• Title/Summary/Keyword: Neck Stiffness

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Management of a ruptured posterior inferior cerebellar artery (PICA) aneurysm with end-to-end in situ bypass: Case report

  • Livio Pereira de Macedo;Delson Culembe Baptista-Andre;rlindo Ugulino-Netto;Kaue Franke;Pierre Vansant Oliveira Eugenio;Auricelio Batista Cezar-Junior;Igor Vilela Faquini;Eduardo Vieira de Carvalho-Junior;Nivaldo S. Almeida;Hildo Rocha Cirne Azevedo-Filho
    • Journal of Cerebrovascular and Endovascular Neurosurgery
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    • v.26 no.2
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    • pp.216-222
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    • 2024
  • Dissecting posterior inferior cerebellar artery (PICA) aneurysms are uncommon lesions. Their anatomy and the location of the dissection are variable, however, they usually occurs at the origin of the PICA. Dissecting PICA aneurysms generally have non-vascular morphology involving an entire segment of the artery and cannot be cut. Nevertheless, the detection of these vascular lesions has increased latterly, so it is necessary to recognize it and take the appropriate management modalities for these injuries. In this report, we describe a case of a 73-year-old male patient, who presented a history of severe headache, associated with neck stiffness, nausea, vomiting, dizziness, hypoactivity, mental confusion, and walking difficulty. Radiographic investigation with brain computed tomography (CT) showed mild bleeding in a pre-medullary and pre-pontine cistern, and cerebral angiogram showed a dissecting PICA aneurysm. Despite being a challenging treatment, microsurgery management was the chosen modality. It was performed an end-to-end anastomosis between the p2/p3 segments, showing to be effective with good clinical and radiographic outcomes. We discussed an unusual case, reviewing the current literature on clinical presentations, the angiographic characteristics of the dissecting aneurysms of PICA, and evaluating the clinical and angiographic results of patients undergoing microsurgical treatment.

A study on characteristics and physiological variables of chest pain induced by exercise test in angina suspected patients (협심증이 의심되는 환자에서 운동부하검사로 유발되는 흉통의 양상과 생리적 변인에 관한 연구)

  • Cho, Mi-Kyoung;Choe, Myoung-Ae
    • Journal of Korean Biological Nursing Science
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    • v.2 no.2
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    • pp.1-19
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    • 2000
  • The purpose of this study was to identify the characteristics and physiological variables of chest pain induced by exercise test in angina suspected patients. The subjects of this study consisted of 28 inpatients and outpatients aged between 40 and 75 who underwent treadmill test at exercise testing laboratory of S-University from January 2000 to June 2000. Subjects were interviewed with questionnaire regarding sociodemography, the past health history and history related to chest pain before the exercise test. Subjects were interviewed with questionnaire concerning quality, intensity, duration of chest pain induced by walking on the treadmill(Marquette, U.S.A. 1992) according to Bruce protocol following exercise test. Systolic and diastolic blood pressure were measured before, during and after the test, heart rate was determined by ECG. The results of this study were as follows ; 1) Quality of chest pain induced by exercise test were feeling stiffness 19(67.9%), heavy 10(36.0%), exploded 9(32.1%), crushing, suffocating, tight 8(28.6%), stuffy, prickly 7(25.0%), burning 6(21.4%), clasp 5(17.9%), cleaved, tensed, piercing 3(10.7%), perfectly fitting, sore 2(7.1%), tearing, tingling, ticklish, heartburn 1(3.6%). 2) Mean score of VAS(intensity of pain) following exercise test was $5.79{\pm}2.27$ and mean duration of chest pain after the test was $7.83{\pm}5.31$ minutes. 3) Sites of chest-pain induced by exercise test were middle site 11(39.3%), left-chest 10(35.6%), right-chest 6(21.5%). Radiation site of chest-pain was neck(18.0%), right flank site 1(3.6%), left shoulder & arm 2(7.1%) and back 1(3.6%). 4) Symptoms other than chest-pain induced by exercise test were dyspnea 21(75.6%), perspiration 14(50.4%), fatigue 12(43.2%), leg-pain 11(39.6%), dizziness 7(25.2%) anxiety toward chest-pain 3(10.8%), thirst 2(7.1%), and palpation, headache and tingling sensation of hand and leg 1(3.6%). 5) Mean MET(intensity of exercise) during the exercise test was $7.64{\pm}2.57$ and mean RPE(rating of perceived exertion) was $15.89{\pm}2.36$. Mean duration of exercise was $6.79{\pm}2.88$. 6) correlation coefficients between RPE and VAS was 0.500(p=0.003), those between MET and VAS was 0.287(p=0.069) and those between either depression or elevation of ST segment and VAS was 0.236(p=0.114). 7) There was a significant difference in mean systolic pressure between before and after the test as $146.29{\pm}28.18mmHg$ and $177.96{\pm}28.82mmHg$(t=-5.640, p=0.000), a significant difference in mean diastolic blood pressure between before and after the test as $84.85{\pm}15.07mmHg$ and $88.89{\pm}13.72mmHg$(t=-2.082, p=0.047), and there was a significant difference in mean heart-rate between before and after the test as $81.89{\pm}12.22/min$ and $160.68{\pm}21.77/min$(t=-21.255, p=0.000).

