ABSTRACT
OBJECTIVES: Gastric resection may predispose gallstone formation. However, the mechanism has not been clearly understood. To evaluate the relationship between gastric resection and gallstone formation, we compared gallbladder(GB) motility in gastrectomized patients and control subjects. METHODS: We compared the GB volume and ejection fraction of the 46 gastrectomized patients with 37 healthy controls using real time ultrasonography. RESULTS: GB volume increased significantly in the gastrectomized group in fasting (30.2 13.9 ml). The GB volume after a fatty meal was greater in the gastrectomized group (12.6 6.4 ml) than in the control group (4.3 3.3 ml) (p +ADw- 0.01). A significant reduction of ejection fraction was found in gastrectomized patients (56.9 13.0+ACU-) in comparison with the control group (75.5 16.1+ACU-) (p +ADw- 0.01). The GB ejection fraction had a poor correlation to the postoperative period (r +AD0- 0.232). CONCLUSION: A gastrectomy appears to be a risk factor of GB dysmotility, which may play a major role in gallstone formation in gastrectomized patients.
Subject(s)
Adult , Aged , Female , Humans , Male , Cholelithiasis/diagnostic imaging , Cholelithiasis , Comparative Study , Eating , Endosonography , Fasting , Gallbladder/diagnostic imaging , Gallbladder , Gallbladder Emptying , Gastrectomy , Gastrointestinal Motility , Middle Aged , Probability , Prospective Studies , Reference Values , Risk Assessment , Stomach NeoplasmsABSTRACT
BACKGROUND: Experiences on Objective Structured Clinical Examination(OSCE) for student assessment are limited in medical colleges in Korea. The purposes of this study were to develop an OSCE to fourth-year medical students after completion of all clerkships at Hanyang University Medical College. METHODS: The OSCE was a 8-station examination, with each station taking five minutes. We conducted two parallel OSCEs simultaneously by duplication. We checked each stage of the process in the development of OSCEs with recording of diary. We analysed validity and costs of the OSCE. We got feedback from all participants by questionnaires. RESULTS: Of the total 102 fourth-year students, only 74 persons(72.5%) were evaluated. The rate of pass was 63.5%. Cronbach alpha of the OSCE was 0.14. The scores were different between sites according to stations, especially in items related to attitude and physical. The total OSCE score was not significantly different either between duplication sites or among groups. OSCE scores didn't relate to those of both multiple choice tests and entrance exam for internship. Our use of only a few SP's contributed to relatively low cost of $85 per examinee. Both students and faculty were satisfied with the examination, and felt that the material tested was relevant and appropriate for primary care. The OSCE process served to identify weakness in the curriculum and/or teaching methods, and thus could serve as a mechanism to improve educational effectiveness. CONCLUSIONS: Problems of validity and reliability were detected in the developing process of the OSCE. It appeared financially feasible. Setting appropriate goal, optimum number of station, training of evaluators, development of good checklist, and enthusiastic support of the school's administartion were all needed more to success of such a program.