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

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

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*

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.

PURPOSE: To evaluate the usefulness of CT for determining the causes of intestinal obstruction followingsurgery for abdominal cancer. MATERIALS AND METHODS: CT scans were performed in 54 patients with benign (n = 25)or malignant (n = 29) bowel obstruction after surgery for abdominal malignancies ; the causes of obstruction wereconfirmed pathologically (n = 34) or clinically (n = 20). Three radiologists interpreted the CT scans andevaluated their accuracy, sensitivity, and specificity. Through analysis of CT findings, malignant and benignobstruction was compared with regard to the presence of mass or lymphadenopathy, bowel change, mesenteric change,ascites, and other ancillary findings. RESULTS: In distinguishing malignant from benign obstruction, thediagnostic accuracy achieved by three radiologists was 67%, 74%, and 78%. When there was a mass at the obstructedor prior surgical site, lymphadenopathy, an abrupt transitional zone, or irregular wall thickening at anobstructed site, malignant obstruction was suspected (P < .05) ; in the absence of a mass, CT findings ofmesenteric vascular engorgement, extensive ascites, a smooth transition zone and normal or smooth wall thickeningat the obstructed site suggested benign obstruction (P < .05). The presence of omental infiltration, mesentericinfiltration and metastatic lesions at other sites did not always indicate malignant obstruction. In addition,bowel wall thckness, luminal diameter and the interval between surgery and bowel obstruction were notstatistically significant. CONCLUSION: CT is useful for determining the causes of obstruction following surgeryfor abdominal cancer, though particularly when definite peritoneal mass is not demonstrated this usefulness inlimited.
Ascites ; Humans ; Intestinal Obstruction ; Lymphatic Diseases ; Phenobarbital ; Sensitivity and Specificity ; Tomography, X-Ray Computed

PURPOSE: To standardize hospital management of patients with simple congenital heart disease (CHD), we developed a protocol called the 'clinical pathway (CP)'and evaluated quality improvement in patient outcomes. METHODS: The study included a group of 60 patients with simple CHD who had surgery between June 1 and October 31, 1998. The control group included 48 patients who had surgery for the same disease during the corresponding time in 1997. Two CPs were developed according to state and place of residence of patients. Information on patients was reviewed including: education, physical examination, hospital stay, type of care and date of discharge from the hospital. The effect of each protocol on standard procedures was reviewed. After patient discharge additional performance information was assessed including: procedures used, duration of hospital stay, medical cost, treatment outcome, complications and parent satisfaction. RESULTS: The duration of hospital stay prior to surgery (1.8 days vs. 3.0 days), the ICU stay (1.3 days vs. 3.6 days), number of ward days after surgery (5.3 days vs. 7.9 days) and total number of hospital days (8.5 days vs. 14.7 days) were significantly shortened in the study group compared to the control group. The intubation time (P=0.000) and the frequency of laboratory studies (P=0.000) during the hospitalization decreased in the study group compared to the control group. The average medical costs of cases was also significantly lower in the study group (P=0.001). There were no deaths, readmissions or serious complications in the study group. A questionnaire survey of patient family members showed that they were satisfied with care; with more than 85 percent response rate to questionnaire items. CONCLUSION: Application of our new CP protocol shortens hospital stay and reduces medical costs while improving the quality of care for patients and their families. This CP protocol should now be considered for more complex CHD.
Critical Pathways* ; Health Care Costs ; Heart Defects, Congenital ; Heart* ; Hospitalization ; Humans ; Intubation ; Length of Stay ; Parents ; Patient Discharge ; Physical Education and Training ; Quality Improvement ; Surveys and Questionnaires ; Thoracic Surgery*

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

Between January 1980 and September 1988, 68 patients with advanced T3 & T4 glottic carcinoma were treated with RT and surgery/RT in the Department of Radiation Oncology, Yonsei Cancer Center and ENT, Yonsei University College of Medicine. The mean age was 60 years old (range 33 to 79 year old). The 34 patients were treated with irradiation alone, and the remaining 34 patients with surgery and irradiation. Initial nodal presentation was 37% (25/68); 31% (11/34) in RT alone group and 41% (14/34) in combined treatment group. The minimum follow-up was 2 years. The local control rate after treatment was 47% in RT alone group and 65% in combined treatment group; 57% for node negative and 27% for node positive patients treated with RT alone; 65% for node negative and 64% for node positive patients treated with combined treatment. The treatment failure was observed in 30 patients; 14 patients for primary local failure, 6 patients for regional nodal failure, 6 patients for local and regional failure, 26 patients for primary failure and/or distant metastasis, and 2 patient for regional failure and/or distant metasasis. The overall 5-year survival rate was 57%; 37% in RT alone group and 76% in combined treatment group; 55% for node negative and 20% for node positive patients treated with RT alone; 73% for node negative and 77% for node positive patients treated with combined treatment. In conclusion, the combined treatment groups in the treatment of advanced T3 and T4 glottic cancer showed the better results in local control rates and 5-year actuarial survival rates than RT alone group. We suggest that total laryngectomy and postoperative RT in the most patients of advanced glottic cancer were performed. However, in cases of node negative patients, RT alone is prefer as a treatment modality over combined surgery and RT since the treatment results were comparable and furthermore functional preservation could be achieved.
Follow-Up Studies ; Humans ; Laryngectomy ; Middle Aged ; Neoplasm Metastasis ; Radiation Oncology ; Survival Rate ; Treatment Failure

Positron emission tomography(PET) is an imaging technique that produces images reflective of tissue biochemistry rather anatomy. The great versatility of PET and its potential of direct noninvasive study of tumor function will make it a very important clinical and research tool in oncology. Recently, whole body PET techniques have been developed which permit imaging of the entire body during a single scanning session promising both in determining the nature of a localized lesion and in defining the systemic extent of malignant disease. FDG-PET scan seems valuable in evaluating patients with GTT resistant to chemotherapy with persistent elevation of beta-hCG levels and localizing the site of a viable tumor. We present three cases of FDG-PET scan in patients with metastatic gestational trophoblastic tumor with a brief review of literatures.
Biochemistry ; Drug Therapy ; Electrons ; Humans ; Neoplasm Metastasis ; Trophoblastic Neoplasms* ; Trophoblasts*