Pulmonary Embolism can develop in variable conditions, and presents with nonspecific symptoms and signs. If diagnosis is delayed, it can be resulted in catastrophic results. Therefore, early diagnosis and adequate treatment is crucial in Pulmonary Embolism. Lung Perfusion Scan is useful screening test. Negative result can exclude pulmonary embolism, But, perfusion defects don't always mean pulmonary embolism. To find the better methods of interpretation of king perfusion scan and To evaluate the clinical course and outcomes of the patients, in whom pulmonary embolism was suspected by lung perfusion scan, we reviewed the clinical records of 49 cases suspected by lung perfusion scan at Seoul National University Hospital during the period of January, 1995 to July, 1996. The results are as follows. First impression of cases in which PE was present at time of admission were pulmonary embolism (63%), heart diseases (26%), and pneumonia (11%) in orders. Underlying diseases of cases in which PE developed during admission were malignancy (36.5%), 10-I (22.7%), sepsis (13.7%), and SLE (9.1%) in orders. The predisposing factors were operation (20%), cancer (16%), immobility (16%), connective tissue disease (16%), heart dis. (10%), old age (10%), and preg/pelvic dis. (8%) The results of lung perfusion scan were HPPE 40cases(26.8%), IPPE 21 cases(14.1%), LPPE 88 cases(59.l %) and cases(%) of treatment in these cases were HPPE 34 cases(85%), IPPE 9 cases(42,9%), IPPE 0 case(0.0%). Treatments were heparin and warfarin (69.5%), heparin alone (8.2%), warfarin alone (2.0%), embolectomy(4.1%), thrombolytics (20%), IVC filter (2.0%), and no treatment (12.2%) In 34 cases (694%), follow up could be done, and 5 cases were recurred (10.2%). The causes of recurrence was incomplete anticoagulant therapy (3 cases) 2rnd recurrence of predisposing factor (2 cases). Expired case due to pulmonary embolism was one who was expired just before trial of thrombolytie therapy. CONCLUSION: Efforts should be made to shorten the interval from onset of Sx to Dx, ie, high index of suspision.
Causality ; Connective Tissue Diseases ; Diagnosis ; Early Diagnosis ; Follow-Up Studies ; Heart ; Heart Diseases ; Heparin ; Humans ; Lung* ; Mass Screening ; Perfusion* ; Pneumonia ; Pulmonary Embolism* ; Recurrence ; Seoul ; Sepsis ; Warfarin

BACKGROUND: Endotoxin, the component of outermembrane of gram negative organism, plays an important role in the initiation and amplification of inflammatory reaction by its effects on inflammatory cells. Until recently, there have been continuing efforts to delinate the mechanisms of the signal trasduction pathway of endotoxin stimuli on inflammatory cells. By uncovering the mechanisms of signal transduction pathway of endotoxin stimuli, we can expect to have tools to control the excessive inflammatory responses which sometimes may be fatal to the involved host. It was generally accepted that endotoxin exerts its inflammatory effects through inflammatory cytokines that are produced by endotoxin-stimulated inflammatory cells and there were some reports on the importance of protein kinase C and protein tyrosine kinase activation in the production of inflammatory cytokines by endotoxin. So we evaluated the effect of pretreatment of protein kinase C inhibitors (H7, Staurosporin) and protein tyrosine kinase inhibitors(Herbimycin, Genistein) on the endotoxin-stimulated cytokines(IL-8 & TNF-alpha) mRNA expression. METHOD: Peripheral blood monocytes were isolated from healthy volunteers by Ficoll-Hypaque density gradient method and purified by adhesion to 60mm Petri dishes. Endotoxin(LPS 100ng/ml) was added to each dishes except one control dish, and each endotoxin-stimulated dishes was preincubated with H7, Staurosporin(protein kinase C inhibitor), Herbimycin or Genistein(protein tyrosine kinase inhibitor) respectively except one dish. Four hours later the endotoxin stimulation, total RNA was extracted and Northern blot analysis for IL-8 mRNA and TNF-alpha mRNA was done. RESULT: Endotoxin stimulation increased the expression of IL-8 mRNA and TNF-alpha mRNA expression in human peripheral blood monocyte as expected and the stimulatory effect of endotoxin on TNF-alpha mRNA expression was inhibited by protein kinase C inhibitors(H7, Staurosporin) and protein tyrosine kinase inhibitors (Herbimycin, Genistein). The inhibitory effect of each drugs was increased with increasing concentration. The stimulatory effect of endotoxin on IL-8 mRNA was also inhibited by H7 and protein tyrosine kinase inhibitors (Herbimycin, Genistein) dose-dependently but not by Staurosporin. CONCLUSION: Protein kinase C and protein tyrosine kinase are involved in the endotoxin induced signal transduction pathway in human peripheral blood monocyte.
Blotting, Northern ; Cytokines ; Healthy Volunteers ; Humans ; Interleukin-8 ; Monocytes* ; Phosphotransferases ; Protein Kinase C* ; Protein Kinases* ; Protein-Tyrosine Kinases* ; RNA ; RNA, Messenger ; Signal Transduction* ; Tumor Necrosis Factor-alpha

