PURPOSE: The aim of this study is to evaluate the effect of radiotherapy for the patients with Graves' orbitopathy who were intolerable to corticosteroid therapy. METHODS: From December 1995 to June 2000, We reviewed medical records of thirteen patients who had received orbital radiation delivering 2000 cGy in 10 fractions over 2 weeks. RESULTS: Compressive optic neuropathy was improved in 3 of 4 patients (75%), and soft tissue swelling was improved in eight of 9 patients (88%). Proptosis was reduced in 3 of 13 (30%) patients. However, diplopia and ocular motility responded poorly and was improved only in 2 of 10 (20%) patients. No adverse effects of radiotherapy occurred in any patient. Specifically there was no sign of radiation-induced injury to optic nerve, retina, or lens. CONCLUSIONS: Radiotherapy was successful in patients with acute Graves' orbitopathy especially who had compressive optic neuropathy or soft tissue swelling. This modality was useful for those who showed intolerable side effects from the use of corticosteroid or the recurrence with corticosteroid treatment.
Diplopia ; Exophthalmos ; Humans ; Medical Records ; Optic Nerve ; Optic Nerve Diseases ; Orbit ; Radiotherapy ; Recurrence ; Retina ; Thyroid Gland*

PURPOSE: With its increasing popularity, several complications, such as infection, exposure, and extrusion have been reported in the use of the porous orbital implants. Exposure of the implants is one of the most difficult complications to treat. We evaluate the effect of treatment in exposed porous orbital implants with various techniques. METHODS: From January 1995 to December 2000, 15 patients visited our clinic with exposure of implant after porous orbital implantation. The following procedures were used to cover the implants: observation with delayed prosthesis fitting and posterior vaulting of the prosthesis, burring away the anterior surface of the hydroxyapatite implant and placing dermis fat graft, removing infected implants and dermis fat graft, and removal and 180degrees rotation and replacement of porous implants according to the degree of exposure. RESULTS: Porous implants exposures occurred 1 to 12 weeks after implantations (mean, 5.2 weeks). Small areas of exposure (<3mm) closed spontaneously (2 cases), remained stationary (2 cases), and increased the exposure area requiring dermis fat graft (1 case). During the follow-up period (mean, 19 months), no porous orbital implant was exposed again except 1 case who received previous orbital irradiation therapy. CONCLUSIONS: Small exposure of porous orbital implants less than 3 mm in diameter may be closed with nonsurgical methods. In the case of exposure larger than 4 mm, dermis fat graft or removal and 180degrees rotation and replacement of porous implants were effective in the treatment of exposure.
Dermis ; Durapatite ; Follow-Up Studies ; Humans ; Orbit* ; Orbital Implants* ; Prostheses and Implants ; Prosthesis Fitting ; Transplants

The educational goal of premedical education is to provide a desired college-level training in liberal arts as well as sciences, and to provide a basis for future medical studies. However, there has been concern that the current premedical education at Korea University has been unproductive and has not met the educational goals. The objectives of this study were to evaluate the current premedical academic curriculum at Korea University and to provide baseline data for developing an improved premedical curriculum. A survey involving faculty, residents, and students from Korea University Medical School was conducted. The results of the study suggested that the current premedical curriculum was not relevant to future medical studies and the General Studies Program as a source for learning liberal arts and humanities, were not appropriate. There was a growing need for structural and functional integration between premedical and medical studies and in addition to requirement of reinforcing the social and human sciences into the premedical curriculum.
Curriculum* ; Education, Premedical ; Humanities ; Humans ; Korea* ; Learning ; Schools, Medical

Neuromyelitis optica (Devic`s syndrome) is a rare demyelinating disorder of unknown etiology in which unilateral or bilateral optic neuritis and transverse myelitis occur within an 8-week time interval. It is 8 disorder that occurs more common in children than in adults. The prognosis is better in children than in adults. The authors experienced 8 case of neuromyelitis optica in a 5-year-old female who developed acute visual loss of the left eye, sensory loss below the 4th thoracic derinatoine, paraplegia, fever and nuchal ridigity ; all following viral prodromes. We diagnosed this case through neurologic features, magnetic resonance imaging, and cerebrospinal fluid findings. She has irnproved without any specific treatment.
Adult ; Cerebrospinal Fluid ; Child* ; Child, Preschool ; Demyelinating Diseases ; Female ; Fever ; Humans ; Magnetic Resonance Imaging ; Myelitis, Transverse ; Neuromyelitis Optica* ; Optic Neuritis ; Paraplegia ; Prognosis

