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김영훈(Young Hoon Kim),최인석(In Suck Choi),박영태(Young Tae Park),최동섭(Dong Seop Choi),박정의(Jeong Euy Park) 대한내과학회 1986 대한내과학회지 Vol.31 No.1
N/A We have experienced a patient who had a blunt chest trauma by a fork-crane. The patient suffered a little externally visible wound but came in complaining of chest pain. The EKG showed complete RBBB with Wenckebach A-V block. On two dimensional echocardiography, the interventricular septum was longitudinally split for 4.1 cm long with it's proximal opening of the channel opened to RV. The patient had a permanent pacemaker put in and went back to his previous job and has been followed up at the clinic in good condition. The interventricular septal rupture following blunt chest trauma is a well recognized entity, but the longitudinal split of the septum is probably rare. We reported a patient with the review of literature.
김용일(Yong Il Kim),이영돈(Young Don Lee),오재환(Je-Hwan Oh),최인석(In Suck Choi),차 한(Hann Chah),이의돈(Eui Don Lee),함봉진(Bong Jin Han),이 근(Keun Lee),이병국(Byung Kook Lee),임윤명(Yoon-Myung Im),박귀화(Gwi Hwa Park) 한국의학교육학회 2003 Korean journal of medical education Vol.15 No.2
Purpose: The aims of this paper are to develop a student evaluation format as a part of core clinical clerkship (student internship) program at Gachon Medical School, and to identify its impeding factors in implementation. Methods: Both rating scale of Likert type and check list for student s clerkship assessment were designed; the rating scale format was developed into two parts, namely attendance and the clinical competence demonstrated during the clerkship in which 3 domains of knowledge, skills and attitude were included in balance; the professional competence was made of 9 items, each being designed to accommodate 3 degrees by learner s performance. The clinical instructors in charge were requested to sit a short feedback session on the evaluation results with students who were signed at the end. Nursing staff was also asked to participate in evaluation of the student attitude in a limited area. Results: Despite the full acceptance of the evaluation approach theoretically, its practical implementation was not successful because of difficulties related to adjustment of their department-based scoring system to the comprehensive assessment, or unfamiliarity with face-to-face feedback system. Conclusion: The authors assume that this Likert type of the rating scale is a simple, more comprehensive and strong tool to meet the learning objectives, and easy to enhance the feedback effect. It is, however, advised that the formative reporting system is crucial to transform the traditional evaluation approach into the pass/fail format so that unnecessary conversion risk is eliminated.
박귀화(Gwi-Hwa Park),고희정(Hi-Jung Koh),최인석(In-Suck Choi),이영돈(Young-Don Lee),임윤명(Yoon-Myung Yim),김용일(Yong-Il Kim) 한국의학교육학회 2002 Korean journal of medical education Vol.14 No.2
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.
관상동맥질환 환자 , 운동선수 및 정상 대조군에서 혈청지질 및 Apolipoproteins 에 대한 연구
박정의(Jeong Euy Park),김우주(Woo Joo Kim),최인석(In Suok Choi),김대원(Dae Won Kim),이갑노(Kap No Lee),김성수(Sung Soo Kim),유원상(Won Sang Yoo),최석구(Suck Koo Choi),이건주(Kun Joo Rhee),서순규(Soon Kyu Suh),이영(Young Lee),고영박(You 대한내과학회 1991 대한내과학회지 Vol.40 No.5
N/A To investigate the usefulness of serum lipids and apolipoproteins as indices of risk factors for coronary artery disease (CAD) and to know the effects of regular exercise on the serum lipids and apolipoproteins, we measured the serum lipids and apolipoproteins in the patients with coronary artery disease, athletes and normal control persons. The study subjects included 67 patients with CAD (57. 8±11.2yr), 22 athletes (21.5±2.1yr) and 62 normal control persons (34.3±11.4yr). 1) In the patients with CAD the serum total cholesterol (TC) was 177. 2±38.5 mg/dl and the HDL-cholesterol (HDL-C) was 39.0±11.2mg/dl. In the normal control persons TC was 162.5±33.5 mg/dl and HDL-C was 42.4±12.6mg/dl, which were not significantly different from the values of CAD patients. 2) The serum apolipopratein A (Apo-A) was significantly lower (201.9±39.6mg/dl, p<0.05), and the apolipoprotein B (Apo-B) was significantly higher (132.3±29.7 mg/dl, p<0.05) in the patients with CAD, compared with normal control persons (age over 40 years; Apo-A: 246.3±39.9 mg/dl, Apo-B: 117.9±26.4 mg/dl). 