No abstract available.
Rubinstein-Taybi Syndrome*

Brunner's gland adenoma(or Brunneroma) is clinically relevant tumor-like lesion of the duodenum which is composed of submucosal Brunner's gland tissue. Since the first case by autopsy was described by Cruveihier in l935, there have been less than 190 reports in the world literature, Brunner's gland adenoma is an extremely rare entity that accounts for only 10.6% of benign duodenal tumors, which are themselves relatively rare representing 0.008% of all surgical and autopsy specimens. The clinical manifestation of this tumor are non-specific gastrointestinal complaints, such as bloating or epigastric pain, and tumor often gives rise to melena or obstruction, It is postulated that this tumor are hamartomas rather than true neoplasm. However, they undergo rarely malignant transformation. We report on a case of a large pedunculated Brunner's gland adenoma, which was successfully polypectomized.
Adenoma* ; Autopsy ; Duodenum ; Hamartoma ; Melena

Brunner's gland adenoma(or Brunneroma) is clinically relevant tumor-like lesion of the duodenum which is composed of submucosal Brunner's gland tissue. Since the first case by autopsy was described by Cruveihier in l935, there have been less than 190 reports in the world literature, Brunner's gland adenoma is an extremely rare entity that accounts for only 10.6% of benign duodenal tumors, which are themselves relatively rare representing 0.008% of all surgical and autopsy specimens. The clinical manifestation of this tumor are non-specific gastrointestinal complaints, such as bloating or epigastric pain, and tumor often gives rise to melena or obstruction, It is postulated that this tumor are hamartomas rather than true neoplasm. However, they undergo rarely malignant transformation. We report on a case of a large pedunculated Brunner's gland adenoma, which was successfully polypectomized.
Adenoma* ; Autopsy ; Duodenum ; Hamartoma ; Melena

BACKGROUND: Evaluation of clinical performance is an essential area for the students who are preparing their career as a medical doctor. However the clinical skills has neither been taught with balanced proportion nor adequately being assessed their abilities. Yet no significant studies on this issue has been reported in Korea so far. The present study was done as a part of preliminary study to seek a model that would be introduced clinical performance assessment in Korean Medical Licensure Examination system. Purpose: The objectives of this study is to develop items of clinical performance and the effective methods to carry out the clinical performance assessment in Korean Medical Licensure Examination system. METHODS: Primary list of clinical performances which was generated through discussion between researchers and medical experts has been distributed to the physicians of various levels. Six hundred ninety seven medical doctors including professors, family physicians, and public health doctors were asked to express their opinion by mail questionnaire. Final items were selected after the reaction of questionnaires and each item has been carefully studied its validity, achievability, and practicality. RESULTS: Thirty five items were selected among fifty one items presented according to the checked number of "essential" and "frequently useful". Seven items were added according to the higher rate of recommendation by open questionnaire. The forty two items were confirmed as a final list which the students should be expected to demonstrate prior to graduation from undergraduate medical school("exit objective"). The OSCE was performed without any serious logistic problems and both examinees and evaluators thought the experience positively. CONCLUSION: To look at the present environment and the readiness it is recommendable to apply the items of psychomotor skills at the beginning for Medical Licensure Examination. For that purpose various medical dolls, kits and subjects can be used.
Clinical Competence ; Humans ; Korea ; Licensure, Medical* ; Physicians, Family ; Postal Service ; Public Health ; Surveys and Questionnaires

Traumatic fat necrosis is a localized reaction of panniculus resulting from blunt trauma occurring predominantly on large pendulous breasts in elderly females and on the face in children. The facial lesions in children need no treatment and therapeutic excision is not indicated because a reasonable cosmetic result comes from spontaneous healing in a year or more. The clinicians unfamiliar with this problem may have confusion in diagnosis and management. Herein we report a case of a three-year-old girl who presented with a 3 cm sized erythematous and bullous plaque on her right cheek. The diagnosis of traumatic fat necrosis was made following clinical and pathological findings.
Aged ; Breast ; Cheek ; Child* ; Diagnosis ; Fat Necrosis* ; Female ; Humans

BACKGROUND: Evaluation of clinical performance is an essential area of Medical Licensure Examination. Yet, clinical skills has been neither uniformly well taught nor adequately assessed. This study was done as a part of preliminary study to introduce clinical performance assessment to Korean Medical Licensure Examination. The goals of this study were to identify the potential logistic problems and to examine the feasibility of OSCE to Medical Licensure Examination. METHODS: 48 minutes long OSCE, which consist of eight 5-minute stations, was developed. The same examination was administered to students over a four-week period. RESULTS: Total 26 volunteer fourth-year medical students were tested. 11 students were examined at the first administration and the rest of them were evaluated four-week later. Cronbach alpha of the total stations was 0.52. Any big administration problems were not revealed. There was no significant total score difference between early examinee and later ones. Students evaluated the OSCE contents and process positively. CONCLUSION: To acquire more reliable and valid examination, we need to develop more objective checklist and evaluator and SP training.
Checklist ; Clinical Competence ; Humans ; Licensure, Medical* ; Students, Medical ; Volunteers

