PURPOSE: The purpose of this study is to investigate the trends and traits of moral sensitivity and reasoning over six years of medical school. METHODS: The participants in this study consisted of 217 first to sixth-year medical students of Sungkyunkwan University School of Medicine in Korea. Essay type questionnaire was used for evaluating moral sensitivity and the Korean-Defining Issues Test (KDIT) was used for evaluating moral reasoning. RESULTS: It was found that the medical students' sensitivity of 'public welfare', 'prospective result' and 'role-taking as a doctor' was significantly higher than that of the pre-medical students'. Moral sensitivity increased in the 3rd and the 4th years but decreased in the 5th and the 6th years. Moral reasoning decreased in the 3rd and the 4th years but increased in the 5th and the 6th years. No correlation was observed between moral sensitivity and reasoning(r=0.033). Developmental trends of moral sensitivity and reasoning showed a significant difference in terms of year of medical school. CONCLUSION: The results suggest that medical school curriculum tends to impct students' moral sensitivity. This school has implemented the problem-based learning curriculum into the 3rd and the 4th years. It is necessary to consider the developmental state of the student's morality when developing an effective medical ethics program.
Curriculum ; Ethics, Medical ; Humans ; Korea ; Morals ; Problem-Based Learning ; Schools, Medical ; Students, Medical* ; Surveys and Questionnaires

OBJECTIVES: Since the 1990s, drug-resistant bacteria have become common pathogens of hospital-acquired infections. In recent years, healthcare-associated infections have come to the fore, and it is reported that distribution rates of these bacteria are comparable to those of hospital-acquired infections. However, there have been few studies on differences in resistant bacteria depending on the size of hospitals. Thus, the authors studied differences in drug-resistant bacteria between a tertiary hospital and smaller medical institutions. METHODS: We retrospectively analyzed the clinical findings and sputum culture results of patients transferred from tertiary hospitals (group A, n=74) and those transferred from smaller medical institutions (group B, n=65). RESULTS: The number of patients with malignancy was higher in group A than in group B. The length of intensive care unit stay was longer in group A than in group B. Antibiotic therapy and mechanical ventilation were more frequently used in group A than in group B. There were no significant differences between the 2 groups in bacterial species (Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa) and their resistance rates to carbapenem, while there were significant differences between the 2 groups in the bacterial species (Acinetobacter baumannii) and its resistance rate to carbapenem. CONCLUSION: In this study, there were significant differences between the 2 groups in the bacterial species and resistance rates to carbapenem for A. baumannii infection unlike other bacterial infections. Further studies on risk factors and patient classification are needed to confirm our results.
Acinetobacter baumannii ; Bacteria ; Bacterial Infections ; Drug Resistance, Bacterial* ; Escherichia coli ; Humans ; Intensive Care Units ; Klebsiella pneumoniae ; Pseudomonas ; Respiration, Artificial ; Retrospective Studies ; Risk Factors ; Tertiary Care Centers*

OBJECTIVE: Most cases of syringomyelia with arachnoid scarring were related to spinal trauma or inflammatory reaction. The aim of this study is to analyze the influence of arachnoid scarring on the altered dynamics of cerebrospinal fluid(CSF) and determine the proper treatment. METHODS: Between Jan 1991 and Dec 2001, We have operated on 15 patients with progressive neurological deficits associated with syringomyelia. We analyze the clinical presentations, radiographic and magnetic resonance images. RESULTS: As to cause of syringomyelia, 11 patients were related with trauma and 4 patients were tuberculous meningitis. Shunting procedures underwent in 11 patients and 5 showed clinical improvement. Subarachnoid adhesiolysis and expansile duraplasty were performed in 4 patients and 3 experienced clinical improvement. The 6 patients with shunting procedures were neurologically deteriorated and 4 were reoperated. CONCLUSION: The arachnoid scarring interferes with CSF flow and causes syringomyelia. Successful long-term outcome in the surgical treatment of syringomyelia caused by focal arachnoid scar appeared to require microsurgical dissection of scar and expansile duroplasty. For extensive arachnoid scarring over multiple spinal levels or after previous surgery, shunting procedure may be indicated only.
Arachnoid* ; Arachnoiditis* ; Cerebrospinal Fluid ; Cicatrix ; Humans ; Syringomyelia* ; Tuberculosis, Meningeal