3) The TC/HDL-C ratio and Apo B/A ratio were significantly higher (4.9±1.6, 0.67±0.17, p<0.005 for TC/HDL-C ratio and p<0.05 for Apo B/A ratio) in the CAD patients compared with normal control persons (age over 40 years; 3.6±1.1, 0.49±0.10). 4) The TC/HDL-C ratio ≥4.0 and Apo B/A ratio ≥0.55 were the good discriminating criteria separating the CAD patients from the normal control persons. 5) In the athletes, the serum triglyceride (TG) was significantly lower (65.7±20.7mg/dl, p<0.001), and the HDL-C was significantly higher (57.8±11.2 mg/dl, p<0.001) compared with normal control persons (age under 30 years; TG; 119.8±94.3 mg/dl, HDL-C: 44.6±11.0mg/dl). The Apo-A, Apo-B, TC/HDL-C ratio and Apo B/A ratio were all significantly lower (p<0.01) compared with those in the normal control persons. 6) Among the athletes, the HDL-C was highest and the TG was lowest in the swimmers compared with fencing players and wrestlers. The Apo B/A ratio and TC/HD1-C ratio were better discriminating indices of risk factors for CAD compared with individual lipids or apolipoprotein values. The Apo-A and Apo-B were considered to be good indices of risks for CAD. The athletes had lowest risks for CAD.
Verapamil전처치 개흉견에서 심근허혈과 재관류에 따른 좌심실 기능적 확장에 관한 연구
최인석,노영무 고려대학교 의과대학 1990 고려대 의대 잡지 Vol.27 No.1
Although early reperfusion limits or even prevents myocardial necrosis, this beneficial effect does not lead to immediate functional improvement, and the return of functional expansion in both ischemic and nonischemic myocardium following reperfusion is delayed depending on duration of ischemia and reperfusion, and drug treatment. To investigate the effect of early reperfusion on the left ventricular systolic function and the functional expansion of the left ventricle, left anterior descending coronary artery was occluded by silk snare distal LO the first diagonal branch for 20 minutes and was followed by reperfusion for 40 minutes in 10 verapamil pretreated anesthetized open -chest dogs. All dogs were treated with verapamil in doses that decreased rate by 20% and maintained at that rate through the experiment. Cardiac output was measured by thermodilution method. Left ventricular fractional shortening, endocardial length and endocardial area were measured by 2-D echocar diography at the mid-papillary level of short axis view. Verapamil caused fall in aortic pressure from 120±22mmHg to 85±20mmHg in systole and 72±19mmHg to 36±17mmHg in diastole(mean±S.D., p<0.01), decreased heart rate from 153±13/min to 122±9min(p<0.01), but caused no change in cardiac output( from 2.49L/min to 2.61L/min). Coronary occlusion decreased cardiac output from 2.61±1.26L/min to 2.15±1.18L/min(N.S) and fractional shortening from 32.1±0.5% to 21.4±0.8% (p<0.01), increased end-systolic posterior length and area(non-ischemic myocardium) by 21.5% and 66.7%, and anterior length and area(ischemic myocardium) by 34.9% and 146.8%, respectively in 1 minute; also increased end-diastolic posterior length and area by 11.56/b and 12.0%, and anterior length and area by 45.0% and 41.9%, respectively in 1 minute. Endocardial length and area of both ischemic (anterior) and non-ischemic myocardium increased with time after coronary occlusion. Recovery of expansion(increased length and area) of ischemic area was achieved in 30 minutes and that of non-ischemic area in 5 minutes after reperfusion. Cardiac output and fractional shortening were recovered in 1 minute after reperfusion and was followed by recovery of non-ischemic area in 1-5 minutes. The findings are summarized as follows. 1. Coronary occlusion causes expansion of both ischemic and non-ischemic myocardium immediately (in 1 minute), more prominently in ischemic area and at end-systole, and depression of systolic function immediately (in 1 minute). 2. Reperfusion causes recovery of systolic function immediately, which was followed by recovery of non-ischemic myocardium. Recovery of expansion of ischemic myocardium is slower that of non - ischemic myocardium. These findings indicate that recovery of systolic function was prompt on reperfusion and was followed by recovery of expansion of non-ischemic myocardium in verapamil pretreated dog. The recovery of left ventricular systolic function following reperfusion may play a role in normalizing functional expansion of non-ischemic myocardium caused by coronary occlusion.