PURPOSE: The evaluation of a lecture by students is one of the good way to improve a lecture. In one medical school, we started one-year-integrated-lecture curriculum for sophomore. And we evaluated lectures using formal lecture evaluation sheet after completion of each integrated lectures. The results were fed back to lecturers. But lecturers were indifferent to the results. So we performed this study to evaluate the current lecture evaluation method. METHODS: Answering patterns of evaluation sheets were reviewed. 50 students entitled to integrated lectures were given structured questions. 44 of them recovered. And randomly selected 10 students were interviewed. RESULTS: Analysis of evaluation sheets showed that some students checked the items just for fun. More than half of the students answered that they did not check the questions seriously. Reasons why the evaluation of lectures were not going well were; students were not trained to evaluate something; evaluation sheet was not designed to evaluate individual lecturer; listed items were too many in number and inappropriate; some students were suspicious about the impact of evaluation of lectures. In addition to this, it was revealed that students thought the timing of evaluation of lecture was important, too. CONCLUSION: Indifference of lecturers to the results is one form of resistance to the evaluation of lectures by students. To make evaluation of lectures effective, numbers and contents of evaluation items must be selected carefully, students need to be trained, and adequate evaluation timing should be determined with frequent feed backs.
Curriculum ; Humans ; Lectures ; Schools, Medical*

OBJECTIVE: The purpose of this study was to describe the various symptomatic complications following decompressive bilateral laminotomy for treating lumbar spinal stenosis. METHODS: Out of 878 patients who underwent decompressive laminotomy from 2006 through 2008, 178 patients who were able to be followed for a minimum of 24 months were included in this study. The mean age at the time of surgery was 64.4 years (range, 38-79), and the average follow-up period was 32.7 months. The development of symptomatic complications was observed using simple radiographs and MR imaging during the follow-up period. Imaging and clinical complications were focused on postoperative spondylolisthesis, disc herniation, and facet cysts, and were analyzed according to developmenttime, the degree of symptom, and their course. RESULTS: Postoperative simple radiographs revealed that eight out of 178 patients (4.4%) had developed symptomatic spondylolisthesis and six required an interbody fusion procedure. Five patients with disc herniation (2.8%) at the level of the decompressive bilateral laminotomy site underwent another operation within 24 months after the first surgery. In two patients, disc herniations developed within 1 month after surgery. Three (1.7%) out of 178 patients showed facet cysts but all symptoms were relieved by conservative treatment. Spontaneous regression of the cysts was observed during the follow-up period. CONCLUSIONS: Although decompressive bilateral laminotomy for spinal stenosis is believed to effective and reduces the need for fusion, various symptomatic complications were observed after this procedure. It is important to be aware of the possibility for these various complications to improve the surgical outcome.
Constriction, Pathologic ; Follow-Up Studies ; Humans ; Laminectomy ; Spinal Stenosis ; Spondylolisthesis

BACKGROUND: Recombinant human bone morphogenetic proteins (rhBMPs) have been widely used in regenerative therapies to promote bone formation. The production of rhBMPs using bacterial systems such as Escherichia coli (E. coli) is estimated to facilitate clinical applications by lowering the cost without compromising biological activity. In clinical practice, rhBMP-2 and osteoconductive carriers (e.g., hydroxyapatite [HA] and bovine bone xenograft) are used together. This study examined the effect of E. coli-derived rhBMP-2 combined with porous HA-based ceramics on calvarial defect in rabbits. METHODS: Six adult male New Zealand white rabbits were used in this study. The experimental groups were divided into the following 4 groups: untreated (NC), bovine bone graft (BO), porous HA (HA) and porous HA with rhBMP-2 (HA-BMP). Four transosseous defects of 8 mm in diameter were prepared using stainless steel trephine bur in the frontal and parietal bones. Histological and histomorphometric analyses at 4 weeks after surgery revealed significant new bone formation by porous HA alone. RESULTS: HA-BMP showed significantly higher degree of bone formation compared with BO and HA group (P<0.05). The average new bone formation % (new bone area per total defect area) of NC, BO, HA, and HA-BMP at 4-week after surgery were 12.65±5.89%, 29.63±6.99%, 28.86±6.17% and 49.56±8.23%, respectively. However, there was no statistical difference in the bone formation between HA and BO groups. CONCLUSIONS: HA-BMP promoted more bone formation than NC, BO and HA alone. Thus, using E. coli-derived rhBMP-2 combined with porous HA-based ceramics can promote new bone formation.
Adult ; Bone Morphogenetic Proteins ; Ceramics* ; Durapatite ; Escherichia coli ; Escherichia* ; Humans* ; Hydroxyapatites ; Male ; Osteogenesis ; Parietal Bone ; Rabbits* ; Stainless Steel ; Transplants

