President's address: 20 years of perspiration and 20 years of admiration / 보건의료교육평가

No abstract available.

What Kind of Physicians Should We Foster? / 한국의학교육

No abstract available.

President's address: Improving the quality of testing / 보건의료교육평가

No abstract available.

Introduction and Administration of the Clinical Skill Test of the Medical Licensing Examination, Republic of Korea (2009) / 보건의료교육평가

The first trial of the clinical skill test as part of the Korean Medical Licensing Examination was done from September 23 to December 1, 2009, in the clinical skill test center located in the National Health Personnel Licensing Examination Board (NHPLEB) building, Seoul. Korea is the first country to introduce the clinical skill test as part of the medical licensing examination in Asia. It is a report on the introduction and administration of the test. The NHPLEB launched researches on the validity of introducing the clinical skill test and on the best implementation methods in 2000. Since 2006, lists of subjects of test items for the clinical skill test has been developed. The test consisted of two types of evaluation, i.e., a clinical performance examination (CPX) with a standardized patient (SP) and objective structured clinical examination (OSCE). The proctor (medical faculty member) and SP rate the examinees' proficiency for the OSCE and CPX respectively. Out of 3,456 applicants, 3,289 examinees (95.2%) passed the test. Out of 167 examinees who failed the clinical skill test, 142 passed the written test. This means that the clinical skill test showed characteristics independent from the written test. This successful implementation of the clinical skill test is going to improve the medical graduates' performance of clinical skills.

Comparison of the CT and Pathologic Findings of Pulmonary Fat Embolism Induced by Triolein and Oleic Acid in Rabbits

PURPOSE: The aim of this study was to evaluate the CT findings of pulmonary fat embolism syndrome that was induced by triolein and oleic acid, along with its pathologic correlation. MATERIALS AND METHODS: 16 rabbits were included in this study. The rabbits in group I (n=8) were embolized with 0.2 mL triolein and the rabbits of group II (n=8) were embolized with 0.2 mL oleic acid through ear veins. HRCT scans were done prior to embolization and at 0.5, 4, 24, 48 and 72 hours post-embolization. The pathologic correlations were determined at 0.5, 24, 48 and 72 hours. RESULTS: At 24 hours, one group I rabbit showed abnormal CT findings that were composed of several 2-3 mm nodules and multiple ill-defined peripheral ground glass opacities. The pathologic finding of this rabbit at 48 hours was mainly intraarveolar edema. All the group II rabbits (n=8/8) showed ill-defined bilateral and peripheral ground glass opacities with (n=6/8) or without consolidations (n=2/8) on the 0.5 hour CT. All the rabbits (n=7/7) showed that the new ground glass opacities and ground glass opacities noted on the 0.5 hour CT were changed into consolidation. The margins of the ground glass opacities and consolidations were more sharpened on the 24 hours CT. All 6 rabbits (n=6/6) showed consolidations without ground glass opacities and the margins of the consolidations were more sharpened on the 48 hours CT. There was no significant interval change on the 72 hours CT. The pathologic findings of ground glass opacities were interstitial edema or mild intraalveolar edema. The pathologic findings of consolidation were intraalveolar edema, hemorrhage and coagulation necrosis. CONCLUSION: The CT findings after fat embolization using triolein and oleic acid were ill-defined peripheral ground glass opacities with/without consolidations. These findings occurred in only one triolein group with the time lag, but these findings were immediately and extensively seen in all group II rabbits. These CT findings may be important for making a diagnosis of pulmonary fat embolism syndrome.

Intradural Extramedullary Capillary Hemangioma with Long Segment of Transient Cord Edema: A Case Report

We present a case of intradural extramedullary capillary hemangioma of the thoracic spine with a long segment of transient cord edema. Spinal capillary hemangiomas are extremely rare vascular tumors and only a few cases have been reported. On the MR images, the mass showed hypointensity on the T1-weighted images, hyperintensity on the T2-weighted images relative to the spinal cord, and strong homogeneous enhancement on the contrast-enhanced T1-weighted images. The T2-weighted images showed a long segment of ill-defined hyperintense area in the spinal cord which was completely resolved after surgery.

