2006

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Background
: Central venous catheterization allows the measurement of hemodynamic variables, the delivery of medications and nutritional support. It also has been used as a means to treat sepsis, cardiogenic and hemodynamic shocks. Arterial puncture, hematoma, and pneumo-hemothorax are the most common mechanical complications during the insertion of central venous catheters. This study was done to find out the factors attributing to the increase of puncture attempts in subclavian venous catheter insertion.

Methods : We have conducted surveys in residents who had previous experience with insertion of subclavian venous catheterization in Ilsan hospital from 01/09/2003 to 30/11/2003. A total of 40 cases were marked as two groups, those with less than three puncture attempts and those with more than or equal to three attempts.

Results : The incidence of three or less insertion attempts were 23, whereas in 17 cases three or more attempts were required. The results of the comparison between these two groups proved that the patient's hemoglobin level, skeletal deformity, the level of experience (more than 20), puncture site marking and insertion in the mid-clavicular line were significant factors (P＜0.05).

Conclusion : It seemed necessary to try three or less puncture attempts in order to decrease the incidence of mechanical complications. The operator factors such as previous experience with the procedure, puncture site marking prior to insertion, and insertion in the mid-clavicular line had affected the number of puncture attempts.

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How Many Diabetes Patients Know the Name of Hypoglycemic Agents They Are Taking?.: Oh Byung Kwon, Jong Ho Yu, Kyoung Kon Kim, Hee Cheol Kang, Bang Bu Youn; J Korean Acad Fam Med 2005;26(8):456-463. Published online August 10, 2005

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Background
: Numerous diabetes patients do not know the name of hypoglycemic agents that they are taking, even though they have taken them for a long time. The aim of this study was to find out the percentage of diabetes patients who recognize the name of their hypoglycemic agents and to clarify whether such recognition have effect on their glycemic control.

Methods : A cross-sectional questionnaire survey was done from March to May 2004, targeting inpatients and outpatients who had been taking oral hypoglycemic agents for diabetes treatment in 2 hospitals.

Results : 134 patients (89.3%) of 150 completed the questionnaire. Only 20 (14.9%) patients accurately knew the name of at least one of the hypoglycemic agents they were taking. Smoking (P=0.0086), recognition of the name of hypoglycemic agents (P＜0.0001), history of change of prescribed hypoglycemic agents (P=0.0095), diet and exercise (P＜0.0001), explanation of hypoglycemic agents (P=0.0231), and forgetting to take medicine (P＜0.0001) were significantly related to the HbA1c level. Among these factors, history of change of prescribed hypoglycemic agents (P=0.0006), diet and exercise (P=0.0002), and forgetting to take medicine (P＜0.0001) were the independent related factors after adjustment.

Conclusion : The recognition rate of the name of hypoglycemic agents was low. It may be associated with patients' HbA1c, but was not an independent related factor.

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An Analysis of Attitudes on Euthanasia between Residents and Judicial Apprentices.: Jong Ho You, Oh Byung Kwon, Kyoung Kon Kim, Hee Cheol Kang, Myung Se Son, Kyoung Whan Lee; J Korean Acad Fam Med 2005;26(6):327-336. Published online June 10, 2005

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Background
: Recently, the legal and ethical issues relative to euthanasia are becoming controversial in Korea. This study was designed to verify the differences of the attitudes on euthanasia between judicial apprentices and residents.

Methods : The questionnaire was conducted on the 35th-group of the judicial apprentices on March 24, 2004, and on the residents from April 2 to May 22, 2004. The respondents were 636 in total consisting of 460 judicial apprentices and 176 residents.

Results : Of the total 636 subjects, 373 (81.1%) of the judicial apprentices and 149 (84.7%) of residents agreed that allowing euthanasia is moral, without any significant difference (P＞0.05). The number of residents was greater (59 people, 33.5%) than that of judicial apprentices (112 people, 24.4%) who agreed with active euthanasia (P＜0.05). Among the total, 397 (86.3%) of the judicial apprentices and 160 (91.4%) of the residents answered that the law for euthanasia was necessary, without any significant difference (P＞0.05). But, among these supporters, the respondents who agreed on active euthanasia were significantly different in number between judicial apprentices (n=93, 23.4%) and residents (n=54, 33.8%) (P＜0.05).

Conclusion : This study did not find any significant differences between the two groups in the necessity of the law for euthanasia, but the rate of agreement on active euthanasia was higher in residents group than in judicial apprentices group.

