The Relationship between Senior Year Examinations at a Medical School and the Korean Medical Licensing Examination / 한국의학교육

PURPOSE: Most medical schools prepare for the Korean medical licensing examination (KMLE) with various tests. By assessing the degree to which these exams and the KMLE are related, students, professors, and institutions can be well prepared and some schools use these exams as predictive tools for KMLE scores. Therefore, we determined the relevance of KMLE results to midterm exams and the objective structured clinical examination (OSCE), administered to senior students at a medical school. METHODS: From 2002 to 2004, KMLE results were compared with midterm examinations, the KMLE, and the OSCE. The total score, or T-score, of the KMLE was used, as was a pass or nonpass score. Windows SPSS 14.0 and MedCalc 9.0 were used for statistical analysis. RESULTS: The yearly correlation coefficient of the KMLE and school exams was highest for the midterm exams in 2002 and the KMLE in 2003 and 2004. The correlation coefficient of midterm exams and the KMLE were related to a high degree, yet the values were as low as that of the OSCE. Compared with the KMLE results, the sensitivity and specificity of the average midterm exam were 100.0% and 93.8%, and the sensitivity and specificity of the average trial exams were 100.0% and 95.8%, respectively. CONCLUSION: In conclusion, the KMLE results have a strong relationship with midterm exams, trial exams, and the combination of midterm and trial exams, but not with the OSCE. Thus, we believe that using both midterm exams and trial exams to predict KMLE results is superior to the use of only one type of school exam.

Treatment and Prognostic Factors for Traumatic Liver Injury

PURPOSE: Due to its size and locatin, the liver is frequently injured in abdominal trauma. Recently, nonoperative management for liver injuries has been extended due to the development CT imaging, intensive care units, and their equipment and techniques. Herein, patients with traumatic liver injury were analyzed to evaluate its treatment and prognostic factors. METHODS: From 2001, January to 2003, July, 65 patients at our facility were confirmed to have traumatic liver injury. The operative or nonoperative managements were decided on the basis of the systolic blood pressure if no peritoneal irritation sign was noted. If the systolic blood pressure was stable, or recovered to within the normal range following hydration and transfusion at the emergency room, patients were managed nonoperatively. Hemodynamically unstable patients were managed operatively. The data were analysed using the SPSS program (Chi-squared tests and logistic regression analyses). RESULTS: 48 patients were treated nonoperatively, with 3 mortalities. The overall mortality rate was 15.8%, but only 6.4% in the nonoperative management group, compared to 67% in operative management group. In a Multivariate analysis the systolic blood pressure was found to be a reliable factor in traumatic liver injury and the mentality and ISS (injury severity score) reliable in finding complications in the nonoperative management group. The mentality was found statistically reliable for determining mortality in the operative management group, with the exception for the systolic blood pressure. CONCLUSION: The systolic blood pressure was an important indicator when considering the treatment plan in traumatic liver injury. An extensive study will be required that incorporates both nonoperative and operative management groups.

Epigastric Hernia

An epigastric hernia is a protrusion of the extra-peritoneal fat to the linea alba, between the xiphoid process and the umbilicus. About 3~5% of people develop epigastric hernias. The authors have experienced a case of a 79 year-old woman who had an asymptomatic epigastric hernia, where an abdomen CT is helpful in its diagnosis. The size of the defect was large, and a hernia sac existed. The case of an epigastric hernia, which was treated by a primary repair, is reported, with a brief review of the literature.

Appropriateness of the Method and Evaluation in Pure-tone Audiometry in the Special Periodic Health Examination of Noise-exposed Workers / 대한산업의학회지

