PURPOSE: The aim of the study is to evaluate the possibility of giving student interns intern- level responsibilities and to discuss the various obstacles. METHODS: Modifications were made to the student internship program, including rotations through major departments, for 4th-year medical students and was conducted at the College of Medicine, Kangwon National University. We surveyed 49 students for the evaluation of the program, administered a checklist evaluation for their performance, and interviewed two focus groups of faculties and residents to find out the obstacles of the program. RESULTS: Most of the students answered that the program was satisfactory and necessary. Of the students, 71.4% performed as an acting intern. The mean score of the students' performance was 84.1. The students had the most difficulty with time management and making diagnostic and management decisions. Initially, at the start of the program, both students and residents were somewhat confused about the student interns' duties. They suggested that definite learning objectives, legal and institutional support to students' clinical practice, and announcements to patients and hospital staff should be put in place prior to the implementation of such a program. CONCLUSION: We discovered that it was possible for student interns to perform at the level of interns. We suggest that systemic improvements continue for the establishment of such student internship program.
Checklist ; Education, Medical ; Focus Groups ; Gangwon-do ; Humans ; Internship and Residency* ; Learning ; Students, Medical ; Time Management

PURPOSE: The aim of this study is to evaluate the students' clinical competency from the patient safety perspective. METHODS: We conducted this evaluation in 2006 at College of Medicine, Kangwon National University. We surveyed 50 fourth-year medical students after finishing all clinical clerkships. 49 Students evaluated their achievement with 5-Likert score scale. The questionnaires were composed 6 domains: communication skills, prevention & management of adverse events, using evidence and information techniques, teamwork & leadership, medical ethical behaviors, and procedural skills. The each domains were constituted several items. Total 53 items was evaluated. RESULTS: The students' preparedness was relatively low in 28 items of the total 53(difficult communication, detecting and managing medical errors, using evidence and information technique, understanding of complex systems, autonomy, and procedural skills). CONCLUSION: The items with low achievement were closely related with medical errors and patient safety. These findings suggest that the clinical education is insufficient for preventing medical errors by students. For patient safety, we should understand the importance of achievement of competency related with patient safety and establish a systematic clinical curriculum with explicit learning outcomes.
Clinical Clerkship ; Curriculum ; Education ; Gangwon-do ; Humans ; Leadership ; Learning ; Medical Errors ; Patient Safety* ; Students, Medical ; Surveys and Questionnaires

PURPOSE: Computer-aided diagnosis system was developed to improve the accuracy and the efficacy of the image interpretation. This article is to provide a possibility of computer- aided diagnosis for detection of masses in mammograms. METHODS: The craniocaudal and mediolateral images of 120 mammograms from 30 patients that were histologically proven to be malignant and 30 patients that were histologically proven to be benign were analysed using the mammography softwere. The contralateral mammograms were used as control images. Correct marks of the lesions were scored as a true positive and marks not at the location of the lesions were scored as a false negative. Any marks of the normal images were scored as a false positive and no mark of normal images were scored as a true negative. RESULTS: It took approximately 2 min to scan and 1 min to process 24 by 18-cm mammograms. There was an average of 1.4, 2.0 and 2.1 marks per image in normal, benign and malignant mammograms respectively. Mass detection rate of malignant lesion was 90.0% (27 of 30) and that of benign lesion was 63.6% (21 of 33). Mass detection rate of dense breasts was 68.8% (22 of 32) and that of fatty breasts was 83.9% (26 of 31). Mass detection rate of BI-RADS category 4, 5 and 0 was 85.7% (42 of 49) and that of category 1, 2 and 3 was 42.9% (6 of 14). The overall sensitivity was 76.2% and specificity was 28.1%. CONCLUSION: In this study, mass detection rate for malignant lesions was higher than that of benign lesions and dense breast has lower detection rate than fatty breast. According to the BI-RADS category, mass detection rate was higher in the more malignant category. Computer-aided diagnosis system for this study had limited specificity but acceptable sensitivity.
Breast* ; Diagnosis* ; Humans ; Mammography ; Sensitivity and Specificity

PURPOSE: This study was performed to evaluate the usefulness of abdominal computed tomography (CT) for patients with right lower quadrant (RLQ) pain. METHODS: Between January 2006 and July 2008, 191 consecutive patients with RLQ pain underwent abdominal CT (CT group). Forty-two patients who had undergone abdominal ultrasound (US group) and 52 patients without abdominal CT or abdominal ultrasound for RLQ pain (clinical Dx group) underwent emergent operations. Using the Alvarado scoring system, we scored all patients. The abdominal CT was performed in the abdominal and pelvic area with contrast. RESULTS: One hundred twenty-one (63.4%) of the 191 patients in the CT group were preoperatively diagnosed as having acute appendicitis and underwent surgery. There were three cases of negative appendectomy (1.6%). In the US group and the clinical Dx group, the negative appendectomy rates were 4.8% and 3.8%, respectively. The sensitivity of the abdominal CT was 96.7%. In the CT group, in addition to acute appendicitis, colitis, nonspecific enteritis, diverticulitis, urinary stone, ovary, uterine, and diseases were indentified. CONCLUSIONS: In this study, abdominal CT scans in patients with RLQ pain were useful for the diagnosis acute appendicitis and for the differential diagnosis of other diseases presenting with RLQ pain. The false positive rate was significantly lower in the CT group than in the other groups.
Appendectomy ; Appendicitis ; Colitis ; Diagnosis, Differential ; Diverticulitis ; Enteritis ; Female ; Humans ; Ovary ; Urinary Calculi

