There are many problems in the treatment of intertrochanteric fracture of the femur in elderly patients due to poor bone quality and unstable pattern of the fracture. In the internal fixation of intertrochanteric fracture, it is known that the important prognostic factors include the accuracy of anatomic reduction, the stability of reduction, and the proper positioning if the lag screw. However, in elderly patients, the loss of reduction frequently occur as a postoperative complication in spite of the adequate anatomic reduction. In general, the bone graft increases initial stability of the fracture and promotes bone healing. So authors tried a prospective study using plain films to determine the effects of bone graft in the treatment of osteoporotic unstable intertrochanteric fracture of the femur with large bone defect in the posteromedial cortex. The study population included 35 patients who had been treated at the Department of Orthopaedic Surgery, Yonsei University College of Medicine from Mar. 1990 and to Feb. 1994. The results were as follows. 1. Among 35 patients, there are 22 cases of anatomically reduced (6 cases of bone graft group and 16 cases of non-bone graft group) and 13 cases of nonanatomically reduced (5 cases of bone graft group and 8 cases of non-bone graft group). 2. The average sliding length was 5.7mm in antomically reduced (5.0mm in bone graft group and 6.1mm in non-bone graft group) and 7.9mm in nonanatomically reduced (6.0mm in bone graft group and 9.6mm in non-bone graft group). 3. The loss of reduction during follow-up period was found in 6 cases in anatomically reduced (27.3%), 1 case in bone graft group (16.7%) and 5 cases in non-bone graft group (31.2%), and 6 cases (75%) in nonanatomically reduced without bone graft. In conclusion, additional bone graft in the treatment of osteoporotic unstable intertrochanteric fracture of the femur decreased postoperative complications such as the varus and posterior angular deformity. Therefore, we recommend selective bone graft in the treatment of osteoporotic unstable intertrochanteric fracture of the femur with large bone defect in the posteromedial cortex.
Aged ; Congenital Abnormalities ; Femur ; Follow-Up Studies ; Humans ; Postoperative Complications ; Prospective Studies ; Transplants

Ewing's sarcoma is rarely found occurs in the bones of the hands and feet. We report a case of Ewing's sarcoma of the left calcaneus in a 15-year-old girl who complained of left heel pain and swelling. An open biopsy was performed and histological examination showed the proliferation of uniform small round cells. Immunohistochemical staining for CD99 showed diffuse strong positivity in the cytoplasmic membrane of the tumor cells. After preoperative chemotherapy, a below knee amputation was performed.
Adolescent ; Amputation ; Biopsy ; Calcaneus* ; Cell Membrane ; Drug Therapy ; Female ; Foot ; Hand ; Heel ; Humans ; Knee ; Sarcoma, Ewing*

The p53 oncoprotein, a product of the tumor suppressor gene encoded on the short arm of chromosome 17, has been noted in a number of human tumors as a tumor suppressor and some what has been related with cellular apoptosis. Thus, mutant p53 inhibits apoptosis. Like the mutant p53 oncoprotein, the bcl-2 oncoprotein expressed in various epithelial and nonepithelial cells plays a major role in inhibiting cellular apoptosis. To elucidate the role of bcl-2 and mutant p53 oncoprotein expression in gastric adenocarcinomas, immunohistochemical stains were carried out in 60 cases of gastric adenocarcinomas including 10 cases of early gastric cancer. We studied the expression patterns of the bcl-2 and the mutant p53 protein according to age, sex, histologic differentiation, tumor location, tumor size, lymph-node involvement, and depth of tumor invasion. The results were as follows: 1) p53 protein expression was detected in 39 of 60 cases (65%), and bcl-2 protein expression was detected in 29 of 60 cases (48%). 2) The p53 and the bcl-2 expression rates for early gastric cancer were 60% and 50%, and those for advanced gastric cancer were 66% and 40%, respectively. 3) There was no significant correlation of p53 or bcl-2 expression with sex, age, histologic differentiation, tumor location, tumor size, and lymph-node involvement; however, the expression of p53 was correlated with the depth of tumor invasion (p=0.049). Based on the present study, the expression of p53 is thought to be correlated with tumor progression and may be a useful prognostic factor in gastric adenocarcinomas.
Adenocarcinoma* ; Apoptosis ; Arm ; Chromosomes, Human, Pair 17 ; Coloring Agents ; Genes, bcl-2* ; Genes, p53* ; Genes, Tumor Suppressor ; Humans ; Immunohistochemistry ; Stomach Neoplasms

