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

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

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

BACKGROUND: Because of their large size and excellent computerized records of illness and services rendered, the importance of national insurance program is getting much attentions from the public health researchers and the national and local health authorities. In reality, however, most health records from medical insurance program suffer very much from inaccurate disease coding, and therefore, they are practically in no use. METHODS: Pattern of incorrect disease coding of 6 Notifiable Acute Communicable Diseases that believed not to have been occurred in Korea lately was reviewed. The reasons of such incorrect codings in different level of medical institutions were studied. This study also attempted to see how an official intervention asking the medical institutions to correct their coding behavior works by comparing the frequencies of incorrect disease coding before and after the intervention. RESULTS: Study results showed that more incorrect disease codings came from clinics than hospitals, and non-physician personnel in clinics and hospitals seemed to be responsible for most of the incorrect disease codings. Most frequent diseases coded incorrectly such as cholera and poliomyelitis were the ones that physicians and non-physician personnel in the clinics and hospitals had been familiar with for a long time period. CONCLUSION: Even a simple official intervention asking the clinics and hospitals to correct their coding behavior was very effective : total number of incorrect disease codings before intervention (398 cases from 144 institutions) dramatically decreased (14 cases from 8 institutions) after intervention. Significant decrease in incorrect disease coding was found more in small institutions such as clinics and public health facilities than large institutions.
Attention ; Cholera ; Clinical Coding* ; Communicable Diseases* ; Insurance* ; Korea ; Poliomyelitis ; Public Health

This study is aimed at preparing basic data required for establishment of a cancer screening program by examining the status of cancer screenings performed by residents in a community and the factors that have an effect on determination for a cancer screening by residents. Cervix, breast and stomach cancers were chosen as target cancers of the study due to the fact that merits of screening for these cancers have been proved by studies done in different countries. In order to find out the status of cancer screening and the factors having an effect on the determination for a cancer screening, 10 Dongs and a total of 1988 people were selected as study area and subjects by a random cluster sampling method, and the subjects were questioned on different aspects by questionnaires. Additionally, in order to find out how cancer screening is performed at medical facilities and how cancer screening is recommended by doctors, medical facilities doing cancer screening were also questioned. The results of the study are as follows: 1. In the case of the screening of the stomach cancer, 16.1% of male subjects and 25.6% of female subjects turned out to have had one or more screening for the cancer. In the cases of the breast and the cervical cancers, 21.6% and 62.6% of the subjects turned out to have had one or more screenings respectively. 2. As to the screening for the stomach cancer, there was a tendency that more of the subjects with lower level education, excepting those without education, had themselves screened for the cancer. Higher screening rates were shown by the subjects in higher ages, those who visited doctors regularly. 3. As to the screening rate by education levels, a high rate of screening was shown by the subjects with above-university education level and there was not a big difference between the screenings done for high school graduates and for those with lower education levels. Regarding the rates of screening by age groups the screening rate turned out to be higher with the higher ages. Screening rates, checked on the basis of the income levels, did not show a big differences between income levels. 4. The highest rate of screening for the breast cancer was shown by the subjects with postgraduate level of education and regarding the rate by income level, a slightly higher level was shown by the subjects with the monthly income of the 2,010,000 won, but the difference between the rates of screening by subjects at different income levels was overall not significant. 5. The rates for selecting the health screening facilities were higher in orders of the reasons that 1) they were close: 2) service was excellent and 3) equipment and facilities were good. Based on the above-mentioned results obtained by the study, it is anticipated that this study will play a vital role as basic data for the development and execution of cancer screening program for a community, and the analysis, done on the basis of the status of the cancer screening, of the factors related to the determination for the cancer screening showed that for the development of a cancer screening program, factors like income levels, education levels, whether people consult doctors regularly and the local government' care for health in a community should be considered, and in addition to which active participation of doctors in the program is also requested.
Breast ; Breast Neoplasms ; Early Detection of Cancer* ; Education ; Female ; Humans ; Male ; Mass Screening ; Stomach Neoplasms ; Uterine Cervical Neoplasms ; Surveys and Questionnaires

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