Clinical reasoning is considered a crucial concept in reaching medical decisions. This paper reviews the reasoning processes involved in clinical reasoning from the perspective of cognitive psychology. To properly use clinical reasoning, one requires not only domain knowledge but also structural knowledge, such as critical thinking skills. In this paper, two types of reasoning process required for critical thinking are discussed: inductive and deductive. Inductive and deductive reasoning processes have different features and are generally appropriate for different types of tasks. Numerous studies have suggested that experts tend to use inductive reasoning while novices tend to use deductive reasoning. However, even experts sometimes use deductive reasoning when facing challenging and unfamiliar problems. In clinical reasoning, expert physicians generally use inductive reasoning with a holistic viewpoint based on a full understanding of content knowledge in most cases. Such a problem-solving process appears as a type of recognition-primed decision making only in experienced physicians' clinical reasoning. However, they also use deductive reasoning when distinct patterns of illness are not recognized. Therefore, medical schools should pursue problem-based learning by providing students with various opportunities to develop the critical thinking skills required for problem solving in a holistic manner.
Decision Making ; Humans ; Problem Solving ; Problem-Based Learning ; Psychology ; Schools, Medical ; Thinking

Clinical reasoning is considered a crucial concept in reaching medical decisions. This paper reviews the reasoning processes involved in clinical reasoning from the perspective of cognitive psychology. To properly use clinical reasoning, one requires not only domain knowledge but also structural knowledge, such as critical thinking skills. In this paper, two types of reasoning process required for critical thinking are discussed: inductive and deductive. Inductive and deductive reasoning processes have different features and are generally appropriate for different types of tasks. Numerous studies have suggested that experts tend to use inductive reasoning while novices tend to use deductive reasoning. However, even experts sometimes use deductive reasoning when facing challenging and unfamiliar problems. In clinical reasoning, expert physicians generally use inductive reasoning with a holistic viewpoint based on a full understanding of content knowledge in most cases. Such a problem-solving process appears as a type of recognition-primed decision making only in experienced physicians' clinical reasoning. However, they also use deductive reasoning when distinct patterns of illness are not recognized. Therefore, medical schools should pursue problem-based learning by providing students with various opportunities to develop the critical thinking skills required for problem solving in a holistic manner.

We studied the intradural variations of spinal nerve rootlets in 100 cases of Korean adults. The results of the study are as follows ; 1. The incidence of intrasegmental variations (abberrant rootlets) is high in cervical segments and decreased toward lumbosacral segments. The incidence is higher in posterior rootlets than anterior, except cervical sesments. 2. The incidence of intersegmental variations is higher in posterior rootlets than anterior, and generally high in cervical and lumbar segments. 3. We divide the intersegmental variations into supernumerary rootlets, dividing rootlets, and anastomosing rootlets, and among them the incidence of anastomosing rootlets is higher. We divide the anastomosing rootlets into parallel anastomosing rootlets, uniting anastomosing rootlets, and rearrangement anastomosing rootlets. 4. The anterior to posterior anastomosing of spinal nerve rootlet is present in 4 of cases studied.
Adult ; Humans ; Incidence ; Spinal Nerves*

Traditionally, radical hysterectomy is the main surgical method for the treatment of early cervical carcinoma and always results in the loss of fertility. But, large numbers of young women are recently being diagnosed with cervical carcinoma and fertility preservation has become a concern. So, there has been a move towards more conservative approaches for the treatment of cervical carcinoma in recent years. Radical trachelectomy, which allows preservation of uterus but removes the cervix, parametrium and upper one third of the vagina, is a conservative but locally radical procedure. We performed radical abdominal trachelectomy with pelvic lymphadenectomy for two cases of invasive cervical carcinomas, which may be the first report in korea. One patient was 37 years old single women who had stage Ib cervical cancer and was disease free for 17 months after treatment. The other patient was 19 years old student who was also single and had stage IIa cervical cancer and was disease free for 14 months after treatment. We report the first two cases and review the literature on radical trachelectomy.
Adult ; Cervix Uteri ; Female ; Fertility ; Fertility Preservation ; Humans ; Hysterectomy ; Korea ; Lymph Node Excision* ; Uterine Cervical Neoplasms ; Uterus ; Vagina ; Young Adult