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An Early Experience of Electroejaculation in Anejaculatory Men with Spinal Cord Injury (척수손상 환자에 대한 전기자극 인공사정의 초기 경험)

  • Kang, Il-Gyu;Cho, Myoung-Kwan;Oh, Chung-Hwan;Moon, Young-Tae;Kim, Sae-Chul;Choi, Jong-Han
    • Clinical and Experimental Reproductive Medicine
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    • v.19 no.1
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    • pp.87-94
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    • 1992
  • From December 1991 to March 1992, 34 anejacuratory patients with spinal cord injury underwent 90 of electric stimulations with Seager NRH model 12. The average patient age was 43.5 years with a range of 23 to 48 years. The level of cord injury was cervical in 7, thoracic in 6, lumbar in 11, lumbosacral in 7 and conus medullaris in 3. The average number of electric stimulation per a patient was 2.65 with a range of 1 to 4. The average voltage and amplitude per a stimulation were 17.72 volts and 309. 89 mAmp with ranges of 5 to 25 volts and 50 to 500 mAmp. The total and motile sperm number were evaluated microscopically and analyzed statistically by paired t-test according to the frequency of electroejaculation, level of cord injury and voiding pattern. The results were obtained as follows. 1. An overall success rate of electroejaculation was 85.3% among 34 patients and 82.2% among 90 electric stimulations. 2. The total and motile sperm number per a stimulation were not correlated the frequency of electric stimulation, level of cord injury and voiding pattern. 3. Complications occured in 10 cases; severe low abdominal pain in 5, hypertension in 2, sweating in 1, headache in 1 and neck stiffness in 1. All the copmlications subsided spontaneously within 5 to 10 minutes after transient interruption of the electric stimulation. In summary, rectal probe electroejaculation is an accepted safe means of procuring sperm from spinal cord injury patients with ejaculatory incompetence. However very poor sperm motility was found and it was not related with the frequency of electroejaculation, level of cord injury and voiding pattern. Further investigation would be needed to conclude and to identify the reasons for impaired sperm motility.

