There is concerns about the perceived decline in the knowledge of gross anatomy of the medical students and postgraduate trainees. It is partly caused by the introduction of integrated medical curriculum and the shortage of basic medical science program and the extension of clinical clerkship consequently. There is widespread variability in the teaching style and anatomical curricular content at the medical school in Korea. Despite these changes in the anatomical education, there have been few attempts to assess the opinions of senior clinical teachers on the state of anatomical knowledge of students and the place of anatomy teaching within the curriculum. We sought the views of the clinical teachers on the adequacy of the anatomical knowledge of current students and recent graduates of 5 medical schools in Pusan and Gyeongsang-Nam do areas. Most of the clinical teachers were of the opinion that current medical students have an insufficient anatomical knowledge. They indicated the causes of decline were the clinical irrelevant anatomical teaching content and weakness of identity of anatomy by the introduction of the integrated medical education program. There was widespread support for both the concepts of spreading anatomy teaching throughout the medical course, and an optional, clinically related final year student project in the anatomy.
Busan ; Clinical Clerkship ; Curriculum ; Education ; Education, Medical ; Humans ; Korea ; Schools, Medical ; Students, Medical*

PURPOSE: The purpose of this research was to describe our group counseling methods for medical students with drop-out experiences. METHODS: Group counseling was offered to 11 medical students with drop-out experiences in their previous second semester. All subjects provided written informed consent before participating and completed a 2-day group counseling program using the Gestalt approach. The self-assertiveness training group counseling program consisted of 6 sessions, each of which lasted 90 minutes. Experience reports by participants after the program and data from semi-structured qualitative interviews were qualitatively analyzed. RESULTS: Program participants reported that they were moderately satisfied with the program regarding its usefulness and helpfulness on self-awareness, understanding, and reminding them of attempts to change behavior. Most students showed heightened levels of sincerity perceptions and positive attitudes in every session. The results demonstrated significant changes in experience in self-esteem, self-recognition, and interpersonal relationships. CONCLUSION: A group counseling program using the Gestalt approach could help medical students with drop-out experiences to adjust with 1 year their juniors, enhance their self-esteem, contribute to their psychological well-being, and prevent student re-failure through effective stress management and improved interpersonal relationships.
Counseling ; Humans ; Informed Consent ; Students, Medical

Insulin therapy is indicated in the treatment of gestational diabetic women and overt diabetic pregnant women for hyperglycemia after failure to respond to the diets and exercise regimens. The insulin is administered to mimic normal pancreatic function. The normal pancreas secretes 50% of the total daily insulin as mealtime boluses. This delivery may be mimicked by four-injection-per-day of combination of NPH and regular insulin (RI). Hypoglycemia is a well-recognized complication of intensive insulin therapy in patients with Type II diabetes. Recently, it has been reported that insulin-lispro, an analogue of regular human insulin with a peak insulin action achieved with a 1 hour after injection improves postprandial glucose concentration in non-pregnant diabetic patients. Treatment of gestational or diabetic pregnant women with NPH and insulin-lispro has significantly lower postprandial glucose levels without an increase in hypoglycemic events. Here, we report 2 cases of hyperglycemic control with four times daily administration of NPH & insulin-lispro on diabetes in pregnancy, with brief reviews.
Diabetes Mellitus ; Diet ; Female ; Glucose ; Humans ; Hyperglycemia ; Hypoglycemia* ; Insulin Lispro* ; Insulin* ; Meals ; Pancreas ; Pregnancy* ; Pregnant Women