Diffusion-Weighted MR Imaging in Acute Wernicke's Encephalopathy Associated with Pseudomembranous Colitis: A Case Report and Review of the Literature

Wernicke's encephalopathy is a common complication of thiamine deficiency among chronic alcoholics. However, there have been few reports about MR imaging findings, including the diffusion-weighted changes of this neurologic disorder, in nonalcoholic patients. We present here a rare case of acute Wernicke's encephalopathy that developed in a patient who received prolonged total parenteral nutrition for his pseudomembranous colitis. The MR imaging, including the diffusion-weighted imaging, was performed at the onset of disease and during follow-up. The diagnosis was made by the characteristic MR imaging findings and it was supported by the clinical features. The initial and follow-up MR imaging findings with diffusion-weighted imaging changes are described and correlated with the clinical status.

Forty Years of Korean Academy of Medical Sciences: History of Leadership and Contribution

It has been forty years of the establishment of Korean Academy of Medical Sciences. It has started with the members of 34 academies in October 6, 1976 and now reaches to the number of 138. It takes the role of the main organization among medical academies has increasingly been growing in the volume and the business. We can say a lot of things that has lead the growth of Korean Academy of Medical Sciences but the most noticeable dynamic power of leading Korean Academy of Medical Sciences in last 40 years is due to the people who has the strong leadership and a large contribution. Many staffs and the committees have dedicated their time to Korean Academy of Medical Sciences. The record says the total of 691 medical scientists have served as the staff and the committee. We believe that it was impossible to execute so many works without their dedication because of the insufficiency of finances in last 40 years. Looking back upon the history of last 40 years, we sometime had necessity of the strong charisma of leadership and there is a right person who has met the needs of the times. His name is Munho Lee who served as a president in 22 years. It is singular in the history of Korean Academy of Medical Sciences. We believe that we are so lucky that we has a person like him who was admired by a lot of people in spite of his long-term seizure of the position. Our medical science has advanced to the world-class level, which means it gives us an assignment different from the past. Our society of medical scientists now has to step out for the leading the medical society of the world. We should not be satisfied with the increasing numbers of SCI dissertation. We also are responsible for producing people who can take that role of leaders.

Ultrasound-Guided Radiofrequency Ablation of Thyroid Gland: A Preliminary Study in Dogs

PURPOSE: The purpose of this study was to evaluate the possibility of using radiofrequency ablation as the treatment modality for the benign or malignant thyroid nodules in humans. Therefore, we examined the results of using radiofrequency ablation on the thyroid glands in dogs, in respect of the extent of the ablated tissue and the complications. MATERIALS AND METHODS: Five dogs (10 lobes of the thyroid glands) were included in this study. US-guided radiofrequency ablation was undertaken with a 10mm, uncovered 17 gauge cool-tip needle. The power and duration was 20 wattage and 1 minute in five thyroid lobes (group 1) and 20 wattage and 2 minutes in another 5 thyroid lobes (group 2). The ultrasound scans and the pre-and post-enhancement CT scans were undertaken before and immediately after the procedures, and at 24 hours, 72 hours and 1 week later. The US and CT findings of the ablated tissue and complications were evaluated. Blood sampling was done at the pre-procedure time and 1 week later for evaluating the functional status of the thyroid gland. Laryngoscopy was done at the pre-procedure and post-procedure times, and at 24 hours, 72 hours and 1 week later for the evaluation of any recurrent laryngeal nerve palsy. RESULTS: The echo pattern of the ablated thyroid gland at immediately after the radiofrequency ablation appeared as poorly marginated and hyperechoic. On the US obtained 24 hours after radiofrequency ablation, the echo pattern of the ablated thyroid gland was hypoechoic. The maximum diameters after RFA were 9.4+/-0.5 mm in group I and 11.4+/-0.5 mm in group II. The pre-enhanced CT scan taken at immediately after the radiofrequency ablation showed ill defined hypodense areas in the ablated thyroid gland. Differentiation between the normal and abnormal portions of the thyroid gland was difficult on the contrast enhanced CT scan. Complications induced by radiofrequency ablation were one recurrent laryngeal nerve palsy, two perforations of esophagus and five thickenings of the esophageal wall. In summary, the radiofrequency ablation therapy for the benign or malignant thyroid nodules located in anterior aspect (within a 5 mm radius) of the thyroid gland in human suggests this is an effective treatment, through this was an animal study performed on dogs.