BACKGROUND: Histamine, released from mast cells in atheromatous plaque, has been known to cause cardiac ischemia or sudden cardiac death in atherosclerosis patient. Previous reports have suggested that histamine induced coronary vasoconstriction was due to increase in IP(3) and DAG, which induce release of Ca2+ from SR and increase the Ca2+ sensitivity of contractile element via activation of PKC. Recently, it was reported that application of histamine cause depolarization of intestinal smooth muscle, which may contribute to histamine-induced contraction via augmenting Ca2+ influx through activation of Ca2+ channels. However, the underyling mechanism of histamine-induced depolarization and its contribution to the magnitude of coronary vasoconstriction are still uncertain. METHOD: To elucidate the underlying mechanism of Ca2+ influx change during histamine-induced vasoconstriction, we examined the effect of Ca2+ channel antagonist and PKC blocker on histamine-induced contractions, and then measured the effect of PKC antagonist on whole cell K+ current using patch clamping method in rabbit coronary smooth muscle cells. RESULTS: Application of histamine induced phasic and tonic constraction of coronary rings via activation of H(1) receptors. Pretreatment of Ca2+ channel antagonist (nifedipine, 1 microM) or PKC blockers (10 nM staurosporine and 10 microM Go6976) markedly inhibited histamine-induced tonic contraction, which suggest that the magnitude of tonic contraction depend on the Ca2+ influx. Application of 4-AP, a blocker of voltage-dependent K+ channels, increased resting tone of coronary rings, and combined treatment of nifedipine blocked this 4-AP induced increase of resting tone. Application of active analoge of DAG (1,2-DiC(8)) significantly inhibited the activity of voltage-dependent K+ current in single smooth muscle cell, meanwhile the inactive analogue of DAG (1,3-DiC(8)) has no apparent effect on the activity of voltage-dependent K+ current. Furthermore, pretreatment of calphostin C (1 microM), a blocker of PKC, diminished the 1,2-DiC(8)-induced inhibition of K+ current. CONCLUSION: PKC dependent inhibition of voltage-dependent K+ current may be responsible for the maintaining of histamine-induced tonic contraction in rabbit coronary artery.
Atherosclerosis ; Constriction ; Coronary Vessels* ; Death, Sudden, Cardiac ; Histamine ; Humans ; Ischemia ; Mast Cells ; Muscle, Smooth ; Myocytes, Smooth Muscle ; Nifedipine ; Protein Kinase C ; Staurosporine ; Vasoconstriction

PURPOSE: Our understanding of the characteristics that make a 'good doctor' is continually changing. The aim of this study is to identify the attributes deemed important for being a 'good doctor' and to examine to what extent doctors actually possess them. METHODS: A list of characteristics of a good doctor was generated from literature review and from opinions from medical education experts, a focus group of medical students and a pilot survey of patients. An inventory comprising 33 statements was administered to 598 medical students, 145 faculty, 164 primary care physicians and 85 patients. RESULTS: All participants regarded 'accurate diagnosis and treatment' as the most important attribute for being a 'good doctor' and 'keeping up-to-date' as the second important attribute. Empathy towards patients, continuing professional development (CPD), kind manners towards patients were also regarded as important. There was a discrepancy between perceived importance and competency in the areas of communication skills, health advocacy and social contribution according to the participating groups. CONCLUSION: Excellence in clinical ability was identified as the most important attribute of a 'good doctor'. Compassion and CPD were also identified as important characteristics. More sophisticated studies are needed to further explore the attributes of a 'good doctor' for our society.
Diagnosis ; Education, Medical ; Empathy ; Focus Groups ; Humans ; Physicians, Primary Care ; Students, Medical

Vitreous fluorophotometry was used to measure blood retinal barrier permeability to fluorescein in 15 patients with branch retinal vein occlusion(BRVO). Mean posterior vitreous fluorescein concentration(3mm) was 20.0 +/- 11.3(ng/ml) in affected eyes, and 2.99 +/- 1.22(ng/ml) in unaffected eyes. There was a statistically significant difference between the affected eye and unaffected eye(p<0.05). Also there was a correlation between the hemorrhage area and the posterior vitreous fluorescein concentration(r2=0.819). This study revealed that the permeability of blood retinal barrier was increased in BRVO as compared to the contralateral eye, and the higher permeability values were associated with the extent of area involved.
Blood-Retinal Barrier ; Fluorescein ; Fluorophotometry ; Hemorrhage ; Humans ; Permeability ; Retina* ; Retinal Vein Occlusion* ; Retinal Vein* ; Retinaldehyde*