BACKGROUND: To evaluate clinical manifestations, endoscopic findings and response to treatment in adult Henoch-Sch?nlein purpura (HSP) patients with hemorrhagic gastroenteritis. METHODS: Twenty patients who were admitted to Kyungpook National University Hospital between 1996 and 2003 were included, based on the following criteria: 1) diagnosed as HSP according to the criteria proposed by Michel et al., 2) older than 15 years old and 3) had evidences of gastrointestinal (GI) bleeding. Thirteen HSP patients who were older than 15 years old and had no evidences of GI bleeding were recruited as controls. We evaluated the clinical features and findings of upper GI endoscopy and colonoscopy. RESULTS: Mean age and male to female ratio were not significantly different between patients with and without hemorrhagic gastroenteritis (age: 29.5 +/- 15.1 vs. 30.5 +/- 13.5; M:F=14:6 vs. 9:4, respectively). Patients with hemorrhagic gastroenteritis had a significantly higher frequency of petechiae on the upper extremities (p=0.015). In the multivariate analysis, petechial lesion on the upper extremities was a significant risk factor for hemorrhagic gastroenteritis (p=0.041). Mucosal lesions were found in 94.7% and 83.3% of patients on upper GI endoscopy and colonoscopy, showing that most patients (82.3%) had both upper and lower GI bleeding. Most patients with hemorrhagic gastroenteritis showed good response to high dose glucocorticoid therapy. Mortality and relapse rate were 10% and 5%, respectively. CONCLUSION: In adult HSP patients, presence of petechiae on upper extremities may be a risk factor for hemorrhagic gastroenteritis. The present data suggest that both upper and lower GI examinations are necessary for proper evaluation of HSP patients with hemorrhagic gastroenteritis.
Adolescent ; Adult* ; Colonoscopy ; Endoscopy ; Female ; Gastroenteritis* ; Gyeongsangbuk-do ; Hemorrhage ; Humans ; Male ; Mortality ; Multivariate Analysis ; Purpura* ; Recurrence ; Risk Factors ; Upper Extremity

BACKGROUND: Aortic valve endocarditis(AVE) may produce secondary involvement of the mitral aortic-intervalvular fibrosa(MAIVF) and the anterior mitral valve leaflets(AMVL). These complications may result in the systolic regurgitation of blood from the left ventricular outflow tract into the left atrium, or formation of an aneurysm or perforation of the AMVL. Early recognition of these complications is important for optimal management and corrective surgery. The aims of the persent study were to examine the utility of transesophageal echocardiography(TEE) in the diagnosis of these subaortic complications compared to conventional transthoracic echocardiography(TTE) and to observe the prevalence and pattern of these complications. METHOD: Both TTE and TEE were performed in patients with AVE from June 1991 to June 1993. A 2.5 MHz probe was used for TTE and a 5 MHz biplane one for TEE with Hewlett Packard SONOS 1,000 All procedures were recorded in super VHS tape and reviewed by two experienced cardiologist. AVE was diagnosed clinically by the presence of continuous bacteremia or demonstration of vegetations during open heart surgery. RESULT: Ten consecutive patients with AVE underwent TTE and TEE of these patients, 6(60%) had involvement of subaortic structures, including one with an abscess in the MAIVF, two with perforation of the MAIVF into the left atrium, one with multiple vegetations in the AMVL, and two with pseudoaneurysm formation and perforation of the AMVL, TEE visualized all these lesions with high resolution images, whereas TTE detected only multiple vegetations in the AMVL in one patients and eccentric mitral regurgitation of unknown etiology in 2 patients. In 4 patients, corrective surgery was performed in which the TEE findings were confirmed. CONCLUSION: The results implicate that 1) involvement of the subaortic structures would be a common complication in patients with AVE, 2) TEE is superior to conventional TTE in the detection of these complications, and 3) routine screening with TEE would be necessary in patients with AVE to diagnose or exclude these subaortic complications.
Abscess ; Aneurysm ; Aneurysm, False ; Aortic Valve* ; Bacteremia ; Diagnosis ; Echocardiography* ; Echocardiography, Transesophageal ; Endocarditis* ; Heart Atria ; Humans ; Mass Screening ; Mitral Valve ; Mitral Valve Insufficiency ; Prevalence ; Thoracic Surgery