The term halo congenital nevus is a condition in which halo formation is associated with congenital melanocytic nevus. The regression of congenital melanocytic nevi is usually accompanied by the halo phenomenon and this is considered to be a rare event, although this may be underestimated. We describe here a 9-year-old boy with verrucous congenital nevus surrounded by a depigmented halo on the right upper arm. Histologically, the nevus lesion revealed a dense lymphocytic infiltration in the upper dermis intermingled with some remnants of nevus cell nests. Most of the infiltrating cells were CD8+ T lymphocytes. At the edge of the lesion, corresponding to the area of the halo, neither melanocytes nor melanin were found in any significant amounts.
Arm ; Child ; Dermis ; Humans ; Melanins ; Melanocytes ; Nevus ; Nevus, Pigmented ; T-Lymphocytes

Steroid sulfatase (STS) is an enzyme responsible for the hydrolysis of aryl and alkyl sulfates. STS plays a pivotal role in the regulation of estrogens and androgens that promote the growth of hormone-dependent tumors, such as those of breast or prostate cancer. However, the molecular function of STS in tumor growth is still not clear. To elucidate the role of STS in cancer cell proliferation, we investigated whether STS is able to regulate the integrin signaling pathway. We found that overexpression of STS in HeLa cells increases the protein and mRNA levels of integrin β1 and fibronectin, a ligand of integrin α5β1. Dehydroepiandrosterone (DHEA), one of the main metabolites of STS, also increases mRNA and protein expression of integrin β1 and fibronectin. Further, STS expression and DHEA treatment enhanced phosphorylation of focal adhesion kinase (FAK) at the Tyr 925 residue. Moreover, increased phosphorylation of ERK at Thr 202 and Tyr 204 residues by STS indicates that STS activates the MAPK/ERK pathway. In conclusion, these results suggest that STS expression and DHEA treatment may enhance MAPK/ERK signaling through up-regulation of integrin β1 and activation of FAK.
Androgens ; Breast ; Cell Proliferation ; Dehydroepiandrosterone ; Estrogens ; Fibronectins ; Focal Adhesion Protein-Tyrosine Kinases ; HeLa Cells ; Humans* ; Hydrolysis ; Phosphorylation ; Prostatic Neoplasms ; RNA, Messenger ; Steryl-Sulfatase* ; Sulfates ; Up-Regulation ; Uterine Cervical Neoplasms*

Fourteen consecutive patients underwent application of V.S.P(Variable Screw Placement) spinal plate between January 1989 and July 1989. Operative indications were spondylolisthesis, spinal stenosis, segmental instability, herniated disc with instability, pseudoarthrosis. unstable fracture, and failed surgery syndrome. Our patients consist of 8 cases of spondylolisthesis, 4 cases of fracture-dislocation, one case of spondylolysis with instability, one case of herniated disc(L1- 2 interspace). Overall results showed 36% excellent, 50% good, 7% fair, 7% poor. Two deep wound infections were observed. Screw alignment and the angular relationship of each screw to the spinal plate is considered as important technical factors in minimizing screw failure.
Humans ; Intervertebral Disc Displacement ; Pseudarthrosis ; Spinal Stenosis ; Spine* ; Spondylolisthesis ; Spondylolysis ; Wound Infection

