PURPOSE: We observed the actual half life of the alpha-fetoprotein (AFP) had clinical meaning in that it reflected the long term prognosis more individually at a certain level of preoperative alpha-fetoprotein. METHODS: From preoperative and postoperative measurements of alpha-fetoprotein in 96 hepatocellular carcinomas the actual half lives were calculated with the formula: AHL T1/2 (days) = -0.3x(T/log(C1/C0)), where T was the time interval between C1 and C0, in which C1 meant the level of AFP at postoperative 7 day, C0 the original AFP level. We investigated overall survival and disease free survival rate between delayed AHL group and non-delayed AHL group under various definitions of delay. RESULTS: The average actual half life of all cases was 5.1+/-13.6 days. One, three and five year overall survival rates of the group with actual half life less than 4 days were 82.1%, 66.7%, 61.1% respectively, whereas those of the group with actual half life more than 4 days showed 83.0%, 36.5%, 18.2% respectively. The significance of different survival rates was much higher, when only the patients with preoperative alpha-fetoprotein above 100 ng/ml were taken into account (n=53, P=0.0019). The disease free five year survival rates were also significantly different. CONCLUSION: We can predict the elevated postoperative survival rate in the patients with actual half life of alpha-fetoprotein less than 4 days. And this has also relevant clinical meaning in the prognostication of disease free survival, if the preoperative alpha-fetoprotein of patients has elevated up to over 100 ng/ml. The measurement of actual half life of postoperative hepatocellular carcinoma patientscan be a clinical useful parameter for the prognosis of long term survival.
alpha-Fetoproteins* ; Carcinoma, Hepatocellular* ; Disease-Free Survival ; Half-Life* ; Humans ; Prognosis ; Survival Rate

PURPOSE: Witten/Herdecke University, Germany, is the only private medical school and university that has offered a wide range of new curricula in the early age of innovation in medical education. The aim of the study is to review how the educational goal of this institution is realized in its curriculum. METHODS: Descriptive study of the educational goal, foundation history, and structure of Witten-Herdecke University's curriculum, as well as its organizational style, through analysis of the literature and publications. RESULTS: Witten/Herdecke University provides an integrated education that ranges from medicine and music therapy to economics and art. This structure is intended to ensure that students receive the broadest education possible to build their own humanity. The results of its innovative education have been recognized as admirable in recent objective publications. CONCLUSION: Through its curriculum, Witten/Herdecke University uses a unique approach in educating its students to become sentient, compassionate human beings. Their program shows us that the direction of innovative medical education in recent decades is justified.
Curriculum ; Dietary Sucrose ; Education, Medical ; Empathy ; Germany ; Humans ; Music Therapy ; Professional Competence ; Schools, Medical

PURPOSE: As the importance of teaching professionalism has become more emphasized in medical education, Korean medical educators are trying to introduce and revise new learning materials concerning professionalism. The purpose of this study is to analyze the transition of curricula subjects related to medical professionalism in Korean medical schools. METHODS: A search for the learning subjects was done by reviewing the' Korean Medical Education Guide'from 1998 to present. Subject titles relating to medical professionalism and the time allocation of these subjects in lectures and laboratories in the 41 Korean Medical Schools were identified. The annual increasing rate of related subjects, as well as some characteristic differences between medical schools were analyzed. RESULTS: There were 28 subjects with content on medical professionalism in 1998/99. There was a rapid increase in the introduction of professionalism to the curriculum annually. Although private medical schools outnumber the public system, there was no significant difference between them in the number of established subjects. But schools with fewer students had more programs relating to professionalism. This may be seen as a reflection of the relatively newly established schools with fewer students being more ready to adopt curriculum reform than older, larger medical schools. CONCLUSION: The results show that there has been a rapid growth in the number of subjects relating to medical professionalism in the curriculua at Korean medical schools. This study focused mainly on analyzing the current subject constellation in the curricula. A further study on the specifics of curriculum content and its teaching method is required.
Curriculum ; Education* ; Education, Medical ; Ethics ; Humans ; Learning ; Lectures ; Schools, Medical* ; Teaching

BACKGROUND: Due to its high diagnostic accuracy, preoperative sonographic evaluation of gallbladder disease is accepted as the most reliable and effective procedure. However we have encountered, though not so often, cases in which the sonographic tumor revealed only sludge material in reality. METHODS: A retrospective review of 11 cases that had been preoperatively diagnosed as a gallbladder mass or stone focused on the features of the patients and the characteristics of the sonographic findings. RESULTS: Of the cholecystectomized 2486 cases in which gallstones or gallbladder polyps had been preoperatively diagnosed, 0.4% had only sludge in reality. Symptomatic patients were 7 (64%). Pseudo- tumorous lesions of the gallbladder resembled the shapes of the stones, as well as the shapes of polyps, in their echogenic characteristics. CONCLUSIONS: Gallbladder sludge alone can make the sonographic image of a stone or a polyp. The application of more advanced sonography, such as contrast-enhanced Doppler sonography, may contribute to the differential diagnosis of pseudo-tumorous lesions of the gallbladder; however, an indefinite lesion on sonography always deserves operative intervention.
Diagnosis, Differential ; Gallbladder Diseases ; Gallbladder* ; Gallstones ; Humans ; Polyps ; Retrospective Studies ; Sewage* ; Ultrasonography*