OBJECTIVE: To evaluate the performance and reproducibility of a computer-aided detection (CAD) system in mediolateral oblique (MLO) digital mammograms taken serially, without release of breast compression. MATERIALS AND METHODS: A CAD system was applied preoperatively to the full-field digital mammograms of two MLO views taken without release of breast compression in 82 patients (age range: 33-83 years; mean age: 49 years) with previously diagnosed breast cancers. The total number of visible lesion components in 82 patients was 101: 66 masses and 35 microcalcifications. We analyzed the sensitivity and reproducibility of the CAD marks. RESULTS: he sensitivity of the CAD system for first MLO views was 71% (47/66) for masses and 80% (28/35) for microcalcifications. The sensitivity of the CAD system for second MLO views was 68% (45/66) for masses and 17% (6/35) for microcalcifications. In 84 ipsilateral serial MLO image sets (two patients had bilateral cancers), identical images, regardless of the existence of CAD marks, were obtained for 35% (29/84) and identical images with CAD marks were obtained for 29% (23/78). Identical images, regardless of the existence of CAD marks, for contralateral MLO images were 65% (52/80) and identical images with CAD marks were obtained for 28% (11/39). The reproducibility of CAD marks for the true positive masses in serial MLO views was 84% (42/50) and that for the true positive microcalcifications was 0% (0/34). CONCLUSION: The CAD system in digital mammograms showed a high sensitivity for detecting masses and microcalcifications. However, reproducibility of microcalcification marks was very low in MLO views taken serially without release of breast compression. Minute positional change and patient movement can alter the images and result in a significant effect on the algorithm utilized by the CAD for detecting microcalcifications.
Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms/radiography ; Calcinosis/radiography ; False Positive Reactions ; Female ; Humans ; Mammography/*methods ; Middle Aged ; *Radiographic Image Interpretation, Computer-Assisted ; Reproducibility of Results ; Sensitivity and Specificity

The thoracic spine is rigidly stabilized by the ribs, anterior and posterior longitudinal ligaments, and a sagittal orientation of the facet joints that resists axial rotation and horizontal translation. Thus, a significant force is required to cause a fracture and dislocation in the thoracic spine. A 32-year-old man was involved in a motor-vehicle accident and presented with complete paraplegia and spondyloptosis on the 8th thoracic vertebral segment. He also suffered with hypoxia and hypovolemic shock. Posterior reduction and fixation with pedicle screw was achieved with the anatomic alignment and rigid stability. This posterior technique for thoracic spondyloptosis is believed to be sufficient to make good alignment and solid fixation.
Adult ; Anoxia ; Dislocations ; Humans ; Longitudinal Ligaments ; Paraplegia ; Ribs ; Shock ; Spine ; Zygapophyseal Joint

PURPOSE: The purpose of this research was to analyze drinking on the day of injury, usual drinking pattern, factors associated with the injury and socioeconomic factors for patients who visited the emergency room (ER) for injuries. METHODS: From among all the trauma patients who visited ER, this research included 474 patients who were over 18 years of age and who visited the ER within 48 hours of their injury. Questionnaire surveys, telephone surveys, and serologic tests were conducted for all the patients. RESULTS: The drinking rate before injury was 51.9% among the 337 drinkers. The rate of drinkers was 72.2% (male 85%, female 42.6%), and the rate of habitual drinkers was 22.4% among the 466 subjects. The rates of habitual drinkers and nonhabitual drinkers were 31.5% and 68.5%, retrospectively, among the 337 drinkers. Such groups as assaulted patients, patients operated on under local anesthesia, patients injured indoor or outdoor except on roads, patients diagnosed as laceration, and patients injured between midnight and 8 a.m., and between 4p.m. and midnight had significantly higher incidents of drinking on the day of the injury (p=0.00~0.02). Such groups as males, older people, married people, people with low levels of education, people with high incomes and assaulted patients had significantly higher numbers of habitual drinkers (p= 0.00 ~ 0.04 ). CONCLUSION: This study suggests that alcohol use is an important factor for patients who visit the ER for injuries and alcohol drinking. But it can not be concluded that there is a causal relation between alcohol use and injury. Such groups who visit the ER for injuries as males, older people, married people, people with low levels of education, people with high incomes and assaulted patients need to be screened for alcohol misuse.
Alcohol Drinking ; Anesthesia, Local ; Drinking* ; Education ; Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Lacerations ; Male ; Surveys and Questionnaires ; Retrospective Studies ; Serologic Tests ; Socioeconomic Factors ; Telephone