A Debate on the Subinternship

No abstract available.

Inflammatory Pseudotumor Involving the Pulmonary Artery: Case Report

Pulmonary inflammatory pseudotumor is the most common primary lung mass seen in children, but extraparenchymal involvement is relatively rare. We report here on a case of inflammatory pseudotumor involving the mediastinum and the pulmonary artery. A 48-year-old man presented with enlargement of the right hilum on a simple chest radiograph. He had a history of exertional dyspnea for 1 year. A non-homogeneous enhancing mass was noted in the right pulmonary artery on computed tomography. Mediastinotomy and pulmonary artery angiography with a forcep biopsy revealed inflammatory pseudotumor of the mediastinum and pulmonary artery.

For Better Continuing Medical Education

No abstract available.

A Proposal for Medical Education to the New Administration

No abstract available.

A Comparative Study of Intra-arterial and Intramuscular Administration of phVEGF165 in a Chronic Ischemic Model of Rabbit Hindlimb

PURPOSE: To obtain phVEGF165 for angiogenesis and to compare the effects of its intra-arterial and intramuscular administration in a chronic ischemic rabbit hindimb model. MATERIALS AND METHODS: Chronic ischemic models were constructed in the left hindlimb of rabbits and divided into control (n=6), intra-arterial (n=7) and intramuscular groups (n=5). Plasmid DNA (phVEGF165) expressing vascular endothelial growth factor (VEGF) was obtained from HL60 cells, and transfection into CHO cells and western blot analysis of the medium, as well as proliferation assay of CPAE cells were performed. Two weeks after construction of the models, 500 mug phVEGF165 was injected into both the left common iliac artery and thigh muscles. Angiography was performed and the number of vessels counted, and ELISA was used to determine the quantity of VEGF in blood samples. Wilcoxon signed rank test was employed for statistical analysis. RESULTS: VEGF165 was expressed on western blot of the culture medium. Proliferation assay showed that optical densities were 0.73+/-0.043 in the control study and 1.09+/-0.015 in phVEGF165. The angiographic scores were 1.32+/-0.13 (pre-gene therapy) and 1.30+/-0.07 (post-gene therapy) in the control group, 1.42+/-0.15 and 1.59+/-0.09 in the intra-arterial group, 1.59+/-0.27 and 1.14+/-0.12 in the intramuscular group. The differences were not statistically significant. In the intra-arterial group, serum VEGF levels were 39.96+/-1.08 pg/ml (pregene therapy), 44.99+/-2.13 pg/ml (4th day), 48.18+/-1.49 pg/ml (1st week), 45.70+/-3.77 pg/ml (2nd week), and 46.54+/-5.47 pg/ml (3rd week), but in the control and intramuscular groups there were no increases. CONCLUSION: phVEGF165 affected the proliferation of CPAE cells. There was no difference in angiographic scores and serum VEGF levels between intra-arterial and intramuscular administrations.

