Problem-based learning(PBL) is widely used as an effective educational tool; the fields in which it has been applied include medicine. Several reports have described the results of trials comparing problem-based and conve ntional approaches to learning; none, however, have compared the results between two groups where one had not undergone medical training, and the other had been partially trained, using the conventional approach. The aim of this study was to determine whether there was any difference in medical performance between two groups, as described above. Before the possible incorporation of PBL into our curriculum, we also wished to investigate many possible problems. Group A consisted of five premedical school students and group B of six students in the first year of medical school at our college. The same case which had been used in the tutor training program in the University of New Mexico School of Medicine was used by the same tutor who attended that program, and the whole procedure was evaluated by other faculty members through closed-circuit TV monitor. We also analyzed the results of evaluation by the tutors and students themselves. The general performance of the students was excellent, while the performance of the tutors were acceptable. Many possible problems, including library facilities and educational environments were also discussed. In conclusion, PBL is an approach which can be used in our medical college from an early stage. Before it is fully introduced, however the large number of potential problems should be carefully evaluated.
Curriculum ; Education ; Humans ; Learning* ; New Mexico ; Schools, Medical

PURPOSE: Laparoscopic surgery has become the mainstream surgical operation due to its stability and feasibility. Even for liver surgery, the laparoscopic approach has become an integral procedure. According to the recent international consensus meeting on laparoscopic liver surgery, laparoscopic left lateral sectionectomy (LLS) might be a new standard of care for left lateral surgical lesions. This study was designed to compare open LLS to laparoscopic LLS. METHODS: In total, 82 patients who had undergone LLS at Chonnam National University Hwasun Hospital between 2008 and 2015 were enrolled in this study. Among them, 59 patients underwent open LLS and 23 underwent laparoscopic LLS. These two groups were compared according to general characteristics and operative outcomes. RESULTS: The data analysis results showed that laparoscopic liver resection is superior to open liver resection in terms of the amount of bleeding during the operation and the duration of hospital stay. There was no statistical difference between the two groups in terms of operation time (p value=0.747). The amount of bleeding during the operation was 145.5±149.4 ml on average for the laparoscopic group and 320±243.8 ml on average for the open group (p value=0.005). The mean duration of hospital stay was 10.7±5.8 days for the laparoscopic surgery group and 12.2±5.1 days for the open surgery group (p value=0.003). CONCLUSION: This study showed that laparoscopic LLS is safe and feasible, because it involves less blood loss and a shorter hospital stay. For left lateral lesions, laparoscopic LLS might be the first option to be considered.
Consensus ; Hemorrhage ; Humans ; Jeollanam-do ; Laparoscopy ; Length of Stay ; Liver ; Standard of Care ; Statistics as Topic

Neurofibromatosis type 1 (NF1) is an autosomal dominant hereditary disorder. The pathogenesis of NF1 is suggested to be an alteration of the NF-1 gene, which normally functions as a tumor suppressor. A mutation of NF-1 causes the development of viable tumors in various sites. On the other hand, the synchronous manifestation of a gastrointestinal stromal tumor (GIST) and neuroendocrine tumor (NET) in the background of NF1 is extremely rare. This paper reports three cases treated with surgical intervention along with the long-term follow-up results. Three patients showed synchronous ampullary NET and GIST in association with NF1 supported by postoperative histopathologic analysis. Surgical treatments, such as pancreatoduodenectomy and local excision were applied. No recurrence occurred during the postoperative follow-up period of 10, 9, and 2.7 years. Synchronous GIST and NET in the background of NF1 is extremely rare, but the possible coexistence of other tumors in NF1 patients is relatively higher than that in the general population. Furthermore, both NETs and GISTs occurring in NF1 patients tend to be smaller in size compared to that in the general population. Therefore, when NF1 patients present with vague abdominal discomfort, close attention must be paid to identifying the coexistence of other neoplasms.
Follow-Up Studies ; Gastrointestinal Stromal Tumors ; Hand ; Humans ; Neuroendocrine Tumors ; Neurofibromatoses ; Neurofibromatosis 1 ; Pancreaticoduodenectomy ; Recurrence

