Malignant tumor originated from external auditory canal (EAC) is very rare with an annual incidence of around 1 per million. Pathologically, squamous cell carcinoma is incidentally most common, and adenoid cystic carcinoma, basal cell carcinoma, and melanoma follow in decreasing order. Due to the rarity of malignant tumor of EAC, there is no widely accepted treatment modality yet. But basal cell carcinoma, known to be less aggressive tumor, can be removed with a minimal safety margin and have better treatment results. Recently we experienced a case of basal cell carcinoma in the EAC, confined in the cartilaginous portion of EAC, presenting with intermittent otorrhea for several years. The patient was treated with a sleeve resection of the EAC with a safety margin reconstructed with a split-thickness skin graft. No tumor recurrence or complication was noted in the first postoperative year.
Aminocaproic Acids ; Carcinoma, Adenoid Cystic ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Ear Canal ; Humans ; Incidence ; Melanoma ; Recurrence ; Skin ; Transplants

PURPOSE: Endoscopic thyroidectomy has recently been widely used in clinical practice. The operative method can be classified into CO2gas insufflation and the gasless technique. This study assessed the safety of low pressure CO2gas insufflation (up to 6 mmHg) by performing continuous measurement of the end-tidal CO2 (ETCO2) pressure. METHODS: From March 2003 to October 2006, 95 patients (90 hemithyroidectomies and 5 total thyroidectomies) underwent endoscopic thyroidectomy. The low pressure CO2gas insufflation technique was applied in all cases. The ETCO2 pressure of the patients was measured by capnometry at the time of a pre-gas insufflation status (0 minutes) and at the time of post-CO2gas insufflation (30 minutes) and then it was measured every 30 minutes with also performing capnograms. We analyzed the ETCO2 pressure at the time of the pre-CO2gas insufflation status (0 min) and we compared this with that of each status by using paired T-test. RESULTS: For all 95 cases, the mean patient age was 36.2+/-9.1 (range: 21~57 years), the mean tumor size was 1.7+/-1.1 (range: 0.1~4.5 cm) and the mean operative time was 135.0+/-46.1 (range: 50~340 min). The mean ETCO2 pressure (mmHg) was 33.0+/-3.9 at the time of pre-CO2gas insufflation status (0 min); the mean ETCO2 pressure was 31.1+/-3.7 at 30 min (n=95), 33.5+/-3.7 at 60 min (n=95), 35.2+/-3.6 at 90 min (n=95), 34.9+/-3.7 at 120 min (n=90), 34.6+/-3.8 at 150 min (n=70), 34.1+/-3.4 at 180 min (n=40), 34.3+/-5.2 at 210 min (n=15) and 34.0+/-4.2 at 240 min (n=9). There was a significant difference the early post-CO2gas insufflation status (P<0.05 at 30 min, 90 min, 120 min), but there was no significant difference in the late post-CO2gas insufflation status (P>0.05; at 60 min, 150 min, 180 min, 210 min, 240 min). At each time point, the ETCO2 pressures were all within the normal range. CONCLUSION: We successfully performed endoscopic thyroidectomy with using the low pressure CO2gas insufflation technique and there were no significant complications. We think that performing endoscopic thyroidectomy with using the low pressure CO2gas insufflation technique is a safe procedure.
Humans ; Insufflation* ; Operative Time ; Prospective Studies* ; Reference Values ; Thyroidectomy*

OBJECTIVES: This study investigated changes in gene expressions concerning of differentiation, proliferation, mineralization and inflammation using Human-8 expression bead arrays when white Mineral Trioxide Aggregate and calcium hydroxide-containing cement were applied in vitro to human dental pulp cells (HDPCs). MATERIALS AND METHODS: wMTA (white ProRoot MTA, Dentsply) and Dycal (Dentsply Caulk) in a Teflon tube (inner diameter 10 mm, height 1 mm) were applied to HDPCs. Empty tube-applied HDPCs were used as negative control. Total RNA was extracted at 3, 6, 9 and 24 hr after wMTA and Dycal application. The results of microarray were confirmed by reverse transcriptase polymerase chain reaction. RESULTS: Out of the 24,546 genes, 43 genes (e.g., BMP2, FOSB, THBS1, EDN1, IL11, COL10A1, TUFT1, HMOX1) were up-regulated greater than two-fold and 25 genes (e.g., SMAD6, TIMP2, DCN, SOCS2, CEBPD, KIAA1199) were down-regulated below 50% by wMTA. Two hundred thirty nine genes (e.g., BMP2, BMP6, SMAD6, IL11, FOS, VEGFA, PlGF, HMOX1, SOCS2, CEBPD, KIAA1199) were up-regulated greater than two-fold and 358 genes (e.g., EDN1, FGF) were down-regulated below 50% by Dycal. CONCLUSIONS: Both wMTA and Dycal induced changes in gene expressions related with differentiation and proliferation of pulp cells. wMTA induced changes in gene expressions related with mineralization, and Dycal induced those related with angiogenesis. The genes related with inflammation were more expressed by Dycal than by wMTA. It was confirmed that both wMTA and Dycal were able to induce gene expression changes concerned with the pulp repair in different ways.
Aluminum Compounds ; Calcium ; Calcium Compounds ; Calcium Hydroxide ; Dental Pulp ; Dental Pulp Capping ; Drug Combinations ; Gene Expression ; Glutamates ; Guanine ; Humans ; Hydroxides ; Inflammation ; Interleukin-11 ; Minerals ; Oxides ; Polytetrafluoroethylene ; Reverse Transcriptase Polymerase Chain Reaction ; RNA ; RNA-Directed DNA Polymerase ; Silicates ; Transcriptome ; Pemetrexed