Hepatic CT Enhancement: Comparison between Dimeric and Monomeric Nonionic Contrast Agents in Rabbits

PURPOSE: To determine the hepatic and vascular enhancement profiles with nonionic dimeric, iodixanol, contrast agent in the rabbit and to compare them with nonionic monomeric, ioversol, contrast agent. MATERIALS AND METHODS: Seven rabbits initially underwent hepatic dynamic CT scan with either iodixanol or ioversol, followed by repeated CT scan with other unused contrast agent with one week interval between scans. Pre and post contrast attenuation values of hepatic parenchyma, aorta and portal vein were measured sequentially. The mean enhancement of the hepatic parenchyma, aorta and portal vein were compared between two agents. The mean peak enhancement and peak enhancement time of the liver, aorta, and portal vein were also compared. RESULTS: The attenuation values of ioversol showed a greater mean hepatic enhancement than iodixanol from 18 seconds to 39 seconds after injection (from late arterial phase to early portal venous phase) with a statistical significance (p<0.05). The mean peak enhancement of hepatic parenchyma, aorta and portal vein was also greater using ioversol than iodixanol, but the mean peak enhancement times of ioversol and iodixanol were nearly identical. CONCLUSION: Ioversol may have the greater effects than iodixanol on hepatic tumor conspicuity, especially from late arterial phase to early portal veneous phase.

Acute Pulmonary Oxygen Toxicity in Rats: Findings and Lung Density Changes in High Resolution Computed Tomography

PURPOSE: To evaluate imaging findings and lung density changes after 95% oxygen inhalation in rat. MATERIALS AND METHODS: A total of 18 rats were divided into three groups on the basis of inhalation time: group I(n=6) inhaled 95 % oxygen for 24 hours, and group II(n=6) for 48 hours, group III(n=6) for 60 hours. A control group(n=6) inhaled room air(21% oxygen). Chest radiograph and high resolution computed tomography were performed, and pathologic and imaging findings were compared. RESULTS: Chest radiograph showed abnormality only in group III. High resolution CT, however, revealed abnormal findings in all three groups : diffuse ground glass opacity in groups I, II and III, additional focal patchy consolidation at the peripheral portion in group II, and diffuse consolidation in group III. Lung density was sig-nificantly higher in group I than in controls(p 0.05). In group III, density was significantly higher than in group II. The lung density changes seen in all groups showed a bilateral diffuse increased pattern. but, in group III, changes were more severe in the central, peripheral and posterior portion of the lower lung. Ground glass opacity and focal patchy consolidaton seen on HRCT were found on pathologic examination to be due to alveolar cell hyperplasia and septal thickening. Consolidation was caused by alveolar edema and hemorrage. Pathologic lesions were randomly distributed in both lungs. CONCLUSION: One HRCT images, rat exposed to hyperoxia showed ground glass opacity, patchy consolidation and diffuse consolidation. Depending on exposure time, the pathologic findings also indicated increased lung density and a bilateral, diffuse distribution pattern, as well as alveolar cell hyperplasia and septal thickening, alveolar edema and hemorrage. HRCT may be more helpful than simple X-rays for the early detection of pulmonary oxygen toxicity.

Relationship of the Mother Society and Its Affiliated Branches in Medical Science in Korea

No abstract available.

Shoulder Impingement Syndrome: Evaluation of the Causes with MRI

PURPOSE: Various mechanical causes which induce shoulder impingement syndrome have been identified with the help of MRI. The aim of this study is to evaluate the incidence of such causes. MATERIALS AND METHODS: A total of 54 patients with clinically confirmed shoulder impingement syndrome and a normal control group(n=20) without symptoms were included. We evaluated the incidence of hook shaped acromion, low lying acromion, downward slope of the acromion, subacromial spur, acromioclavicular joint hypertrophy, coracoacromial ligament hypertrophy, high cuff muscle bulk, and os acromiale. RESULTS: Among the 54 patients, the following conditions were present: acromioclavicular joint hypertrophy(n=36), coracoacromial ligament hypertrophy(n=20), subacromial spur(n=18), downward sloping of the acromion(n=16), hook shaped acromion(n=11), relatively high cuff muscle bulk(n=6), low lying acromion relative to the clavicle(n=3), and os acromiale(n=1). In the normal control group there were nine cases of acromioclavicular joint hypertrophy, nine of coracoacromial ligament hypertrophy, nine of downward sloping acromion, and three of low lying acromion, but hook shaped acromion, high cuff muscle bulk, and os acromiale were not found. Among 54 patients, the syndrome was due to five simultancous causes in one patient, four causes in two, three causes in 12, two causes in 22, and one cause in 17. CONCLUSION: Hook shaped acromion and subacromial spur are the statistically significant causes of shoulder impingement syndrome. In 69 % of patients, the condition was due to more than one cause.