No abstract available.
Plasma* ; Spectrum Analysis* ; Trace Elements*

Because of various current problems and issues which are low health insurance medical fee of National Health Insurance Corporation, extreme competition with very large general hospitals, new supply of more than of 3,000 new doctors, many medical practitioner's offices who are suffering management difficulties are increasing. In order to investigate their current overall management situations, we made this study through statistical extraction procedures with the sample population of the medical practitioners which are registered in Korean Medical Association and subsequently we made the study with 1,031 selected cases. The average number of patients is 53.6 patients per day. 44.4% of the medical practitioners' offices are working at night and legal holidays and 8.5% are working at Sunday. Average working hours is 50.1 hours per week, which greatly exceeds 40 hours per week that is regulated in the Labor Standards Act. According to the management performance analysis of those medical clinics through profit and loss statements, average total annual sales revenue in 2010 fiscal year was 444,167,867 KRW, the expenses were 314,217,081 KRW and the earnings before taxes was 129,940,786 KRW. The average net profit (earnings before taxes) of the director of the medical practitioners' offices was 122,337,868 KRW per year and 10,194,822 KRW per month. According to the study results, we have found that we need to increase doctor's bill for outpatient, and establishment and its improvement of medical service delivery systems and classification standards of medical services for first and succeeding outpatients. Considering overall results of the study, readjustment of outpatients' treatment fees and reestablishment of more efficient medical service delivery systems which require the first medical service is to be provided properly should be realized in order to improve the management performance of the medical practitioners' offices.
Commerce ; Fees and Charges ; Fees, Medical ; Holidays ; Hospitals, General ; Humans ; Insurance, Health ; Korea ; National Health Programs ; Outpatients ; Stress, Psychological ; Taxes

Sodium nitroprusside given by intravenous drip has been used to control hypertensive crises since 1929. Its evanescent action makes it suitable for controlled hypotension during general anesthesia with enflurane. The patients (n=10) were all undergoing Cotrel-Dubousset instrumentation for the operative treatment of scoliosis or spinal stenosis. Hemodynamic variables were obtained during administration of sodium nitroprusside. Mean arterial pressure was decreased to 50-60mmHg, while cardiac output, central venous pressure, systemic vascular resistance showed only minor changes. The average dosage of sodium nitroprusside (ug/kg/ min), plotted against age, showed a significant correlation (p<0.05, r= -0.63). The amonut of whole blood transfused during operation was 5.7+/-2.2 units (mean+/-SD) and postoperative hemoglobin and hematocrit (11.19+/-1.21g/dl, 33.49+/-3.79%, respectively, mean+/-SD) were singificantly lowered than preoperative hemoglobin and hematocrit (12.94+/-1.78g/dl, 37.22+/-4.88%, respectively, mean+/-SD) (hemoglobin: p<0.004, hematoorit: p<0.006).
Anesthesia, General* ; Arterial Pressure ; Cardiac Output ; Cardiovascular System* ; Central Venous Pressure ; Enflurane* ; Hematocrit ; Hemodynamics ; Humans ; Hypotension* ; Hypotension, Controlled ; Infusions, Intravenous ; Nitroprusside* ; Scoliosis ; Sodium* ; Spinal Stenosis ; Vascular Resistance

A stent fracture combined with a coronary artery aneurysm is a rare event. As these events can lead to a harmful outcome, such as the development of myocardial ischemia by in-stent restenosis or thrombosis, repeated coronary intervention may be required. We report a case of a stent fracture combined with a coronary artery aneurysm. The fracture was thought to have developed by mechanical stress produced from a change of regional wall motion after an anteroseptal myocardial infarction. As detected by the use of intravascular ultrasound, neither in-stent restenosis nor a thrombus in the fractured stent was present. A cardiac magnetic resonance image showed that no viable myocardium in the anteroseptal wall was present. Therefore, the patient underwent medical treatment without intervention of the fractured stent.
Aneurysm ; Anterior Wall Myocardial Infarction ; Coronary Vessels ; Humans ; Magnetic Resonance Spectroscopy ; Myocardial Ischemia ; Myocardium ; Stents ; Stress, Mechanical ; Thrombosis