PURPOSE: Despite radical lymph node dissection and combined resection, the operative results of treating advanced gastric cancer remains inadequate. The aim of this study was to determine the risk factors for recurrence of gastric cancer and the pattern of recurrence after curative resection for advanced gastric cancer. METHODS: Out of 220 patients who underwent curative resection for advanced gastric cancer from 1990 to 2000, 50 whose recurrence was confirmed by clinical, radiological, endoscopic or reoperative findings were studied retrospectively. We undertook a detailed analysis of the pattern of recurrence based on the morphologic and histopathologic characteristics of the initial tumor. RESULTS: The mean time to recurrence was 19.0 months. Early recurrence was found in 38 patients (76.0%), intermediate recurrence was found in 11 patients (22.0%), and late recurrence was found in 1 patient (2.0%). The patterns of recurrence were as follows: hepatic recurrence was found in 14 cases, peritoneal recurrence in 19 cases, local recurrence in 10 cases, extraperitoneal recurrence in 6 cases. In univariate analysis, the depth of invasion, extent of lymph node metastasis, TNM stage, and combined resection were important for recurrence. In multivariate analysis, depth of invasion and lymph node metastasis were important for recurrence. CONCLUSION: The peritoneal recurrence was the most frequently encountered pattern of recurrence. The two years following surgery was the most important period for recurrence. Depth of invasion and lymph node metastasis were related to recurrence with statistical significance. Since the results of treatment remain dismal, studies of perioperative adjuvant therapy in an attempt to reduce recurrence are warranted.
Humans ; Lymph Node Excision ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Recurrence* ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms*

PURPOSE: To determine if pattern analysis of defecography can predict the responsiveness of biofeedback therapy in patients with chronic functional constipation. MATERIALS AND METHODS: Over a two-year period, 104 patients with chronic functional constipation underwent defecography and biofeedback therapy. Two blinded readers analyzed the defecographic findings and classified them into six types; I = normal defecation, II = hypertonic lower anal sphincter (poor anal opening due to a persistent contraction of the lower anal sphincter), III = dyskinetic puborectal sling (inadequate laxity of the puborectal sling), IV = spastic pelvic floor syndrome (persistent contraction of both the puborectal sling and the lower anal sphincter), V = unclassified (including paradoxical contraction of the anal sphincter), VI = anatomical obstruction. In addition, the degree of rectal contraction during defecation was scored (grade 0 to 3). After biofeedback therapy, the differences in the defecography patterns or rectal contractions between the two groups, the responsive or non-responsive group, were analyzed. RESULTS: The defecograms revealed that the type IV of the spastic pelvic floor syndrome was most common (50 of 104 patients, 48%), followed by II (21/104, 20%), III (12/104, 11.5%), V (9/104, 9%) and VI (12/104, 11.5%). Biofeedback therapy showed a therapeutic response in 71 out of 104 patients (68%) but failed in 33 patients (32%). However, there were no significant differences in the defecographic pattern between the responsive and non-responsive groups (p=0.630). The defecograms revealed rectal contractions in 78 patients (75%) and moderate to vigorous contractions (more than grade 2) in 66 patients. Most of the biofeedback-responsive group showed rectal contractions (66 of 71 patients, 93%, p<0.001). CONCLUSION: In patients with chronic functional constipation, there was no significant difference in the morphological patterns of the defecogram between the responsive and non-responsive biofeedback groups. However, the presence of rectal contractions during defecation was strongly associated with the therapeutic response after biofeedback therapy.
Anal Canal ; Biofeedback, Psychology* ; Constipation* ; Defecation ; Defecography* ; Humans ; Muscle Spasticity ; Pelvic Floor

