Severe injuries of hands frequently expose the bone and joint due to the defect of crushing of soft tissues. Although the several methods are introduced, the treatment of bone and joint exposure of finger and hand is very difficult to control satisfactorily. From October 1986 to February 1988, we performed the pedicled skin flap in 11 cases; 9 abdominal skin flaps and 2 pectoral skin flaps. Follow up stuides showed good results. The successful surviving of flaps was accomplished in all cases and the dead bones were regenerated by the creeping substitution. Therefore this pedicled skin flap operation can be considered to be a simple and effective method in treating the bone and joint exposure of fingers.
Fingers ; Follow-Up Studies ; Hand ; Joints ; Methods ; Skin

In Korea, many medical schools have adapted their curricula to the recent paradigm shift introducing a professional graduate school system with universal accreditation criteria for medical education. This rapid transformation has driven the new adoption of system-based integrated curriculum, problem-based learning, team-based learning, and competency-based assessment. In the hundred years since the publication of Flexner's report that suggested a two-phase educational structure consisting of a basic science didactic curriculum followed by the practicum of clinical clerkships, there have been many advancements in curriculum development for medical education. Medical education is undergoing a major paradigm shift from structure- and process-based to competency-based education utilizing outcome-based assessments. The authors reviewed the existing medical literature to provide practical insight into the clinical presentation curriculum introduced by University of Calgary in 1994, developing a roadmap to accomplish full implementation and evaluation. In the clinical presentation based curriculum, schemata (schemes) are organized by experts from terminal objectives, and are considered to have two functions: first, to serve as frameworks around which students can learn new information and secondly, to provide an approach to clinical problem solving. We conclude that there should be further meticulous review of this new system and a prospective evaluation of the students' ability to benefit from it before launching a program based on the indiscreet adoption of a fashionable curricular reform.
Accreditation ; Adoption ; Clinical Clerkship ; Collodion ; Competency-Based Education ; Curriculum ; Decision Support Techniques ; Education, Medical ; Humans ; Korea ; Learning ; Problem Solving ; Problem-Based Learning ; Publications ; Schools, Medical

No abstract available.
Animals ; Rats* ; Vitamin A* ; Vitamins* ; Wounds and Injuries*

We have treated total 37 cases of femoral neck fracture in children who were under the 16 years old in age at the Catholic University Medical College since 1985, followed them for average 21 months to analyse their types of fracture and treatment, complications and prevention of complications, and obtained the following results. 1. According to the Delbet's classification, type I was 1 case, II were 18(49%), most common, III were 10 and IV were 8 cases. Their ages were average 8.2 years and boys were predominant in 27 cases. 2. Thirty-six cases were treated with open reduction and internal fixation within 1-13 days after fracture, but only one type IV was treated with closed reduction, followed by hip spica cast for 6 to 9 weeks in all. 3. The fixation devises were removed at average 8.7 months after operatio. 4. fifteen complications were observed in 11 cases(37%), that were AVN(3 cases), early physeal closure(8 cases), coxa vara(3 cases), coxa valga and limb shortening(each 1 case), and their causes were severe fracture displacement(2 cases), penetration of fixation devices to physis(8 cases), incomplete reduction and loss of initial reductio (1 case) etc, but were not correlated with their method of fracture treatment. Conclusively, the femur neck fracture in children could favorably be treated with open reduction and internal fixation to reduce their complications. Physeal early closures due to penetration of screws and pin were most common cause of complications, and their long-term follow-up should be necessary.
Child ; Classification ; Coxa Valga ; Extremities ; Femoral Neck Fractures ; Femur Neck ; Femur ; Follow-Up Studies ; Hip ; Humans ; Methods