Because of the significant reduction in complications from transfusion owing to the development in the technique of preservation of blood, the tendency of hemoglobinuria during anesthesia and surgery has decreased. it seems that there are many causes of hemoglobinuria, and its prognosis is varied. The incidence of Rb negative blood in Korea is no more than 0.2%. Therefore, such a rare blood type may be presserved by freesing for longterm storage. But this freesing and thawing of blood leads to partial hemolysis of the red cells. A case of hemoglobinuria occured during transfusion of Rh negative type B frozen blood.
Anesthesia* ; Erythrocytes* ; Hemoglobinuria* ; Hemolysis ; Incidence ; Korea ; Prognosis

A pathological fracture occurs spontaneously or with minimal trauma. The underlying pathological changes may be subtle and the diagnosis not obvious. The two goals in the treatment of pathologic fracture in weight bearing long bones are to provide relief of pain by secure fixation of the fracture and to permit early smbulation and a prompt return to prefracture status. Thirteen cases of pathological fracture were treated during the period from June, 1986 to February, 1988 at Kangnam Sacred Heart Hospital. The results are as follows. 1. Most patients were over 45 of age. 2. Malignancy was the common cause. 3. Most frequent involved site was femur. 4. Occured by trivial trauma such as slip down injury. 5. Satisfactory result by curettage, open reduction and internal fixation, bone graft or bone cement augmentation.
Clinical Study ; Curettage ; Diagnosis ; Femur ; Fractures, Spontaneous ; Heart ; Humans ; Transplants ; Weight-Bearing

With the goal of providing optimal care to patients, student-centered active learning and the development of clinical competency have become vital components of the education of future physicians capable of sustainably coping with future challenges. However, the shape of future medicine is dramatically changing based on advances in information and communication technology, and the current classroom model seems to have difficulties in fully preparing students for the future of medicine. New trends in teaching and assessment methods include computer-aided instruction, virtual patients, augmented reality, human patient simulations, and virtual reality for the assessment of students’ competency. The digital technologies introduced in medical and dental education include Google Forms to collect students’ answers, YouTube livestreaming, Google Art & Culture (an online art museum), and choose-your-own-adventure as a story-telling technique. Innovations in digital technology will lead the way toward a revolution in medical and dental education, allowing learning to be individualized, interactive, and efficient.

With the goal of providing optimal care to patients, student-centered active learning and the development of clinical competency have become vital components of the education of future physicians capable of sustainably coping with future challenges. However, the shape of future medicine is dramatically changing based on advances in information and communication technology, and the current classroom model seems to have difficulties in fully preparing students for the future of medicine. New trends in teaching and assessment methods include computer-aided instruction, virtual patients, augmented reality, human patient simulations, and virtual reality for the assessment of students’ competency. The digital technologies introduced in medical and dental education include Google Forms to collect students’ answers, YouTube livestreaming, Google Art & Culture (an online art museum), and choose-your-own-adventure as a story-telling technique. Innovations in digital technology will lead the way toward a revolution in medical and dental education, allowing learning to be individualized, interactive, and efficient.

PURPOSE: The caspase (ICE/CED-3) family of proteases have been implicated to play a important role in apoptosis and caspase-3(CPP32, YAMA, Apopain) exhibits the highest similarity to CED-3 which produced by CED-3 gene, the prototype of cell death gene in nematode. The objective of this study is to evaluate the prognostic value of expression of caspase-3 in bladder cancer and renal cell carcinoma. MATERIALS AND METHODS: Seventy five patients with bladder cancer and thirty eight patients with renal cell carcinoma were enrolled in this study. We performed immunohistochemical staining of caspase-3 in formalin-fixed and paraffin-embedded tissue section using goat polyclonal antibody, specific for the p20 subunit of caspase-3. The expression of caspase-3 were compared with TNM stage, Ash grade, and size of tumor in bladder cancer, and TNM stage, Robson stage, Fuhrman nuclear grade, and size of tumor in renal cell carcinoma. RESULTS: The expression of caspase-3 were significantly correlated with T stage and N stage in bladder cancer(p=0.04, p=0.03). However, there were no significant correlation between the expression of caspase-3 and other prognostic parameters in bladder cancer and renal cell carcinoma. Caspase-3 was diffusely stained in only 1 case of renal cell carcinoma. CONCLUSIONS: The prognostic value of expression of caspase-3 in patients with bladder cancer and renal cell carcinoma were insufficient, but caspase-3 paly an important role in apoptosis and more studies are necessary for evaluation of many steps in apoptotic cascade of many cancers.
Apoptosis ; Carcinoma, Renal Cell ; Caspase 3* ; Cell Death ; Goats ; Humans ; Immunohistochemistry ; Peptide Hydrolases ; Urinary Bladder Neoplasms* ; Urinary Bladder*

Cavernous transformation of the portal vein that is resulted as a collateral vessel formation from a portal hypoplasia is very rarely to be observed in human being. Such an abnormal transformation can be caused by congenital defect of vein formation in the early embryonal development or congenital hematologic hypercoagulability which gives rise to the cavernous development of cavernous collateral branches. Acute thrombosis of portal vein can also be the cause of acquired cavernous transformation. In most cases it extends into the parenchyme of liver, and often has porto-systemic shunt (with left gastropiploic vein and varices around spleen) or porto-portal shunt (with varices around gallbladder). A 48 years old male patient underwent splenectomy at the age of 24 owing to splenomegaly. He had liver cirrhosis without hepatitis and alcohol history. Intrahepatic stone in left lateral lobe of liver was diagnosed in the course of medical treatment. The cavernous transformation of portal vein with right lobe hypoplasia was confrimed during the operation.
Congenital Abnormalities ; Hepatitis ; Humans ; Liver Cirrhosis ; Liver* ; Male ; Middle Aged ; Portal Vein* ; Splenectomy ; Splenomegaly ; Thrombophilia ; Thrombosis ; Varicose Veins ; Veins