BACKGROUND: The risk of rubella infection is higher in hospital workers than in others because of high possibility of exposure to rubella viruses. Moreover, rubella infection during pregnancy can cause serious problems, special preventive measures should be taken for female employees in the hospital. METHODS: This study was performed from October to December, 1995 and the subjects were 307 female employees in a university hospital, who were aged 20 to 40 and had many chances cf exposure to rubella patient during working. Rubella virus antibody was detected by the method of ELISA. For the antibody-negative employees, we gave active immunization and retested the antibody titer after six weeks. RESULTS: Among 307 subjects, 289 cases (94.1%) were positive for rubella IgG antibody. There was no significant difference in positive rates of rubella antibody by type of occupation, age, medical department, and duration employed. The seroconversion rate was 93.8% (15/16). CONCLUSIONS: According to these findings, we recommend that the employees in the hospital, especially women aged 20 to 40 should be checked for Rubella Ab (IgG) and be vaccinated when they don't have it.
Enzyme-Linked Immunosorbent Assay ; Female* ; Humans ; Immunoglobulin G ; Occupations ; Pregnancy ; Rubella virus ; Rubella* ; Vaccination

BACKGROUND: The risk of rubella infection is higher in hospital workers than in others because of high possibility of exposure to rubella viruses. Moreover, rubella infection during pregnancy can cause serious problems, special preventive measures should be taken for female employees in the hospital. METHODS: This study was performed from October to December, 1995 and the subjects were 307 female employees in a university hospital, who were aged 20 to 40 and had many chances cf exposure to rubella patient during working. Rubella virus antibody was detected by the method of ELISA. For the antibody-negative employees, we gave active immunization and retested the antibody titer after six weeks. RESULTS: Among 307 subjects, 289 cases (94.1%) were positive for rubella IgG antibody. There was no significant difference in positive rates of rubella antibody by type of occupation, age, medical department, and duration employed. The seroconversion rate was 93.8% (15/16). CONCLUSIONS: According to these findings, we recommend that the employees in the hospital, especially women aged 20 to 40 should be checked for Rubella Ab (IgG) and be vaccinated when they don't have it.
Enzyme-Linked Immunosorbent Assay ; Female* ; Humans ; Immunoglobulin G ; Occupations ; Pregnancy ; Rubella virus ; Rubella* ; Vaccination

No abstract available.
Radiotherapy*

Medical education is the process of transforming a layman into a medical professional. Anatomy is a major, primary subject for students entering medical school. How students learn anatomy is important for becoming a doctor. The object of this study is to determine what influences students to get their values and attitudes as an altruistic healer, and to develop professional competence from educational courses in the medical school. We focused on how the lessons and disciplines of the anatomy course guided medical students to become doctors. Interviews of narrative inquiry were conducted in which the students and graduates talked about the experience of learning in their course-work. Anatomy is an important subject for medical students, at both the cognitive and the emotional level. Through learning anatomy, students adapt their emotions and attitudes to the medical profession and become bona fide medical students. They face very stressful condition at first, but they learn how to adapt to their circumstances. They studied with passion, and could develop their own way of studying. Besides, they felt that they were gradually becoming health experts by learning medical terminology, and could enhance their professionalism by practicing anatomy. Indelible experiences in dissection laboratory and rite in memory of cadaver donors evoke deep reflection on thankfulness and altruism. This study addressing the issue of altruistic professionalism in anatomy will have to be continued by following students into the preclinical and clinical years. Public concerns with commercialism in teaching hospitals and schools are also emphasized.
Altruism ; Cadaver ; Education, Medical ; Hospitals, Teaching ; Humans ; Learning ; Memory ; Professional Competence ; Schools, Medical ; Students, Medical ; Tissue Donors