BACKGROUND/AIMS: Second-look endoscopy is performed to check for the possibility of post-endoscopic submucosal dissection (ESD) bleeding and to perform prophylactic hemostasis in most hospitals; however, there is little evidence about the efficacy of second-look endoscopy. We investigated whether second-look endoscopy after ESD is useful in the prevention of post-ESD bleeding. METHODS: A total of 550 lesions with gastric epithelial neoplasms in 502 patients (372 men and 130 women) were treated with ESD between August 18, 2009 and August 18, 2010. After the exclusion of three lesions of post-ESD bleeding within 24 hours, 547 lesions (335 early gastric cancers and 212 gastric adenomas) were included for the final analysis. RESULTS: The occurrence rate of delayed post-ESD bleeding was not significantly different between the second-look group and the no second-look group (1% vs 2.5%, p>0.05). The only predictor of delayed bleeding was tumor size, regardless of second-look endoscopy after ESD (22.8+/-9.87 vs 15.1+/-10.47, p<0.05). There was no difference between the prophylactic hemostasis and nonprophylactic hemostasis groups, including the occurrence rate of delayed bleeding. In the second-look group with prophylactic hemostasis, the hospital stay was more prolonged than in the second-look group without prophylactic hemostasis, but there was no significant difference (p=0.08). CONCLUSIONS: Second-look endoscopy to prevent delayed bleeding after ESD provides no significant medical benefits.
Adult ; Aged ; Aged, 80 and over ; Female ; Gastrectomy/adverse effects ; Gastric Mucosa/surgery ; *Gastroscopy ; Humans ; Length of Stay ; Male ; Middle Aged ; Postoperative Hemorrhage/*diagnosis/etiology ; Retrospective Studies ; Risk Factors ; Second-Look Surgery ; Stomach/pathology/surgery ; Stomach Neoplasms/pathology/*surgery ; Time Factors

BACKGROUND/AIMS: When undergoing endoscopic submucosal dissection (ESD), patients with liver cirrhosis (LC) may suffer from a high risk of bleeding, bacteremia and tissue vulnerability. There have been few reports evaluating the efficacy and safety of ESD in patients with LC. METHODS: From January 2004 to March 2010, 23 patients with LC (cirrhosis group) underwent ESD for superficial gastric neoplastic lesions. The number of patients with a liver function in the Child-Pugh classes A and B were 20 and 3, respectively. The clinical outcomes and complications were compared with 69 patients without LC (control group) that were matched for age and sex. RESULTS: The en bloc resection, R0 resection and en bloc plus R0 resection rates of the cirrhosis group were 82.6%, 91.3%, and 82.6%, respectively, and did not show significant differences from the rates of the control group. No local recurrence was found in either group during the follow-up period. The procedure length of time (41.0 vs 39.0 minutes), rate of bleeding (4.3% vs 7.2%) and rate of perforation (0.0% vs 1.4%) in the cirrhosis group were also comparable to the results from the control group. CONCLUSIONS: ESD was safely performed in patients with LC, and satisfactory outcomes were achieved with high en bloc and R0 resection rates for superficial gastric neoplastic lesions.
Bacteremia ; Fibrosis ; Follow-Up Studies ; Hemorrhage ; Humans ; Liver ; Liver Cirrhosis ; Recurrence ; Retrospective Studies

Ventricular premature complexes (VPCs) are known to be one of the most benign cardiac arrhythmias when they occur in structurally normal hearts. We experienced a 32-year old man who presented with dyspnea, palpitations and very frequent VPCs (31% of the total heart beats). Echocardiography revealed a dilated left ventricle (LV 66 mm at end-diastole and 57 mm at end-systole) and a decreased ejection fraction (34%). Very frequent VPCs had been detected 10 years previously and he underwent a failed radiofrequency catheter ablation (RFCA) procedure at that time. The patient had been treated with heart failure medications including betablockers, ACE inhibitors and spironolactone for the two most recent years. Six months after we eliminated these VPCs with a second RFCA procedure, the heart returned to normal function and size. Long standing and very frequent VPCs could be the cause of left ventricular dysfunction in a subset of patients who suffer with dilated cardiomyopathy, and RFCA should be the choice of therapy for these patients.
Ventricular Premature Complexes/*complications ; Tachycardia, Ventricular/*etiology/therapy ; Male ; Humans ; *Catheter Ablation ; Cardiomyopathies/*etiology/therapy ; Adult