OBJECTIVE: This study was undertaken to evaluate that noise-exposed workers have been appropriately selected for the special periodic health examination and that pure-tone audiometry has been correctly applied and the results of these have been properly analyzed. METHODS: We obtained health examination data of noise-exposed workers from 48 special periodic health examination agencies. The data consisted of special periodic health examination results and audiograms that had performed examination during the latter half of 1998. We analysed the appropriateness of the subject selection for the second special periodic health examination of noise-exposed workers, the method of pure-tone audiometry, and the evaluation of audiogram. RESULTS: The screening performance rate is 67.65% in the special periodic health examination of noise-exposed workers. Although 34.29 persons per agency should have had a second examination according to our criteria, only 18.44 persons were actually examined. So a third of subjects were omitted. The air and bone conduction performance rate by each frequency is 75.71 %. 24.29 % persons did not have a bone conduction and were evaluated only by air conduction. The correct use rate of symbols(right, left-unmasked AC, masked AC, unmasked BC, and masked BC) recommended by ASHA(American Speech-Language-Hearing Association) was 70.36 %. Generally air conduction threshold is equal to or higher than bone conduction threshold. In the reverse case, especially if the gap is more than 10 dB(BC-AC > 10), this is considered to be incorrect. When we applied this criteria, the result indicated that it was correct in 75.46 %. The performance rate of air masking was 15.03 %, and bone masking was 26.21 %. 7 among 48 agencies diagnosed NIHL(Noise-Induced Hearing Loss) only by air conduction, 8 performed air masking and 13 did bone masking. When compared with ISO Standard(1964) and Ministry of Labor Standard, the results of evaluation(D1, D2) on hearing loss according to hearing loss type and threshold were rather low. CONCLUSIONS: Hearing Quality Assurance Program about periodic special examination agencies and examiners will continue to be needed and also the evaluation of hearing loss should be performed and controlled using accurate criteria. This will reduce the error among examiners and results in individuals by means of a standard that is capable of being accurate and reliable.

A Case of Primary Non-Hodgkin's Lymphoma Presented as Appendicitis

Malignant lymphoma comprise 1~4% of the malignant neoplasms of the gastrointestinal tract (GIT), although primary lymphoma of the appendix is exceedingly rare. Primary non-Hodgkin's lymphoma (NHL) of the appendix reportedly represents 0.015% of all GIT lymphomas. Most cases of primary appendiceal lymphoma have presented with a clinical appearance of acute appendicitis. It is therefore difficult to diagnosis preoperatively. We report a case of primary NHL of the appendix in a 31 year-old female. Appendectomy was performed as a result of the clinical diagnosis of acute appendicitis, due to the rebound tenderness of McBurney's point and a thickend appendiceal wall seen on abdominal ultrasonography. Microscopic examination demonstrated an atypical large lymphoid cell dispersed in a background of small lymphocytes. There were no invading tumor cells on the resection margin. Immunohistochemical studies revealed the large atypical cells stained with B cell marker (CD20), Bcl-6, Ki-67 and UCHL-1 (CD45R0). The post-operative work- up consisted of a CT scan of the abdomen and thorax, a bone marrow biopsy and a gastrofiberscope. These results were normal. No further treatment was recommended. The patient is now 12 months post-operative and doing well.

Characteristics of Occupational Skin Disease Reported by Surveillance System / 예방의학회지

OBJECTIVES: This study was carried out to estimate the magnitude of skin disease related to occupation and to find out the characteristics of it. METHODS: We collected and analyzed the cases of occupational skin disease reported by surveillance system composed of doctors and nurses in 150 enterprises with dispensary or attached hospital and physicians in 92 specific health examination institutes and 150 dermatologists from May to November, 1998. RESULTS: Among members of surveillance system, 66 enterprises and 47 specific health examination institutes and 55 dermatologists reported 571 cases of occupational skin disease in 512 workers. Excepting 81 cases reported by dermatologists, We analyzed 490 cases reported by enterprises and specific health examination institutes. Among 490 cases, contact dermatitis was most common(368 cases, 75.1%) and the second was hyper or hypopigmentation(36 cases, 7.3%). When we analyzed the characteristics of workers with occupational contact dermatitis, male workers were 281(79.2%) and female were 74(20.8%). 165 workers(64.5%) had chronic skin disease with repeated cure and relapse. 245 workers(72.5%) answered positively that their coworkers had similar skin disease. 27 workers(8.7%) experienced absence due to contact dermatitis related to occupation. To analyze the type of industries of workers with occupational contact dermatitis, automobile and trailer manufacturing industry was most common(105 cases, 29.6%) and the second was manufacturing industry for image, sound and communication equipment(55 cases, 15.5%). Organic solvent(183 cases, 46.7%) was the most common treating material of workers with contact dermatitis and the second was various kinds of chemicals(59cases, 15.1%). CONCLUSIONS: This is the first study using nationwide surveillance system to collect data of occupational skin disease. We found that many workers had skin disease related to occupation and characteristics of occupational skin disease were chronic and clustering. Therefore, we had to establish counterplan to manage occupational skin disease and to operate surveillance system to identify trends of occupational skin disease, continuously.