Embryonal sarcomas of the liver, often called undifferentiated sarcomas or malignant mesenchymomas, are extremely rare tumors that occur chiefly in children with poor prognosis and uncertain histogenesis. Histologically, tumor cells are stellate or spindle shaped, loosely arranged in edematous or myxoid pattern alternating with highly cellular zones and do not show evidence of differentiation. Ultrastructural and immunohistochemical studies by previous investigators indicate that the neoplastic cells are mostly primitive mesenchymal cell which occasionally differentiate to fibroblasts, lipoblasts, histiocytes and smooth muscle cells via intermediate cell types. The authors experienced a case of 6-year old boy who presented with an enlarging abdominal mass of the liver which revealed typical histological and ultrastructural features of embryonal sarcoma with focal areas of unusual chondrosarcomatous differentiation.
Child ; Male ; Female ; Humans

No abstract available.
Brain* ; Cerebral Palsy* ; Electroencephalography* ; Evoked Potentials*

The correction of risk fators is very important in the prevention of stroke. This study was designed to investigate the risk factors of stroke patients and to correlate these risk factors with Functional Independence Measure(FIM) scores to be used for possible prognostic values in rehabilitation program. The subjects were 75 patients from 36 to 84 years of age. Data collection was done through chart reviews on risk factors of stroke including hypertension, transient ischemic attacks or previous stroke history, diabetes mellitus, heart disease, cigarette smoking, alcohol intake and hypercholesterolemia. Risk factors in stroke by the order of frequency were hypertension(68.0%), previous stroke history(38.7%), heart diseases(22.7%), hypercholesterolemia(24.0%), and diabetes mellitus(16.0%). The frequency of hypercholesterolemia, diabetes mellitus, heart disease, smoking in cerebral infarction group was higher than in intracerebral hemorrhagic group. There was no stastically significant correlation between risk factors and FIM scores. The results suggest that hypertension was the most important risk factor in stroke and the rate of risk factors was higher in cerebral infarction than in cerebral hemorrhage.
Cerebral Hemorrhage ; Cerebral Infarction ; Data Collection ; Diabetes Mellitus ; Heart ; Heart Diseases ; Humans ; Hypercholesterolemia ; Hypertension ; Ischemic Attack, Transient ; Rehabilitation ; Risk Factors* ; Smoke ; Smoking ; Stroke*

PURPOSE: The purpose of this study is to introduce the operational design of clinical skills training program and to evaluate the outcome of one-year experience in Gachon Medical School. METHODS: The School set up a clinical skills training center(laboratories) helping preclinical year-students being able to improve their clinical competences by using simulators and models prior to start their clerkship so that they can apply accurate and stable clinical technical skills to the patients. The program was divided into two parts; one for the communication and interviewing skills(M3) and the other for development of basic clinical skills(M4). For the latter, a total of 32 skill units with model items were selected from the minimum essential clinical skills requirements. The training course was conducted 3 weeks for 37 students of the fourth year medical school(M4) students in the second semester of 2001. Pass/Fail system with 2 credits was applied as a student evaluation. Both advantages and disadvantages of the program were analysed by questionnaires. RESULTS: Every students met the school requirement and passed the requirements mostly by the second trial within the two weeks duration following self-directed hard practice for every items. Of 37 students, 80% became confident on their final performance, and 72% agreed themselves being much enthusiastic compared to other courses. The visiting frequency to the center was over 2~3 times/day during the course, and their average staying hours/week were 20~30 hours. Students(78%) were satisfactory to the appropriativeness of faculty's instructional skills and their evaluation results. CONCLUSION: We conclude that the clinical skills training program is a useful tool not only to improve the essential technical skills prior to take their responsibilities of subinternship but also to motivate students' learning during the preclinical studies.
Clinical Competence* ; Education* ; Humans ; Learning ; Schools, Medical* ; Surveys and Questionnaires

