PURPOSE: The purpose of this study is to test the reliability of the clinical performance examination (CPX) using Generalizability theory (G-theory). Through G-theory, the effects of not only students and tasks but also the school will be analyzed as primary sources of error, which can affect the interpretation of the reliability of the CPX. METHODS: One thousand three hundred nineteen students from 16 medical schools that participated in the Seoul-Gyeonggi CPX Consortium 2008 were enrolled. In our research design, we suppose that student is nested within school and crossed with task. Data analysis was conducted with urGenova. RESULTS: According to our analysis, the percentage of error variance was 6.2% for school, 14.9% for student nested within school, 14.4% for task, and 3% for interaction between school and task. An effect of school on students was observed, but the interaction between task and school was insignificant. When student is nested within school, the universe score decreased and the g-coefficient was less than the g-coefficient of the p x t (p: studentm, t: task) design. CONCLUSION: The results show that generalizability theory is useful in detecting various error components in the CPX. Using the generalizability theory to improve the technical quality of performance assessments provides us with greater information compared with traditional test theories.
Humans ; Research Design ; Schools, Medical ; Statistics as Topic

OBJECTIVE: To determine whether the follicle stimulating hormone(FSH) receptor gene mutation (C566T point mutation) is present in Korean women with premature ovarian failure and normal karyotype. METHODS: Genomic deoxyribonucleic acid(DNA) obtained from 40 patients with chromosomally competent premature ovarian failure and from 30 normal fertile women(control group) was amplified by polymerase chain reaction(PCR). PCR products were digested by the enzyme BsmI and polyacrylamide gel(PAG) elctrophoretic patterns of these enzyme-digested products were analyzed. The direct sequencing of PCR products was also performed. RESULTS: All patients with premature ovarian failure and 30 normal control women demonstrated homozygous, normal alleles with 51- and 27- base pairs fragments in PAG elctrophoresis. The absence of C566T point mutation in both group was confirmed by direct DNA sequencing. CONCLUSIONS: A C566T mutation in FSH receptor gene is rare in Korean women with premature ovarian failure and normal karyotype.
Alleles ; Base Pairing ; Female ; Follicle Stimulating Hormone* ; Humans ; Karyotype* ; Point Mutation ; Polymerase Chain Reaction ; Primary Ovarian Insufficiency* ; Receptors, FSH* ; Sequence Analysis, DNA

Paraovarian cysts arise in the mesosalpinx, between the ovarian hilum and the fallopian tube. Clinical significance of paraovarian tumors is considerably less frequent than ovarian tumors, and malignant paraovarian lesions are exceedingly rare. Paraovarian carcinomas or borderline malignancy mostly occur in young women. Abdominal enlargement and pelvic pain are the usual complaints. Usually they have a capsule, are unilateral and are connected to the broad ligament. Little is known about the biological behavior of the paraovarian borderline malignancies, since these lesions are so rare. The appropriate therapy for this unusual lesion have not been fully defined. We had experienced a case of papillary serous adenocarcinoma of borderline malignancy and report this case with a brief review of literature.
Adenocarcinoma ; Broad Ligament ; Fallopian Tubes ; Female ; Humans ; Pelvic Pain

PURPOSE: This study was conducted for evaluation of the effects of new antiepileptic drugs on bone mineral density in children with epilepsy. METHODS: The study group consisted of 35 age and gender matched controls and 35 epileptic children taking new antiepileptic drugs: 14 on topiramate, 10 on lamotrigine, and 11 on oxcarbazepine in monotherapy. All patients were treated for more than one year and all were normally ambulatory children. We measured serum levels of calcium, alkaline phosphatase, 25-hydroxyvitamin D, and 1,25-dihydroxyvitamin D. BMD was measured by dual-energy X-ray absorptiometry at lumbar spine regions L1-L4. RESULTS: Vitamin D levels of the oxcarbazepine group (25-hydroxyvitamin D: 40.3+/-10.5 ng/mL and 1,25-dihydroxyvitamin D: 57.9+/-15.2 pg/mL) were significantly lower than in controls (44.6+/-11.5 ng/mL, 66.2+/-10.5 pg/mL, P<0.05); however, they did not differ significantly in the topiramate and lamotrigine groups. The bone mineral density value was significantly lower in the oxcarbazepine (L1-L4: 0.73+/-0.11 g/cm2) group, compared with the controls (0.84+/-0.06 g/cm2, P<0.05) or patients taking topiramate or lamotrigine. CONCLUSION: Monitoring of bone metabolism is recommended for patients treated with new antiepileptic drugs, particularly oxcarbazepine.
Absorptiometry, Photon ; Alkaline Phosphatase ; Anticonvulsants ; Bone Density ; Calcium ; Carbamazepine ; Child ; Fructose ; Humans ; Spine ; Triazines ; Vitamin D

