No abstract available.
Creativity ; Education, Medical

Medical schools have been working to produce competent doctors and improve the quality of care by introducing and implementing new curricula and innovative teaching and learning methods. Despite these efforts, health disparities within and between countries still exist. To close these gaps, medical schools must identify the priorities of the community, region, and/or nation and conduct education, research, and service that reflect them-the core foundation of the social accountability of medical schools. Many medical schools and networks around the world have tried to achieve social accountability, but this needs more attention in Korea. This study will review the literature in aims to improve understanding and promote the implementation of the social accountability of medical schools. Most medical schools that practice the principles of social accountability focus primarily on the medically underserved in their communities or those who have limited access to health services, and have built collaborative partnerships with stakeholders to meet the needs of society. In addition, in order to implement social accountability effectively and efficiently, medical schools have developed strategies and various evaluation frameworks appropriate to the context of each school. To have more socially accountable medical schools, it is necessary to clarify the concept of social accountability and to establish a system that can evaluate the impacts. Medical schools exist to alleviate suffering and promote health, and this can be accomplished through social accountability.

Purpose: With the increasing incidence of recompression fractures after vertebroplasty or kyphoplasty, this study analyzed the risk factors that affect the occurrence of recompression vertebral fractures, such as cement distribution, existence of avascular necrosis (Kummell’s disease), type of procedures, bone mineral density, sex, and age. Materials and Methods: Two hundred and thirty-eight patients who underwent vertebroplasty or kyphoplasty at the author’s clinic from 2005 to 2015 were enrolled in this study. The patients were divided into four groups according to the distribution of injected cement. The patients were classified as type 1 and type 2 when injected cement was contacted only to the upper or lower endplate of the body respectively. They were classified as type 3 when both the upper and lower endplates were contacted by injected cement. When neither the upper nor the lower endplate was contacted, the patients were called type 4. This study statistically evaluated the effects of the risk factors, including the cement distribution on the incidence of recompression vertebral fracture after vertebroplasty or kyphoplasty. Results: There were 59 cases (24.8%) of recompression fracture after vertebroplasty or kyphoplasty, among the 238 cases. According to the analysis, the recompression of the vertebral body after vertebroplasty or kyphoplasty occurred more often when the compression fracture was accompanied by osteonecrosis at the body (p<0.05). The patients who had injected cement distributed at both upper and lower plate simultaneously (type 3) had a lower incidence of recompression fracture of the vertebral body after vertebroplasty or kyphoplasty (p=0.008). In addition, the kyphoplasty group had a lower incidence of recompression after the procedure than vertebroplasty group (p=0.02). Conclusion Careful attention should be given to these patients with osteonecrosis at the compression fracture level through a preoperative evaluation. In addition, if the injected cement does not contact both the upper and lower endplates, careful observation is required during the follow-up period based on the high incidence of vertebral recompression fractures proven through this study. Further technical and biomechanical research and efforts will be needed to make the cement contact both endplates.

PURPOSE: The aim of this study was to evaluate the effectiveness and indication of radiofrequency ablation(RFA) using renal VX2 tumors by implantation of VX2 tumor cells under the renal capsule in rabbits. MATERIALS AND METHODS: Ten rabbits were injected with 30-40microliter VX2 tumor cells(1.2x10(7) viable cells/ml) under the renal capsule of the right kidney by right subcostal incision. On the 14th day after the tumor cells were implanted, we checked for the development of renal tumors, and the sizes and shapes(exophytic or central) of the tumors by the use of computed tomography. We performed RFA in the renal VX2 tumors with a 17G StarBurst electrode through kidney exposure. After the first and third day following RFA, renal function was checked. On the third day, we performed CT and harvested the kidneys for gross and microscopic evaluation. RESULTS: We confirmed the development of renal VX2 tumors in nine cases. Tumor shapes were exophytic in seven cases and central in two cases; the mean size of the tumors was 2.1 cm(range, 1.1-3.8cm). In all tumors, RFA was performed. From the use of enhanced CT after RFA on the third day, all of the lesions treated with RFA showed no enhancement. From the pathological findings, coagulative necroses were seen on all of the lesions treated with RFA. The necrotized tumor size after RFA was not different statistically as measured by CT and a pathological examination (p=0.833) CONCLUSIONS:: In centrally located renal tumors, we experienced thermal injury in pelvocalyceal systems. RFA is an effective method for nephron sparing surgery as the tumor cells completely disappear and there is preserved renal function and the procedure is easy to apply. We suggest that the RFA method for exophytic renal tumors is more effective than other procedures.
Rabbits ; Animals