PURPOSE: To evaluate prognosis-related CT findings in hypoxic ischemic encephalopathy. MATERIALS AND METHODS: For the purpose of prognosis, 28 children with a clinical history and CT findings suggestive of hypoxic ischemic encephalopathy (HIE) were restrospectively reviewed. The diagnostic criteria for HIE, as seen on CT scanning, were as follows : 1, ventricular collapse ; 2, effacement of cortical sulci ; 3, prominent enhancement of cortical vessels ; 4, poor differentiation of gray and white matter ; 5, reversal sign ; 6, obliteration of perimesencephalic cistern ; 7, high density on tentorial edge, as seen on precontrast scans ; and 8, low density in thalamus, brain stem and basal ganglia. On the basis of clinical outcome, we divided the patients into three groups, as follows : group I(good prognosis) ; group II(neurologic sequelae), and group III(vegetative state or expire), and among these, compared CT findings. RESULTS: There were thirteen patients in group I, six in group II, and nine in group III. Ventricular collapse, effacement of cortical sulci, and prominent enhancement of cortical vessels were noted in all groups, whereas poor differentiation of gray and white matter, reversal sign, obliteration of perimesencephalic cistern, high density on tentorial edge, on precontrast scan, and low density in brain stem and basal ganglia were observed only in groups II and III. CONCLUSION: CT findings showed distinct differences between groups in whom prognosis was good, and in whom it was poor. An awareness of poor prognostic CT findings may be clinically helpful in the evaluation of patients with hypoxic ischemic encephalopathy.
Basal Ganglia ; Brain Stem ; Child* ; Humans ; Hypoxia-Ischemia, Brain* ; Prognosis* ; Thalamus ; Tomography, X-Ray Computed

The purpose of this study is to investigate the relationship between the self-reported musculoskeletal symptoms and related factors among VDT operators in bank. The subjects were 950 women workers. The characteristics of subjects were 26.6 years of average age, 5.7 years of average VDT use duration and 6.5 hours of daily VDT use time. The results were as follows. The prevalence of self-reported musculoskeletal symptoms more than severe in Likert scale were 51.4%, 43.9% at the shoulder, 38.3%, 31.8% at the lower back, 38.0%, 31.3% at the neck, 31.2%, 25.2% at the upper back, 21.7%, 16.5% at the wrist and 13.6%, 8.8% at the fingers (while on duty, after home-coming). General characteristic variables affecting the musculoskeletal symptoms were married, number of child and daily house-working time. Work-related factors affecting the musculoskeletal symptoms were VDT working career, daily working time, daily VDF use time, VDF use time without rest, daily work-load and regular rest. As the result of the multiple logistic regression analysis, daily working time, daily VDT use time and VDT working career were significant variables accounting for the musculoskeletal symptoms.
Child ; Cumulative Trauma Disorders ; Female ; Fingers ; Humans ; Logistic Models ; Neck ; Prevalence* ; Shoulder ; Wrist

An unstable fracture-dislocation of the spine usually results in a neurological deficit below the level of the injury. For this type of injury to occur at the mid-thoracic level without spinal cord injury is rare. This case report is of a T5-6 fracture-dislocation, without neurological deficit, which occurred in combination with a mid-clavicular fracture and a 5th rib fracture. The patient was treated by halter traction and pelvic traction for 14 days, and cervico-thoraco-lumbosacral orthosis for three months. Plain radiographs and a CT scan taken three months after trauma revealed a good healing process. At the last assessment, made two years post-trauma, the patient was completely asymptomatic with a pain-free full range of back motion, and was able to participate in various sports. In cases where an oblique shear injury of the back is suspected, and in cases of clavicular fracture, rib fracture and/or hemo-pneumothorax, more attention should be given to detecting a possible fracture-dislocation of the mid-thoracic spine without a neurological lesion.
Humans ; Orthotic Devices ; Rib Fractures ; Spinal Cord Injuries ; Spine* ; Sports ; Tomography, X-Ray Computed ; Traction