BACKGROUND: Low values of lung compliance have been reported in patients with increased pulmonary blood flow due to intracardiac left to right(L-R) shunt. The compliance had returned to within normal limits 4 to 6 weeks after surgical correction of the shunt. We investigated whether lung compliance was improved immediately after surgical correction of the shunt. METHODS: Fifty four pediatric patients who were undergoing repair of intracardiac L-R shunt were evaluated. Lung compliance, arterial oxygen tension(PaO2) and arterial to end-tidal carbon dioxide tension difference(Pa-ETCO2) were measured after induction of anesthesia and at the completion of surgery. Left atrial pressure(LAP) was monitored. Lung compliance and end-tidal carbon dioxide tension were measured by monitoring system built in Cato anesthetic ventilator system. RESULTS: Lung compliance was significantly lower after surgery(6.57+/-6.46 ml/mbar) than after induction of anesthesia(7.71+/-7.18 ml/mbar). After surgery, PaO2 was significantly decreased and Pa-ETCO2 significantly increased than after induction of anesthesia. The decrease in lung compliance after surgery significantly correlated with a decrease in PaO2(r=0.43) and an increase in Pa-ETCO2 (r=0.47) but not correlated with LAP. CONCLUSIONS: Although surgical correction of intracardiac L-R shunt reduces pulmonary blood flow, the lung compliance decreases in immediate postoperative period. Therefore a deterioration of postoperative lung compliance may need judicious management for pulmonary and hemodynamic instability.
Anesthesia ; Carbon Dioxide ; Compliance ; Hemodynamics ; Humans ; Lung Compliance* ; Lung* ; Oxygen ; Postoperative Period ; Ventilators, Mechanical

Protein losing enteropathy (PLE) is characterized by the loss of protein into the gastrointestinal tract that results in hypoalbuminemia and generalized edema. PLE is associated with several clinical disorders, but it is a rare manifestation of systemic lupus erythematosus (SLE), and it may be the presenting manifestation of SLE. We report a patient with SLE presenting with PLE, in whom methylprednisolone pulse therapy was highly effective. A 29-year-old women was admitted to our hospital with generalized edema. Laboratory findings revealed hypoalbuminemia, hypercholesterolemia and antinuclear antibody 1:160, speckled type. Mucosal biopsies of the duodenal bulb and terminal ileum revealed edema and dilated lymphatics with infiltration of chronic inflammatory cells. PLE was diagnosed by marked elevation of alpha-1 antitrypsin clearance in stool and abnormal radioactivity within small intestine on 99mTc-labeled human serum albumin scan. Hypoalbuminemia and generalized edema improved rapidly after methylprednisolone pulse therapy.
Adult ; Antibodies, Antinuclear ; Biopsy ; Edema ; Female ; Gastrointestinal Tract ; Humans ; Hypercholesterolemia ; Hypoalbuminemia ; Ileum ; Intestine, Small ; Lupus Erythematosus, Systemic* ; Methylprednisolone ; Protein-Losing Enteropathies* ; Radioactivity ; Serum Albumin

