No abstract available.
Aneurysm* ; Posterior Cerebral Artery*

PURPOSES: This study reports the possible causes of seizure recurrence in patients underwent previous epilepsy surgery, and surgical strategy for resection of the additional epileptogenic zone locating at the distant area to the site of first resection. METHODS: A total of 10 patients with previous surgery due to intractable epilepsy were studied. Five of these underwent standard temporal lobectomy, four extratemporal resection, and one corticoamygdalectomy. Seizure outcome of these were class III-IV. Evaluation methods for reoperation included MRI, 3D-surface rendering of MRI, PET, prologned video-EEG recording with surface electrodes and subdural grid electrodes. Additional resection was done in the frontal lobe in two, in the temporal lobe in three, in the parietal lobe in two, and in the supplementary sensori-motor area in two. Tumor in the superior frontal gyrus in the left hemisphere was removed in one patient. Extent of resection was decided based on the results of ictal subdural grid EEGs and MRI findings. Awake anesthesia and electrocortical stimulation were performed in the two patients for defining the eloquent area. RESULTS: Histopathologic findings revealed extratemporal cortical dysplasia in six, hippocampal sclerosis and cortical dysplasia of the temporal neocortex in one, neuronal gliosis in two, and meningioma in one. Previous pathology of the five patients with cortical dysplasia in the second operation was hippocampal sclerosis plus cortical dysplasia of the temporal neocortex. After reoperation, seizure outcomes were class I in six, class II in three, class III in one at the mean follow-up period of 17.5 months. Characteristically, patients in class II-III after reoperation showed histopathologic findings of hippocampal sclerosis plus temporal neocortical cortical dysplasia plus extratemporal cortical dysplasia. CONCLUSIONS: Seizure recurrence after epilepsy surgery was related with the presence of an additional epileptogenic zone distant to the site of first operation, and the majority of the histopathology of the surgical specimens was cortical dysplasia. In particular, hippocampal sclerosis plus temporal neocortical cortical dysplasia was highly related with seizure recurrence in patients with previous operation. In these patients, multimodal evaluation methods were necessary in defining the additional epileptogenic zone.
Anesthesia ; Electrodes ; Electroencephalography ; Epilepsy* ; Follow-Up Studies ; Frontal Lobe ; Gliosis ; Humans ; Magnetic Resonance Imaging ; Malformations of Cortical Development ; Meningioma ; Neocortex ; Neurons ; Parietal Lobe ; Pathology ; Recurrence ; Reoperation ; Sclerosis ; Seizures ; Temporal Lobe

Mycobacterium chelonae is a rapidly growing organism that has been found in water, soil, and dust. Although it can colonize healthy persons without sequelae, it can also cause skin and soft tissue infections, pulmonary infections and other sequelaes and rarely, disseminated disease in immunocompromised patients. But, infections due to rapidly growing mycobacteria are probably markedly underdiagnosed and these organisms are capable of causing a wide spectrum of clinical disease. We experienced a case of wound infection with M. chelonae after percutaneous endoscopic gastrostomy and report with review of literatures.
Colon ; Dust ; Gastrostomy* ; Humans ; Immunocompromised Host ; Mycobacterium chelonae* ; Mycobacterium* ; Skin ; Soft Tissue Infections ; Soil ; Wound Infection* ; Wounds and Injuries*

PURPOSE: The purpose of this research was to describe our group counseling methods for medical students with drop-out experiences. METHODS: Group counseling was offered to 11 medical students with drop-out experiences in their previous second semester. All subjects provided written informed consent before participating and completed a 2-day group counseling program using the Gestalt approach. The self-assertiveness training group counseling program consisted of 6 sessions, each of which lasted 90 minutes. Experience reports by participants after the program and data from semi-structured qualitative interviews were qualitatively analyzed. RESULTS: Program participants reported that they were moderately satisfied with the program regarding its usefulness and helpfulness on self-awareness, understanding, and reminding them of attempts to change behavior. Most students showed heightened levels of sincerity perceptions and positive attitudes in every session. The results demonstrated significant changes in experience in self-esteem, self-recognition, and interpersonal relationships. CONCLUSION: A group counseling program using the Gestalt approach could help medical students with drop-out experiences to adjust with 1 year their juniors, enhance their self-esteem, contribute to their psychological well-being, and prevent student re-failure through effective stress management and improved interpersonal relationships.
Counseling ; Humans ; Informed Consent ; Students, Medical