PURPOSE: Although there have been studies emphasizing the re-education of North Korean (NK) doctors for post-unification of the Korean Peninsula, study on the content and scope of such re-education has yet to be conducted. Researchers intended to set the content and scope of re-education by a comparative analysis for the scores of the preliminary examination, which is comparable to the Korean Medical Licensing Examination (KMLE). METHODS: The scores of the first and second preliminary exams were analyzed by subject using the Wilcoxon signed rank test. The passing status of the group of NK doctors for KMLE in recent 3 years were investigated. The multiple-choice-question (MCQ) items of which difficulty indexes of NK doctors were lower than those of South Korean (SK) medical students by two times of the standard deviation of the scores of SK medical students were selected to investigate the relevant reasons. RESULTS: The average scores of nearly all subjects were improved in the second exam compared with the first exam. The passing rate of the group of NK doctors was 75%. The number of MCQ items of which difficulty indexes of NK doctors were lower than those of SK medical students was 51 (6.38%). NK doctors' lack of understandings for Diagnostic Techniques and Procedures, Therapeutics, Prenatal Care, and Managed Care Programs was suggested as the possible reason CONCLUSION: The education of integrated courses focusing on Diagnostic Techniques and Procedures and Therapeutics, and apprenticeship-style training for clinical practice of core subjects are needed. Special lectures on the Preventive Medicine are likely to be required also.
Clinical Competence ; Democratic People's Republic of Korea ; Diagnostic Techniques and Procedures ; Education ; Foreign Medical Graduates ; Humans ; Lectures ; Licensure ; Managed Care Programs ; Prenatal Care ; Preventive Medicine ; Refugees* ; Students, Medical

PURPOSE: This study aimed to develop a core competency model for translational medicine curriculum in the Korean graduate education context. METHODS: We invited specialists and key stakeholders to develop a consensus on a core competency model. The working group composed of 17 specialists made an initial draft of a core competency model based on the literature review. The initial draft was sent to the survey group by email to ask whether they agreed or disagreed with each core competency. The working group simplified, merged, or excluded the competencies that received less than 80% agreement among the 43 survey respondents. The working group also reorganized the order of the domains and competencies based on the survey results, and clustered the domains into four major areas. RESULTS: The final core competency model has four areas, 12 domains, and 34 core competencies. The major areas are theory-based problem assessment and formulation, study design and measurement, study implementation, and literature review and critique. CONCLUSION: This new core competency model will provide guidance for the competency based education of translational medicine in Korea.
Competency-Based Education ; Consensus ; Curriculum* ; Education, Graduate ; Electronic Mail ; Evaluation Studies as Topic ; Korea ; Specialization ; Surveys and Questionnaires ; Translational Medical Research*

Capillary hemangioma of the adult nasal cavity is rare. We report a case which occurred in the right nasal cavity of a 25-years-old woman, together with the multiphase enhanced CT findings. The patients who had a history of recurrent nasal bleeding, had experienced nasal obstruction and swelling during the two-month period prior to presentation, and one month before presentation, spontaneous vaginal delivery occurred. Physical examination revealed the presence of a well-defined round mass, with redness in the right nasal vestibule. The mass showed rim enhancement at early arterial-phase CT scanning, increased enhancement at the late arterial phase, and moderately homogeneous enhancement at the delayed phase.
Adult* ; Capillaries* ; Epistaxis ; Female ; Hemangioma ; Hemangioma, Capillary* ; Humans ; Nasal Cavity* ; Nasal Obstruction ; Nose ; Physical Examination ; Tomography, X-Ray Computed

Granular cell tumors are uncommon soft tissue neoplasm of nerve sheath origin, which are predominately benign. Granular cells can be found at any site in the body including the tongue, skin, subcutaneous tissue, breast, gastrointestinal, and urogenital systems. However, granular cell tumors have only been rarely described in the chest wall. Here we report a case of a granular cell tumor that occurred in the chest wall of a 59-year-old woman, along with a review of the literature.
Breast ; Female ; Granular Cell Tumor ; Humans ; Middle Aged ; Skin ; Soft Tissue Neoplasms ; Subcutaneous Tissue ; Thoracic Wall ; Thorax ; Tongue ; Urogenital System

The potential role of topical valproate (VPA) in hair regrowth has been recently suggested. However, safety reports of VPA as a topical formulation are lacking. Therefore, in the present study, we investigated whether VPA causes skin irritation in humans. We first performed a cell viability test and showed that VPA did not exhibit toxicity toward HaCaT keratinocytes, fibroblasts, and RBL-3H mast cells. We then performed clinical patch test and skin irritation test through transdermal drug delivery with the help of microneedle rollers. No significant findings were obtained in the clinical patch test. In the skin irritation test, only 1 patient showed erythema at 1 hr, but the irritation reaction faded away within a few hours. Erythema and edema were not observed at 24 hr. We concluded that VPA has minimal potential to elicit skin irritation. Therefore, we consider that VPA can safely be applied to human skin.
Cell Survival ; Edema ; Erythema ; Fibroblasts ; Hair ; Humans ; Keratinocytes ; Mast Cells ; Patch Tests ; Skin ; Valproic Acid

Fibrous dysplasia is a bone disorder characterized by progressive replacement of normal bone by fibrous bone tissue. Common involving sites of fibrous dysplasia are the skeletal system including long bones, ribs, craniofacial bones and the pelvis. If maxilla were affected by fibrous dysplasia, antrum is almost always involved. And fibrous dyplasia in maxillary sinus were followed the shape of bone. In our case, the lesion involves antrum but, its shape was different from typical fibrous dysplasia pattern of maxillary sinus. Therefore we report a case of monostotic pediculated fibrous dysplasia in the maxillary sinus with a review of literature.
Bone and Bones ; Maxilla ; Maxillary Sinus* ; Pelvis ; Ribs