PURPOSE: We tested the effect of team-based learning (TBL) on medical education through the second-year premedical students’ TBL scores in biochemistry classes over 5 years. METHODS: We analyzed the results based on test scores before and after the students’ debate. The groups of students for statistical analysis were divided as follows: group 1 comprised the top-ranked students, group 3 comprised the low-ranked students, and group 2 comprised the medium-ranked students. Therefore, group T comprised 382 students (the total number of students in group 1, 2, and 3). To calibrate the difficulty of the test, original scores were converted into standardized scores. We determined the differences of the tests using Student t-test, and the relationship between scores before, and after the TBL using linear regression tests. RESULTS: Although there was a decrease in the lowest score, group T and 3 showed a significant increase in both original and standardized scores; there was also an increase in the standardized score of group 3. There was a positive correlation between the pre- and the post-debate scores in group T, and 2. And the beta values of the pre-debate scores and “the changes between the pre- and post-debate scores” were statistically significant in both original and standardized scores. CONCLUSION: TBL is one of the educational methods for helping students improve their grades, particularly those of low-ranked students.
Biochemistry* ; Education, Medical ; Education, Premedical ; Humans ; Learning* ; Linear Models ; Schools, Medical

Seven patients with large aneurysm of the inferior wall of the internal carotid artery were treated during a recent six-year period; this report presents the findings. In this type of aneurysm, the neck arises from the ventral surface of the internal carotid artery at the level of the segment of the posterior communicating artery(PComA). As is the case with the ventral paracliniod type, the treatment of the this aneurysms presents the surgeon with technical problems involving safe exposure and clipping. The incidence of female patients was high, and aneurysms were large; in all cases, the clinical presentation was subarachnoid hemorrhage. In three cases, clipping was incomplete. During surgery, the neck of the aneurysms was hidden by the segment of PComA, and the dome adhered to the PComA and to the anterior choroidal artery. The outcome was considered good in five patients; one, however, was moderately disabled, and one died. We classified these aneurysms as separate from those of the internal carotid artery-PComA junction, and described their surgical treatment and related problems.
Aneurysm* ; Arteries* ; Carotid Artery, Internal ; Choroid ; Female ; Humans ; Incidence ; Neck ; Subarachnoid Hemorrhage

No abstract available.
Catheters* ; Epidural Space*

No abstract available.
Catheters* ; Epidural Space*

Pneumolabyrinth is an uncommon condition in which air bubbles in the labyrinth are described, although its underlying pathophysiology is still not widely understood. It may be associated with barotrauma, stapedial surgery, cochlear implantation, head trauma, and temporal bone fracture. When it occurs, it is ususally identified on high-resolution computed tomography of the temporal bone and an early surgical intervention leads to a more rapid resolution of vestibular symptoms and preservation of existing auditory function. Recently, the authors have experienced two cases of pneumolabyrinth resulting from trauma. Hence, we report two cases with a review of literature.
Barotrauma ; Cochlear Implantation ; Cochlear Implants ; Craniocerebral Trauma ; Ear, Inner ; Temporal Bone

Postburn sternomental contractures (PBSMC) of the neck can cause difficulties in endotracheal intubation when the cervical hyperextension and lifting of the mandible are impaired. Ten patients with a healed burn of the neck were assessed prior to surgery using the modified Mallampati test, and by measuring the sternomental distance, interincisor gap with their mouth fully open, and using Onah's classification system for PBSMC. Difficult endotracheal intubation was predicted. The patients were intubated successfully with a fiberoptic bronchoscope. The fiberoptic bronchoscope was found to be a useful device for managing patients with PBSMC. Moreover, Onah's classification system can be used for assessing postburn contractures.
Airway Management* ; Anesthesia* ; Bronchoscopes ; Burns ; Classification ; Contracture* ; Humans ; Intubation, Intratracheal ; Lifting ; Mandible ; Mouth ; Neck

No abstract available.
Amebiasis* ; Diabetes Mellitus* ; Humans ; Kidney* ; Liver*