Supply and Demand of Radiologists in Korea: Is it adequate?

Department of Choong Ang University College of Medicine PURPOSE: To assess adequate supply and demand for diagnostic radiologists in Korea in the future. MATERIALS AND METHODS: We analysed previous supply for residents of diagnostic radiology during the last eight years, and evaluated the cause and problems of increasing numbers of residents in diagnostic radiology in Korea. The appropriate numbers of residents in diagnostic radiology in Korea were estimated. RESULTS: The number of diagnostic radiologists in Korea in 1998 increased three times as compared with that in mid-1980s. The number of diagnostic radiologists in Korea in 1999 increased eight times as compared with that in 1980s. Causes of increasing numbers of residents of diagnostic radiology were increasing demand of residents in each hospital in the past, and limitation of control of the number by the Korean Radiological Society as well as the Korean Hospital Association. Problems of increasing number of residents of diagnostic radiology was decreasing quality of education and oversupply of diagnostic radiologists. The appropriate number of residents in diagnostic radiology in the future would be about 100 per year. CONCLUSION: A new plan and strategy for the appropriate supply and demand of diagnostic radiologists in Korea are needed.

CT Findings of Post Urinary Dive rsion: Normal Findings and Detection of Cancer Recurrence

PURPOSE: To determine normal postoperative CT findings and tumor recurrence in patients who have under-goneradical cystectomy and urinary diversion. MATERIALS AND METHODS: We retrospectively reviewed the postoperative CTscans of 51 patients who had un-dergone radical cystectomy with urinary diversion, and in analysis speciallyemphasised normal postoperative CT findings and recurrent cancer in the surgical bed. Among these 51 patients, 43had undergone incontinent urinary diversion(Bricker operation), while for six, diversion had been continent (Kockprocedure). Attempts were also made to characterise the CT findings of each procedure according to the location ofthe ileal pouch, the pattern of contrast collection within the pouch, and the morphology of the ileocutaneostomysite. RESULTS: Each urinary diversion procedure demonstrated characteristic postoperative CT appearances. TheBricker procedure revealed a contrast-filled ileal conduit in the right lower quadrant excreting into theileocu-taneostomy site, while the Kock procedure demonstrated layering of contrast and urine within the pouch aswell as artificially intussuscepted afferent and efferent ileal loops at the anastomotic sites. Thirty-three smallsoft tissue density lesions in the surgical bed were seen in 19 patients (37%). Thirty one were bilateral (n=28)or unilateral (n=3) triangular or oval shaped soft-tissue-density lesions and two were unilateral irregular shapedlesions. Follow-up CT scans showed that all triangular or oval-shaped lesions were smaller (n=8) or show no changein size (n=23) ; they were thought to represent postoperative fibrosis or granulation tissue. Two cases ofirregular-shaped soft-tissue-density lesions were seen on follow-up CT scans to be larger, and these wereconfirmed by percutaneous biopsy to be recurrent cancer. CONCLUSION: It is important for the radiologist to befamiliar with normal postoperative CT findings of various urinary diversion procedures as well as to recognize arelatively high incidence (37%) of small soft tissue den-sity lesions in a surgical bed. In our study, smalltriangular or oval-shaped soft-tissue-density lesions in the sur-gical bed (especially when these were bilateral)were thought to represent postoperative fibrosis or granulation tissue, and close follow-up by means of CTscanning rather than an invasive procedure is therefore warranted.