BACKGROUND/AIMS: The role of hepatic resection for metastatic gastric cancer is less well defined due to its tendency of multiple intra- and extra-hepatic metastatic patterns. We have reviewed our experiences in the gastric cancer patients with liver metastases to define good candidates for the prolonged survival by hepatic resection. METHODS: Records of eleven patients who underwent hepaatic resection for metastatic gastric cancer from January 1988 to December 1996 at Seooul National University Hospital were reviewed. The clinicopathologic features and their long-term results were analysed. RESULTS: All resected hepatic metastases were solitary mass. Among eight patients with synchronous liver metastases, only one patient who had early gastric cancer with lymph node metastases (T1N2M1) was alive for 9 years 6 months after hepatic resection without recurrence. Among three patients with metachronous liver metastases, two patients who had advanced gastric cancer with lymph node metastases (T3N2M0, T2N1M0 at initial operation, respectively) survived 8 years 6 months and 3 years after hepatic resection, respectively. Median survival time of synchronous and metachronous liver metastases were 13.0 and 74.3 months, respectively. CONCLUSION: Good prognosis may be expected in some selected patients who underwent hepatic resection for metastatic gastric cancer.
Hepatectomy ; Humans ; Liver ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Stomach Neoplasms* ; Treatment Outcome

PURPOSE: The purpose of this study was to evaluate the clinical benefits of preoperative percutaneous transhepatic drainage (PTGBD), especially regarding morbidity and mortality, in patients aged 60 or older with acute cholecystitis. METHODS: A retrospective study was done on a series of elderly patients (>60 years old; n=132) who had been diagnosed between January 2007 and December 2009 as having acute cholecystitis. The patients were divided into 4 groups; cases in which only laparoscopic cholecystectomy (LC) was done (Group 1, n=84), cases in which LC was done after preoperative PTGBD (Group 2, n=15), cases in which only open cholecystectomy was done (Group 3, n=23), and cases in which open cholecystectomy was done after preoperative PTGBD (Group 4, n=10). We analyzed between group differences in surgical outcomes including periods of postoperative fast and postoperative hospital stay, OP. morbidity, and open conversion rate. RESULTS: Patients in Group 1 had fewer underlying medical problems and lower ASA scores than patients in groups 2, 3, or 4 (p<0.05). Mean operating time in Group 2 (113.66+/-107.5 min) was significantly longer than in group 1 (72.02.9+/-34.2 min) (p<0.05) and the open conversion rate was higher (8.33% vs 26.67%). But, blood loss (ml) and OP time in Group 2 were lower than in Group 3 or 4 (p<0.001). Postoperative recovery progression (periods of postoperative fasting and length of postoperative hospital stay) of Group 2 were better than in groups 3 or 4 (p<0.001). CONCLUSION: Pre-operative PTGBD procedures in elderly patients with acute cholecystitis is a good clinical option as a pretreatment to a cholecystitis operation.
Aged ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute ; Drainage ; Fasting ; Gallbladder ; Humans ; Length of Stay ; Retrospective Studies

PURPOSE: The laparoscopic appendectomy has been a basic part of the principal of a more complex laparoscopic technique for the surgical trainee. As the number of laparoscopic appendectomies performed by surgical trainees has increased, we are trying to check the stability of, which is controversial, and the learning curve associated with a laparoscopic appendectomy. METHODS: We studied the demographics, histologic diagnoses, operative time, the number of complicated cases, and hospital duration of one hundred and three patients who underwent an open appendectomy (group A, 53) or a laparoscopic appendectomy (group B, 50) retrospectively through a review of their medical records. The learning curve for the laparoscopic appendectomy was established through the moving average and ANOVA methods. RESULTS: There were no differences in the operative times (A, 64.15 +/- 29.88 minutes; B, 58.2 +/- 20.72 minutes; P-value, 0.225) and complications (A, 11%; B, 6%; P-value, 0.34) between group A and group B. Group B was divided into group C who underwent the operation in the early period (before the learning curve) and group D who underwent the operation in the later period (after the learning curve). The average operative time for group C was 66.83 +/- 21.55 minutes, but it was 45.25 +/- 10.19 minutes for group D (P-value < 0.0001). Although this difference was statistically significant, no significant difference in the complication rate was observed between the two groups. CONCLUSION: A laparoscopic appendectomy, compared with an open appendectomy, performed by a surgical trainee is safe. In this study, the learning curve for a laparoscopic appendectomy was thirty cases.
Appendectomy ; Demography ; Humans ; Laparoscopy ; Learning ; Learning Curve ; Medical Records ; Operative Time ; Retrospective Studies

A medullary carcinoma of the breast is an uncommon breast cancer subtype, but has a fair prognosis. The histopathological criteria for a medullary carcinoma were delineated by Ridolfi et al. in 1977, and most pathologists use these criteria. The authors experienced a huge carcinoma of the breast, which was diagnosed as an atypical medullary carcinoma. A 47-year old female visited our clinic due to a breast mass of six months duration. The mass was 16 cm in size and exophytic in the left lower breast. There had been necrosis, with a foul odor in most of the mass. A large fixed axillary lymph node was noted, but there was no evidence of distant metastasis. A radical mastectomy was performed due to invasion of the pectoralis major. On pathological examination, the tumor was diagnosed as an atypical medullary carcinoma.
Breast ; Breast Neoplasms* ; Carcinoma, Medullary ; Female ; Humans ; Lymph Nodes ; Mastectomy, Radical ; Necrosis ; Neoplasm Metastasis ; Odors ; Prognosis