Tracheoesophageal fistula (TEF) after prolonged intubation could present as chronic aspiration and could be mistaken as unilateral or bilateral vocal fold palsy, especially when there was combined posterior glottic synechia. We present a case of post-intubation TEF which was successfully treated with tracheal resection and anastomosis with primary esophageal closure. The accompanying posterior glottic web was treated by endoscopic technique of web lysis, with topical application of mitomycin C solution.
Anastomosis, Surgical ; Intubation ; Laryngostenosis ; Mitomycin ; Tracheoesophageal Fistula ; Vocal Cord Paralysis

This study was undertaken in order to estimate the accuracy of disease code of the Korean National Medical Insurance Data and disease the characteristics related to the accuracy. To accomplish these objectives, 2,431 cases coded as notifiable acute communicable diseases (NACD) were randomly selected from 1994 National Medical Insurance data file and family medicine specialists reviewed the medical records to confirm the diagnostic accuracy and investigate the related factors. Major findings obtained from this study are as follows: 1. The accuracy rate of disease code of NACD in National Medical Insurance data was very low, 10.1% (95% C.I.: 8.8-11.4). 2. The reasons of inaccuracy in disease code were 1) claiming process related administrative error by physician and non-physician personnel in medical institutions (47.0%), 2) input error of claims data by key punchers of National Medical Insurer (31.3%) and 3) diagnostic error by physicians (21.7%). 3. Characteristics significantly related with lowering the accuracy of disease code were location and level of the medical institutions in multiple logistic regression analysis. Medical institutions in Seoul showed lower accuracy than those in Kyonngi, and so did general hospitals, hospitals and clinics than tertiary hospitals. Physician related characteristics significantly lowering disease code accuracy of insurance data were sex, age group and specialty. Male physicians showed significantly lower accuracy than female physicians; thirties and forties age group also showed significantly lower accuracy than twenties, and so did general physicians and other specialists than internal medicine/pediatric specialists. This study strongly suggests that a series of policies like 1) establishment of peer review organization of National Medical Insurance data, 2) prompt nation-wide expansion of computerized claiming network of National Medical Insurance and 3) establishment and distribution of objective diagnostic criteria to physicians are necessary to set up a national disease surveillance system utilizing National Medical Insurance claims data.
Information Storage and Retrieval ; Communicable Diseases ; Diagnostic Errors ; Female ; Hospitals, General ; Humans ; Insurance Carriers ; Insurance* ; Logistic Models ; Male ; Medical Records ; Professional Review Organizations ; Seoul ; Specialization ; Tertiary Care Centers

BACKGROUND AND OBJECTIVES: Carcinogenesis is known to arise as a result of the accumulation of genetic alterations including unilateral chromosomal losses and epigenetic modification. In this study, we investigated the extent of chromosomal losses and the status of CpG methylation in squamous cell carcinoma of the head and neck in relation to the clinicopathologic factors. SUBJECTS AND METHOD: A total of 20 tumor foci from 12 cases were examined wtih PCR-based loss of heterozygosity (LOH) analysis using a panel of 41 microsatellite markers on 8 chromosomes and a total of 10 tumor foci from 5 cases were examined with methylation-specific PCR on 2 extragenic regions of the 3 cancer-linked genes. RESULTS: In 20 tumor foci, LOH was found most frequently on the chromosome 8p. Multiple tumor foci of a given case had the same or a similar extent of chromosomal losses and yielded an overall mean value of 5.5 per tumor focus. Even though the tumor foci showed histological homogeneity, they revealed genetical heterogeneity. The relation between methylation changes between the paired normal mucosa and tumor site was variable and 10 tumor sites examined for the methylation status of 6 extragenic regions showed 21 (35%) hypomethylation changes, 6 (10%) hypermethylation changes, and 33 (55%) no methylation changes. The degree of methylation changes indicated the tendency to cluster in the range of U1 and M1 low-grade changes. With respect to relationship between bet methylation changes and clinicopathologic factors, hypomethylation changes were dominant in those cases with increased depth of invasion. CONCLUSION: These results showed that multiple intratumoral foci of the head and neck cancer patients were generally under the influence of a similar level of chromosomal losses and hypomethylation changes.
Carcinogenesis ; Carcinoma, Squamous Cell* ; Epigenomics ; Head and Neck Neoplasms ; Head* ; Humans ; Loss of Heterozygosity ; Methylation* ; Microsatellite Repeats ; Mucous Membrane ; Neck* ; Polymerase Chain Reaction ; Population Characteristics