PURPOSE: The aim of this study is to determine whether levels of circulating free DNA (cfDNA) increase according to cancer progression, whether they are restored after surgical resection, and to evaluate cfDNA in gastric cancer patients as a useful biomarker. METHODS: A case-control study design was used. Thirty gastric cancer patients and 34 healthy subjects were enrolled from two hospitals in South Korea. The plasma cfDNA of patients with gastric cancer were obtained before surgery and 24 hours after surgery, and then analyzed by a quantitative, real-time polymerase chain reaction. Plasma samples were also obtained from the control group. RESULTS: The mean levels of cfDNA in the healthy control group, patients with early gastric cancer, and with advanced gastric cancer were 79.78 +/- 8.12 ng/mL, 106.88 +/- 12.40 ng/mL, and 120.23 +/- 10.08 ng/mL, respectively (P < 0.01). Sensitivity was 96.67% and specificity was 94.11% when the cutoff value was 90 ng/mL. Variables representing the tumor burden such as tumor size, T stage, TNM stage, and curative resection are also associated with the levels of cfDNA. The levels of cfDNA in the 24-hour-after-surgery group decreased significantly (112.17 +/- 13.42 ng/mL vs. 77.93 +/- 5.94 ng/mL, P < 0.001) compared to the levels of cfDNA in the preoperation group. CONCLUSION: The changes in the levels of cfDNA can act as reliable biomarkers to detect cancer early, to predict tumor burden, estimate curative resection and even prognosis.
Biomarkers ; Case-Control Studies ; DNA* ; Humans ; Plasma ; Prognosis ; Real-Time Polymerase Chain Reaction ; Republic of Korea ; Sensitivity and Specificity ; Stomach Neoplasms* ; Tumor Burden

A clinical observation was done on random 42 cases of acute and uncomplicated bacterial pyelonephritis. The following results were obtained: 1. All cases were female. 2. The most common age group was 2nd decade (47.6%). 3. All isolated organisms were Gram negative bacteria and E. coli was most common (90%). 4. On excretory urogram, 3 cases (7%)were abnormal and one of them showed acute segmental pyelonephritis. 5. The right side was affected 3 times more than left and 8 cases were bilateral.
Female ; Gram-Negative Bacteria ; Humans ; Pyelonephritis*

PURPOSE: Congenital dermoid cysts develop during the fusion of the embryo when the ectodermal tissue gets trapped in the line of fusion. Dermoid cysts of the head are rare lesions comprised of epidermal and mesodermal elements. Furthermore, dermoid cysts in the occipital area are extremely rare. Only a few cases of dermoid cysts in the posterior scalp have been reported. Especially, A bilateral, synchronous presentation in this location has not been reported previously in the literature. METHODS: All 5 cases had a gradually enlarging mass of the posterior aspect of the scalp. The cysts were mobile, noncompressible, and non-tender, without evidence of an associated sinus tract, skin dimpling, discoloration, or communication with adjacent structures. The CT scan displayed a hypodense cystic lesions about -87 to +24HU (Housefield units, average +3.2HU) with hypodense capsule and no postcontrast enhancement. All tumors were found just under the skin, and were well encapsulated, so they were completely removed the mass with adjacent periosteum. RESULTS: On gross findings, all tumors were oval-or round-shaped, and when the cystic tumor was cut open it presented a greasy and caseous substance. Histologically, all specimens contain desquamated squamous epithelium and keratin in the lumen and are encapsulated and lined by keratinized stratified squamous epithelium. And, all cases of posterior mass are the presence of adnexal structures. CONCLUSION: Appropriate diagnosis requires not only an index of suspicion for this rare tumor a very careful history and search for skin changes. Especially, CT can reveal the exact location of the cyst, its relationship with the adjacent structures. We think that occipital dermoids divide into superficial and deep type. In our cases, because they did not have intra-cranial involvement or fistula formation, they are superficial type. This report describes the clinical and operative aspects of the superficial dermoid cysts and provides a review of the literatures.
Dermoid Cyst ; Ectoderm ; Embryonic Structures ; Epithelium ; Fistula ; Head ; Keratins ; Mesoderm ; Periosteum ; Scalp ; Skin ; Skull