Neurofibromatosis type 1 (NF1) is an autosomal dominant hereditary disorder. The pathogenesis of NF1 is suggested to be an alteration of the NF-1 gene, which normally functions as a tumor suppressor. A mutation of NF-1 causes the development of viable tumors in various sites. On the other hand, the synchronous manifestation of a gastrointestinal stromal tumor (GIST) and neuroendocrine tumor (NET) in the background of NF1 is extremely rare. This paper reports three cases treated with surgical intervention along with the long-term follow-up results. Three patients showed synchronous ampullary NET and GIST in association with NF1 supported by postoperative histopathologic analysis. Surgical treatments, such as pancreatoduodenectomy and local excision were applied. No recurrence occurred during the postoperative follow-up period of 10, 9, and 2.7 years. Synchronous GIST and NET in the background of NF1 is extremely rare, but the possible coexistence of other tumors in NF1 patients is relatively higher than that in the general population. Furthermore, both NETs and GISTs occurring in NF1 patients tend to be smaller in size compared to that in the general population. Therefore, when NF1 patients present with vague abdominal discomfort, close attention must be paid to identifying the coexistence of other neoplasms.
Follow-Up Studies ; Gastrointestinal Stromal Tumors ; Hand ; Humans ; Neuroendocrine Tumors ; Neurofibromatoses ; Neurofibromatosis 1 ; Pancreaticoduodenectomy ; Recurrence

Purpose: We aimed to compare the operative outcomes of laparoscopic right posterior sectionectomy (RPS) and open RPS and evaluate the feasibility of laparoscopic RPS. Methods: From January 2009 to December 2017, laparoscopic liver resections were performed in 235 patients at Chonnam National University Hwasun Hospital, South Korea. We retrospectively analyzed the clinical data of 16 patients who underwent laparoscopic RPS and compared the outcomes with those who underwent open RPS (n=17). Results: The laparoscopic group had a mean tumor size of 3.82±1.73 cm (open group [OG]; 4.18±2.07 cm, p=0.596), mean tumor-free margin of 10.44±9.69 mm (OG; 10.06±10.62 mm, p=0.657), mean operation time of 412.2±102.2 min (OG; 275.0±60.5, p<0.001), mean estimated blood loss of 339.4±248.3 ml (OG; 236.4±102.7 ml, p=0.631), mean postoperative hospital stay of 11.63±2.58 days (OG; 14.71±4.69 days, p=0.027), and mean postoperative peaks of aspartate aminotransferase, alanine aminotransferase, total bilirubin, and prothrombin time of 545 mg/dl, 538 mg/dl, 1.39 mg/dl, 1.41 international normalized ratio (OG; 237 (p<0.001), 216 (p<0.001), 1.52 (p=0.817), and 1.45 (p=0.468)), respectively. There were no deaths or major complications in ether group. There were no cases of open conversion. Laparoscopic RPS was associated with a shorter hospital stay, prolonged operation time and lower complication rate. With long-term prognosis, no difference was found in overall survival rate and disease-free survival rate between the two groups. Conclusion Laparoscopic RPS can be performed, but the problems of long operative time and decrease in liver function should be resolved.

The etiology of acute pericarditis is often thought to be autoimmune, and Graves' disease has been reported in a few series to manifest as acute pericarditis. Since the etiology of recurrent pericarditis is known to be more associated with autoimmune causes, recurrent acute pericarditis may be a potential cardiovascular complication of Graves' disease. We report a case of recurrent acute pericarditis that was presumed to be associated with Graves' disease which was controlled after management of the problem of the thyroid.
Graves Disease ; Pericarditis ; Thyroid Gland