Purpose: This randomized controlled study aimed to evaluate the effects of an electric toothbrush with 3 colors of light-emitting diodes (LEDs) on antiplaque and bleeding control. Methods: This randomized, placebo-controlled, double-blinded, parallel-group clinical trial included 50 healthy adults with gingivitis, who were randomly assigned to 2 groups. The experimental group used electric toothbrushes with 3 colors of LEDs and the control group used the same electric toothbrush as the experimental group, but with LED sources with one-hundredth of the strength. The subjects used the electric toothbrush 3 times a day for 4 minutes each time. As clinical indices, bleeding on marginal probing (BOMP), the LöeSilness gingival index (GI), and the Turesky-Quigley-Hein plaque index (QHI) were assessed at baseline, at 3 weeks, and at 6 weeks. Results: There were significant decreases in all clinical indices (BOMP, GI, QHI) in both the experimental and control groups compared to baseline at 3 weeks and at 6 weeks. In a comparison between the experimental and control groups, no statistically significant differences were observed for any clinical indices at 3 weeks (P>0.05). However, at 6 weeks, statistically significant differences were observed between the experimental and control groups in BOMP and GI, which are indicators of gingival inflammation (P<0.05). Conclusions This study demonstrated that an electric toothbrush combined with 3-color LEDs reduced gingival bleeding and inflammation after 6 weeks.

Objectives: The sphincter of Oddi(SO) manometry via transpapillary route is performed usually for a period of several minutes. To investigate whether there is a considerable variation in the manometric measurements of SO over a longer period of time, we have performed long-term manometry of SO via transpapillary(n=5) as well as percutaneous(n=7) route. Methods: Transpapillary manometry of SO was carried out by conventional low- compliant continuously perfused techni~que. The location of the manometric catheter was maintained at the same level by observing the video monitor. SO manometry and the duodenal migrating motor complex(MMC) was simuitaneously measured with specially designed catheter via pereutaneous route. Results: The mean recording time was 41 minutes(range 11-72 minutes). The frequency of phasic contractions of SO varied from 0 to 12/min. Throughout the whole recording period, high-frequency contractians(over 8/min) were noted in 14.9 % of the time. In the eases of percutaneous transductal SO manometry, the periods of high-frequency contractions coincided with the phase III of duodenal MMC. The interval between the first high-frequency contractions and the second was 47 minutes. The mean duration of high-frequency contractions was 6 minutes and 4~2 seconds. There as no significant change in the amplitude, basal pressure and contraction sequence among the various periods of frequencies. Conclusions: Long-term continuous recording of SO manometry via transpapillary and percutaneous route showed that the contraction frequency of SO was not constant and tachyoddia appearde periodically. In the interpretation of tachyoddia, it is necessary to consider the period of phase III of the duodenal MMC.
Catheters ; Manometry* ; Sphincter of Oddi*

BACKGROUND: In infective endocarditis, the recent introduction of transesophageal echocardiography(TEE) improved diagnostic sensitivity and detection of complications. Although the detection rate of vegetations is above 90% by TEE, the prognostic significance of these lesions remains unclear. The purpose of this study was to investigate prognostic factors for systemic embolism and death in infective emdocarditis by the analysis of transesophageal echocardiographic findings. METHODS: Transthoracic echocardiography(TTE0 and TEE were performed in 56 patients with active left-sided infective endocarditis during admission. If a vegetation was present, the size, mobility and consistency of vegetation were analyzed and paravalvular complications were assessed by TEE. Systemic emboli and in-hospital death dude to infective endocarditis were correlated to clinical and echocardiographic findings. RESULTS: 1) Echocardiographic evaluation revealed vegetations(53 patients), abscess(13 patients) and left ventricular dysfunction(13 patients). Systemic embolic events occured in twenty patients(36%) and death occured in thirteen patients(23%). 2) The size, mobility or consistency of vegetation was all foung not to be significant predictor of systemic embolism. But the incidence of embolism is significantly higher in patients who revealed increased vegetation size on follow-up echocardiogram. 3) The incidence of death was significantly higher in patients with left ventricular dysfunction or abscess on echocardiography. Although the mobility or consistency of vegetation was not related to mortality, the mortality was higher significantly in patients with larger vegetations. CONCLUSION: Our data suggest that left ventricular dysfunction, abscess and large vegetation are risk factors for higher mortality and increased vegetation size on follow-up echocardiography is risk factor for systemic embolism. Because TEE is more useful than TTE in evaluating of vegetation and paravalvular complications, TEE should be performed early in all patients with active left-sided infective endocarditis.
Abscess ; Echocardiography ; Echocardiography, Transesophageal* ; Embolism ; Endocarditis* ; Follow-Up Studies ; Humans ; Incidence ; Mortality ; Prognosis ; Risk Factors ; Ventricular Dysfunction, Left