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.

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

Neurofibromatosis type 1, an autosomal dominant disorder, is clinically characterized by the presence of cafe-au-lait spots and cutaneous neurofibromas. Malignancy is a frequently cited and feared complication of neurofibromatosis. Neurofibromatosis has been reported to be associated with some CNS tumors, neurofibrosarcoma, pheochromocytoma, and nonlymphocytic leukemia. Also malignant lymphoma may develop in patients with neurofibromatosis. In Korea, only a case of lung cancer and a case of pheochromocytoma have been reported to develop in patients with neurofibromatosis type 1. Recently, we experienced a case of malignant lymphoma involving the stomach in a 70-year-old woman with neurofibromatosis type 1. An esophagogastroduodenoscopy revealed a 5 cm sized ulcerofungating mass on the greater curvature of the upper body. Histologic diagnosis of the biopsied specimen was B-cell diffuse small and large cell lymphoma. This case illustrates that malignant lymphoma should be included in the differential diagnosis of gastric tumors in patients with neurofibromatosis type 1.
Aged ; B-Lymphocytes* ; Cafe-au-Lait Spots ; Diagnosis ; Diagnosis, Differential ; Endoscopy, Digestive System ; Female ; Humans ; Korea ; Leukemia ; Lung Neoplasms ; Lymphoma ; Lymphoma, B-Cell* ; Neurofibroma ; Neurofibromatoses* ; Neurofibromatosis 1* ; Neurofibrosarcoma ; Pheochromocytoma ; Stomach*

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*

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