In spinal cord injury, various options exist for the management of the neurogenic bladder. For the management of neurogenic bladder, urethral stent was placed under a cystoscopic guidance as one day procedure. Urethral stents were inserted in a T12 spinal cord injured patient who had recurrent urinary tract infections and a vesicoureteral reflux (VUR) and a T3 spinal cord injured patient who had a detrusor-sphincter dyssynergia. In the first case, recurrent urinary tract infection and VUR were resolved after the stenting. In the second case, urethral stent was removed because of the failure of continuous drainage. Because of its easily reversible nature, the urethral stent can be adopted for use in pateints as an option of neurogenic bladder management.
Ataxia ; Drainage ; Humans ; Spinal Cord Injuries* ; Spinal Cord* ; Stents* ; Urinary Bladder, Neurogenic* ; Urinary Tract Infections ; Vesico-Ureteral Reflux

The importance of neuropathy in the pathogenesis of foot lesions has been well recognized in diabetes. Blood flow in ischemic limbs has been extensively investigated but the circulation of limbs affected by peripheral neu ropathy has received little attention. Some studies on blood flow in peripheral neuropathy have shown a remarkable increase in resting flow, transcutaneous venous oxygen tension, and vascularity, along with loss of the spontaneous variations which occur normally with sympathetic activity of the foot in patients with diabetes. The aim of present study is to find out the effects of somatic and autonomic nervous function in early change of blood flow of foot in diabetic patients, We have studied fifty-one patients of non-insulin-dependent(type II) diabetes with no history of hypertension of diabetic foot ulcers. The evidence of neuropathy was screened by nerve conduction studies and sympathetic skin response of both lower extremities. Blood flow of dorsalis pedls and posterior tibial arteries was measured by portable doppler machine and presented as pressure index(ankle-to-arm systolic pressure ratio). The patients with sympathetic dysfunction showed significant decrease in pressure index compared to normal control and diabetic patients with normal sympathetic function, suggesting that changes of the blood flow occur in diabetic patients with sympathetic dysfunction.
Blood Pressure ; Diabetic Foot ; Extremities ; Foot* ; Hemodynamics* ; Humans ; Hypertension ; Lower Extremity ; Neural Conduction ; Oxygen ; Peripheral Nervous System Diseases ; Skin ; Tibial Arteries ; Ulcer

PURPOSE: To investigate change of CT attenuation of biliary stones in water soluble contrast media with time as well as the factors contributing to this change. MATERIALS AND METHODS: Thirty biliary stones were placed within cone-shaped plastic tubes, and as a control study, spiral CT scanning was performed 50 minutes after immersion in normal saline. The stones were rescanned at 5, 10, 20, 30, 45, 60, 90 and 120 minutes after immersion in water soluble contrast media. Mean CT attenuation value and volume of the stones were measured after three-dimensional reconstruction of images. Physical factors such as porosity[(wet weight - dry weight) / wetweight]x100, volume, and cholesterol as a chemical factor were measured. RESULTS: The pattern of change of CT attenuation was classified as one of three types. Fifteen stones (50%) were classified as type 1, in which attenuation increased with immersion time; in ten stones, this increase was rapid, particularly within the first 5 minutes. Twelve (40%) were classified as type 2, in which attenuation showed no significant change. Three stones showed no regular pattern, and these were classified as type 3. The mean porosity of type 1 (median; 32.7, mean+/-SD; 52.83+/-34.48) was greater than that of type 2 (median; 6.7, mean+/-SD; 30.58+/-48.25)(p<.05). The volume and cholesterol fraction of stones were not significantly different between type 1 and 2. CONCLUSION: In some biliary stones, CT attenuation value increases in water-soluble contrast media with time, and porosity is the most important factor in attenuation change.
Cholesterol ; Contrast Media* ; Immersion ; Plastics ; Porosity ; Tomography, Spiral Computed