Purpose: This study aimed to investigate the differences in the perception between professors and students regarding medical educators’ roles and discuss their desirable roles. Methods: A survey was administered to 116 professors and 379 students of the medical colleges from Dankook University and Hallym University. The subjects were given a self-created questionnaire designed to measure their perception of medical educators’ roles. Results: First, “student performance management” for professors and “teaching skill development” for students were recognized as the most essential medical educators’ role. Second, females students perceived the roles to be more important than males in eight of 10 roles. Conclusion First, “student performance management” for professors and “teaching skill development” for students were recognized as the most essential medical educators’ role. Second, females students perceived the roles to be more important than males in eight of 10 roles.

BACKGROUND: While procarbazine, CCNU (lomustine), and vincristine (PCV) has been an alternative chemotherapy option for malignant gliomas, it is worth investigating whether the combination of only procarbazine and CCNU is comparable because vincristine adds toxicity with uncertain benefit. The purpose of this study was to evaluate the feasibility of procarbazine and CCNU chemotherapy for recurrent glioblastoma multiforme (GBM) with O6-methylguanine-DNA-methyltransferase (MGMT) promoter methylation. METHODS: Eight patients with recurrent GBM following concurrent chemoradiotherapy and temozolomide (TMZ) adjuvant therapy were enrolled in this trial; they received no other chemotherapeutic agents or target therapy. They received CCNU (75 mg/m²) on day 1 and procarbazine (60 mg/m²) through days 11 and 24 every 4 weeks. The median cycle of CCNU and procarbazine was 3.5 (range: 2–6). RESULTS: One patient achieved stable disease. The median progression-free survival (PFS) with procarbazine and CCNU chemotherapy was eight weeks (range: 5–73), and the PFS rates were 25% and 12.5% at 16 and 30 weeks, respectively. The median overall survival (OS) from the initial diagnosis to death was 40 months, and the median OS from the administration of procarbazine and CCNU chemotherapy to death was 9.7 months (95% confidence interval: 6.7–12.7). Serious adverse events were found at six visits, and two cases were considered to be grade 3 toxicities. CONCLUSION: The efficacy of procarbazine and CCNU chemotherapy is not satisfactory. This study suggests the need to develop other treatment strategies for recurrent and TMZ-refractory GBM. Trial registry at ClinicalTrials.gov, NCT017337346.
Chemoradiotherapy ; Diagnosis ; Disease-Free Survival ; Drug Therapy* ; Glioblastoma* ; Glioma ; Humans ; Lomustine* ; Methylation* ; Procarbazine* ; Vincristine

PURPOSE: The purpose of this study was to investigate the feasibility and survival benefits of combined treatment with radiotherapy and adjuvant temozolomide (TMZ) in a Korean sample. MATERIALS AND METHODS: A total of 750 Korean patients with histologically confirmed glioblastoma multiforme, who received concurrent chemoradiotherapy with TMZ (CCRT) and adjuvant TMZ from January 2006 until June 2011, were analyzed retrospectively. RESULTS: After the first operation, a gross total resection (GTR), subtotal resection (STR), partial resection (PR), biopsy alone were achieved in 388 (51.7%), 159 (21.2%), 96 (12.8%), and 107 (14.3%) patients, respectively. The methylation status of O6-methylguanine-DNA methyltransferase (MGMT) was reviewed retrospectively in 217 patients. The median follow-up period was 16.3 months and the median overall survival (OS) was 17.5 months. The actuarial survival rates at the 1-, 3-, and 5-year OS were 72.1%, 21.0%, and 9.0%, respectively. The median progression-free survival (PFS) was 10.1 months, and the actuarial PFS at 1-, 3-, and 5-year PFS were 42.2%, 13.0%, and 7.8%, respectively. The patients who received GTR showed a significantly longer OS and PFS than those who received STR, PR, or biopsy alone, regardless of the methylation status of the MGMT promoter. Patients with a methylated MGMT promoter also showed a significantly longer OS and PFS than those with an unmethylated MGMT promoter. Patients who received more than six cycles of adjuvant TMZ had a longer OS and PFS than those who received six or fewer cycles. Hematologic toxicity of grade 3 or 4 was observed in 8.4% of patients during the CCRT period and in 10.2% during the adjuvant TMZ period. CONCLUSION: Patients treated with CCRT followed by adjuvant TMZ had more favorable survival rates and tolerable toxicity than those who did not undergo this treatment.
Biopsy ; Chemoradiotherapy* ; Disease-Free Survival ; Follow-Up Studies ; Glioblastoma* ; Humans ; Korea* ; Methylation ; Radiotherapy ; Retrospective Studies* ; Survival Rate

