No abstract available.
Aortic Aneurysm, Abdominal ; Marfan Syndrome

PURPOSE: This study was designed to analyze the current status of multicampus medical education in Korea, to identify its educational significance, and to develop strategies for overcoming such disadvantages. METHODS: The logistic data were collected from 41 medical schools, and the educational impacts based on the location of campuses and clinical teaching hospitals, types of education, major functions, and collaboration system between campuses were analyzed. RESULTS: 35 from 41 medical schools ran various forms of multicampus education, and only 8 claimed a system that bridged the school campus and teaching hospital (s). However, none were equipped with any form of meaningful liaison accommodating a distant learning system between learning centers. Regardless, the advantages of multicampus school system aimed to provide a wide range of learning experiences, serious disadvantages remained without the system developing an effective method for overcoming difficulties of communication or establishing an achievement to reach a common educational consensus. CONCLUSION: Various advantages of multicampus system in terms of producing pleuripotential physicians have been rationalized, but any measures for their effective collaboration remains limited. This paper stresses the development of a responsible unit for better support between school campus and clinical teaching centers in multicampus curriculum planning. It is also crucial to design an educational communication channel between them.
Consensus ; Cooperative Behavior ; Curriculum ; Education ; Education, Distance ; Education, Medical* ; Hospitals, Teaching ; Humans ; Korea* ; Learning ; Schools, Medical

Transoral endoscopic thyroid surgery vestibular approach (TOETVA) is now widely performed globally with good cosmetic outcomes. However, there are complications related to this approach which surgeons should be aware of. We report here a 41-year-old female patient who had an unusual ocular complication after total thyroidectomy via TOETVA. She was diagnosed with papillary thyroid carcinoma and received total thyroidectomy via TOETVA. She complained of floating particles in her right eye immediately after the operation. Fundus examination revealed intraocular hemorrhage in her right eye. At one-month follow-up, all of the intraocular hemorrhage was improved by fundus examination, resolving her chief complaint. Surgeons and anesthesiologists should be aware of increased intracranial pressure during the TOETVA and possible ocular complications after the surgery, although they are rare.

OBJECTIVE: We aimed to assess the efficacy of neoadjuvant chemotherapy followed by surgery (NACT+S), and compared the clinical outcome with that of concurrent chemoradiotherapy (CCRT) in patients with International Federation of Gynecology and Obstetrics (FIGO) IB-IIB cervical cancer. METHODS: We reviewed 85 patients with FIGO IB-IIB cervical cancer who received NACT+S between 1989 and 2012, and compared them to 358 control patients who received CCRT. The clinical application of NACT was classified based on the following possible therapeutic benefits: increasing resectability after NACT by reducing tumor size or negative conversion of node metastasis; downstaging adenocarcinoma regarded as relatively radioresistant; and preservation of fertility through limited surgery after NACT. RESULTS: Of 85 patients in the NACT+S group, the pathologic downstaging and complete response rates were 68.2% and 22.6%, respectively. Only two young patients underwent limited surgery for preservation of fertility. Patients of the NACT+S group were younger, less likely to have node metastasis, and demonstrated a higher proportion of FIGO IB cases than those of the CCRT group (p≤0.001). The 5-year locoregional control, progression-free survival, and overall survival rates in the NACT+S group were 89.7%, 75.6%, and 92.1%, respectively, which were not significantly different from the rates of 92.5%, 74%, and 84.9% observed in the CCRT group, respectively (p>0.05). CONCLUSION: NACT+S has no therapeutic advantages over CCRT, the standard treatment. Therefore, NACT+S should be considered only in selected patients through multidisciplinary discussion or clinical trial setting.
Adult ; Aged ; Aged, 80 and over ; *Chemoradiotherapy ; Chemotherapy, Adjuvant ; Female ; Humans ; *Hysterectomy ; Middle Aged ; *Neoadjuvant Therapy ; Neoplasm Staging ; Retrospective Studies ; Treatment Outcome ; Uterine Cervical Neoplasms/diagnosis/mortality/pathology/*therapy

PURPOSE: This study aims to introduce a one semester 'Global Citizenship' program, being offered as a part of the premedical course at Gachon Medical School. The program was designed to meet the community needs in terms of etiquette and manner education for the future physicians and also to review the outcome of short-term experience. METHODS: The program was offered to M1(premedical students year-1) students from the first semester after entrance to the school with following objectives: to understand the anthropological aspect of culture, to motivate students in relation to medical scientific foundation, and to develop the appropriate human relations, including international etiquette and manners, prior to the subinternship in M5(medical student year-3). RESULTS: The program consisted of 12 sessions of lectures and/or practice-based learning such as etiquette for dormitory life, Korean traditional culture, gender role in the 21st century, dining etiquette in various cultural programs, netiquette(for computer usage), Korean housing and its architectural beauty, etiquette for alcoholic beverage drinking, dressing, and the respect and understanding of other cultures, services and manners. They were all instructed with presentations combined with site-visits or hands-on experience followed by a reflection paper and group discussion. Although the program was costly and time-consuming compared to the traditional theory-based natural science and humanity subjects, students expressed their strong motivation and concerns on their future responsibilities. CONCLUSION: We conclude that "Global Citizenship" course is a useful program to provide a meaningful motivation to the newly enrolled students, Further, it encourages students to understand human relations as a global citizen equipped with the appropriate etiquette and manners.
Alcoholic Beverages ; Bandages ; Beauty ; Drinking ; Education ; Gender Identity ; Housing ; Humans ; Learning ; Lectures ; Motivation ; Natural Science Disciplines ; Problem-Based Learning ; Schools, Medical