PURPOSE: Traditionally the patients with early stage non-Hodgkin's lymphoma of he head and neck was treated with radiotherapy. But the results were not satisfactory due to distant relapse. Although combined treatment with radiotherapy and chemotherapy was tried with some improved results and chemotherapy alone was also tried in recent years, the choice of treatment for the patients with early stage non-Hodgkin's lymphoma of the head and neck has not been defined. Therfore, in order to determine the optimum treatment method, we analysed retrospectively the outcomes of the patients with Ann Arbor stage I and II non-Hodgkin's lymphoma localized to the head and neck who were treated at Serverance Hospital. MATERIALS AND METHODS: 159 patients with stage I and II non-hodgkin's lymphoma localized to the head and neck were treated at our hospital from January, 1979 to December, 1992. Of these patients, 114 patients whose primary sites were Waldeyer's ring or nodal region, and received prescribed radiation dose and/or more than 2 cycles of chemotherapy, were selected to analyze the outcomes according to the treatment methods (radiotherapy alone, chemotherapy alone, and combined treatment with radiotherapy and chemotherapy). RESULTS: Five year overall actuarial survival of the patients whose primary site was Waldeyer's ring was 62.5%, and that of the patients whose primary site was nodal region was 53.8%. There was no statistically significant difference between survivals of both groups. Initial response rate to radiotherapy, chemotherapy, and combined treatment was 92%, 83%, 94% respectively, and 5 year relapse free survival was 49.9%, 52.4%, 58.5% respectively (statistically no significant). In the patients with stage I, 3 year relapse free survival of chemotherapy alone group was 75% and superior to other treatment groups. In the patients with stage II, combined treatment group revealed the best result with 60.1% of 3 year relapse free survival. The effect of sequential schedule of each treatment method in the patients who were treated by combined modality was analyzed and the sequence of primary chemotherapy + radiotherapy + maintenance chemotherapy shoed the best result (3 year relapse free survival was 79.1%). There was no significant survival difference between BACOP regimen and CHOP regimen. Response to treatment was only one significant (p<0.005) prognostic factor on univariate analysis and age and mass size was marginally significant (p<0.01). On multivariate analysis, age (p=0.026) and mass size (p=0.013) were significant prognostic factor for the relapse free survival. CONCLUSION: In summary, the patients who have non-Hodgkin's lymphoma of the head and neck with stage I and mass size smaller that 10cm , can be treated by chemotherapy alone, but remainder should be treated by combined treatment method and the best combination schedule was the sequence of initial chemotherapy followed by radiotherapy and maintenance chemotherapy.
Appointments and Schedules ; Drug Therapy ; Head* ; Humans ; Lymphoma, Non-Hodgkin* ; Maintenance Chemotherapy ; Multivariate Analysis ; Neck* ; Radiotherapy ; Recurrence ; Retrospective Studies

PURPOSE: This study aims to explore an one-year experience of intensive core clinical clerkship (student internship, subinternship) in Gachon Medical School for junior clinical students, and the immediate outcome of the program was discussed along the with advantages and student load. METHODS: 36 junior medical students (M5) were exposed to 36 weeks of core clinical clerkship including internal medicine (12wks), pediatrics (6wks), obstetrics-gynecology (6wks), general surgery (4wks), psychiatry (4wks), and emergency medicine (4wks). The clinical service team was made of faculty member (1), senior resident (1), intern (1) and M5 students (1-2), and the students who were involved a wide range of baseline responsibilities corresponding to those of regular rotating interns. They were encouraged to participate the various procedures and decision making process, but their participation was restricted by keeping 3 levels of performance policy according to degree of supervision. Questionnaire analysis was carried out immediate after the student internship. RESULTS: Students were proud of themselves being as the subinterns and showed a strong motivation, while they had a difficulty to tolerate a strong psychologic pressure by taking their roles of subinternship. Major responsibilities of clerkship were focused on the clinical information collection (history taking and physical examination), students-directed group conference, faculty-led small group discussion, technical skill learning and ward round in order. Students appreciated well to this internship in terms of acquisition of clinical skills and identification of their role, but shortage of space, frequent on-call, lack of self-directed learning opportunity, unclarified requests from the hospital authority were pointed out. CONCLUSION: It is assumed that student internship is a strong tool to promote the quality of clinical learning process, but requires details of teaching instructions (manuals) aside from solving a series of legal on malpractice, for which critical defining of clinical participation is essential to upgrade the Korean version of clerkship.
Clinical Clerkship ; Clinical Competence ; Decision Making ; Education, Medical ; Emergency Medicine ; Humans ; Internal Medicine ; Internship and Residency* ; Learning ; Malpractice ; Motivation ; Organization and Administration ; Pediatrics ; Program Development* ; Schools, Medical* ; Students, Medical ; Surveys and Questionnaires

