In order to find out affecting factors to utilization of a rural health subcenter for primary health care, a study was carried out, through analyzing the specific survey data of 284 out of 1,151 total householders in a rural community, Su Dong-Myun, Nam Yang Ju-Gun, Kyung Gi-Do, Korea, and the medical records of total outpatients of the health subcenter in the district during 1976-1987. The following results were obtained: 1) Since 1977, the annual utilization rate showed decreasing tendency such as 900 per 1,000 inhabitants in 1977, 846 in 1979, 708 in 1981, 618 in 1985, 594 in 1983 and 341 in 1987. 2) The age specific utilization rate showed the highest in the group of age of 0-4 with 2,067.4 per 1,000 inhabitants in 1976, 2,402.7 in 1981 and 2,308.2 in 1986, respectively. In the other age groups, no any significant difference was found in the specific rate. 3) In the choice rate of medical facillities for primary health care, health subcenter was the highest(43.3%), and hospital (29.6%), generalist clinic (15.5%) and specialist clinic (11.6%) were in decreasing order. 4) Among the householders surveyed, 92.6% experienced to visit the rural health subcenter more than once. However, 21.1% of them said that the health subcenter is not proper medical facillitics for their situation. 5) In choice reasons of the health subcenter for primary health care, dominent priority factors were sincerity and kindness of health personnels containing staffs(57.8%), near distance from living place (24.6%), proper medical facillities(9.2%) and lower medical cost(8.4%) 6) The utilization rate of health subcenter in the district, revealed a tendency that the nearer distance from the health subcenter, the more patients visit health subcenter. 7) More than half (59.8%) of the householders surveyed, answered that primary health care was interfered mainly with the daily farm work in the district. 8) For the enhancement of utilization rate, the householders surveyed demanded the health subcenter to have good attitude of health subcenter personnel (28.5%), to observe the time and/or extend the duty hours(10.9%), to provide proper medical facillicies (9.5%) and the others(7.1%).

Diplopia may result from a variety of causes. The cases reported here illustrate several etiologies, progneses, and diagnostic investigation. The most common ocular motor palsy was the abducens nerve palsy(48%), and the others were oculomotor nerve palsy(24%), convergence palsy(16%), trochlear nerve palsy(8%) and divergence palsy (4%) in this order. The most common cause of ocular movement palsy was vascular disorder (44%), and the other causes were trauma(16%), aneurysm(8%), neoplasm(4%) and hydrocephalus(4%). The ocular motor palsy due to vascular disorder was best prognosis.

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• Two Cases of Diplopia and Ptosis from Cerebrovascular Disease Treated with Joganiknoe-tang
  Yun-Sun Lyu, Jang-Ho Park, Dal-Bit Bae, Go-Eun Lee, Hyoung-Won Kang, Yeoung-Su Lyu
  Journal of Oriental Neuropsychiatry.2012; 23(3): 117.     CrossRef

A clinical analysis of the surgically managed neonatal surgical diseases was made with 92 patients under 4 weeks old who were admitted during 12 years period from Jan. 1976 to Dec. 1987. And the outcome of the first half period was compaired with that of the second half period. The results were as follows. 1) Pediatric surgical patients were 17.6% of total patients admitted in the department of the general surgery, and 4.6% of these (92 cases) were neonatal surgical patients. The number of neonatal surgical patients were increased significantly during the second half period. 2) 69 cases were male and 23 cases were female. A ratio of male to female was 3:1. 3) About 60% of the cases were admitted during their first week of life and there were 30% of the cases who admitted during the last week of their neonatal period. 4) Except three cases, 89 cases (96.7%) were admitted with congenital surgical anomalies. 5) More frequent diseases were as follows: congenital hypertrophic pyloric stenosis ; 24 cases (26.1%), jejuno-ileal atresia or stenosis ; 13 cases(14.1%), imperforate anus; 13 cases (14.1%) and congenital duodenal obstruction; 11 cases(11.1%). 6) Vomiting was the main symptom to three quarters of the cases. 7) The number of cases associated with the other congenital anomalies were 14 cases(15.7%). 8) The postoperative complication rate was equally 26% during the first half (9/35) and the second half period (15/57), and the frequent complications were the respiratory problems, sepsis, and wound complications. 9) The mortalities were 28.6% (10/35) during the first half and 8.8% (5/57) during the second half period. Better understanding of neonatal physiology, adequate attention, and active management of pre- and postoperative neonates have certainly contributed to the increased survival during the second half period.