We have randomly selected 1,200 psychiatric inpatients from the whole psychiatic inpatients population in Korea, and analyzed their length of stay far the purpose of contributing to community mental health practice in Korea. The results were as follows: 1) The half of total samples' length of stay were within 761 days, and 75% of them wihin 2, 613 days. 2) As for length of stay P50, asylums showed the length of stay within 2,303 days for the half of selected samples: 483 days for private mental hospitals and they showed very long-term hospitalization compared to university hospital(20 days), general hospitals(41 days), private psychiatric clinics(45 days) and national mental hospitals(83 days). 3) As for length of stay according to age distributions, the older the patients were, length of stay showed the longer. 4) Among the length of stay at P50 according to diagnoses, mental retarded patients were the longest hospitalization group in private hospitals(707 days) and small psychitric inpatient units(below 30 beds, 166 days). But schizophrenics were the longest hospitalization group(2, 560 days) at asylums. 5) Length of stay at P50 according to medical security had great differences between the medical aid group and medical insurance group, especially in asylum(2,461 days vs. 1,715 days) and mental hospitals(615 days vs. 271 days). From the above results, the authors propose that for diminishing the length of stay policy, Korean mental health system should develop new rehabilitation programs for acute symptom relieved schizophrenic patients. In addition, the treatment for the younger mentally-ill patients should be more active and intensive.
Age Distribution ; Diagnosis ; Hospitalization ; Hospitals, Psychiatric ; Humans ; Inpatients ; Insurance ; Korea* ; Length of Stay* ; Mental Health* ; Rehabilitation

PURPOSE: The purpose of this study was to investigate the possibilities for serial in vivo localized proton magnetic resonance spectroscopy (MRS) examination of bone marrow in patients with acute le,ukemia. MATERIALS AND METHODS: Selective measurements of the relaxation times Tl and T2 for the water and fat resonance in the bone marrow spectra were performed (1.5 Tesla whole body magnetic resonance scanner). Six patients with acute leukemia were examined at diagnosis. Follow-up examinations of four patients with acute leukemia in complete remission were also examined. Six normal control subjects were examined with identical methods for comparison. RESULTS: Significant differences could be detected in the spectral patterns from lumbar spine in patients with leukemia at diagnosis compared to healthy normal controls. The relative water content was increased in leukemic patients compared to normal subjects, which indicate an increase in the amount of hemopoietic tissue and a corresponding decrease in marrow fat content. A significant correlation was found between cellularity assessments derived from conventional bone marrow core biopsies and relative water content of proton MRS data. The Tl relaxation time of the water resonance in leukemic patients were significantly prolonged at diagnosis compared to normal controls. After chemotherapeutic induction of remission, the spectra from the bone marrow of lumbar spine resembled normal subjects. CONCLUSIONS: This method provide the possibility for serial measurements of bone marrow in patients with leukemia, and may provide information from regions inaccessible to bone marrow biopsy. This therefore appears to be a promising application of proton MRS that can be performed on a routine basis in a clinical setting.
Biopsy ; Bone Marrow* ; Diagnosis ; Drug Therapy* ; Follow-Up Studies ; Humans ; Leukemia ; Magnetic Resonance Spectroscopy* ; Protons* ; Relaxation ; Remission Induction ; Spine ; Water

OBJECTIVE: We investigated the clinical and radiological advantages of unilateral laminectomy in posterior lumbar interbody fusion (PLIF) procedure comparing with bilateral laminectomy, under the same procedural condition including bilateral instrumentation and insertion of two cages, in patients with degenerative lumbar disease with unilateral leg symptoms. METHODS: We retrospectively reviewed 124 consecutive cases of PLIF via unilateral or bilateral approach between January 2006 and April 2010. In 80 cases (bilateral group), two cages were inserted via bilateral laminectomy, and in 44 cases (unilateral group), via unilateral laminectomy. The average follow-up duration was 29.5 months. The clinical outcomes were evaluated with the Visual Analogue Scale (VAS) and the Oswestry disability index (ODI). The fusion rates and disc space heights were determined by dynamic standing radiographs and/or computed tomography. Operative times, intra-operative and post-operative blood losses and hospitalization periods were also evaluated. RESULTS: In clinical evaluation, the VAS and ODI scores showed excellent outcomes in both groups. There were no significant differences in term of fusion rate, but the perioperative blood loss and the operative time of the unilateral group were lower than that of the bilateral group. CONCLUSION: Unilateral laminectomy can minimize the operative time and perioperative blood loss in PLIF procedure. However, the different preoperative disc height between two groups is a limitation of this study. Despite this limitation, solid fusion and satisfactory symptomatic improvement could be achieved uniquely by our surgical method. This surgical method can be an alternative surgical technique in patients with unilateral leg pain.
Follow-Up Studies ; Hospitalization ; Humans ; Laminectomy ; Leg ; Operative Time ; Retrospective Studies