OBJECTIVES: This study was to assess management outcome of patient undergoing decompressive craniectomy for space-occupying cerebral infarction refractory to medical treatment and to identify risk factors associated with unfavorable outcomes. PATIENTS AND METHODS: Between January 1999 and June 2004, total 20 patients were analyzed. The preoperative consciousness was rated using Glasgow Coma Scale (GCS). The clinical outcome was rated using Glasgow Outcome Scale (GOS) at 3 months follow up and divided into 2 groups;favorable outcome group (GOS> or =3) and unfavorable outcome group (GOS<3). The prognostic factors were analyzed multivariately. RESULTS: Fourteen patients were men and six patients were women (mean age, 58.7 yrs). Seventeen patients had right hemispheric infarction, and three patients had left hemispheric infarction. 16 patients had only middle cerebral artery (MCA) infarction, and 2 patients had combined anterior cerebral artery (ACA) or posterior cerebral artery (PCA) infarction respectively. Eleven patients showed anisocoria preoperatively. The mean time interval between symptom onset of infarction and operation was 61.5 hrs. 8 patients showed favorable outcome, and 12 patients showed unfavorable outcome. CONCLUSIONS: The existence of preoperative anisocoria and low preoperative GCS score were statistically significant prognostic factor related to unfavorable outcome.
Anisocoria ; Anterior Cerebral Artery ; Cerebral Infarction* ; Consciousness ; Decompressive Craniectomy* ; Female ; Follow-Up Studies ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Humans ; Infarction ; Male ; Middle Cerebral Artery ; Posterior Cerebral Artery ; Risk Factors

OBJECTIVES: This study was to define the clinical characteristics and formulate the management strategies of the patients with infectious cerebral aneurysms. METHODS: During the past 30 years, among 2,830 patients who were treated with intracranial aneurysms, 11 patients had infectious cerebral aneurysms. The authors reviewed the database and the imaging studies as sources for identification and analysis. RESULTS: Nine patients had ruptured lesions: Five patients presented with subarachnoid hemorrhage (SAH) and 4 patients presented with intracerebral hemorrhage (ICH). Two patients were Hunt and Hess Grade I, 1 Grade II, 2 Grade III, 3 Grade IV, and 1 Grade V. Seven aneurysms were located at middle cerebral artery, 2 at anterior cerebral artery, 1 at internal carotid artery, and 1 at posterior circulation. Ten aneurysms were small ((8 mm). Seven aneurysms were fusiform, and the remaining 4 aneurysms were saccular. Five of the 11 patients (44.4%) had multiple aneurysms. All patient were treated by microsurgery. The obliteration methods of the aneurysms were trapping in 7 patients, and neck clipping in 4 patients. Nine patients showed favorable outcome (good : 7, fair : 2) and 2 patients showed unfavorable outcome (poor : 1, dead : 1). CONCLUSION: Infectious cerebral aneurysms had high frequency of ICH, fusiform-shape, multiple aneurysms, and initial poor clinical grade. Surgery was necessary for ruptured lesion and unruptured lesions which size was increased at follow up angiography. The ultimate management outcome was satisfactory. Co-work with cardiologist and cardiovascular surgeon is necessary.
Aneurysm ; Angiography ; Anterior Cerebral Artery ; Carotid Artery, Internal ; Cerebral Hemorrhage ; Follow-Up Studies ; Humans ; Intracranial Aneurysm* ; Microsurgery ; Middle Cerebral Artery ; Neck ; Subarachnoid Hemorrhage