Authors report a case of cystic tuberculosis of left olecranon in a 44 year-old woman, which mimicked the bone tumor at initial presentation. She complained mild discomfort in the left elbow over a month. On examination there were no local redness, swelling, tenderness and deformity. There was no limitation of left elbow motion. After open curettage of the lesion, bone tuberculosis was confirmed by histological study. Postoperative triple chemotherapy of 12 months (Rifamcpicin, ethambutal, INH) could cure the disease.
Congenital Abnormalities ; Curettage ; Elbow ; Female ; Humans ; Olecranon Process ; Tuberculosis ; Tuberculosis, Osteoarticular

The longitudinal integrated clerkship is an innovative approach in medical education that emphasizes continuity as a key principle to provide student-centered experiences and learning. Seoul National University College of Medicine decided to adapt longitudinal integrated clerkships to the new curriculum beginning in 2018, and therefore conducted pilot studies in 2016 and 2017. This study aimed to analyze the program evaluation results of the two pilot programs and discuss issues related to the successful implementation of longitudinal integrated clerkships in Korea. We conducted a focus group interview with nine students who participated in the 2016 pilot program and 13 students who participated in the 2017 pilot program. We also conducted a focus group interview with 11 faculty members who either participated in the pilot program or will participate in the main program. From the 2016 experience, we found that it is not appropriate to assign each patient to a single student and let the students contact their patients personally for feasibility and safety reasons. In the 2017 pilot program, we assigned each patient to a group of students, which made it more feasible for the students to follow-up with their patients. The students were satisfied with their new experience of longitudinal patient follow-up and regular meetings in the pilot program. Faculty emphasized the importance of establishing the course objectives and holding an orientation for the students and the faculty. Further study is planned to evaluate the early outcomes of the main longitudinal integrated clerkship.
Curriculum ; Education, Medical ; Focus Groups ; Follow-Up Studies ; Humans ; Korea ; Learning ; Linear Energy Transfer ; Pilot Projects ; Program Evaluation ; Seoul

PURPOSE: Team-based learning (TBL) is increasingly employed in medical education because of its potential to promote active group learning. In TBL, learners are usually asked to assess the contributions of peers within their group to ensure accountability. The purpose of this study is to assess the validity and reliability of a peer evaluation instrument that was used in TBL classes in a single medical school. METHODS: A total of 141 students were divided into 18 groups in 11 TBL classes. The students were asked to evaluate their peers in the group based on evaluation criteria that were provided to them. We analyzed the comments that were written for the highest and lowest achievers to assess the validity of the peer evaluation instrument. The reliability of the instrument was assessed by examining the agreement among peer ratings within each group of students via intraclass correlation coefficient (ICC) analysis. RESULTS: Most of the students provided reasonable and understandable comments for the high and low achievers within their group, and most of those comments were compatible with the evaluation criteria. The average ICC of each group ranged from 0.390 to 0.863, and the overall average was 0.659. There was no significant difference in inter-rater reliability according to the number of members in the group or the timing of the evaluation within the course. CONCLUSION: The peer evaluation instrument that was used in the TBL classes was valid and reliable. Providing evaluation criteria and rules seemed to improve the validity and reliability of the instrument.
Education, Medical ; Humans ; Learning* ; Methods* ; Reproducibility of Results* ; Schools, Medical ; Social Responsibility

This study was designed to investigate the expression and production of interleukin-1beta (IL-1beta) in human peripheral blood of trained runners and untrained controls after temporary moderate intensity exercise. Male long-distance trained runners (TR) and untrained sedentary control subjects (SED) ran for 1 h at 70% of heart rate reserve (HRR). IL-1beta gene and protein expressions were significantly higher in TR than those with SED at all 3 intervals examined independently. Significant increases in total sweat volume and oral temperature were observed after exercise in both groups, however, there were some differences between the groups. We conclude, therefore, that sweating due to exercise is associated with increase of IL-1beta and it is correlated with decrease of oral temperature.
Body Temperature* ; Heart Rate ; Humans ; Interleukin-1beta* ; Male ; Sweat* ; Sweating*