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A Clinical Study of Headache in 58 Cases (두통(頭痛)의 임상양상(臨床樣狀) 및 생체전기자율반응에 대(對)한 임상적(臨床的) 고찰(考察))

  • Lee Sang-Ryong;Kim Myung-Jin
    • Journal of Oriental Neuropsychiatry
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    • v.12 no.2
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    • pp.103-122
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    • 2001
  • The clinical study was carried out the 58 patients with Headache who were treated in Department of Neuropsychiatry, College of Oriental Medicine, Dae Jeon University from 14 October 1999 to 15 October 2001. The results were summarized as follows. 1. The ratio of male and female was 15:43, 40s(36.2%) was frequent, the ratio of Tension headache and Migraine was 43:12, hypernoia and overwork oneself were the most inducing factor. 2. In distribution of the period of the clinical history, Tension headache was comparatively short term within 1 month(62.8%) and Migraine was comparatively long term over 1 year(91.7%), Tension headache was frequent at whole portion(41.3%) and occipital portion(26.1%), Migraine was frequent at temporal portion(76.9%). 3. In pain type, Tension headache has many vandlike discomport type, Migraine has many pulsatile type, neck-stiffness-pain and dizziness were mainly coexited. 4. Toung aspect has many SULDAMHONGTAEBAEKHOO(舌淡紅苔白厚), GINMAEK(緊脈) and HEUNMAEK(弦脈) were frequent in Pulse type, the GAEDAMSUNKIJEETONG(祛淡順氣止痛) prescription drugs were frequent such as GEYNTONGA(肩痛A), GEYNTONGDODAMTANG(?通導淡湯), Tension headache patients were well treated(90.7%). 5. In Tension headache and Migraine, the Curve has many SL except Tension headache‘s 2th SANGHAN(상한), in Regulation RR was frequent at 1th, 2th, 3th, 4th, 7th SANGHAN and RL was frequent at 5th, 6th SANGHAN, the result of Graph, Activity and Reactivity have many low response at the whole. 6. The Curve was within normal limit at whole portion and frequent SL at temporal portion, the whole and temporal portion s Regulation also have many RR at 1th, 2th, 3th, 4th, 7th SANGHAN and RL at 5th, 6th SANGHAN, Activity and Reactivity have many low response at the whole. 7. The occipital and frontal portion‘s Curve have many SL at 1th SANGHAN, the occipital portion’s Regulation has many RR at 1th, 2th, 4th, 7th SANGHAN and RL at 5th, 6th SANGHAN, Activity has many low response at the whole, Reactivity has many low response at 1th, 4th, 5th, 6th SANGHAN and high response 2th, 3th SANGHAN, the frontal portion s Regulation has many RL at 1th, 3th, 5th, 6th, 7th SANGHAN and RR at 4th SANGHAN, Activity and Reactivity also have many low response at the whole except 6th, 7th SANGHAN respectively.

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The clinical observation of patient with Headache Treated by Trigger point acupuncture therapy (발통점(發通點)을 이용(利用)한 두통(頭痛) 치험례(治驗例) 보고(報告))

  • Lee Seung-Yeon;Kim Jang-Hyun
    • The Journal of Pediatrics of Korean Medicine
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    • v.12 no.1
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    • pp.133-143
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    • 1998
  • Myofascial pain syndrome is one of the pain syndrome resulted from myofascia which covered muscles and clinically characteristic feature by sensitive trigger point in skeletal muscles and referred pain reactivated by stimulating each trigger point. The origin of headache are local lesion such as head, chest, abdominal organ, systemic lesion with fever or in toxic state. the other factors are consciousness, personality, anxiety, depression, which cause muscle strain in physiological environment. The Oriental Medical therapy for headache has herb medication and acupuncture. especially acupuncture therapy has not only classical systemic acupuncture(體鍼) but also neo-acupuncture(新鍼) such as commonly using auricular acupuncture(耳鍼) and manual acupuncture (手鍼), recently trigger point acupuncture is used. The author analyzed 27 cases of patient with headache treated by trigger point acupuncture therapy in Dong-yu Oriental Medical Hospital from March 1st 1997 to February 28th 1998. The following results were obtained. 1. The sex ratio of the female was 59.26%(16 cases) and male was 40.74%(11 cases), the ratio of high school student was 62.96%(17cases) as first. 2. The headache duration ratio of 2-3 years was 37.04%(10 cases) as first, 1-2 years was 25.93%(7 cases) as second. 3. The portion ratio of whole headache was 33.33%(9 cases) as first, lateral headache was 29.63%(8 cases) as second 4. The combined symptoms ratio of anorexia was 40.74%(11 cases) as first, fatigue was 33.33%(9 cases) as second, neck stiffness and dizziness was each 25.93%(7 cases) as third. 5. The therapeutic duration ratio of below 1 week was 29.63%(8 cases) as first, 2-3 weeks was 22.22%(6 cases) as second, 1-2 weeks and 3-4 weeks was each 18.52%(5 cases) as third. 6. The ratio of family history was 11 cases(40.74%). mother with headache was 6 cases, father was 3 cases, and brothers & sisters was 2 cases. 7. The herb medication ratio of Chungsanggyuntongtang(淸上?痛湯) was 37.04%(10 cases), Kamiondamtang(加味溫膽湯) was 22.22%(6 cases), Hyangsapyunguisan(香砂平胃散) was 18.25%(5 cases) etc. 8. The remedial effect ratio of good was 25.93%(7 cases), fair was 48.15%(13 cases), not improved was 7.41%(2 cases), side effect was 3.70%(1 cases), and unknown was 14.81%(4 cases).