OBJECTIVES: To evaluate the effect of obstructive sleep apnea (OSA) surgery on long-term (5-year) subjective outcomes, including sleep disordered breathing (SDB) symptoms and other complications, in patients with OSA. METHODS: We enrolled patients who underwent diagnostic polysomnography for OSA between January 2006 and December 2006 in ten hospitals. Patients either were treated for OSA or were not treated for OSA. All patients completed a brief telephone survey regarding their SDB signs and symptoms (e.g., snoring, apnea, nocturnal arousals, and daytime sleepiness), positive airway pressure (PAP) compliance, and any adverse effects of either the surgery or PAP. A positive subjective outcome for either surgery or no treatment was taken to be the alleviation of apnea, defined as a > or =50% increase in score. A positive subjective outcome (compliance) for PAP was defined as a PAP usage of > or =4 hours per night and > or =5 days per week. RESULTS: A total of 229 patients were included in this study. Patients were divided into three groups: a surgery group (n=87), a PAP group (n=68), and a control (untreated) group (n=74). The surgery group exhibited significant improvement in all SDB symptoms compared with the control group. The long-term subjective outcomes of the surgery (52.9%) and PAP (54.4%) groups were significantly better than those of the control group (25.0%). The subjective outcome of the surgery group was not significantly different from that of the PAP group. The overall surgical complication rate was 23.0% (20 of 87) in the surgery group, and 55.0% (22 of 40) of all patients with PAP experienced adverse effects. CONCLUSION: The extent of SDB symptoms was consistently improved in patients with OSA at 5 years postsurgery. Information about the potential long-term subjective outcomes should be provided to patients when considering surgery.
Apnea ; Arousal ; Compliance ; Humans ; Polysomnography ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive* ; Snoring ; Telephone ; Treatment Outcome

Kikuchi's disease is a benign disease characterized mainly by fever and cervical lymphadenitis. We report a case of Kikuchi's disease that manifested as intra-abdominal lymphadenitis. A 39 year old woman presented with fever that had persisted for one week. Her history and physical examination were unremarkable. The laboratory findings revealed mild leukopenia and increased C-reactive protein. Abdominal CT revealed multiple lymph node enlargements in the mesenteric root and around the ileocecal valve. Positron emission tomography-computed tomography (PET-CT) revealed increased 18-fluoro-deoxyglucose(FDG) uptake in the lymph nodes observed by abdominal CT. A laparoscopic excisional biopsy of the lymph node was performed for a confirmatory diagnosis and the pathology findings were compatible with Kikuchi's disease. Although intra-abdominal Kikuchi's disease is a rare disease, it should be considered in a differential diagnosis of intra-abdominal lymphadenopathy with increased FDG uptake on PET-CT.
Biopsy ; C-Reactive Protein ; Diagnosis, Differential ; Electrons ; Female ; Fever ; Histiocytic Necrotizing Lymphadenitis ; Humans ; Ileocecal Valve ; Leukopenia ; Lymph Nodes ; Lymphadenitis ; Lymphatic Diseases ; Lymphoma ; Physical Examination ; Positron-Emission Tomography ; Rare Diseases

OBJECTIVE: To evaluate the perinatal outcomes and maternal complications associated with triplet pregnancies. METHODS: Medical records of consecutive triplet pregnancies delivered in ( )( )Hospital from 1997 to 2005 were reviewed for maternal and neonatal outcomes. Pregnancies associated with lethal congenital anomalies or the case that being delivered before 20 weeks of gestation were excluded. Neonatal outcomes included respiratory distress syndrome, retinopathy of prematurity, necrotizing enterocolitis, intraventricular hemorrhage and low Apgar scores, congenital anomaly and so on. Maternal outcomes included preeclampsia, preterm delivery, anemia and blood transfusion and so on. RESULTS: The mean gestational age at delivery was 31.5+/-4.1 weeks, and the mean birth weight for triplets was 1,654.4+/-578.1 g. 31 of total 39 neonates (79.5%) were admitted to the neonatal intensive care unit, and 9 neonates (23.1%) received mechanical ventilator care as well. Neonatal death occurred in 6 of 39 neonates (15.4%). Congenital anomaly was seen in 3 of 39 neonates (7.7%). Hyperbilirubinemia developed in 16 of 39 neonates (44.4%). Respiratory distress syndrome developed in 3 of 39 neonates (7.7%). The most common maternal complication was preterm labor (76.9%), followed by anemia (46.1%), preterm premature rupture of membrane (30.8%) and blood transfusion (7.7%). Five patients (5/13, 38.5%) received tocolytic therapy. CONCLUSION: The main cause of neonatal death in triplet pregnancies is the respiratory distress syndrome in extreme preterm delivery. The most common neonatal morbidities are hyperbilirubinemia and apnea of prematurity. There is no difference in neonatal outcomes according to birth order. The most common maternal complications are preterm delivery and anemia. The adverse outcomes of triplet pregnancies are mainly due to preterm delivery.
Anemia ; Apnea ; Birth Order ; Birth Weight ; Blood Transfusion ; Enterocolitis, Necrotizing ; Female ; Gestational Age ; Hemorrhage ; Humans ; Hyperbilirubinemia ; Infant, Newborn ; Intensive Care, Neonatal ; Medical Records ; Membranes ; Obstetric Labor, Premature ; Pre-Eclampsia ; Pregnancy ; Pregnancy, Triplet* ; Retinopathy of Prematurity ; Rupture ; Tocolysis ; Triplets* ; Ventilators, Mechanical