BACKGROUND: Family physicians are interested in health promotion for maintaining one's sound health. But there is little information on what patients think about the practice of health promotion by family physicians. Therefore, we found out whether patients think that it is appropriate for family physicians to be concerned about problems relating to four health risk factors, and the patients' perception both of their own health problems and of the concern actually shown by their family physicians. METHODS: Patients who had visited our two family medicine offices from March to August 1998 was asked to complete a self administered questionnaire. Questions on attitudes to wards and perceptions of family physicians' interest in weight, smoking, drinking, and fitness problems were included. 586 questionnaires with adequate response were analyzed using chi square test and Mantel Haenszel's linear trend test. RESULTS: A total of 586 respondents consisted of 230 men and 356 women. Of the respondents, the proportion of people who thought that family physicians should be concerned about the health risk factors ranged from 83.6% in the case of smoking to 86.5% of fitness, but 76.6% thought their family physicians had in fact been interested in smoking and 72.2% thought so about fitness. There was a significant age group trend in the case of attitudes towards family physician concern for smoking with larger proportions of older patients (p<0.01). Significantly more women than men thought that their family physicians seemed interested in health risk factor with 62.2% to 70.0% in men and 78.6% to 80.9% in women (p<0.001). There were significant age group differences in proportions who thought that their family physicians seemed interested in weight (p<0.001), smoking (p<0.001), and drinking (p<0.05) problems except for fitness problem. 31.6% of the respondents thought that they had a weight problem, 20.5% smoking problem, 14.0% drinking problem, and 28.2% fitness problem. CONCLUSION: These results suggest that many patients thought that most of their family physicians seemed interested in health promotion, but felt the need that they should be come more interested.
Surveys and Questionnaires ; Drinking ; Female ; Health Promotion* ; Humans ; Male ; Physician's Role* ; Physicians, Family ; Risk Factors ; Smoke ; Smoking

BACKGROUND: For diagnosis of hypertension, prompt blood pressure measurement is necessary. In a clinical setting, increased blood pressure is often recorded during urine-holding. The aim of this study was to assess the effect of urine-holding on blood pressure. METHODS: We analyzed 172 subjets who visited a hospital in Pusan for examinafion of pelvic ultrasonography. We measured urine holding time, blood pressure in a urine-holding state, and blood pressure immediately after urination when pelvic ultrasonography was examined. Paired t-test was performed to compare the pre-voiding blood pressure. The relationship between urineholding time and difference in blood pressure were assessed by Pearsons's correlatian coefficients. RESULTS: In subjects who held urine for no less than 3 hours, mean pre-voiding systolic blood pressure was 124.2+/-20.8 mmHg, mean pre-voiding diastolic blood pressure was 78.3+/-13.3 mmHg, post-voiding systolic blood pressure was 120.0+/-21.0 mmHg, and post-voiding diastolic blood pressure was 75.4+/-12.3 mmHg. Mean difference in systolic bload pressure was 4.2+/-10.7mmHg, and mean difference in diastolic blood pressure was 2.8+/-7.7 mmHg(p<0.05). The correlation between urineholding time and differences in systolic and diastolic blood pressure was not significant(P>0.05) CONCLUSION: Urine-holding for no less than 3 hours made systolic and diastolic blood pressure rise. However, the rise in blood pressure was not proportianal to urine-holding time.
Blood Pressure* ; Busan ; Diagnosis ; Hypertension ; Ultrasonography ; Urination

BACKGROUND: Physicians who provide primary care should be trained specifically to manage the problems encountered in a primary care practice. This study was carried out to know the resident's concerns and problems during outpstient care by analysing case discussions as an outpatient teaching. METHODS: We used 533 records discussed by 3 resident's teams for 1 year. Of discussion contents, symptoms or diseases were classified into codes and chapters using the ICPC(lnternational Classification of Primary Care) coding system and the main topics of discussion into 12 types. We compared data among 3 resident's teams and also between the discussed contents and the diseases of patients who visited a family practice for 1 year. We used relative discussion ratio to compare data. RESULTS: Of 533 discussed records, 106 kinds of symptoms or diseases were used and the 20 most common kinds accounted for 61.7%. Contents about menopausal sympto/complaint were 47 records(8.8%) and was the most frequent. Digestive part was the most frequent chapter(22.0%). Distribution of discussed main topics were diagnosis(35.5%), medication(26.8%), other treatment(11.6 %), follow-up(5.8%), etc. There was some difference among 3 resident's teams by chapters and topics. Visiting patients were 3,436 persons with 79 kinds of symptoms and diseases and prior 20 kinds accounted for 86.6%. Visited patients were some what different with the discussed contents by chapters. CONCLUSIONS: Contents of case discussion in ambulatory setting were some what different among each teams and more diverse than the visiting patients The residents could exchange many informations and find problems during ambulatory care. We think case discussion can be a good method for outpatient teaching.
Ambulatory Care* ; Classification ; Clinical Coding ; Education, Medical ; Family Practice ; Humans ; Outpatients* ; Primary Health Care

