The Korean Medical Association (KMA) has been working on medical appraisals for the last 30 years. In 2019, the Korean Medical Practice Review Authority (KMPRA) was established to systematically promote medical appraisal. In addition, regulations related to medical appraisals were amended, professional committees of KMPRA established, and medical case management programs developed. This study reviews the history, present challenges, and the future of KMPRA.Current Concepts: The efforts made by KMA for the development of KMPRA have provided evidence of the excellence of medical appraisal system, with a highly professional, fast, and transparent medical practice review system. Nevertheless, KMPRA has not completely resolved the social distrust of fairness and the quickness of medical appraisals. It is necessary to identify the obstacles that exist in the current appraisal system for the continued development of KMPRA. Currently, KMPRA faces several challenges, such as lack of independence, financial constraints, dichotomized process of medical appraisal, and insufficient administrative manpower, in the process of handling thousands of requested cases. To improve the level of expertise of the professional medical appraisal system, independence, fairness, and speed of its process, KMPRA requires more attention and support from KMA and other major professional medical organizations.Discussion and Conclusion: KMPRA is committed to fulfilling the social responsibility of fair medical appraisal, and it will ultimately contribute to resolving social conflicts derived from medical services and further improving trust relationships with the public.

The Korean Medical Association (KMA) has been working on medical appraisals for the last 30 years. In 2019, the Korean Medical Practice Review Authority (KMPRA) was established to systematically promote medical appraisal. In addition, regulations related to medical appraisals were amended, professional committees of KMPRA established, and medical case management programs developed. This study reviews the history, present challenges, and the future of KMPRA.Current Concepts: The efforts made by KMA for the development of KMPRA have provided evidence of the excellence of medical appraisal system, with a highly professional, fast, and transparent medical practice review system. Nevertheless, KMPRA has not completely resolved the social distrust of fairness and the quickness of medical appraisals. It is necessary to identify the obstacles that exist in the current appraisal system for the continued development of KMPRA. Currently, KMPRA faces several challenges, such as lack of independence, financial constraints, dichotomized process of medical appraisal, and insufficient administrative manpower, in the process of handling thousands of requested cases. To improve the level of expertise of the professional medical appraisal system, independence, fairness, and speed of its process, KMPRA requires more attention and support from KMA and other major professional medical organizations.Discussion and Conclusion: KMPRA is committed to fulfilling the social responsibility of fair medical appraisal, and it will ultimately contribute to resolving social conflicts derived from medical services and further improving trust relationships with the public.

PURPOSE: Couinaud described segment IV as being equivalent to segments II and III, as the umbilical portion of the portal vein (PV), and its equal branch of segment II, originated from the transverse portion of the PV. On the contrary, Healey suggested the presence of left lateral and medial segments, on the basis of umbilical fissure. Recently, some author have claimed the branch of segment II originated from the distal portion of the ligamentum venosum (LV), and that this branch was not equal to, only a branch of, the umbilical portion. Our goal was to evaluate the surgical anatomy of the left lobe of the liver through dissecting Korean cadavers. METHODS: The number of cadavers dissected totaled 10. PV, its branches, and the LV were dissected and the length of the transverse portion measured. The distance between the origin of the transverse portion and that of the segment II branch were also measured. RESULTS: The branch of segment II originated from the distal portion of the LV in all 10 cases. The length of the transverse portion was 18.8+/-5.8 mm, and the distance between the origins of the LV and segment II branch was 7.0+/-3.1 mm. CONCLUSION: Considering the embryology of the liver, as well as the above result, the umbilical portion and segment II branch were not equal anatomic structures. The umbilical portion and LV are equal anatomic structures. The branch of segment II is only one of the branches of the umbilical portion. We think Healey's classification is more accurate for the left lobe of the liver.
Cadaver* ; Classification ; Embryology ; Hepatectomy ; Liver* ; Portal Vein

Waldenstrom's macroglobulinemia is a disorder of malignant proliferation of plasmacytoid lymphocytes and monoclonal immunoglobulin M. However, the patients occasionally present with malabsorption and diarrhea due to deposition of extracellular periodic acid-Schiff positive homogenous eosinophilic, amorphorous, and proteinaceous materials in the villi and/or lamina propria of the duodenum. We report a 62-year-old man who, despite involvement of the duodenal mucosa, presented only with fatigue, dypnea on exertion, and anemia. Characteristic duodenoscopic and pathologic findings of this patient are described.
Anemia ; Diarrhea ; Duodenum ; Eosinophils ; Fatigue ; Humans ; Immunoglobulin M ; Lymphocytes ; Middle Aged ; Mucous Membrane ; Waldenstrom Macroglobulinemia*

Trichuris trichiura (whipworm) is a ubiquitous parasite that resides in the human intestinal tract, and it is known as whipworm because of its whip-like appearance. Trichuriasis is rare in developed countries, but it is more prevalent in tropical countries and areas with suboptimal sanitation. In most patient, whipworm infection is asymtomatic but patient with heavy infection present with anemia, diarrhea, trichuris dysentery syndrome, abdominal pain, weight loss, appendicitis and rectal prolapse. It is characterized by the invasion of the colonic mucosa by the adult Trichuris and produces minor inflammatory changes at the sites of localization. Its diagnosis is usually made by identification of football-shaped eggs in the stool or by confirming adult whipworm during colonoscopy. We report four cases of whipworm infection that were incidentally diagnosed on colonoscopy.
Abdominal Pain ; Adult ; Anemia ; Appendicitis ; Colon* ; Colonoscopy ; Developed Countries ; Diagnosis ; Diarrhea ; Dysentery ; Eggs ; Humans ; Mucous Membrane ; Ovum ; Parasites ; Rectal Prolapse ; Sanitation ; Trichuriasis ; Trichuris* ; Weight Loss