Allergen-specific immunotherapy (AIT) can alter the natural course of an allergic disease. It is widely held that the efficacy of a given therapeutic modality should be proven by well-designed double-blind placebo-controlled randomized clinical trials and meta-analyses. In this article, the therapeutic efficacy of AIT for allergic respiratory diseases, such as allergic rhinitis and asthma, is reviewed. In addition, potential clinical and experimental predictors of the treatment response are reviewed for AITs requiring long-term treatment, and for some allergic rhinitis and asthma patients who show no response to AIT.

Allergen-specific immunotherapy (AIT) can alter the natural course of an allergic disease. It is widely held that the efficacy of a given therapeutic modality should be proven by well-designed double-blind placebo-controlled randomized clinical trials and meta-analyses. In this article, the therapeutic efficacy of AIT for allergic respiratory diseases, such as allergic rhinitis and asthma, is reviewed. In addition, potential clinical and experimental predictors of the treatment response are reviewed for AITs requiring long-term treatment, and for some allergic rhinitis and asthma patients who show no response to AIT.

Although allergen-specific immunotherapy (AIT) is a standard treatment for allergic diseases, only 5% or less of patients in whom AIT is indicated have been receiving immunotherapy because AIT needs a long-term therapeutic duration of up to 5 years. To overcome this limitation of conventional AIT, Kündig and his colleagues first introduced intralymphatic immunotherapy (ILIT) in patients with allergic rhinitis, publishing their results in 2008. Since then, 10 clinical trials that evaluated therapeutic efficacies and adverse effects of ILIT have been conducted. This article reviews the clinical trials of ILIT and suggests unmet needs in research fields of ILIT.

OBJECTIVES: Although successful fusion rates have approached almost 100%, fusion may increase the biomechanical stresses imposed on the adjacent segments leading to transitional disease. These issues have leg some investigators to explore novel approaches, that is 'posterior dynamic stabilization'. In this study, we compared clinical outcome of two different posterior dynamic stabilization instruments: 'Interspinous U' and 'DIAM' device, respectively. METHODS: A retrospective review was performed for all the patients with disc degenerative diseases treated with decompression procedure from 2004 to 2007. The plain lateral and flexion-extension views were taken immediately after surgery and at each follow-up. The disc height ratio(DH), total lumbar lordotic angle (TLA) and segmental lordotic angle (SLA) were used to observe the change of initial status. The clinical outcome was measured by Odom's criteria and compared. Also, in lateral view, decrease of bony density around instruments was regarded as bony erosion. RESULTS: Mean follow-up durations for 'Interspinous U' and 'DIAM' were 39 and 14 months, respectively. Instruments were used for 21 and 16 patients for 'Interspinous U and 'DIAM' groups, respectively. Satisfactory groups were 61% and 74% for 'Interspinous U and 'DIAM' groups. But, there was no statistical difference between two groups in the change of DH, TLA and SLA. In 'Interspinous U' group, two cases showed spinal instability with bony erosion, and five cases showed bony erosion around instruments. CONCLUSION: 'DIAM'group showed higher patient satisfaction and no bony erosion. To ascertain the difference, analysis with larger population and a long-term follow-up period will be needed.
Decompression ; Follow-Up Studies ; Humans ; Leg ; Patient Satisfaction ; Research Personnel ; Retrospective Studies

No abstract available.
Female ; Luteal Phase*

Acute fatty liver of pregnancy is a rare, clinically distinct cause of jaundice occuring during the third trimester of pregnancy, with maternal death as the usual outcome and first described in 1,940 by Sheehan, which may be characterized by nausea, vomiting, epigastric pain, jaundice and confirmed by liver biopsy. We have experienced a case of acute fatty liver at 38 weeks of gestation in 30 year-old primigravida woman and reproted with a brief review of related literatures.
Adult ; Biopsy ; Fatty Liver* ; Female ; Humans ; Jaundice ; Liver ; Maternal Death ; Nausea ; Pregnancy Trimester, Third ; Pregnancy* ; Vomiting