BACKGROUND AND OBJECTIVES: Retrospective reflect of canal wall up (CWU) mastoidectomy with posterior tympanotomy revealed some problems such as ineffectiveness against the recurrence of cholesteatoma, reclosure of ventilation route and that a posterior tympanotomy might be harmful to inner ear. Objectives of this study is to evaluate the effect of mastoidectomy with anterior tympanotomy on postoperative hearing results and complications. SUBJECTS AND METHOD: From January 1998 through July 2001, 29 cases of CWU mastoidectomy with anterior tympanotomy were reviewed retrospectively. All of the cases were difficult to perform posterior tympanotomy due to anatomical variations and had lesions restricted to anterior epitympanum. The hearing results were assessed by postoperative 1-year pure tone average and postoperative 1-year air-bone gap (ABG), and we checked complications. RESULTS: Of the 29 cases, 21 cases (72.4%) had ABG <20 dB in the postoperative 1-year, with the postoperative 1-year ABG of 14.9+/-9.2 dB. The postoperative hearing gain was 10.1+/-10.6 dB. There were 3 cases of chorda tympani nerve cutting, 1 case of accidental malleoincudal joint dislocation and 1 case of recurrence. CONCLUSION: Anterior tympanotomy could be a good approach for ventilation in selected CWU mastoidectomy approach, and further long term follow-up is needed to study about recurrence.
Cholesteatoma ; Chorda Tympani Nerve ; Dislocations ; Ear, Inner ; Follow-Up Studies ; Hearing ; Joints ; Mastoid ; Otitis Media ; Recurrence ; Retrospective Studies ; Ventilation

Purpose: Granular corneal dystrophy type 2 (GCD2) is a hereditary disease that features granular and lattice stromal deposits in the cornea. There are homozygotes and heterozygotes and the opacities are exacerbated by corneal trauma or surgery, such as laser in situ keratomileusis (LASIK). As there is individual variability in GCD2 phenotypes, we investigated various corneal features of GCD2 patients in their twenties, the main age group for refractive surgery. Methods: From genetically confirmed GCD2 patients who had an R124H mutation of the transforming growth factor β induced (TGFBI) gene at age 20 to 29 years, we chose representative patients: one homozygote; one compound heterozygote; one simple heterozygote with a severe phenotype with many granular deposits; one common heterozygote; and four heterozygotes with normal corneas. The corneas of all patients were subject to slit-lamp examination and photographed. Results: The homozygote had confluent granular deposits covering the cornea. The compound heterozygote had granular and lattice deposits covering the center of the cornea. The patient with a severe phenotype had more than 30 granular deposits in one eye, but was a simple GCD2 heterozygote, verified by full-sequencing of the TGFBI gene. In the four patients with normal corneas, a single small lesion was subsequently detected during follow-up in two, at 3 weeks and 6 months, respectively. Both corneas were judged clear at chance examinations. Conclusions Among Koreans in their twenties, GCD2 patients have various phenotypes, from clear corneas to severe confluent opacities. There are GCD2 heterozygotes with nearly clear corneas, so caution must be taken when choosing patients for refractive surgery.

Wernicke's encephalopathy (WE) caused by thiamine deficiency is an acute neurological disorder. Clinically, the classic triad of WE consists of ophthalmoplegia, ataxia, and mental status changes. Thiamine deficiency is known to occur commonly in chronic alcoholic patients. Sometimes, it can occur in patients after gastrointestinal surgery and in those with malabsorption. In addition, patients undergoing renal dialysis, suffering from hyperemesis gravidarum, receiving total parenteral nutrition (TPN), and being treated with chemotherapeutic agents are also prone to develop thiamine deficiency. Herein, we report two cases of WE that developed following simultaneous 5-fluorouracil (5-FU) chemotherapy and TPN in colon cancer patients which was successfully treated with thiamine administration.
Adult ; Antimetabolites, Antineoplastic/*therapeutic use ; Brain/radiography ; Colonic Neoplasms/*drug therapy ; Fluorouracil/*therapeutic use ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Parenteral Nutrition, Total ; Thiamine/therapeutic use ; Vitamin B Complex/therapeutic use ; Wernicke Encephalopathy/*diagnosis/drug therapy