Objective: Regional control is occasionally unsatisfactory in cervical cancer, with the optimal radiation dose for nodal metastases in definitive radiotherapy (RT) with concurrent chemotherapy (CRT) remaining controversial. We investigated dose-response relationship for nodal local control in cervical cancer. Methods: We identified 115 patients with 417 metastatic nodes who received definitive CRT for cervical cancer with nodal metastases. External beam radiation therapy and brachytherapy plans were summated to determine total dose received by each node. Prognostic factors of nodal control and dose-response relationship were investigated using Cox-regression and restricted cubic spline function. Results: The 2-year progression-free survival rate was 69.4%. Among 43 patients with failures, 17 patients (37.5%) had regional failure included in first failure sites of which all except one were in-field only regional failures. Total 30 nodes showed recurrence at initial metastatic site after treatment. Neutrophil-to-lymphocyte ratio (NLR) ≥3.1, total radiation dose (minimum dose received by 98% of the target volume in equivalent dose in 2 Gy per fractions), and initial nodal volume ≥5.29 mL were poor prognostic factors (all p<0.050) of nodal local control. Restricted cubic spline functions revealed strongest dose-response relationship in high NLR (NLR ≥3.1) and initial nodal volume ≥5.29 mL subgroup. Conclusion Initial nodal volume, radiation dose, and NLR were significant factors of nodal local control in cervical cancer; a stronger dose-response relationship was seen in bulky nodes with high NLR. Clinicians may consider these factors when determining the RT dose and the need for boost to nodal metastases in cervical cancer.

PURPOSE: The purpose of this study is to introduce the operational design of clinical skills training program and to evaluate the outcome of one-year experience in Gachon Medical School. METHODS: The School set up a clinical skills training center(laboratories) helping preclinical year-students being able to improve their clinical competences by using simulators and models prior to start their clerkship so that they can apply accurate and stable clinical technical skills to the patients. The program was divided into two parts; one for the communication and interviewing skills(M3) and the other for development of basic clinical skills(M4). For the latter, a total of 32 skill units with model items were selected from the minimum essential clinical skills requirements. The training course was conducted 3 weeks for 37 students of the fourth year medical school(M4) students in the second semester of 2001. Pass/Fail system with 2 credits was applied as a student evaluation. Both advantages and disadvantages of the program were analysed by questionnaires. RESULTS: Every students met the school requirement and passed the requirements mostly by the second trial within the two weeks duration following self-directed hard practice for every items. Of 37 students, 80% became confident on their final performance, and 72% agreed themselves being much enthusiastic compared to other courses. The visiting frequency to the center was over 2~3 times/day during the course, and their average staying hours/week were 20~30 hours. Students(78%) were satisfactory to the appropriativeness of faculty's instructional skills and their evaluation results. CONCLUSION: We conclude that the clinical skills training program is a useful tool not only to improve the essential technical skills prior to take their responsibilities of subinternship but also to motivate students' learning during the preclinical studies.
Clinical Competence* ; Education* ; Humans ; Learning ; Schools, Medical* ; Surveys and Questionnaires

From 1988 to 1991, nineteen patients with unresectable localized pancreatic carcinoma were treated with radiotherapy and/or hyperthermia or in combination with chemotherapy. Radiation dose of 4500-5000 cGy with or without additional 500-1000 cGy was administered over 5 to 6 weeks to the pancreatic tumor area using 10 MV linear accelerator. Five of 19 patients were given chemotherapy, either neoadjuvant or maintenance setting with FAM regimen (5-FU, adriamycin and mitomycin C), which was repeated every 4 weeks for one year or until progression. Symptomatic palliation was achieved in 17 among 19 patients (89%) and objective response(complete or partial response in CT finding) was achieved in 5 among 11 patients (45%). The median survival time was 9 months and one-year survival rate, 32%. Local-regional failure was documented in 10 among 13 patients(77%) and distant failures were found in the liver (3 patients) and carcinomatosis (2 patients). Prognostic significance of various factors such as age, sex, performance status, tumor location, stage, etc. were assessed. Any factors did net have the prognostic significance in univariate analysis. Treatment was well tolerated in most of the patients with only wild to moderate toxicity.
Carcinoma ; Doxorubicin ; Drug Therapy ; Fever ; Humans ; Liver ; Mitomycin ; Particle Accelerators ; Radiotherapy* ; Survival Rate