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Treatment Outcome for Nasopharyngeal Carcinoma in University Malaya Medical Centre from 2004-2008

  • Ee Phua, Vincent Chee;Loo, Wei Hoong;Yusof, Mastura Md;Ishak, Wan Zamaniah Wan;Tho, Lye Mun;Ung, Ngie Min
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.8
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    • pp.4567-4570
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    • 2013
  • Background: Nasopharyngeal carcinoma (NPC) is the commonest radiocurable cancer in Malaysia. This study aimed to determine the treatment outcomes and late effects of radiotherapy for NPC patients treated in University Malaya Medical Centre (UMMC). Materials and Methods: All newly diagnosed patients with NPC referred for treatment to the Oncology unit at UMMC from 2004-2008 were retrospectively analyzed. Treatment outcomes were 5 years overall survival (OS), disease free survival (DFS), cause-specific survival (CSS), locoregional control (LRC) and radiotherapy-related late effects. The Kaplan-Meier method was used for survival analysis and differences in survival according to AJCC stage was compared using the log-rank test. Results: A total of 176 patients with newly diagnosed NPC were treated in UMMC during this period. Late presentation was common, with 33.5% presenting with T3-4 disease, 84.7% with N1-3 disease and 75.6% with AJCC stage 3-4 disease. Radical RT was given to 162 patients with 22.7% having RT alone and 69.3% having CCRT. The stipulated OTT was 7 weeks and 72.2% managed to complete their RT within this time period. Neoadjuvant chemotherapy was given to 14.8% while adjuvant chemotherapy was administered to 16.5%. The 5 years OS was 51.6% with a median follow up of 58 months. The 5 years OS according to stage were 81.8% for stage I, 77.9% for stage II, 47.4% for stage III and 25.9% for stage IV. The 5 years overall CSS, DFS and LRC were 54.4%, 48.4% and 70.6%, respectively. RT related late effects were documented in 80.2%. The commonest was xerostomia (66.7%). Other documented late effects were hearing deficit (17.3%), visual deficit (3.1%), neck stiffness (3.1%), dysphagia (3.4%), cranial nerve palsy (2.5%), pneumonitis (0.6%) and hypothyroidism (1.2%). Conclusions: The 5 years OS and LRC in this study are low compared to the latest studies especially those utilizing IMRT. Implementation of IMRT for NPC treatment should be strongly encouraged.

