There are many controversies concerning therapeutic guidelines for the treatment of Kienbock's disease. We experienced 17 cases of stage II or III Kienbock's disease(Lichtman's classification), which were treated with triscaphe fusion from March 1983 to March 1992. The mean Follow-up peri- od was 25 months. The purpose of this study is to evaluate the clinical and radiological result of triscaphe fusion of 17 cases of Kienbock's disease. 1. The pain was relieved in all cases, but range of motion was not improved after operation. 2. The postoperative results of triscaphe fusion were evaluated by Licthman's method. 9 cases (53%) were rated as satisfactory and 8 cases as unsatisfactory. 75%(3 cases of 4) were rated sat isfactory in IIIA a group and 22%(2 casaes of 9) were rated satisfactory in IIIB group. 3. The psudoarthrosis was noted in 2 cases of 17.
Follow-Up Studies ; Methods ; Osteonecrosis ; Range of Motion, Articular

PURPOSE: The effects of hyperfractionation radiation therapy, such as the failure pattern and survival, on the treatment results in advanced stage head and neck cancer were studied. MATERIALS AND METHODS: Between September 1990 and October 1998, 24 patients with advanced stage (III, IV) head and neck cancers, were treated using hyperfractionation radiation therapy in the Department of Radiation Oncology at the Keimyung University Dongsan Medical Center. The male to female ratio was 7:1, and the age range from 38 to 71 years with the median of 56 years. With regard to the TNM stage, 11 patients were stage III and 13 were stage IV. The sites of primary cancer were the nasopharynx in six, the hypopharynx in 6, the larynx in five, the oropharynx in three, the maxillary sinus in three, and the oral cavity in one patient. The radiotherapy was delivered by 6 MV X-ray, with a fraction size of 1.2 Gy at two fractions a day, with at least 6 hours inter-fractional interval. The mean total radiation doses was 72 Gy, (ranging from 64.4 to 76.8 Gy). Follow-up periods ranged between 3 and 136 months, with the median of 52 months. RESULTS: The overall survival rates at 3 and 5 years in all patients were 66.7% and 52.4%. The disease-free survival rates at 3 and 5 years (3YDFS, 5YDFS) in all patients were 66.7% and 47.6%. The 3YDFS and 5YDFS in stage III patients were 81.8% and 63.6%, and those in stage IV patients were 53.8% and 32.3%. Ten patients were alive with no local nor distant failures at the time of analyses. Six patients (25%) died due to distant metastasis and 12.5% died due to local failure. Distant metastasis was the major cause of failure, but 2 patients died due to unknown failures and 3 of other diseases. The distant metastasis sites were the lung (3 patients), the bone (1 patient), and the liver (2 patients). One patient died of second esophageal cancer. There were no severe late complications, with the exception of 1 osteo-radionecrosis of the mandible 58 months after treatment. CONCLUSION: Although this study was performed on small patients group, we considered hyperfractionated radiation therapy for the treatment of advanced stage head and neck cancer might improve the disease free survival and decrease the local failure with no increase in late complications despite of the slight increase in acute complications.
Disease-Free Survival ; Esophageal Neoplasms ; Female ; Follow-Up Studies ; Head and Neck Neoplasms* ; Head* ; Humans ; Hypopharynx ; Larynx ; Liver ; Lung ; Male ; Mandible ; Maxillary Sinus ; Mouth ; Nasopharynx ; Neck ; Neoplasm Metastasis ; Oropharynx ; Radiation Oncology ; Radiotherapy ; Survival Rate