BACKGROUND: Hypertension is a common disease and one of the most important risk of cardiovascular disease. Majority of patients with hypertension are unaware of their conditions until complications develop. Awareness of hypertension is important in treating and controlling of hypertension. Therefore, we conducted a study on the factors related to awareness of hypertension. METHODS: Awareness of hypertension was evaluated by measuring blood pressure(BP) in 3,344 subjects visiting a health promotion center in Pusan National University Hospital from June 1996 to May 1997. All subjects completed a questionnaire including socio-demographjc factors and family history. Hypertension was defined as systolic BP above 140mmHg and/or diastolic BP above 90mmHg. 135 subjects were diagnosed as hypertension. RESULTS: Among 315hypertensives, only 135 subjects(42.9%) were aware of their conditions. With respect to sex, women had a better awareness of hypertension than men(51.6% vs 36.9%, P<0.05). The awareness was greater for the subjects aged over 60years than for the subjects aged 30-49 years(53.3% vs36.5%), and it was statistically significant(P<0.05). The subjects with stage III hypertension had a better awareness of hypertension than the subjects with stage I(65.5% vs 32.6%, P<0.05) In the occupation-types, the awareness was highest in the group without occupations. But except the group without occupations(56.2%), the awareness was highest in the group of domestic affairs(housewives, 53.2%). Education level and monthly mean income were not related to awareness of hypertension. With respect to marital state, the rate of awareness is highest in the group of widows or widowers(55.8%, P<0.05). The subjects with family history of hypertension had a better awareness of hypertension than the subjects without(59.6% vs 35.7%, P<0.05). The rate of alcohol drinking(47.4% vs 66.7%), smoking(21.5% vs 31.6%) and high salt intake(17.0% vs 25.0%) were lower and the performance rate of regular exercise(24.4% vs 13.3%) was higher in those who were aware of their hypertensions than those who were not. CONCLUSIONS: The awareness of hypertension was also associated with sex, age, marital sate, occupation, stage of hypertension, family history of hypertension, and was related to performance of lifestyle modification (alcohol drinking, smoking, salt intake, exercise).
Busan ; Cardiovascular Diseases ; Drinking ; Education ; Female ; Health Promotion ; Humans ; Hypertension* ; Life Style ; Occupations ; Smoke ; Smoking ; Widowhood ; Surveys and Questionnaires

PURPOSE: Questions are known to be an important teaching technique. And, waiting for the answers is essential in making questions effective and valuable. The objective of this study is to evaluate the status of the use of questions during lectures and to survey the level of awareness of the professors regarding the questioning method including waiting time in one medical college. METHODS: The study subjects were 42 medical college professors who have been lecturing to second year medical students from February to June 2004. The questionnaire consisted of 28 items on the questions used during their lectures. The lecturers were observes by an appointed student to get data on the characteristics of questions used. RESULTS: Most of the professors observed in this study used questions during lectures, predominantly questions requiring answers. The waiting time, however, for answers was too short than reported in the literature. About 50% of the professors answered that their usual waiting time is between 6 to 10 seconds but the results of the observation showed that the average waiting time was 0.6 second. CONCLUSION: There was significant discrepancy about waiting time between the results of the questionnaire and the data from the observation. Because the average waiting time was much shorter than expected, follow up studies after feedback and education would be recommended.
Education ; Education, Medical ; Humans ; Lectures* ; Schools, Medical* ; Students, Medical ; Surveys and Questionnaires

PURPOSE: Insufficient teaching of clinical microbiology, often caused by limited resources in medical schools, might be a reason for inaccurate diagnosis and treatment of infectious diseases by doctors. The purpose of this study is to develop and assess a multimedia self learning tool (MSLT) for clinical microbiology course. METHODS: We developed the MSLT based on existing self-directed learning tools. This tool was used by second- and third-year medical students. We randomly assigned 67 participating students to two groups: one (29) with lectures only and the other (38) with the MSLT only. We conducted pre- and post-tests. RESULTS: There are no differences in the pre- and post-test scores between the lecture group and the MSLT group in knowledge of bacterial classification, understanding of infectious diseases, proper use of laboratory tests, and proper selection of antimicrobials. However, post-test scores were significantly higher in both groups. CONCLUSION: The MSLT was found to be as equally effective as lectures, at least, test scorewise. Teachers could use either this tool alone or combined with conventional lectures to improve and enhance teaching in clinical microbiology. The results shed new insights into the possibility of introducing new teaching methods in clinical microbiology for future medical education.
Classification ; Communicable Diseases ; Computer-Assisted Instruction ; Diagnosis ; Education, Medical ; Humans ; Learning* ; Lectures ; Multimedia* ; Schools, Medical ; Students, Medical* ; Teaching