BACKGROUND: Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disease of an unknown etiology, and this is characterized by spiking fever, evanescent rash, arthritis and multiorgan involvement. OBJECTIVE: This study was conducted to better understand the clinical characteristics of patients with AOSD, and especially the cutaneous features. METHODS: We reviewed the medical records and cutaneous findings of 21 patients who were diagnosed with AOSD at our hospital from 2003 to 2009. The diagnosis of AOSD was based on the criteria proposed by Yamaguchi et al. RESULTS: Eighteen (86%) out of the 21 patients were women, and the age of onset ranged from 18 to 55 years. Fever occurred in 21 (100%) patients, skin rash in 20 (95%), arthralgia in 18 (86%), sore throat in 10 (48%) and lymphadenopathy in 7 (33%). The cutaneous features were as follows: typical maculopapular eruption (70%), urticaria (10%), petechia and purpura (10%), persistent plaques and linear pigmentation (5%) and acne-like lesions (5%). The most common sites of skin lesion were the trunk (80%) and thighs (80%). The histopathologic findings of 9 patients showed non-specific chronic inflammation with a perivascular mononuclear preponderance in 6 patients, and the others were consistent with urticaria or leukocytoclastic vasculitis. CONCLUSION: The various cutaneous features of this study suggest that dermatologists should consider AOSD in any patient with cutaneous eruption associated with fever and arthralgia.
Adult ; Age of Onset ; Arthralgia ; Arthritis ; Exanthema ; Female ; Fever ; Humans ; Inflammation ; Lymphatic Diseases ; Medical Records ; Pharyngitis ; Pigmentation ; Purpura ; Skin ; Still's Disease, Adult-Onset ; Thigh ; Urticaria ; Vasculitis ; Vasculitis, Leukocytoclastic, Cutaneous

BACKGROUND: Tuberculosis is the most frequent opportunistic infection in HIV-infected patients in Korea. We examined the incidence and risk factors for tuberculosis in HIV-infected patients. METHODS: We reviewed the medical records of 143 HIV-infected patients between January 1988 and June 1997 at the Seoul National University Hospita The incidence of tuberculosis was determined by the number of new tuberculosis per 100 patients divided by a total duration of follow-up (cases/100 person- years). The incidence of tuberculosis was analyzed with respect to CD4+ lymphocyte count, status of tuberculin skin reaction, and status of delayed hypersensitivity skin reaction. RESULTS: The total duration of follow-up was 229.6 person-years. During follow-up, 22 patients developed tuberculosis [9.6 cases per 100 person-years (95% CI, 6.0 to 14.5)]. The incidence of tuberculosis according to sex and transmission route showed no significant difference. Tuberculosis occurred more frequently in patients with minimum CD4+ T lympho-cyte counts of less than 200 cells/mm3 (14.2 cases/100 person-years) than in those with higher T lymphocyte counts (3.9 cases/100 person-years) [relative risk, 4.02 (95% CI 1.32 to 12.5), P=0.009]. The incidence of tuberculosis was higher among tuberculin- positive patients [17.0 cases/100 person-years (95% CI, 9.0 to 29.0)] than among tuberculin-negative [8.0 cases/100 person-years (95% CI, 3.2 to 16.6)], but the difference was not statistically significant [relative risk, 2.35 (95% CI, 0.88 to 6.26, P=0.078)]. The rate of tuberculosis in patients with negative delayed hypersensitivity test was not significantly different from that in patients with positive results (P=0.510). CONCLUSION: The incidence of tuberculosis was 9.6 cases per 100 person-years. CD4+ lymphocyte count (<200 cells/mm3) was the most useful predictor for the development of tuberculosis in HIV patients in Korea.
Follow-Up Studies ; HIV ; Humans* ; Hypersensitivity, Delayed ; Incidence* ; Korea* ; Lymphocyte Count ; Medical Records ; Opportunistic Infections ; Risk Factors* ; Seoul ; Skin ; Tuberculin ; Tuberculosis*

A 45-year-old female with psychosis complained urological symptom of urinary incontinence and voiding difficulty with abdominal pains and expansion during her psychiatric hospitalization and suddenly collapsed at the 14th day of the admission. At autopsy, the urinary bladder showed a focal perforation and the abdominal cavity was filled with massive urinary ascites. The both lower lobes and the right upper lobe of the lung were accompanied by atelectasis. The death mechanism of this case could be explained that an increased abdominal pressure produced by massive uroperitoneum with spontaneous bladder rupture led to respiratory failure. The so-called abdominal compartment syndrome was manifested by massive uroperitoneum and caused a death. This would be the first forensic medical case that an undiagnosed spontaneous bladder rupture resulted in death of a psychiatric illness patient.
Abdominal Cavity ; Abdominal Pain ; Ascites ; Autopsy ; Female ; Hospitalization ; Humans ; Intra-Abdominal Hypertension ; Lung ; Middle Aged ; Psychotic Disorders ; Pulmonary Atelectasis ; Respiratory Insufficiency ; Rupture* ; Urinary Bladder* ; Urinary Incontinence