OBJECTIVE: To evaluate the perinatal outcomes and maternal complications associated with triplet pregnancies. METHODS: Medical records of consecutive triplet pregnancies delivered in ( )( )Hospital from 1997 to 2005 were reviewed for maternal and neonatal outcomes. Pregnancies associated with lethal congenital anomalies or the case that being delivered before 20 weeks of gestation were excluded. Neonatal outcomes included respiratory distress syndrome, retinopathy of prematurity, necrotizing enterocolitis, intraventricular hemorrhage and low Apgar scores, congenital anomaly and so on. Maternal outcomes included preeclampsia, preterm delivery, anemia and blood transfusion and so on. RESULTS: The mean gestational age at delivery was 31.5+/-4.1 weeks, and the mean birth weight for triplets was 1,654.4+/-578.1 g. 31 of total 39 neonates (79.5%) were admitted to the neonatal intensive care unit, and 9 neonates (23.1%) received mechanical ventilator care as well. Neonatal death occurred in 6 of 39 neonates (15.4%). Congenital anomaly was seen in 3 of 39 neonates (7.7%). Hyperbilirubinemia developed in 16 of 39 neonates (44.4%). Respiratory distress syndrome developed in 3 of 39 neonates (7.7%). The most common maternal complication was preterm labor (76.9%), followed by anemia (46.1%), preterm premature rupture of membrane (30.8%) and blood transfusion (7.7%). Five patients (5/13, 38.5%) received tocolytic therapy. CONCLUSION: The main cause of neonatal death in triplet pregnancies is the respiratory distress syndrome in extreme preterm delivery. The most common neonatal morbidities are hyperbilirubinemia and apnea of prematurity. There is no difference in neonatal outcomes according to birth order. The most common maternal complications are preterm delivery and anemia. The adverse outcomes of triplet pregnancies are mainly due to preterm delivery.
Anemia ; Apnea ; Birth Order ; Birth Weight ; Blood Transfusion ; Enterocolitis, Necrotizing ; Female ; Gestational Age ; Hemorrhage ; Humans ; Hyperbilirubinemia ; Infant, Newborn ; Intensive Care, Neonatal ; Medical Records ; Membranes ; Obstetric Labor, Premature ; Pre-Eclampsia ; Pregnancy ; Pregnancy, Triplet* ; Retinopathy of Prematurity ; Rupture ; Tocolysis ; Triplets* ; Ventilators, Mechanical

BACKGROUND/AIMS: Despite of increasing numbers of reports on intraductal papillary mucinous tumor (IPMT), there is still difficulty in its' diagnosis, treatment and prediction of prognosis. The purpose of this multicenter study was to evaluate the clinico-pathological features of IPMT in Korea and suggest the prediction criteria of malignancy in IPMT. METHODS: We retrospectively reviewed the clinico-pathological data of 208 patients who underwent operations with IPMT between 1993 and 2002 at 28 institutes in Korea. RESULTS: Of the 208 patients with a mean age of 60.5+/-9.7 years, 147 were men and 61 were women. 124 patients underwent pancreatoduodenectomy, 42 distal pancreatectomy, 17 total pancreatectomy, 25 limited pancreas resection. Benign cases were 128 (adenoma (n=62), borderline (n=66)) and malignant cases were 80 (non-invasive (n=29), invasive (n=51)). A significant difference in 5-year survival was observed between benign and malignant group (92.6% vs. 65.3%; p=0.006). Of the 6 factors (age, location, duct dilatation, tumor appearance, main duct type, and tumor size) that showed the statistical difference in univariate analysis between benign and malignant group, we found three significant factors (tumor appearance (p=0.009), tumor size (p=0.023), and dilated duct size (p=0.010)) by multivariate analysis. CONCLUSION: Although overall prognosis of IPMT is superior to ordinary pancreatic cancer, more curative surgery is recommended in malignant IPMT. Tumor appearance (papillary), tumor size (> or =30 mm) and dilated duct size (> or = 12 mm) can be used as preoperative indicators of malig-nancy in IPMT.
Academies and Institutes ; Diagnosis ; Dilatation ; Female ; Humans ; Korea* ; Male ; Mucins* ; Multivariate Analysis ; Pancreas* ; Pancreatectomy ; Pancreatic Neoplasms ; Pancreaticoduodenectomy ; Prognosis ; Retrospective Studies