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Change of Body Composition in Obese Women with Short-term Low Calory Diets.: Hong Ki Lee, Young Gan Lee, Bok Gi Lee, Kyu Rae Lee, Kyoung Kon Kim, Hee Cheol Kang, Bang Bu Yun; J Korean Acad Fam Med 2004;25(1):21-27. Published online January 10, 2004

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Background
: A reasonable weight reduction method is to reduce fat-body mass while preserving fat-free mass. Recently, many people in Korea have been trying reckless diet therapy for weight reduction by means of low calory and protein diets, which gave rise to many side effects consequently. For reasonable weight reduction, this study was undertaken to investigate the significant dietary factors that change body composition during short-term low calory diet.

Methods : Twenty six healthy obese women aged 23∼37 years, whose BMI was greater than 24, volunteered for the 6 week diet therapy from January to April in 2003. All subjects were instructed to eat approximately 1,200 kcal/day and keep a dietary diary. In the beginning the 3rd week and the 6th week of the study, subjects' body weight were measured and fat body weight were measured by BIA. In the 6th week, the analysis of the dietary diary was conducted.

Results : There was a significant positive correlation between the protein intake per ideal body weight in the first 3 weeks and the fat-free mass increase in the latter 3 weeks (P＜0.05). At the same time, the fat intake in the first 3 weeks had positive correlation with the fat-free mass in the latter 3 weeks, also (P＜0.05). But, we could not find any significant values that had effect on the fat-free mass increase in multiple regression analysis.

Conclusion : The protein intake in the first 3 weeks helped to preserve the fat-free mass in the latter 3 weeks, and had positive effects.

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Do Patients Want Physicians to Inquire about Their Religion?.: Serng Bai Pak, Moon Chul Kang, Bok Gi Lee, Soo Jin Jung, Hee Cheol Kang, Bang Bu Youn; J Korean Acad Fam Med 2003;24(1):72-79. Published online January 10, 2003

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Background
: In Korea, there has been a few medical studies on the relationship between religion and health. In future, active research is anticipated in this area. However, the validity and methods of performing religious inquiry should be tested beforehand. This study was designed to look into the attitudes of patients about religious inquiries by their physicians and to suggest better methods of religious approach to aid future researches on the effect of religion on health.

Methods : A survey was performed on the religious attitude among 177 patients among which 92 were randomly selected from an outpatient clinic of tertiary teaching hospitals and 85 from two local family practice offices on August, 2002. Χ²test was used to verify the difference of results between the subgroups.

Results : As a whole, more than half of patients disagreed with religious inquiries by their physicians regardless of medical situation; however, there was a trend that a critical health reasons produced a higher percentage of patients accepting religious inquiry than in ordinary patients. There was no significant difference in answer between the two practice settings but a significant difference among the subgroups with strong religious belief and among those with a particular type of religion existed.

Conclusion : The results of this study may be used as data on the method of approaching patients with religious inquiries for future studies on the relationship between religion and health, and also should encourage active researches on this subject.

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A Study on Hair Mineral Concentrations in Diabetic Patients.: Soo Ick Jang, Kyoung Kon Kim, Bok Gi Lee, Hyung Joon Kim, Soo Hyun Lew, Hee Cheol Kang, Bang Bu Youn; J Korean Acad Fam Med 2002;23(9):1133-1140. Published online September 10, 2002

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An analysis of fatigue among outpatients.: Bang Bu Youn, Kyun Sang Lee, Hee Cheol kang, Kyung Kyun Shin; J Korean Acad Fam Med 1999;20(8):978-990. Published online August 1, 1999

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Background
: Up to the present, there has been little study on chronic fatigue or chronic fatigue syndrome, and there is equally sparse relevant statistical data For this reason, we attempted to investigate the present status of fatigue, particularly its incidence and actual conditions.

Methods : The study subjects were 12,152 outpatients who visited family practice in hospitals all over Korea between July 24 and September 21,1997. They were given a questionnaire which included questions reflection the (U.S) Center for Disease Control criteria defining chronic fatigue syndrome.

Results : Among the subjects, 861 people complained of fatigue in their response to the questionnaire-re and they became the focus of the study. Of this fatigue group, 426 people(49.4%) had manifested fatigue for more than 6 months, and the male/female ratio was 54%/46%, respectively. People who re-ported that fatigue impaired their ability to function on a daily basis made up 35.8% of the fatigue group and the percentage of people who had considered visiting a clinic due to fatigue was an unexpectedly high 52.8%. The reported causes of fatigue, in decreasing order, were: social interactions(males 68.5%/females 45.1%); sleep disturbance(males 26.8%/females 21.8%); and physical maladies(males 24.2%/fe-mals 26.5%). There were significant gender differences in social interaction relating to domestic problems(males 4.7%/females 16.7%) and emotional problems(males 12.2%.femals 21.4%). Among 33 chronic fatigue syndrome patients who indicted what they thought were the causes of their problems, 68.8% reported physical maladies, 65.5% social life, 31.3% emotional problems, 21.9% sleep disturbance, and 21.9% domestic problems. The associated symptoms of fatigue reported in both males and females, in de-creasing order, included: myalgia, headache and neurological symptoms. The prevalence of chronic fatigue was 0.27%.