The Effect of korean, Chinese and American Ginseng on Blood Pressure of Hypertensive Patients (한국삼, 중국삼, 서양삼이 고혈압 환자의 혈압에 미치는 영향)

  • Lee Cha-ro;Lee Sang-Ho;Rhee Jun-Woo;Na Byong-Jo;Kim Tae-Hun;Jung Woo-Sang;Moon Sang-Ho;Cho Ki-Ho;Bae Hyung-Sup;Kim Young-Suk
    • The Journal of Korean Medicine
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    • v.26 no.3 s.63
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    • pp.228-238
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    • 2005
  • Objectives : We conducted a randomized, double-blinded clinical trial to assess the anti-hypertensive effect of Ginseng and to know the difference of the effect according to it's growing districts md species by 24-hour ambulatory blood pressure measurement (ABPM). Methods : We allocated 96 hypertensive patients enrolled in this trial to Korean ginseng(KG), American ginseng (AG), Chinese ginseng (CG), and Korean red ginseng (KRG) groups by randomization. Each subject was administered 4.5mg/day of encapsulated ginseng for 4 weeks. We assessed anti-hypertensive effect, blood pressure variability using ABPM and toxicity by blood chemistry before and after treatment. We also evaluated changes of symptoms due to hypertension and adverse effect in all groups at the first visit, 2 weeks later and 4 weeks later. Results : Blood pressure after treatments showed significant decrease of systolic blood pressure (sBP) in the CG-group (p<0,05) and diastolic blood pressure (dBP) in the KRG-group (p<0.05). However, there were no significant changes of sBP (or dBP) after treatment in the other groups and no significant difference in changes of BP between before and after treatment among the 4 groups. Blood pressure variability in the CG-group showed significant decrease after treatment but not in the KRG-group. Symptoms such as headache or neck stiffness and heating sensation due to hypertension improved significantly in all groups, especially in the KRG-group. A3l patients had no adverse effect after treatment and there was no liver or kidney toxicity. Conclusions : CG and KRG seem to have anti-hypertensive effects, but there was no significantly different effect depending on growing district and species of Ginseng.

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Operative Treatment of Terrible Triad in Elbow of Adults (성인 주관절의 요골두와 구상돌기 골절을 동반한 탈구의 수술 적 치료 (성인 주관절에 발생한 위험3증주의 수술적 치료))

  • Kim, Byung-Heum;Park, Jong-Seok;Choi, Ho-Rim;Lee, Sang-Sun;Rah, Soo-Kyun;Lee, Hyun-Wook
    • Clinics in Shoulder and Elbow
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    • v.9 no.1
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    • pp.50-59
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    • 2006
  • Purpose: The nonoperative outcome of elbow dislocations with associated radial head and coronoid fractures are often unsatisfactory because of chronic instability and stiffness from proloned immobilization, Therefore we managed these injuries with well programed surgical appproaches. Method: Ten patients with this injury were evaluated retrospectively from May 1998 to June 2004 after a minimum of 12 months. These injuries include elbow dislocation and associated fractures of both the radial head and the coronoid process. All ten patients were treated by one clinic operatively with similar scheduled surgical methods which started on the lateral side and terminated on the medial side of the elbow. Radial head and neck fractures were classified Mason types, as two and three types respectively with six and four cases and six cases were fixated. Coronoid process were fixated with screws anteroposterior directly or anchor suture in all cases, each type was classified one, two and three. where were three type one, four type two, and three type three were according to Regan and Morrey classification. Results: The outcome was three resulting in excellent, four good, two normaland and the remaining case was one poor according to the Mayo Elbow Performance score. At a terminal follow up, the range of motion of the elbow averaged flection contracture, $6^{\circ}(0{\sim}20^{\circ})$ and further flection, $129^{\circ}(115{\sim}140^{\circ})$. Two patients had complications requiring additional care. One, displaced coronoid process which was repaired with capsule and the other patient experienced, palsy of ulnar nerve and contracted elbow joint. Conclusions: Usage of early operation as the minimum injury of medial ligaments complex and the rigid fixation of fractures to prompt motion with our scheduled management for elbow dislocations with associated radial head and coracoid fractures provided excellent results.

