BACKGROUND: Simulation-based medical education has been growing rapidly and becomes one of the most popular teaching methods for improving patient safety and patient care. The Simulation Subcommittee of the Hong Kong College of Emergency Medicine organized an educational program emphasizing the team training, clinical decision-making and communication skills. This study aimed to evaluate the attitude of the participants toward a new training program and the change in the knowledge on clinical performance in emergency physicians and nurses after attending the educational program. METHODS: A course evaluation form was filled in by the participants at the end of the workshop. An assessment of 20 multiple-choice questions with 5 options was administered to the participants before and after the 2-day simulation-based training workshop. RESULTS: A total of 72 doctors and nurses working in the Accident and Emergency Department were enrolled. The average pretest and posttest scores were 12 and 14.3 respectively. The percentage improvement in the mean score of the pretest and posttest was 11.5％. The Chi-square test showed significant improvement in the pretest and posttest score grading (P=0.00). Paired t-test revealed significant difference between the mean scores of the pretest and posttest (P=0.00). CONCLUSIONS: Participants had positive attitude toward this new training program. Significant improvement of the knowledge on clinical performance in healthcare professionals in the Accident and Emergency Department was observed after the participation in this simulation-based educational program.

Histopathological diagnosis of brain stem glioma should be performed for the purpose of the determination of its management and clinical course, but its surgical biopsy has been followed by high mortality and morbidity. We performed the tissue sampling for histological examination with BRW stereotaxic system under local anesthesia successfully.
Anesthesia, Local ; Biopsy* ; Brain Stem* ; Brain* ; Diagnosis ; Glioma* ; Mortality

Job's syndrome is an inflammatory skin disease characterized by (1) severe eczema, (2) recurrent staphylococcal infections of the skin and sinopulmonary tract, (3) cold subcutaneous abscesses, and (4) high serum IgE levels. We describe a 55-year-old woman with long-standing atopic dermatitis-like eczema, recurrent abscesses, and a high level of serum IgE. We suspected this case as Job's syndrome.
Abscess ; Eczema ; Female ; Humans ; Immunoglobulin E ; Job Syndrome* ; Middle Aged ; Skin ; Skin Diseases ; Staphylococcal Infections

BACKGROUND: Women sometimes have eyebrows tattooed for cosmetic purpose. But until recently, the removal of tattoos has been difficult. Several laser techniques have been proposed for the removal of tattoos. The lasers that have been used most successfully are the Q-switched systems because of their ability to target tattoo pigment selectively with minimal risk of adverse tissue response. OBJECTIVE: The objective of this study was to determine the clinical effectiveness of the newest Q-switched system, the alexandrite laser, in removing both eyebrow tattoos and to observe side effects such as scarring or permanent pigmentary changes. METHODS: Forty seven patients with both eyebrows tattooed were treated with the Q-switched alexandrite laser (755 nm, 100 ns) at eight week intervals and clinically evaluated.
Cicatrix ; Eyebrows* ; Female ; Humans ; Lasers, Solid-State*

Trichoblastic fibroma is a rare, benign trichogenic tumor that has both an epithelial and mesenchymal component. This tumor may be confused clinically and/or histologically with basal cell carcinoma and other tumors with hair follicle differentiation. We describe here a patient with trichoblastic fibroma on the nose. For further characterization of the tumor, we studied the bcl-2 expression in this case and compared it with those of trichoepitheliomas and basal cell carcinomas. The bcl-2 expression in this case and trichoepitheliomas were positive at the periphery of the tumor nest only, whereas those of basal cell carcinomas were positive diffusely throughout the tumor nest.
Carcinoma, Basal Cell ; Fibroma* ; Hair Follicle ; Humans ; Nose