Conclusion : Our study showed that 7.1% of family practice outpatients complained of fatigue and that their daily activities or occupational life were disturbed as a result. This group demonstrates is serious need for medical assistance. Therefore, doctors should have more interest in fatigue, particularly in chronic fatigue syndrome, so as to provide real and versatile care.( J Korean Acad Fam Med 1999;20:978-990)

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The effects of acupuncture treatment for smoking cessation: Preliminary study for high school student.: Hee Cheol Kang, Kyng Kyun Shin, Sam Ho Choo, Hyuk Jung Kweon, Bang Bu Youn; J Korean Acad Fam Med 1999;20(4):401-409. Published online April 1, 1999

Abstract
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Background
: Smoking is the single most considerable factor, which may likely affect one's health most adversely. Therefore, an effective control upon smoking has been the most important issue for all of the practitioners. Furthermore, the latter's concern on the alternative medicine has been steadily mounting these days. Accordingly, a series of clinical group study has been mapped out in order to clarify the effect and the outcome of acupuncture treatment and its rate of success.

Methods : The survey has been conducted from April 7th, 1998 for six months with the voluntary help of 130 students as our study objects, who were the 1st, 2nd and 3rd graders at two metropolitan high-schools in Seoul. A basic questionnaire has been prepared and collected at the first interview. The acupuncture treatment has been alternately administered at each side of ears once a week for the respective object students and the information had been questioned in the survey. When 5 months lapsed with no treatment after the initial four weeks of intensive application, a further follow-up survey was repeated all over again(once every week for 4weeks and another after 6 months). for the analysis of our finding, the SAS V6.12 has been used together with the one was ANOVA test, t-test, and Cochran-Armitage trend test.

Results : Those who managed to stop smoking after the acupuncture treatment of one week, four weeks and six months respectively were found as follows; 2 students(61%), 12 students(37.5%), and 8 students(25%), proving that the success rate for smoking cessation after six months was 25%. Those who decreased their number of smoking more than half were; 13 students(39.4%), 15 students(46.9%), 25 students(75%). The number of withdrawal symptom and the smoking cessation as well as the smoking reduction rate were not found correlated each other. The frequency of their smoking, the frequency of the smoking attempt, the period of their abstinence from smoking, the facts whether their family members of relatives smoked or not, the FTQ(Fagerstrom Tolerance Questionnaire), the frequency of their drinking and the motivation types of smoking(Why test) were found not influential upon the change of smoking tastes and their intensity of smoking wish by the treatment of the auricular acupuncture.

Conclusion : The change of smoking taste and the change on the intensity of smoking wish as the outcome of acupuncture treatment for the stop-smoking has been statistically significant.

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A study on perceieved rearing attitude and family function of alcoholic inpatients.: Hee Cheol Kang, Yeon Jun Choi, Seon Jin Chung, Ki Yong Seo, Han Gu Kim; J Korean Acad Fam Med 1995;16(12):848-859. Published online December 1, 1995

Abstract

Conclusion : The score of family's coping with chronic illness shows reliability and validity, as the results of this syudy. The scoring system can be used as a basic screening tool to determine how well a family is coping with chronic illness and as a basic guideline of family therapy in Korea.

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Depression and anxiety tendencies in patients taking general health evaluations.: Hee Cheol Kang, Ji Hwan Lee, Seon Og Rhee, Yeon Jun Choi; J Korean Acad Fam Med 1995;16(7):504-509. Published online July 1, 1995

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The Association between the Family APGAR Score and depression scales , anxiety scales , degree of fatigue.: Eu Sik Jung, Jin Sook Won, Young Ju Park, Hee Cheol Kang; J Korean Acad Fam Med 1994;15(7):411-418. Published online July 1, 1994

Abstract
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Background
: This study was attempted to evaluate the influence of the family function on individual health by analyzing an association between Smilkstein's APGAR Score and depression scales, anxiety scales, degree of fatigue.

Methods : Data were gathered by questionnaires which is consisted of Smilkstein's APGAR Score, Beck's depression inventory(BDI), Zung's self-rating anxiety scale(SAS), and subjective complaints of fatigue from 239 passers of Jeonju Teachers college in 1992.

Results : The mean of Family APGAR Score was 13.74±3.33 and among them the dysfunctional group(point 0 to 13) was 113(47.3%), and functional group(point 14 to 20) was 126(52.7%). There was significant difference between dysfunctional and functional group in depression and anxiety score(P<0.05), but no significant difference in degree of fatigue(P>0.05). The depression scores of each APGAR item showed a significant difference between satisfactional and dissatisfactional groups in all items(P<0.05). Also, there were meaningful difference in all anxiety scores except affection item as well as in all fatigue scores except adaptation item between two groups.