OBJECTIVES: We aimed to examine clinical efficacy of Korean FRAX model with respect to prediction of osteoporotic fracture risk and eligibility of osteoporosis treatment in Korean patients with hip fractures. MATERIALS & METHODS: In 41 elderly patients with a proximal femoral fracture (mean age=78.7 years, range: 63~99 years), fracture probabilities were calculated using FRAX models from Korea and Japan. We then performed comparative analyses between ten-year probabilities of major / hip osteoporotic fractures and the osteoporosis treatment eligibilities based on the FRAX model from Korea and Japan. RESULTS: The mean ten-year probabilities of major osteoporotic fractures and hip fractures using the Korean FRAX model (11.5% and 5.9%, respectively) were significantly lower than those using the Japanese FRAX model (21.5% and 9.2%, respectively, P<0.001). In addition, based on the National Osteoporosis Foundation guideline, pharmacological treatment of osteoporosis would be recommended in 38 patients (92.7%) by the Japanese FRAX model, while only in 30 patients (73.2%) by the Korean FRAX model (P=0.037). CONCLUSIONS: Our results suggest that the Korean FRAX model might underestimate osteoporotic fracture probabilities and eligibility of osteoporosis treatment in Korean patients with hip fracture.
Aged ; Asian Continental Ancestry Group ; Femoral Fractures ; Hip ; Hip Fractures ; Humans ; Japan ; Korea ; Osteoporosis ; Osteoporotic Fractures

The purpose of this study was to examine professors’ and students’ perceptions of curriculum that fosters character in medical school. ‘Character’ can be defined as a desirable personality and the ability to be a good person. A total of 264 subjects (professors=131, students=133) participated in the study. Survey questions were divided into the three parts (education needs, factors of character, and curriculum management strategy). Data were analyzed by using t-test and one-way analysis of variance. Both professors and students recognized the need for character education. Professors were more aware of the need for education than students (t=4.35, p<0.01), and clinical professors were more aware of the need for education than basic medical science professors (t=3.48, p<0.01). Premedical students were more aware of the need for character-centered education than medical students in the later stages of their education (t=3.41, p<0.01). Professors and students commonly referred to ‘consideration and communication’ as the most important factor in building character. Professors considered ‘self-regulation’ more important than the students recognized, while students perceived ‘wisdom’ as more important than the professors did. There was a difference in preference for curriculum development (creating new subjects vs. revising existing subjects) between the two groups. However, both groups agreed on the teaching and evaluation methods. In conclusion, both groups acknowledged the need for character education. However, there were differences in perception on the major factors of character and preference for curriculum development. The results of this study may assist in designing character education in medical education.

Because of extensive vascular injury, reconstruction of ring avulsion injury is classically believed to be challenging for a hand surgeon. We report a case of ring avulsion injury treated by debridement of the damaged artery and interpositioning vessel graft with a healthy proper palmar digital artery, which lead to successful functional recovery.
Arteries ; Debridement ; Glycosaminoglycans ; Hand ; Transplants ; Vascular System Injuries

Objectives: This study surveyed the quality of psychotherapy training and psychotherapy competencies during residency in Korea. Methods: A questionnaire developed by The Committee of Residency Training of the Korean Neuropsychiatric Association was completed by fourth-year residents of Korean psychiatry (n=120). The questionnaire examined their demographic characteristics, their experience of clinical psychotherapy training, their degree of satisfaction in the quality of psychotherapy training, and self-rated competence regarding the six types of psychotherapies, including supportive psychotherapy, cognitive behavioral therapy, interpersonal psychotherapy, psychoanalytic psychotherapy, group psychotherapy, and family psychotherapy. Results: The degree of satisfaction of the residents with the psychotherapy training was diverse among the types of psychotherapy and contents of training. Across all types of psychotherapies, the satisfaction levels of the quantity and quality of supervision education were low, except for psychoanalytic psychotherapy. Overall, more than 70% of residents were not satisfied with the theoretical education, clinical practice, and supervision education in three types of psychotherapies, including interpersonal psychotherapy, group psychotherapy, and family psychotherapy. A positive correlation was found between the degree of satisfaction with the quality of training experience and self-rated competence of psychotherapy. Specifically, the self-rated competence of psychotherapy was more highly correlated with the experience of clinical cases and supervision than theoretical education Conclusion This study showed the quantitative and qualitative status of psychotherapy training in Korean psychiatry residency programs, and the satisfaction level of psychotherapy education was low except for psychoanalytic psychotherapy. There is a strong need for the improvement of psychotherapy training programs in Korea.