We report a case of a 42-year-old woman who suffered from recurrent nodular skin lesions on her left foot. Sporotrichoid fungal infection was suspected and two linear nodular skin lesions that had occurred after trauma in a public pool were treated with itraconazole for 4 months. These nodular skin lesions were completely flattened. However, four months after complete flattening, a new lesion developed in the scar of a previous nodule. N. asteroides, which is extremely rare for sporotrichoid cutaneous nocardiosis, was cultured from the relapsed lesion. We treated this case with trimethoprim-sulfamethoxazole for 6 months under an emperical basis and this resulted in complete healing, and sensitivity of N. asteroide to trimethoprim-sulfamethoxazole was confirmed later. There has been no recurrence for 3 years. To our knowledge, our case is the first report in the english literature of primary sporotrichoid cutaneous nocardiosis caused by N. asteroides in terms of anatomic location below the knee and host immunocompetency.
Adult ; Cicatrix ; Female ; Foot ; Humans ; Itraconazole ; Knee ; Nocardia asteroides* ; Nocardia Infections* ; Nocardia* ; Recurrence ; Skin ; Trimethoprim, Sulfamethoxazole Drug Combination

A case of primary cutaneous CD30(Ki-1)-positive pleomorphic large cell lymphoma in a 51-year-old woman with generalized lichen myxedematosus is presented. Histopathological findings of the biopsy specimens from the lichenoid papules of the left forearm and the dorsum of the right hand were compatible with papular mucinosis. The mucinous material in the papillary dermis stained with alcian blue at pH 2.5 and was susceptible to hyaturonidase, but serum protein electrophoresis showed no abnormal bands and an abnormal paraprotein was not detected in our patient. Histopathological examination of a solitary, firm, purplish nodule on the right popliteal area showed diffuse and extensive infiltration in the reticular dermis composed of large, atypical, often hyperchromatic, sometimes multinucleated and markedly pleomorphic cells. The majority of the large atypical cells were CD30(Ki-1) positive. The TCR gene re-arrangement analysis demonstrated the presence of a monoclonal rearrangement of the y-TCR gene in the skin biopsy specimen of our patient. The organ-system survey revealed no evidence of internal organ involvement. We concluded that this was primary cutaneous CD30(Ki-1)-positive pleomorphic large cell lymphoma developing in a patient with generalized lichen myxedematosus.
Alcian Blue ; Biopsy ; Dermis ; Electrophoresis ; Female ; Forearm ; Genes, T-Cell Receptor ; Hand ; Humans ; Hydrogen-Ion Concentration ; Lichens* ; Lymphoma* ; Middle Aged ; Mucins ; Scleromyxedema* ; Skin

The Sturge Weber syndrome is an uncommon disorder characterized by port-wine nevus of the face with angiomatosis of the ipsilateral cerebral leptomeninges and extensive calcification in the underlying cerebral cortex. Associated with this syndrome are mental retardation, choroidal angioma, buphthalmus or glaucoma, seizure and hemiplegia. We studied a case of incomplete form of Sturage Weber syndrome in a 12 year-old boy, who had generalized seizure, a homonymous hemianopsia, intracranial calcification and leptomeningeal angiomatosis. There are no characteristic facial nevus, mental retardation, occular changes and hemiplegia.

Cutaneous larva migrans(creeping eruption) is a rare cutaneous serpiginous erution caused by the accidental invasion of the skin by parasites. We report herein a 27 year-old female with a mild pruritic erythematous serpiginous linear skin lesion located on the patient's back for a month. Histopathologic examination revealed a larva in the dermis with dense iinfiltrates of eosinophils and lymphocytes. After treatment with oral anitiparasitics, the skin lesions resolved with post-inflammatory hyperpigmentation. This is the first case of larva migrans showing the larva on the biopsy specimen in Korea.
Adult ; Biopsy* ; Dermis ; Eosinophils ; Female ; Humans ; Hyperpigmentation ; Korea ; Larva Migrans* ; Larva* ; Lymphocytes ; Parasites ; Skin

Congenital self-healing reticulohistiocytosis (CSHRH) is a rare Langerhans cell disorder showing spontaneous resolution within 3-4 months. By electron microscopy, the identification of many Birbeck granules and laminated dense bodies in the infiltrated cells is mandatory for the diagnosis of CSHRH. We describe a case of congenital self-healing reticulohistiocyt~osis in a 4-month-old male infant.
Diagnosis ; Humans ; Infant ; Male ; Microscopy, Electron