PURPOSE: In treatment of facial bone fracture, occurred in children, we generally use wires, miniplate, absorbable plate or their combination. These foreign bodies can be palpable, and sometimes may cause infections, and need reoperation for removing. When bone fragments are multiple, small or thin, they are hard to handle and make accurate reduction of all fragments. In these cases, a biodegradable tissue adhesive, Histoacryl(R) (n-butyl-2-cyanoacrylate), can be used as fixation technique for small, multiple, and thin fracture fragments. METHODS: 3 years old and 6 years old children, who has comminuted fracture on frontal sinus, we used Histoacryl(R) for fixation of multiple bone fragments. After approaching by coronal incision, we pulled out all bone fragments and reconstructed bone fragments by Histoacryl(R) and fixed those on frontal sinus by absorbable plates. RESULTS: Photographs and 3-dimensional CT obtained preoperatively and postoperatively. And we compared them each other in terms of accuracy of reconstructed bony contour. We could reconstruct almost all bone fragments easily along 3-dimensional structure and get excellent aesthetic results. There was no complication such as infection. CONCLUSION: In treatment of comminuted facial bone fracture, occurred in children, Histoacryl(R) is an excellent method for accurate reconstruction in small and thin bone fragments which cannot be fixed by wire, miniplate or absorbable plate without complication.
Child ; Enbucrilate ; Facial Bones ; Foreign Bodies ; Fractures, Comminuted ; Frontal Sinus ; Humans ; Reoperation ; Tissue Adhesives

PURPOSE: Nerve sheath myxoma is a rare cutaneous neoplasm originating from the peripheral nerve sheath and divided into three groups : myxoid, cellular and mixed type. There is a controversy on it's origin whether schwannian cell or perineurial differentiation, or anything else. Myxoid nerve sheath myxoma is asymptomatic, soft, papule or nodule in middle-age adults. We report a case of myxoid nerve sheath myxoma on the fingertip. METHODS: A 53-year-old woman presented with a painful, 0.4 x 0.4 x 0.6 cm sized, corn shaped nodule on the left 3rd fingertip. We put into surgical excision and studied it by histopathologically and specific immnohistochemical stain. RESULTS: The tumor has well defined nodules separated by thin fibrous connective tissue with abundant myxoid stroma and were positively stainded for S-100 protein, NSE and GFAP. After surgical treatment it was healed without recurrence. CONCLUSION: Nerve sheath myxoma is rare neoplasm and located mainly on face, but very rarely on the fingertip. We report a case of painful myxoid nerve sheath myxoma located on the 3rd fingertip.
Adult ; Connective Tissue ; Female ; Humans ; Middle Aged ; Neurothekeoma ; Peripheral Nerves ; S100 Proteins ; Zea mays

PURPOSE: Congenital absence of the vagina is a rare case. It occurs as a result of Mullerian duct aplasia or complete androgen insensitivity syndrome. The reconstructive modality includes skin graft, use of intestine and various methods of flap. We report a patient who underwent vulvoperineal fasciocutaneous flap to reconstruct congenital absence of the vagina, while the external genitalia and ovaries are normal. METHODS: A 26-year-old woman presented with vaginal agenesis. Under general anesthesia, a U-shaped incision was made between the urethral meatus and the anus. The new vaginal pocket was created up to the level of the peritoneal reflection between the urinary structures and the rectum. Next, the vulvoperineal fasciocutaneous flaps were designed in a rectangular fashion. Flap elevation was begun at the lateral margin which the adductor longus fascia was incised and elevated, and the superficial perineal neurovascular pedicle was invested by the fascial layer. The medial border was then elevated. A subcutaneous tunnel was created beneath the inferior of the labia to rotate the flaps. The left vulvoperineal flap was rotated counterclockwise and the right was rotated clockwise. The neovaginal pouch was formed by approximating the medial and lateral borders. The tubed neovagina was then transposed into the cavity. RESULTS: In 3 weeks, the vaginal canal remained supple After 6 weeks, the physical examination showed normal-appearing labia majora and perineum with an adequate vaginal depth. A year after the operation, the patient had a 7 cm vagina of sufficient width with no evidence of contractures nor fibrous scar formation. The patient was sexually active without difficulty. CONCLUSION: Although many methods were described for reconstruction of vaginal absence, there is not a method yet to be approved as a perfect solution. We used the vulvoperineal fasciocutaneous flap to reconstruct a neovagina. This method had a following merits: a single-stage procedure, excellent flap reliability, the potential for normal function, minimal donor site morbidity and no need for subsequent dilatation, stents, or obturators. We thought that this operation has a good anatomic and functional results for reconstruction of the vagina.
Adult ; Anal Canal ; Androgen-Insensitivity Syndrome ; Anesthesia, General ; Cicatrix ; Congenital Abnormalities ; Contracture ; Dilatation ; Fascia ; Female ; Genitalia ; Humans ; Intestines ; Male ; Ovary ; Perineum ; Physical Examination ; Polyenes ; Rectum ; Skin ; Stents ; Tissue Donors ; Transplants ; Vagina