Conclusion : These results suggested the family APGAR Score has an association with depression, anxiety, fatigue of individual family members. Thus, it is recommanded to approach for evaluation of family function in treatment of depressive, anxious, or fatigued patients.

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The Relationship between the symptom of the peripehral polyneuropathy and Smoking among the diabetic patients.: Eu Sik Jung, Young Ju Park, Jin Suk Weon, Hee Cheol Kang; J Korean Acad Fam Med 1994;15(4):199-207. Published online April 1, 1994

Abstract
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Background
: As a complication peripheral polyneuropathy is frequently observed in diabetic patients. Although it has been reported that the duration of diabetes and the status of diaberic control played critical roles in pathogenesis of peripheral polyneuropathy, nothing else was known previously. In this paper we investigate the possible relationship between peripheral polyeuropathy and smoking among the diabetic patients, consequently to study if smoking induces any significant effects on the pathogenesis of the peripheral polyenuopathy.

Methods : The one hundred and four patients showing the symptom of periheral polyneuropthy and the same number of patients without the symtpom were chose among 296 patients, after excluding seemingly irrelevant 88 patients, who were hospitalized in the Presbyterian Medial Center at Jeonju from 1992. 1.1 to 1993.7.31. Those selected patients were called up for a inquiry and their medial records were also looked up in order to obtain the relevant data for the current investigation. The obtained data were the age, sex, duration of diabetes dringking behavior, and amount of smoking. These were analyzed statistically by utilizing SAS.

Results : The mean age of the group with the symptom of peripheral polyneuropathy is 57.5 years and that of the group without any symptom is 58.6 years. There shows no difference in the sexual ratio between two groups. Also, observed is that the age of onset of diabetes is younger, the duration of diabetes is longer, and more patients are using insulin in the group without the symptom of peripheral polyneuropathy(P<0.05). compared to the group without the symptom. On the other hand, no difference is noticed between the groups in the fasting blood suqar and the amount of smoking. Neither is seen the diffence of the onset age and duration of diabetes, and the controlling method of the blood glucose between the smoker and nonsmoker group.

Conclusion : It is not observed any relevant association between the smoking and the symptom of the peripheral polyneuropathy among the diabetic patients.

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A clinical observation on childhood bronchial asthma.: Kwang Tae Kim, Jin Seog Oh, Hae Youn Kim, Seog Yong Choi, Hee Cheol Kang, Dong Hak Shin; J Korean Acad Fam Med 1991;12(1):94-101. Published online January 1, 1991

Abstract
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The clinical observation on 136 patients of bronchial asthma were seen at Dong San Medical Center from January 1988 to December1988.
The results were following :
1) Age distribution at the time of visiting Clinic ranged between 1 year and 15 years. Most patients(73.5%) were below 6 years of age. Sex ratio was 3:1 with male predominance.
2) Most patient(69.9%) were below 3 year of age at age of onset.
3) In 11.8% of cases there noted positive allergic history & allergic family history in 32.4%.
4) Eosinophilia was noted in 39.7%.
5) Total IgE level measured by EIA after 5-12 days of onset showed the most increased level of all days.

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A study on family function of the patients with psychiatric disorders.: Hyung Joon Kim, Goang Eun Jung, Hyuk Jung Kweon, Hee Cheol Kang, Bang Bu Youn; J Korean Acad Fam Med 2000;21(5):645-659.

Abstract

BACKGROUND
Psychiatric disorders have been known to occur by the interaction of biologic, psychologic and social factors. A family can affect the occurrence of psychiatric disorders as a primary social factor. On the other hand, psychiatric disorders can affect family function. There fore, we studied to compare family function between the families of psychiatric inpatients and those of normal persons, using Family APGAR and FACES III.
METHODS
Between July 1, 1999 and August 31, 1999, we examined the subject group as 40 relatives to visit psychiatric inpatient and the control group as 40 persons whose family members did not have chronic diseases or psychiatric disorders, using questionnaire of socio-demographic factors and family function.
RESULTS
Family APGAR scores in subject group were lower than those of control group, but not statistically different. But the degrees of 'Partnership' of the Family APGAR in subject group were significantly lower than those of control group.(P<0.05) Adaptability scores of FACES III in two groups were not different. Cohesion scores of FACES III in subject group were lower than those of control group but not statistically different. The Family APGAR scores in the families of the schizophrenics were significantly lower than those of control group. The duration of psychiatric disorders did not affect family function.
CONCLUSION
The family function of subject group was worsened but not statistically different. But in the families of the schizophrenics, the Family APGAR scores were significantly lower than those of control group. Therefore, we should consider serious family dysfunction in the families of schizophrenics.