As a complication following anterior cervical spine screw or plate fixation, a pharyngoesophageal diverticulum (Zenker's diverticulum) is rare in comparison with iatrogenic esophageal perforation or tracheo-esophageal fistula. Esophageal perforation or fistula usually develop abrupt and severe symptoms such as fever, dyspnea, coughing or swelling on the cervical area. However. there is no definite symptoms except mild and chronic dysphagia in case of pharyngoesophageal diverticulum. Therefore, it is very likely that the diagnosis will be delayed and serious complication will be occurred. We report a case of 58-year-old spinal cord injured man with a Zenker's diverticulum following anterior cervical plate fixation.
Cough ; Deglutition Disorders ; Diagnosis ; Dyspnea ; Esophageal Perforation ; Fever ; Fistula ; Humans ; Middle Aged ; Spinal Cord ; Spine* ; Zenker Diverticulum*

Acinetobacter baumannii (AB) is a common pathogen found in patients with hospital-acquired pneumonia all over the world. Community-acquired AB pneumonia, however, is very rare and has seldom been reported in Asia-Pacific countries. Community-acquired AB pneumonia has a fulminant course and is associated with a higher mortality than hospital-acquired AB pneumonia. In Korea, no case of fatal community-acquired AB pneumonia has been reported to date. Here, we describe the first fatal case of fulminant community-acquired AB pneumonia in Korea.
Acinetobacter Infections/diagnosis/*microbiology/therapy ; Acinetobacter baumannii/*isolation & purification ; Community-Acquired Infections/diagnosis/*microbiology/therapy ; Disease Progression ; Fatal Outcome ; Humans ; Male ; Middle Aged ; Republic of Korea ; Time Factors ; Treatment Failure

BACKGROUND: As the population with chronic degenerative disease or functional impairment has increased in terms of the advanced aging society, the inevitability of home health services for the homebound have been augmented as a token of the trend toward the nuclear family along with the family capacity of care declined. For the past several years, home nursing service facilities have been enlarged and partially have been fulfilling these requirements. However, there are a great number of demands for home health service by physicians. Thereupon, we designed the following study to observe the cases of home visits by a medical office practice and to provide some information about the need of the home visit and its clinical features. METHODS: The study was conducted reviewing currently remained 84 data of home visit records at a home-visit- specialized medical office practice for 10 months in 1999. Its information collected was as below: patient's sex, age, frequency and duration of visit, distance to visit location, reason being homebound, and reason for visit. RESULTS: Of the reviewed records of 84 patients, comprised of 356 home visits, the median age of the patients was 67.5 years. They were visited 2 times as a median and with a median duration of 4 days. Physician drove a median distance of 6.1km one-way. Most common diagnoses were cancer and cerebrovascular diseases, equally with 10.8%. Reasons for being homebound were neurologic problem (28.6%), frail elderly (21.4%), terminal illness (20.2%) in order. Sixty two patients (73.8%) were permanently homebound and 12 patients (14.3%) were not. Reasons for visits were routine follow-up (42.1%) and evaluation of a new problem (19.9%) in the chronic homebound and terminal illness care (17.1%). While 102 visits (28.6%) should have begun by doctor-based visit, 233 visits (65.4%) including routine follow-up could be considered to be replaced for home nursing services. Even out of 233 visits, not all could be replaced and some should remain as physician's regular follow-up. CONCLUSION: There were needs of home visit in both permanent and transient homebound patients, in cases of exacerbation, new problem and routine follow-up of chronic homebound patients, and also in acute illness of previously healthy persons. To meet the needs of homebound patients in seeing the physician, and to offer adequate health services, the physician's role should be acknowledged in home nursing service, and home visit by physician should be institutionalized and carried into effect.
Aged ; Aging ; Diagnosis ; Follow-Up Studies ; Frail Elderly ; Health Services ; Home Nursing ; House Calls* ; Humans ; Nuclear Family ; Physician's Role ; Seoul*

PURPOSE: Benign childhood epilepsy with centrotemporal spikes(BECT) is characterized by an excellent prognosis. Therefore, the necessity for the use of antiepileptic drugs is controversial. The object of this study is to know about the long-term follow-up of BECT, comparing daily treatment with antiepileptic drug(AED) versus no medication. METHODS: We retrospectively studied 56 cases of BECTs, examined at Pediatric Neurology Clinic, Korea University Medical Center as reference study time, August 2002. Thirty-eight patients didn't have mediation(group I), while eighteen patients received one or two AED(group II). We evaluated demographics, clinical manifestations at diagnosis, EEG findings and clinical courses in groups I & II. RESULTS: There was no significant differences of sex, age, seizure frequency, seizure type, seizure onset time, family history and EEG findings between group I & II. The reasons to start AED were: parents' anxiety(three cases), frequent seizure(12 cases) and daytime seizure(three cases). There was no evolution of status epilepticus and no difficulty in school performance. CONCLUSION: AED treatment was of no advantage and long-term prognosis was good regardless of treatment strategy. So it is advisable not to choose AED as the first line of therapy, provided that the patient himself/herself or the family understands the benign nature of BECT.
Academic Medical Centers ; Anticonvulsants ; Demography ; Diagnosis ; Electroencephalography ; Epilepsy ; Epilepsy, Rolandic* ; Follow-Up Studies ; Humans ; Korea ; Neurology ; Prognosis ; Retrospective Studies ; Seizures ; Status Epilepticus