BACKGROUND: Impairment of relaxing response and augmentation of contractile response to vasoactive substances have been reported in atherosclerotic arteries. These alterations in vascular reactivity are considered as an underlying mechanism for the development of acute vasospasm in atherosclerotic coronary artery. Recently, it has been reported that lysophophatidylcholine (LPC), an oxidative metabolite of low density lipoprotein causes this functional abnormality. However, the precise mechanism of LPC induced change of vascular reactivity is still uncertain. METHOD: In this study, to elucidate the underlying mechanisms of abnormal vascular reactivity in atherosclerotic coronary artery, we examined the effect of LPC on whole cell K+current using patch clamping technique in rabbit coronary smooth muscle cells. RESULTS: Application of LPC(1microM) showed dual effect on whole cell outward current which depends on the magnitude of test potentials. At relatively high depolarizing test potentials (> 10 mV), LPC increased amplitude of outward current which was blocked by Gd3+ not by iberiotoxin (100 nM) and TEA (1 mM). Reversal potential of this Gd3+sensitive, LPC-induced current was -9.7 +/- 0.6 mV. At less depolarizing test potentials (< 10 mV), LPC decreased whole cell K+currents in a dose dependent manner (from 0.01 to 10 microM) in the range of -30 mV to +0 mV. Half maximal inhibition of K+current was 1.509 microM at 0 mV test potential (n =5). Depolarizing holding potential (0 mV) prevented this LPC-induced inhibition of K+current. Steady state activation and inactivation parameters of K+current were significantly shifted to the positive direction by application of LPC (p < 0.01, n =8). Pretreatment of staurosporine (100 nM), a blocker of protein kinase C partially blocked LPC-induced decrease of K+currents. CONCLUSION: LPC-induced inhibition of voltage dependent K+current may explain abnormal vascular reactivity in atherosclerotic coronary artery.
Arteries ; Constriction ; Coronary Vessels ; Lipoproteins ; Lysophosphatidylcholines* ; Muscle, Smooth* ; Myocytes, Smooth Muscle* ; Protein Kinase C ; Staurosporine ; Tea

BACKGROUND: The College of Medicine at Korea University has lunched the new curriculum which incorporated optional elective courses in 2000. Optional elective course is consisted of 10 subjects. 8 subjects are conducted in classroom lectures and 2 of them are active experiences in research or community service. The purpose of this study is to identify the level of achievement of its own educational goals and objectives. Also, we tried to explore the possibilities of improving this course for the maximum educational effectiveness.. MATERIAL AND METHOD: We conducted a survey and the subjects of this study were second, and third year medical students who finished this course. RESULTS: 84.8% of respondents were aware of the goals of the course. 91.1% of them agreed this course is needed to enhance the effectiveness in undergraduate medical education. Most students agreed the course provide an opportunity to broaden their perspectives of field of medicine(81.4% of respondents). Also, this course provided good informations for students' future career choice(78.6% of respondents). However, students wanted to have more in-depth learning experience. INTERPRETATION: The implementation of the optional elective course at the Korea University, Medical College was successful. Despite of its initial success, the course has to be revised to allow students to get more in - depth study according their own interests.
Curriculum ; Surveys and Questionnaires ; Education, Medical, Undergraduate ; Humans ; Korea ; Learning ; Lectures ; Lunch ; Social Welfare ; Students, Medical

We reviewed our medical records to evaluate the incidenee of and risk factors for retinal detachment after cataract surgery according to the surgical methods. Group 1 included 605 eyes operated on with corneoscleral incision, extracapsular cataract extraction(ECCE) and posterior chamber intraocular lens(PCL) implantation, and Group 2 included 600 eyes with scleral tunneling incision, phacoemulsification and PCL implantation. 8 eyes(1.3 %) developed retinal detachment in group 1, whereas 1 eyes(0.2%) in group 2. The difference in incid ence between the two groups was statistically significant(P<0.05). Axial length is longer than 25mm, intraoperative posterior capsule rupture, and scleral fixation were identified as risk factors for retinal detachment after cataract surgery. From the above results, suggest that phacoemulsification with scleral tunnel incision is preferable to extracapsular cataract extraction(ECCE) with cornea-scleral incision, in cataract surgery, to lower the post operative complication of retinal detachment.
Cataract* ; Incidence* ; Medical Records ; Phacoemulsification ; Retinal Detachment* ; Retinaldehyde* ; Risk Factors ; Rupture