PURPOSE: This study was designed to identify current status of the subspecialist training programs and related factors affecting subspecialists' job selection. METHODS: The study subjects were 5,569 subspecialist trainees in 61 hospitals between 1989 and 1999. Among them, 1,260 subjects were selected to identify employment status after training. Also we analysed factors affecting career selection for 863 subspecialists on which basic information was available. RESULTS: About 26.6% of all subspecialist trainees trained in 1999 was for subspecialties in internal medicine, the largest majority, and 89.3% was in metropolitan areas. Also 91.1% were trained in teaching hospitals. Among subspecialists completed training, 79.5% selected career to work at general or teaching hospitals as of 1999, but 13.5% practised at clinics. The factors affecting career selection after training were gender, ownership of medical school, and specialty. CONCLUSION: The fact that not a few subspecialists work at primary care clinics means there are unreasonable human resource allocation and planning, with probable poor quality of primary care. Therefore, it is necessary to have a human resource plan at the national level for appropriate number of subspecialists, based on each specialty, in particular. Any structural factors affecting destination of subspecialist trainees, such as gender and graduated medical school, etc, should be dealt with in the long run.
Education* ; Employment ; Hospitals, Teaching ; Humans ; Internal Medicine ; Ownership ; Primary Health Care ; Resource Allocation ; Schools, Medical

OBJECTIVE: This study was designed to assess sequential association between right ventricular systolic pressure and cardiothoracic (C/T) ratio of chest radiography in systemic sclerosis (SSc) patients and inferred pulmonary arterial hypertension by increased C/T ratio and right ventricular systolic pressure. METHODS: Twenty-eight consecutive patients with confirmed SSc (22 females, 6 males; mean age 51.1+/-2.1 years), with a mean time of 91.0+/-6.7 months from SSc diagnosis, were prospectively included in the study. C/T ratio was obtained by chest radiography with an interval of two years. The first C/T ratio was taken at diagnosis and second C/T ratio was taken at the time of enrollment. The enrolled subjects were agree to undergo echocardiography and measurement of brain natriuretic peptide. RESULTS: In 24 SSc patients with normal right ventricular systolic pressure, 10 SSc patients had increased C/T ratio, the other four SSc patients with increased right ventricular systolic pressure by echocardiography, had increased C/T ratio all together. In four SSc patients with increased right ventricular systolic pressure, one patient had resting dyspnea, taken cardiac catheterization and confirmed as pulmonary hypertension and the other three patients had no clinical symptoms. The increased right ventricular systolic pressure is related to the increase of C/T ratio (>0.55) in chest radiography (p<0.05) and increased brain natriuretic peptide in blood (p<0.05). CONCLUSION: The increase of C/T ratio (>0.55) in chest radiography was associated with increased right ventricular systolic pressure measured by echocardiography and inferred a role in early detection of asymptomatic pulmonary arterial hypertension in SSc patients.
Blood Pressure* ; Cardiac Catheterization ; Cardiac Catheters ; Diagnosis ; Dyspnea ; Echocardiography ; Female ; Humans ; Hypertension ; Hypertension, Pulmonary ; Male ; Natriuretic Peptide, Brain ; Prospective Studies ; Radiography ; Scleroderma, Systemic* ; Thorax

Lymphoepithelial carcinoma (LEC) is a rare histological type of cancer of the salivary glands. LEC is characterized histologically as non-keratinizing, undifferentiated squamous cell carcinoma with lymphocytic infiltration. According to several in-situ hybridization studies, LEC is strongly associated with Epstein-Barr virus (EBV) infection. We report, along with a review of literature, a rare case of EBV positive primary LEC of the parotid that excluded the possibility of coexisting or metastatic nasopharyngeal carcinoma.
Carcinoma, Squamous Cell ; Electrons* ; Herpesvirus 4, Human* ; Nasopharynx* ; Parotid Gland* ; Salivary Gland Neoplasms

Objective: Botulinum toxin was used to treat patients with difficulty in relaxation of the upper esophageal sphincter (UES), but the treatment did not always yield good results. We, therefore, attempted to investigate if there was any other factor affecting the outcome and hypothesized that this could be caused due to pharyngeal constriction. Methods: We conducted a retrospective study on a botulinum toxin injection treatment given to eleven patients with nasal backflow and pharyngeal stasis in the course of a videofluoroscopic swallowing study from August 2006 to December 2012. After the injection, the cases showing an esophageal passage of diluted barium regardless of aspiration were defined as “good”, and the cases showing no passage were defined as “bad”. Pharyngeal strength was measured using the pharyngeal constriction ratio (PCR), which was compared between the two groups using the Mann-Whitney U test for proving the hypothesis. Results: Five of the eleven patients showed esophageal passage after the injection treatment and were assigned to the “good” group. The remaining 6 were assigned to the “bad” group. When comparing the average PCR of each group, the ‘good’ group’s ratio was at 0.09±0.03 and the ‘bad’ group was at 0.29±0.16, showing a statistically significant difference (P＜0.05). Conclusion The strength of pharyngeal constriction could be considered to be an important factor influencing the outcome after botulinum toxin treatment for the difficulty in relaxation of the UES.