Background: and PurposeInterhospital transfer is an essential practical component of regional stroke care systems. To establish an effective stroke transfer network in South Korea, an interactive transfer system was constructed, and its workflow metrics were observed. Methods: In March 2019, a direct transfer system between primary stroke hospitals (PSHs) and comprehensive regional stroke centers (CSCs) was established to standardize the clinical pathway of imaging, recanalization therapy, transfer decisions, and exclusive transfer linkage systems in the two types of centers. In an active case, the time metrics from arrival at PSH (“door”) to imaging was measured, and intravenous thrombolysis (IVT) and endovascular treatment (EVT) were used to assess the differences in clinical situations. Results: The direct transfer system was used by 27 patients. They stayed at the PSH for a median duration of 72 min (interquartile range [IQR], 38–114 min), with a median times of 15 and 58 min for imaging and subsequent processing, respectively. The door-to-needle median times of subjects treated with IVT at PSHs (n=5) and CSCs (n=2) were 21 min (IQR, 20.0–22.0 min) and 137.5 min (IQR, 125.3–149.8 min), respectively. EVT was performed on seven subjects (25.9%) at CSCs, which took a median duration of 175 min; 77 min at the PSH, 48 min for transportation, and 50 min at the CSC. Before EVT, bridging IVT at the PSH did not significantly affect the door-to-puncture time (127 min vs. 143.5 min, p=0.86). Conclusions The direct and interactive transfer system is feasible in real-world practice in South Korea and presents merits in reducing the treatment delay by sharing information during transfer.

OBJECTIVE: Limited data are available concerning the outcome of the patients with atypical meningioma due to lack of the studies with large series. The authors review atypical meningioma retrospectively and analyzed various parameters concerning its outcome. METHODS: Of the 866 meningioma patients treated between 1990 and 2003, pathologically proven 54 atypical meningiomas were reviewed. Various factors of the patients were analyzed, and surgical specimens were re-examined blindly by neuropathologist without any patient information. Extent of surgical resection was determined according to Simpson's classification by reviewing the chart and postoperative scan if possible. RESULTS: Twenty-three (42.6%) had local recurrences during the follow-up, of which 13 (32.5%) of 40 complete excisions and 10 (71.4%) of 14 incomplete excisions. The median time to recurrence was 47 months, and the overall 3-, 5-, and 10-year local control rates were 62.4%, 41.5%, and 31.1%, respectively. Five (9.3%) died during follow-up period. The mean survival time was 123 months, and the overall 3-, 5-, and 10-year survival rates were 94.2%, 87.2%, and 78.5%, respectively. The extent of surgical excision was the most significant prognostic factor not for survival but for local control (p=0.2179 and 0.0005, respectively). Extracranial metastasis was not seen in our cases. CONCLUSION: Complete surgical excision is the most important factor in improving local control. Careful long-term follow-up is mandatory because atypical meningioma shows a broad range of aggressiveness and natural history.
Classification ; Follow-Up Studies ; Humans ; Meningioma* ; Natural History ; Neoplasm Metastasis ; Radiotherapy ; Recurrence ; Retrospective Studies ; Survival Rate

Substantia gelatinosa (SG) neurons receive synaptic inputs from primary afferent Adelta- and C-fibers, where nociceptive information is integrated and modulated by numerous neurotransmitters or neuromodulators. A number of studies were dedicated to the molecular mechanism underlying the modulation of excitability or synaptic plasticity in SG neurons and revealed that second messengers, such as cAMP and cGMP, play an important role. Recently, cAMP and cGMP were shown to downregulate each other in heart muscle cells. However, involvement of the crosstalk between cAMP and cGMP in neurons is yet to be addressed. Therefore, we investigated whether interaction between cAMP and cGMP modulates synaptic plasticity in SG neurons using slice patch clamp recording from rats. Synaptic activity was measured by excitatory post-synaptic currents (EPSCs) elicited by stimulation onto dorsal root entry zone. Application of 1 mM of 8-bromoadenosine 3,5-cyclic monophosphate (8-Br-cAMP) or 8-bromoguanosine 3,5-cyclic monophosphate (8-Br-cGMP) for 15 minutes increased EPSCs, which were maintained for 30 minutes. However, simultaneous application of 8-Br-cAMP and 8-Br-cGMP failed to increase EPSCs, which suggested antagonistic cross-talk between two second messengers. Application of 3-isobutyl-1-methylxanthine (IBMX) that prevents degradation of cAMP and cGMP by blocking phosphodiesterase (PDE) increased EPSCs. Co-application of cAMP/cGMP along with IBMX induced additional increase in EPSCs. These results suggest that second messengers, cAMP and cGMP, might contribute to development of chronic pain through the mutual regulation of the signal transduction.
1-Methyl-3-isobutylxanthine ; Adenosine ; Animals ; Chronic Pain ; Guanosine ; Myocytes, Cardiac ; Neurons ; Neurotransmitter Agents ; Plastics ; Rats ; Second Messenger Systems ; Signal Transduction ; Spinal Nerve Roots ; Substantia Gelatinosa