Two trials of external quality assessment for the newborn screening tests of inborn errors of metabolism including PKU screening, TSH, T4 (total/free), galactosemia screen, maple syrup urine disease screen and homocytinuria screen, were performed in 2007. Total 20 specimens for the newborn screening tests were distributed to 16 laboratories. The response rate was 100%. All the control materials were sent as filter paper forms. The mean, SD, CV, median and range were analyzed. From this trial, the proficiency tests for newborn screening tests using tandem mass spectrometry (MS/MS) were included as routine quality assessment. Participants results for amino acids, acylcarnitine and their cutoff values were analyzed. In addition, the trial of external quality assessment for glycohemoglobin (HbA1c) was first started in 2007. Two samples prepared from normal whole blood and commercially available abnormal control materials, were distributed to 246 laboratories and the response rate was 93%. Statistical data such as mean, SD and CV were provided for peer groups.
Amino Acids ; Carnitine ; Galactosemias ; Humans ; Infant, Newborn ; Korea ; Maple Syrup Urine Disease ; Mass Screening ; Metabolism, Inborn Errors ; Peer Group ; Tandem Mass Spectrometry

Two trials of external quality assessment for the newborn screening tests of inborn errors of metabolism including PKU screening, TSH, T4 (total/free), galactosemia screen, maple syrup urine disease screen and homocytinuria screen, were performed in 2007. Total 20 specimens for the newborn screening tests were distributed to 16 laboratories. The response rate was 100%. All the control materials were sent as filter paper forms. The mean, SD, CV, median and range were analyzed. From this trial, the proficiency tests for newborn screening tests using tandem mass spectrometry (MS/MS) were included as routine quality assessment. Participants results for amino acids, acylcarnitine and their cutoff values were analyzed. In addition, the trial of external quality assessment for glycohemoglobin (HbA1c) was first started in 2007. Two samples prepared from normal whole blood and commercially available abnormal control materials, were distributed to 246 laboratories and the response rate was 93%. Statistical data such as mean, SD and CV were provided for peer groups.
Amino Acids ; Carnitine ; Galactosemias ; Humans ; Infant, Newborn ; Korea ; Maple Syrup Urine Disease ; Mass Screening ; Metabolism, Inborn Errors ; Peer Group ; Tandem Mass Spectrometry

Two trials of external quality assessment for conventional newborn screening tests for phenylketonuria, congenital hypothyroidism, galactosemia, maple syrup urine disease and homocytinuria and for the newborn screening tests using tandem mass spectrometry (MS/MS) were performed in 2009. Total 20 specimens were distributed to 13 laboratories. All the control materials were send as dried blood spots. The response rate was 100%. The mean, SD, CV, median and range were analyzed. In addition, two trials of external quality assessment for glycohemoglobin (HbA1c) were performed in 2009. Total 6 samples were distributed to 196 laboratories and the response rate was 97.2% (175/180) and 98.5% (193/196) in each trial. From this trial, we performed accuracy-based survey which used challenge specimens that were free from matrix effects and had target values traceable to certified reference material. Bias between each participants result and reference target value were evaluated.
Bias (Epidemiology) ; Congenital Hypothyroidism ; Galactosemias ; Humans ; Infant, Newborn ; Korea ; Maple Syrup Urine Disease ; Mass Screening ; Phenylketonurias ; Tandem Mass Spectrometry

The trial of external quality assessment for inborn error of metabolism was performed twice in 2004. Total 10 specimens for the conventional newborn screening tests were distributed to 43 laboratories. The response rates were 90.7%(39/43) in first trial and 90%(36/40) in second trial. All the control materials were sent as filter paper forms. Each laboratory replied the test results as the screening items they were doing as a routine test at the reception of the specimen among PKU screening, TSH, T4 (total/free), galactosemia screen, maple syrup urine disease screen, homocytinuria screen and histidinemia screen. The mean, SD, CV, median and range were analyzed. From this trial, pilot proficiency test for newborn screening using tandem mass spectrometry (MS/MS) was also performed. Total 8 blood spots were distributed to 7 laboratories performing newborn screening using MS/MS. Participants results for amino acids & acylcarnitine and their cutoff values were analyzed.
Amino Acids ; Galactosemias ; Humans ; Infant, Newborn ; Korea* ; Maple Syrup Urine Disease ; Mass Screening ; Metabolism* ; Tandem Mass Spectrometry