Characteristics of a Focused Assessment with Sonography for Trauma (FAST) in Hollow Viscus Injury

PURPOSE: The usefulness of focused abdominal sonography for trauma (FAST) is now included in the frame work of the advanced trauma life support for examination of thoraco- abdominal trauma. Ultrasonographic screening is controversial in patients with hollow viscus injury. The purpose of this study is to determine the characteristics of emergency trauma sonographic findings in patients with hollow viscus injury. METHODS: All patients with isolated viscus injury after blunt abdominal trauma were retrospectively enrolled in this study during the 5-year period from December 1997 to November 2002. The patients were screened by using ultrasonography and an underwent explolaparotomy. The patients were diagnosed with a hollow viscus injury based on the surgical findings. Patients with viscus injury combined with parenchymal organ injury after abdominal trauma were excluded. Ultrasonographic examinations were performed by the experienced emergency physicians during the trauma resuscitation. RESULTS: Sixty patients were included in this study. The most common injury site was jejunum (23.3%). The common findings of emergency trauma sonography were free fluid collection (56.7%), none of fluid collection (38.3%), free air and fluid collection (3.3%), and free air (1.7%). The presence of mesenteric injury was significantly associated with fluid collection (x2=0009). CONCLUSION: The most common sonographic findings in hollow viscus injury patients after blunt abdominal trauma are free intraperitoneal fluid (anechoic or mixed echo pattern), normal, and free air (reverberation) in that order. Massive intraperitoneal fluid is more often detected in patients who have a viscus injury combined with a ruptured mesenteric vessel.

Effect after Change of Evaluation Method in Surgical Clerkship Program / 한국의학교육

PURPOSE: Since 2002, Department of Surgery, Yonsei University Wonju College of Medicine attempted to revise the evaluation method of surgical clerkship program. The purpose of this study was to analyze the effect after change of evaluation method. METHODS: Major changes in current revisions were summarized as follows; (1) multiple evaluator, (2) student's attitude evaluated by rating scale method, (3) attendance and procedure evaluation were measured in numbers according to the fixed criteria, (4) addition of clinic-based items such as problem-solving items in the final written examination. We compared the measurement of revised evaluation at 2002 with those at 1999. And the correlation or simple linear regression analysis between score of clerkship and student academic grade score were taken. RESULTS: The clerkship score of students at 2002 showed more powerful discrimination between high performance group and poor group than that of 1999's. Even though the subject score of clerkship was significantly correlated with grade score regardless of evaluation method of clerkship, the subject score of clerkship at 2002 was more closely correlated with a grade score than 1999's. The score of knowledge-based items from final written examination is not correlated with clerkship score, but on the other hands, there was significant correlation between score of clinic-based items and clerkship score. CONCLUSION: In conclusion, variable measurements under the exact guideline and principle are more reliable method in evaluation of surgical clerkship.

A Case of Tertiary Hyperparathyroidism Combined with Thyroid Papillary Carcinoma / 대한이식학회지

Secondary hyperparathyroidism is the condition which leads to excessive production of the parathyroid hormone secreted to compensate for longstanding hypocalcemia in chronic renal failure. After restoration of normal renal function, some patients continue to have autonomous parathyroid hyperfunction. In 1963 St. Goar termed it tertiary hyperparathyroidism. Hyperparathyroidism in the chronic renal failure is mostly well managed medically, but sometimes may require surgical intervention in refractory hyperparathyroidism. Recently, we have experienced a female patient diagnosed as tertiary hyperparathyroidism with persistent hypercalcemia after renal transplantation and report the results of subtotal parathyroidectomy and thyroid right lobectomy due to hyperparathyroidism and thyroid papillary carcinoma found coincidentally.