The nm23 gene was originally identified by differential screening of a cDNA library with RNA from low and high metastatic clones of a murine melanoma cell line. And the nm23 gene has been represented as a metastasis suppressor gene. The product of nm23 gene is known to be identical to nucleoside diphosphate(NDP) kinase. The lack of expression of nm23 protein has been correlated with a poorer prognosis in some human tumors, among which are breast carcinoma, malignant melanoma, gastric carcinoma and hepatcelluar cacin-oma. However, in several types of malignant tumors such as colon carcinoma, neuroblastoma and pancreatic carcinoma, unexpected overexpression of nm23 protein was found as compared with normal tissues. Also in a few studies with cervical carcinoma, the expression of nm23 protein was found to be increased as compared with normal cervical tissue recently. Therefore, in this study, we analyzed the expression of nm23-H1 protein by immunohistochemistry method in a series of 40 cervical carcinomas, to determine whether the alterations in the expression of nm23-H1 protein occured in cervical carcinoma as compared with cervical intraepithelial neoplasia(CIN) and normal cervices, and also analyzed the possible association between nm23 protein expression and prognostic parameters of cervical carcinoma at Ewha Womans University Mokdong Hospital from September 1993 to March 1997. The results obtained were as follows; 1. The mean ages of normal control patients, CIN and cervical carcinomas were 42.9 (+/-5.1) years, 39.5(+/-7.7) years, and 49.3(+/-11.7) years respectively. All cases of cervical carcinoma were squamous cell carcinomas. And the number of each stages Ia, Ib, IIa, IIb, III and IV were 13 cases, 8 cases, 6 cases, 9 cases, 2 cases, and 2 cases respectively. 2. In cervical carcinoma, nm23-H1 protein expression was significantly increased as compared with CIN and normal cervical tissue(t=5.017>1.96). 3. In cervical carcinoma, the nm23-H1 protein expression was more increased in higher stages(p=0.021). But it had no significant correlations with primary tumor size, lymphovascular space invasion, parametrial invasion or lymph node metastasis. Our results on nm23-H1 protein expression in cervical carcinoma suggest that cervical carcinoma seems to belong to the group of tumors, like colon carcinoma and neuroblastoma, pancreatic carcinoma in which nm23-H1 overexpression is associated with a more malignant phenotype. In this study, nm23-H1 protein was more expressed in higher clinical stages of cervical carcinoma. Therefore the expression of nm23-H1 protein probably may have a prognostic significance in cervical carcinoma. But a further prospective study on a larger population is needed to establish the role of nm23 gene in this kind of tumor.
Breast Neoplasms ; Carcinoma, Squamous Cell ; Cell Line ; Cervix Uteri* ; Clone Cells ; Colon ; Female ; Gene Library ; Genes, Tumor Suppressor ; Humans ; Immunohistochemistry ; Lymph Nodes ; Mass Screening ; Melanoma ; Neoplasm Metastasis ; Neuroblastoma ; Phenotype ; Phosphotransferases ; Prognosis ; RNA

Liver involvement in multiple myeloma has been known to be common in autopsied series. However, since its clinical significance is uncertain yet, invasive procedure confirming plasma cell infiltration of the liver has been rarely performed. We report a case with multiple myeloma which had plasma cell infiltration of a liver. A peritoneoscopic biopsy of the liver for the purpose of disclosing the nature of the aggravating liver function in a carrier of the hepatitis B virus showed infiltration of lymphoreticular cell which were identified later as lambda-light chain producing primitive plasma cells by immunohistochemical stain.
Adult ; Case Report ; Female ; Human ; *Laparoscopy ; Liver/*pathology ; Multiple Myeloma/*pathology/radiography/radionuclide imaging ; Neoplasm Invasiveness ; Tomography, X-Ray Computed