The necrotizing fascitis, that develops after a Cesarean section, is acknowledged as a rare complication due to the development of antibiotics. Having a very high mortality rate, the only way to prevent the septic shock and the impairment of the cardiopulomary function is the use of adequate antibiotics, the infusion of IV fluids, a radical section of the necrotized fascia and a through cleansing. We have an experience in treating a primipara who had a necrotic fascitis after Cesarean section, and therefore, report this case with the review of articles enclosed.
Anti-Bacterial Agents ; Cesarean Section* ; Fascia ; Fasciitis ; Fasciitis, Necrotizing* ; Female ; Mortality ; Pregnancy ; Shock, Septic

Splanchnic vein thrombosis arising from complications of acute pancreatitis is very rare. It usually occurs as a form of portal, splenic and superior mesenteric vein thrombosis, either in combination or separately. It could develop portal hypertension, bowel ischemia and gastrointestinal variceal bleeding. Treatment of splanchnic vein thrombosis includes anticoagulants, thrombolysis, insertion of shunts, bypass surgery and liver transplantation. In some cases, anticoagulation therapy may be considered to prevent complications. However, the standard protocol for anticoagulation in splanchnic vein thrombosis has not been determined yet. We report a case of 43-year-old man who had portal and splenic vein thrombosis in acute pancreatitis. The patient was successfully treated with oral anticoagulants following low molecular weight heparin therapy.
Adult ; Anticoagulants* ; Esophageal and Gastric Varices ; Heparin, Low-Molecular-Weight ; Humans ; Hypertension, Portal ; Ischemia ; Liver Transplantation ; Mesenteric Veins ; Pancreatitis* ; Splenic Vein* ; Thrombosis* ; Veins ; Venous Thrombosis

PURPOSE: The purpose of this study was to evaluate the CT findings of phytobezoar associated with small bowel obstruction. MATERIALS AND METHODS: In 19 patients with phytobezoar associated with small bowel obstruction, two of whom had underlying small bowel disease, we analyzed the morphological characteristics of phytobezoars and changes in the bowel and perienteric regions, as revealed by abdominal Ct imaging. RESULTS: On CT, phytobezoars appeared as single or multiple, gas-containing masses in 17 patients (89%) and as a solid mass without gas in the remaining two (11%). An encapsulating wall was noted in six patients (32%). Among the 17 without underlying small bowel disease, the bowel wall was thickened in 13 (76%) at the obstructed site and/or the bowel proximal to the obstruction. Mesenteric vascular engorgement and haziness were seen in 18 patients (95%) and a small amount of ascites in six (32%). MR images of one patient showed the phytobezoar as a hypointense mass on all sequences. CONCLUSION: CT imaging is useful for the diagnosis of phytobezoar associated with small bowel obstruction.
Ascites ; Bezoars ; Diagnosis ; Humans ; Tomography, X-Ray Computed

OBJECTIVE: To evaluate the usefulness of MR imaging for diseases of the small intestine, emphasizing a comparison with CT. MATERIALS AND METHODS: Thirty-four patients who underwent both CT and MR imaging using FLASH 2D and HASTE sequences were analyzed. All patients had various small bowel diseases with variable association of peritoneal lesions. We compared the detectabilities of CT and MR imaging using different MR pulse sequences. The capability for analyzing the characteristics of small intestinal disease was also compared. RESULTS: MR imaging was nearly equal to CT for detecting intraluminal or peritoneal masses, lesions in the bowel and mesentery, and small bowel obstruction, but was definitely inferior for detecting omental lesions. The most successful MR imaging sequence was HASTE for demonstrating bowel wall thickening, coronal FLASH 2D for mesenteric lesions, and axial FLASH 2D for omental lesions. MR imaging yielded greater information than CT in six of 12 inflammatory bowel diseases, while it was equal to CT in six of seven neoplasms and inferior in five of seven mesenteric ischemia. In determining the primary causes of 15 intestinal obstructions, MR imaging was correct in 11 (73%) and CT in nine (60%) patients. CONCLUSION: MR imaging can serve as an alternative diagnostic tool for patients with suspected inflammatory bowel disease, small intestinal neoplasm or obstruction. is a high-speed, heavily T2-weighted sequence with a great sensitivity for fluid (11). This advance may make it possible to use breath-hold turbo spin-echo MR.
Comparative Study ; Female ; Human ; Inflammatory Bowel Diseases/*diagnosis ; Intestinal Neoplasms/*diagnosis ; Intestinal Obstruction/*diagnosis ; Intestine, Small/*pathology ; *Magnetic Resonance Imaging ; Male ; Middle Age ; *Tomography, X-Ray Computed