Objectives: This study surveyed the quality of psychotherapy training and psychotherapy competencies during residency in Korea. Methods: A questionnaire developed by The Committee of Residency Training of the Korean Neuropsychiatric Association was completed by fourth-year residents of Korean psychiatry (n=120). The questionnaire examined their demographic characteristics, their experience of clinical psychotherapy training, their degree of satisfaction in the quality of psychotherapy training, and self-rated competence regarding the six types of psychotherapies, including supportive psychotherapy, cognitive behavioral therapy, interpersonal psychotherapy, psychoanalytic psychotherapy, group psychotherapy, and family psychotherapy. Results: The degree of satisfaction of the residents with the psychotherapy training was diverse among the types of psychotherapy and contents of training. Across all types of psychotherapies, the satisfaction levels of the quantity and quality of supervision education were low, except for psychoanalytic psychotherapy. Overall, more than 70% of residents were not satisfied with the theoretical education, clinical practice, and supervision education in three types of psychotherapies, including interpersonal psychotherapy, group psychotherapy, and family psychotherapy. A positive correlation was found between the degree of satisfaction with the quality of training experience and self-rated competence of psychotherapy. Specifically, the self-rated competence of psychotherapy was more highly correlated with the experience of clinical cases and supervision than theoretical education Conclusion This study showed the quantitative and qualitative status of psychotherapy training in Korean psychiatry residency programs, and the satisfaction level of psychotherapy education was low except for psychoanalytic psychotherapy. There is a strong need for the improvement of psychotherapy training programs in Korea.

Public health strategies designed to accomodate the ever-increasing human lifespan are urgently required. A good clinical understanding of frailty, as well as knowledge regarding how to prevent it, will therefore be required in order to overcome this challenge. Sarcopenia is an important component of the frailty syndrome, and its association with osteoporosis can lead to fractures and incident disability. Therefore, this review examined the literatuire pertaining to the association of sarcopenia with osteoporosis in order to assess preventive strategies.
Aged ; Frail Elderly ; Humans ; Osteoporosis* ; Public Health ; Sarcopenia*

PURPOSE: To study the effect of a long-term, oral, fixed dose with a combination of alendronate and calcitriol on the cancellous bone microarchitecture in an ovariectomized rat model. MATERIALS AND METHODS: Twenty eight female Sprague-Dawley rats were divided into 2 equal groups: a non-medication group (OVX), and a medication group (ALD). The ALD group was treated with an oral daily fixed dose with a combination of alendronate and calcitriol for six months, starting from 4 weeks after ovariectomy, while the OVX group was given only a placebo. After six months, all animals were sacrificed, and an in vitro micro-CT analysis of the the distal femur was performed. The bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), trabecular number (Tb.N), structure model index (SMI), connectivity density (Conn.D), and bone mineral density (BMD) were assessed. RESULTS: The ALD group had significantly higher BV/TV, Tb N, BMD and Conn.D and it also had significantly lower Tb Sp and SMI than the OVX group. CONCLUSION: A long term, daily, oral fixed dose with a combination of alendronate and calcitriol could significantly reduce the osteoporotic changes in this ovariectomized rat model.
Alendronate ; Animals ; Bone Density ; Calcitriol ; Female ; Femur ; Humans ; Ovariectomy ; Rats ; Rats, Sprague-Dawley

Japanese-B viral encephalitis (JE) usually has a monophasic illness pattern. A 45-year-old woman in an altered mentality had improved over 1 month. About 1 week after the initial improvement, the patient became comatose with aggravated EEG and MRI findings. Assays of cerebrospinal fluid and serum were positive for the IgM antibody to Japanese-B virus. After intravenous immunoglobulin (IVIG) infusion, the patient recovered. We report a patient with JE who showed a biphasic illness pattern and recovered after IVIG therapy.
Cerebrospinal Fluid ; Coma ; Electroencephalography ; Encephalitis, Viral* ; Female ; Humans ; Immunization, Passive* ; Immunoglobulin M ; Immunoglobulins ; Immunoglobulins, Intravenous ; Magnetic Resonance Imaging ; Middle Aged