Strongyloides stercoralis, which has two different generations: the free living and parasitic generation, is primarily adapted to warm climates, but strongyloidiasis has been reported sporadically in temperate and cold regions. Strongyloidiasis may be asymptomatic in almost 50 percent of the cases, rarely, infestation presents with severe clinical pictures. The reason for this exacerbation of illness is probably a rapid increase in the number of infecting larvas through the development or acceleration of a cycle of autoinfection. A breakdown of the host-parasite equilibrium due to decreased host resistance may occur in malnutrition, debilitating diseases or therapy with immunosuppressive drugs. Corticosteroid treatment may have an important role in the sudden occurrence of severe stongyloidiasis. We experienced a case of strongyloidiasis with severe malnutrition, accompanied with bronchial asthma and diabetes mellitus. This patient has been treated with corticosteroid for several years. So, we report this rare case with the literature review.
Acceleration ; Asthma ; Climate ; Diabetes Mellitus ; Family Characteristics ; Humans ; Larva ; Malnutrition* ; Strongyloides stercoralis ; Strongyloidiasis*

Anisakiasis is a parasitic disease following eating raw fishes infected with Anisakis larvae. The endoscopic features of the gastric mucosa are edema, erosion, ulceration and hemorrhage. Gastric anisakiasis forming submucosal tumor is rare. Twenty six-year-old man who complained of severe epigastric pain was admitted. The pain began approximately three hours after eating slices of raw Astroconger myriaster. Gastric endoscopy revealed a submucosal tumor with central erosion on the gastric fundus. Endoscopic ultrasonography detected a thickening of the gastric wall made of mainly thickened submucosal layer. Abdominal CT scan showed a gastric mass lesion with hypodensity in the gastric fundus and subsequently wedge resection was performed. The pathologic finding of the resected mass was eosinophilic abscess in the submucosal layer. We report a case of gastric submucosal tumor which seems to be caused by Anisakis, with a review of relevant literature.
Abscess ; Anisakiasis ; Anisakis* ; Eating ; Edema ; Endoscopy ; Endosonography ; Eosinophils ; Fishes ; Gastric Fundus ; Gastric Mucosa ; Hemorrhage ; Larva ; Parasitic Diseases ; Tomography, X-Ray Computed ; Ulcer

To evaluate the potential utility of a self-expandable intratracheal nitinol stent with flared ends for the treatment of tracheal collapse in dogs, endotracheal stenting therapy was performed under fluoroscopic guidance in four dogs with severe tracheal collapse. During the 4 to 7 month followup, after stent implantation, clinical signs, including dyspnea and respiratory distress, dramatically improved in all dogs. The radiographs showed that the implanted stents improved the tracheal collapse, and there were no side effects such as collapse, shortening or migration of the stents. In conclusion, the self-expandable intratracheal nitinol stents provided adequate stability to the trachea and were effective for attenuating the clinical signs associated with severe tracheal collapse.
*Alloys ; Animals ; Dog Diseases/*surgery ; Dogs ; Female ; Male ; Prosthesis Implantation/adverse effects/veterinary ; Stents/adverse effects/*veterinary ; Tracheal Stenosis/surgery/*veterinary

A 10-year-old, castrated male, English cocker spaniel dog was presented for evaluation of a mass in the left forelimb. Physical examination revealed a solitary subcutaneous mass measuring 2.7 x 2.1 x 1 cm in size. Radiographs and ultrasonography showed a well-circumscribed, focally mineralized, non-invasive to muscle layer mass without signs of further bone invasion and periosteal reaction. Cytologic evaluation of the mass through fine needle aspiration revealed a mesenchymal cell type malignant tumor without distant metastasis. An excisional biopsy was performed for definitive diagnosis and the mass was diagnosed as cutaneous hemangiopericytoma. This case report presents disagreement between fine needle aspiration and histopathology during diagnostic procedures of cutaneous hemangiopericytoma in a dog.
Animals ; Biopsy ; Biopsy, Fine-Needle ; Dogs ; Forelimb ; Hemangiopericytoma ; Humans ; Male ; Muscles ; Neoplasm Metastasis ; Physical Examination

A seven months old, tiger shovelnose catfish was referred to the veterinary medical teaching hospital of the college of veterinary medicine, Konkuk university because of suspecting a foreign body in the stomach. By physical and radiologic examinations, the catfish revealed abdominal enlargement, vomiting, inactivity and radiopaque foreign bodies in the stomach. Under general anesthesia with dilute isoflurane solution, celiotomy was performed. Stomach was atonic, and three foreign bodies were palpated in the stomach. In this process, three stones came out through mouth. Abdominal muscles were closed with a simple continuous suture pattern, and skin was closed with a simple mattress suture pattern. Sutured site was covered with glue and mucous taken from allogenic skin. On the second day after surgery, the patient recovered to normal condition, showing increased appetite and activity.
Animals ; Catfishes/*surgery ; Foreign Bodies/pathology/*surgery ; Gastroscopy/veterinary ; Stomach/*surgery