PURPOSE: This study aims to explore an one-year experience of intensive core clinical clerkship (student internship, subinternship) in Gachon Medical School for junior clinical students, and the immediate outcome of the program was discussed along the with advantages and student load. METHODS: 36 junior medical students (M5) were exposed to 36 weeks of core clinical clerkship including internal medicine (12wks), pediatrics (6wks), obstetrics-gynecology (6wks), general surgery (4wks), psychiatry (4wks), and emergency medicine (4wks). The clinical service team was made of faculty member (1), senior resident (1), intern (1) and M5 students (1-2), and the students who were involved a wide range of baseline responsibilities corresponding to those of regular rotating interns. They were encouraged to participate the various procedures and decision making process, but their participation was restricted by keeping 3 levels of performance policy according to degree of supervision. Questionnaire analysis was carried out immediate after the student internship. RESULTS: Students were proud of themselves being as the subinterns and showed a strong motivation, while they had a difficulty to tolerate a strong psychologic pressure by taking their roles of subinternship. Major responsibilities of clerkship were focused on the clinical information collection (history taking and physical examination), students-directed group conference, faculty-led small group discussion, technical skill learning and ward round in order. Students appreciated well to this internship in terms of acquisition of clinical skills and identification of their role, but shortage of space, frequent on-call, lack of self-directed learning opportunity, unclarified requests from the hospital authority were pointed out. CONCLUSION: It is assumed that student internship is a strong tool to promote the quality of clinical learning process, but requires details of teaching instructions (manuals) aside from solving a series of legal on malpractice, for which critical defining of clinical participation is essential to upgrade the Korean version of clerkship.
Clinical Clerkship ; Clinical Competence ; Decision Making ; Education, Medical ; Emergency Medicine ; Humans ; Internal Medicine ; Internship and Residency* ; Learning ; Malpractice ; Motivation ; Organization and Administration ; Pediatrics ; Program Development* ; Schools, Medical* ; Students, Medical ; Surveys and Questionnaires

PURPOSE: This study was performed to identify the histopathologic feature by the reevaluation of the pathologic specimen of the cervical tumors and to evaluate the clinical findings and the treatment results of the patients with small cell carcinoma of the cervix treated by radiotherapy. MATERIALS AND METHODS: 2890 patients with cervical carcinoma received radiotherapy at the Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine between October 1981 and April 1995. Of the 2890 patients in this data base, sixty were found to have small cell carcinomas (2.08%). Among them thirty six patients were transferred from other hospitals, the biopsy specimens of those patients were not available. So we could review the slides of the other twenty four patients who were diagnosed at our hospital. Twenty four patients with small cell carcinoma of the cervix were analyzed retrospectively based on the assessment of H & E staining and other four immunohistochemical stains for neuroendocrine differentiation (neuron specific enolase, chromogranin, synaptophysin and Grimelius stain). And we also evaluate the patients and tumor characteristics, response to radiation, patterns of failures, 5 year overall and disease free survival rates. RESULTS: Thirteen tumors were neuroendocrine carcinomas (13/24=54.2%) and eleven tumors were squamous carcinomas, small cell type (11/24= 47.8%) based on the assessment of H & E staining and other four neuroendocrine marker studies. So we classified the patients two groups as neuroendocrine carcinoma and small cell type of squamous carcinoma. Among the 13 neuroendocrine carcinomas, five were well to moderately differentiated tumors and the other eight were poorly differentiated or undifferentiated ones. The median age was 54 years old (range 23-79 years). Eight patients had FIGO stage IB disease, 12 had stage II, 3 had stage III and one had stage IV disease. Pelvic lymph node metastases were found in five patients(20.8%), three of them were diagnosed by surgical histologic examination and the other two were diagnosed by CT scan. There was no difference between two histopathologic groups in terms of patients and tumor characteristics, response to radiation, 5 year overall and disease free survival rates. However the distant metastases rate was higher in neuroendocrine carcinoma patients (6/13:46.2%) than in small cell type of squamous carcinoma patients (2/11:18.2%), but there was no statistically significant difference because of the small number of patients (P>0.05). CONCLUSION: More than half of the small cell carcinoma of the cervix patients were neuroendocrine carcinoma (13/24 : 54.1%) by reevaluation of the biopsy specimen of the cervical tumors. The tendency of distant metastases of the neuroendocrine carcinoma was greater than those of the small cell type of squamous carcinoma (46.2% vs. 18.2%). But there were no differences in the patients and tumor characteristics and other clinical treatment results in both groups. These data suggest that radical local treatment such as radiotherapy or radical surgery combined with combination systemic cytotoxic chemotherapy might provide these patients with the best chance for cure.
Biopsy ; Carcinoma, Neuroendocrine ; Carcinoma, Small Cell* ; Carcinoma, Squamous Cell ; Cervix Uteri* ; Coloring Agents ; Disease-Free Survival ; Drug Therapy ; Female ; Humans ; Lymph Nodes ; Middle Aged ; Neoplasm Metastasis ; Neuroendocrine Tumors ; Phosphopyruvate Hydratase ; Radiation Oncology ; Radiotherapy* ; Retrospective Studies ; Synaptophysin ; Tomography, X-Ray Computed