The Association of Subjective Symptoms of Students and Indoor Air Quality in Private Academic Facilities (학원시설 실내공기질과 이용자의 자각증상에 관한 연구)

  • Jung, Kyung-Sick;Kim, Nam-Soo;Lee, Jong-Dae;HwangBo, Young;Son, Bu-Soon;Lee, Byung-Kook
    • Journal of Environmental Health Sciences
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    • v.35 no.6
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    • pp.468-477
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    • 2009
  • To evaluate the current indoor air quality condition of private academic facilities in Korea and investigate its association with subjective symptoms of student residing at the same academic facilities, air quality monitoring was carried out in total of 20 academic facilities located in Seoul, Daejon and Chungnam from the beginning of January to the end of April, 2009. To assess the air quality condition of academic facilities, 6 air pollutants with temperature and humidity were measured simultaneously inside and outside of academic facilities. The rate of exceeding the Indoor Air Quality (IAQ) guideline concentrations in 6 air pollutants were 5%, 85%, 15%, 5%, 10% and 30% for CO, $CO_2$, PM10, HCHO, TVOCs and TBC, respectively. A questionnaire on 16 subjective symptoms related to indoor air quality was given to 342 students who studied at the 20 academic facilities. The most frequent symptom of students was 'I feel easily tired or sleepy', and this was followed by 'I feel muscular pain or stiffness on shoulder, back and neck'. The association of net difference (subjective symptoms at the academic facility - subjective symptoms of the usual situation) with air pollutants was analyzed using spearman rank correlation. In logistic analysis using proportional odds method, the students whose indoor air concentration of HCHO was ${\geq}60{\mu}g/m^3$ hadsignificant odds of having more subjective symptoms of 'My eyes are dry or feel irritated or itching' (OR=5.026: CI=1.587-15.911), 'I feel easily tired or sleepy' (OR=2.956: CI=1.072-8.152), 'I lose my concentration and I feel my memory is falling' (OR=7.745: CI=1.938-30.955) and 'I feel dizzy' (OR=4.424: CI=1.292-15.149) than those of <$60{\mu}g/m^3$.

Clinical Investigation of Fatigue Among Outpatients (피로를 호소하는 외래환자에 대한 임상적 관찰)

  • Park, Shin-Myong;Seung, Hyun-Suk;Kim, Young-Chul;Lee, Jang-Hoon;Woo, Hong-Jung;Lee, Ji-Hyeon
    • The Journal of Internal Korean Medicine
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    • v.22 no.3
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    • pp.299-307
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    • 2001
  • Objectives: Fatigue is a common symptom experienced by many people who visit Oriental medical clinics or hospital. However, there has been little study about the fatigue in the Oriental medical academic world. For this reason, we attempted to investigate the present status of fatigue of outpatients, and its relation with Health Practice Index(HPI). Methods: The subjects were 63 outpatients who visited the Tonification Clinic in Kyunghee Oriental Medical Center between January 1, 2001 and July 31, 2001. Their chief complaint was fatigue and they did not have any physical or mental problem. They were given a questionnaire which included questions reflecting general characteristics, fatigue degree and health habits. We measured degree of fatigue by Chalder scale et al. Health habits were investigated about 5 articles out of 'Breslow 7 Health habits'. Results: Among the subjects, 48 people(76.2%) were considered as 'fatigue patients' by the Chalder scale. Of this 48 fatigue patients, 27 people(56.3%) had manifested fatigue for more than 6 months. The average of scale II for all the patients was 14.05, which indicates moderate degree of fatigue. They complained fatigue, drowsiness and general weakness, dryness and discomfort of the eyes, headache, shoulder pain and neck stiffness, dizziness, heat in the upper part of the body, and poor concentration. There were no differences in degree of fatigue according to Health habits including exercise or not, smoking or not, the frequency of drinking, hours of sleeping, and body mass index. Conclusions: Many people complain fatigue symptom. Therefore doctors should have more interest in fatigue and care. This study can provide standards of prognosis of fatigue patients. Also prospective studies are needed to find relationship between health habits and fatigue degree.

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