A clinico-statistical analysis was performed on 389 cases of professional voice users who complained to voice disorder at dept. of otolaryngology of Ewha Womans University Hospital during past 10 years from Jan. 1975 to Dec. 1984 and the following results were obtained. 1) Among total of 44,912 who visited the dept. of otolarfyngology, the patients with voice disorders were 1373 cases (3.1%). 2) Among total 1016 cases, male were 586 and female were 787, the ratio being 1:1.3. 3) Among total of 1016 cases, 389 were cases of professional voice users(38.3%) 4) The occupational distribution of professional voice users with voice disorder in order of frequency were acute laryngitis 125 cases (32.1%), chronic laryngitis 67 cases(17.2%), vocal nodule and polyp 155 cases (39.9%), phonasthenia 15 cases (3.9%), laryngeal neurosis 16 cases (4.1%), vocal muscle paralysis 11 cases(2.8%). 5) Among 125 cases of acute laryngitis, vocal musicians were 63 cases (50.4%), Korean classical musicians were 20 cases (16.0%), teachers were 16 cases(12.8%), pastors were 9 cases (7.2%), drama players were 6 cases (4.8%), radio actors were 7 cases(5.6%), announcers were 4 cases (3.2%). 6) Among 67 cases of chronic laryngitis, vocal musicians were 19 cases(28.4%), Korean classical musicians were 15 cases(22.4%), teachers were 19 cases(28.4%), pastors were 6 cases(9.0%), drama players were 4 cases(6.0%), radio actors were 2 cases(2.9%), announcers were 2 cases(2.9%). 7) Among 155 cases of vocal nodule and polyp, vocal musicians were 45 cases(29.1%), Korean classical musicians were 23 cases (14.8%), teachers were 61 cases (39.4%), pastors were 13 cases(8.4%), drama players were 7 cases(4.5%), radio actors were 5 cases(3.2%), announcer was 1case(0.6%). 8) Among 15 cases of phonasthenia, vocal musicians were 6 cases (40.0%), teachers were 6 cases (40.0%), Korean classical musician, announcer and pastor were each 1 case(20.0%). 9) Among 16 cases of laryngeal neurosis, drama players were 6 cases(37.5%), vocal musicians were 5 cases(31.3%), teachers were 4 cases(25.0%), announcer was 1 case(6.2%). 10) Among 11 cases of vocal muscle paralysis, teachers were 6 cases(54.5%), pastors were 2 cases (18.2%), vocal musician, Korean classical musician and drama player were each 1 case(27.3%).

The authors have studied the therapeutic effect of the combinations of mannitol, methylprednisolone(MP), phenytoin and barbiturates on the acute focal cerebral ischemia (AFCI) in cats. The experimental animals were divided into three groups. Group I was the cats with the removal of the orbital contents without occlusion of MCA. Group II was that of 2-hour recirculation after AFCI following the occlusion of MCA for 3 hours. Group C was subdivided into four subgroups as Group III-a, Group III-b, Group III-c and Group III-d. Group III-a was that of treatment of combinations of mannitol and MP, Group III-b that of combinations of mannitol and phenytoin. Group III-c that of combinations of mannitol and barbiturates, and Group III-d that of combinations of mannitol, MP (60mg/kg) phenytoin and barbiturate. As the biochemical studies cytochrome oxidase activities (COA) and the concentrations of lipid peroxidation(LP) were determined, and as the pathohistologic studies the degree of the infarcted areas, hemispheric swellings and the comparative microscopic findings of the infarcted areas were studied. In Group III-a and Group III-b no therapeutic effect on the AFCI was presented. In Group III-c the partial effect of brain protection were demonstrated only in LP and the degree of hemispheric swelling, but Group III-d provided nearly complete protection from ischemic damage. These experimental data suggested that the medical measures of the combinations of mannitol, MP, phenytoin and barbiturates can make the AFCI fully reversible and would applicable in the clinical field.

Spina bifida occulta at the lumbosacral area of a growing child is often associated with a low lying spinal cord that is tethered by one or more forms of intradural abnormalities without producing overt clinical manifestation for a long time. The diagnosis therefore requires a strong clinical suspicision and aggressive investigarion. We reported one case of tethered core syndrome in spina bifida occulta woth brief review of literature.