BACKGROUND: Graduate medical education is shifting from the traditional apprenticeship model to a competency-driven model. Here we describe the design and implementation of competency-based medical education (CBME) in an internal medicine residency program, and report satisfaction survey results. METHODS: We redesigned the residency curriculum as CBME to be resident-centred, systematic, focused on general internal medicine, to provide experience in various care setting, and work-based assessment. In the second year of this CBME transition, we surveyed residents' overall satisfaction using 5-point Likert scale. Feedback on their training program was also analysed. RESULTS: The overall satisfaction score was 3.24 and thirteen residents (61.9%) answered that the preceptor's practical training in an educational atmosphere and improvement through training were the merits of the training program. However, residents complained about the working condition such as work overload. CONCLUSION: With the CBME implementation, most residents expressed satisfaction with the hospital's educational environment but they suffered from overwork. Further efforts to improve the educational program and environment are warranted.
Atmosphere ; Curriculum ; Education ; Education, Medical ; Education, Medical, Graduate ; Internal Medicine ; Internship and Residency

PURPOSE: IgE was identified by Ishizaka as an antibody that is reacted at Type I hypersensitivity reaction, and has been used in the diagnosis of allergic disease and the differential diagnosis of extrinsic and intrinsic asthma. But there was some confusing in the diagnosis because of the broad range of measured serum IgE. Recently it was reported that serum IgE should be standardized for area and age to give the diagnostic reliability. METHODS: We measured serum IgE in 512 Korean children admitted at Ewha Woman University Mokdong Hospital between March 1991 and March 1994 and studied the relationship between asthma and serum IgE standardized for age in Korean children. RESULTS: 1) The geometric mean of serum IgE in non - allergic children and asthma were increased gradually according to age. The ranges of measured IgE in each group were overlapped in some part. 2) Log IgE increased by age similarly in asthma and non - allergic children, but was higher in asthma children than non - allergic children. Z scores of log IgE in asthma children increased by age, but those in non - allergic children was not changed by age. 3) Log IgE in male was not significantly different to that of female (p>0.05). 4) Incidence of asthma increased by increasing of Z score of log IgE standardized for age(p<0.05). 5) The normal range of serum IgE standardized for age was presented. Asthma was absent in children below the lowest normal IgE level (log IgE-1.5SD). CONCLUSIONS: Serum IgE if standardized by age, would be much valuable for the diagnosis of asthma in children.
Asthma* ; Child* ; Diagnosis ; Diagnosis, Differential ; Female ; Humans ; Hypersensitivity, Immediate ; Immunoglobulin E* ; Incidence ; Male ; Reference Values

Diagnosing pseudoaneurysms of the popliteal artery is usually straightforward in physical examinations and imaging findings. However, when a pseudoaneurysm shows a soft tissue mass with adjacent osseous change, it can mimic a bone tumor or a soft tissue sarcoma. We present a case of a 65-year-old man who had a pseudoaneurysm of the popliteal artery showing soft tissue mass and insinuating into the intramedullary cavity of the tibia. This presented case emphasizes the importance of considering pseudoaneurysms in the differential diagnosis of an apparent soft tissue mass with pressure erosion in adjacent bone.
Aged ; Aneurysm, False ; Diagnosis, Differential ; Humans ; Hydrazines ; Physical Examination ; Popliteal Artery ; Sarcoma ; Tibia

PURPOSE: The products of the irreversible non-enzymatic glycation is one of the important toxic components and it is called advanced glycation end products (AGEs). Because AGEs is related to development of neural toxicities, this study is directed to investigate the direct effects of AGEs on the rat bladder fibroblast cells in vitro. MATERIALS AND METHODS: Fibroblast cells were cultured, using Sprague Dawley rat bladder. AGEs-bovine serum albumin (AGEs-BSA) was prepared, characterized by spectrophotometry, SDS-PAGE and ELISA. The viability of the fibroblast cells after AGEs-BSA treatment was measured by 3-(4,5-dimethylthiazol-2-yl)-2,5 diphenyltetrazolium bromide (MTT) assay. Receptor of advanced glycation end products (RAGE), procollagen type I, procollagen type III, and TGF-beta1, 2, 3 mRNA expression levels were measured by reverse transcriptase polymerase chain reaction (RT-PCR) and RNA PCR-Southern blotting. RESULTS: Fibroblast cells were proliferated by high dose AGE (2,200nmol, p<0.05, statistical analysis by ANOVA). RAGE mRNA expression was confirmed in bladder fibroblast in vitro. Procollagen type I mRNA expression levels were increased by high dose AGEs (1,100, 2,200nmol FFI) treatment at 24 hours and 48 hours. TGF-beta2 mRNA expression levels were increased dose dependently at 72 hours. TGF-beta3 mRNA expression levels were suppressed in high dose AGEs treated cells from 24 hours. CONCLUSIONS: AGEs increase procollagen type I mRNA, TGF-beta2, TGF-beta3 mRNA expression and proliferative activity of the bladder fibroblast cells in vitro. These results suggest that AGEs can direct toxic effects to bladder mesenchymal cell proper.
Animals ; Collagen Type I ; Collagen Type III ; Diabetes Mellitus ; Electrophoresis, Polyacrylamide Gel ; Enzyme-Linked Immunosorbent Assay ; Fibroblasts* ; Glycosylation End Products, Advanced* ; Rage ; Rats* ; Reverse Transcriptase Polymerase Chain Reaction ; RNA ; RNA, Messenger ; Serum Albumin ; Spectrophotometry ; Transforming Growth Factor beta1 ; Transforming Growth Factor beta2 ; Transforming Growth Factor beta3 ; Urinary Bladder*

Although shoulder surgery is usually performed during general anesthesia, the use of an interscalene block alone or in combination with other anesthetic procedures is increasing. Blockade of the suprascapular nerve is used in the diagnosis and treatment of shoulder pain and to provide temporary relief from muscle spasm or strain in the supraspinatus or infraspinatus muscle We report a case of a patient that presented with severe shoulder pain who underwent surgery for traumatic humeral head fracture. Anesthesia was provided by an interscalene block follwing suprascapular nerve block.
Anesthesia ; Anesthesia, General ; Brachial Plexus* ; Diagnosis ; Humans ; Humeral Head* ; Nerve Block* ; Shoulder ; Shoulder Pain ; Spasm ; Supine Position*

OBJECTIVES: To evaluate characteristic computed tomography (CT) and magnetic resonance (MR) imaging findings of granulocytic sarcomas of the head and neck. METHODS: The CT (n=11) and MR (n=1) images obtained from 11 patients (7 males and 4 females; mean age, 23.5 yr; age range, 1 to 69 yr) with histologically-proven granulocytic sarcomas of the head and neck were retrospectively reviewed. Histological confirmation was done by bone marrow biopsy in 9 patients, and/or local biopsy in 4 patients. The imaging findings were analyzed with particular attention to location, size, shape, margin, bone destruction, internal architecture, pattern and degree of enhancement, and multiplicity of the lesions. RESULTS: The masses were most commonly located in the orbital cavity (n=8); other locations included lymph nodes (n=5) and palatine/pharyngeal/lingual tonsils (n=3). The mass sizes varied from a mean diameter of 1.3 to 5.8 cm (average, 2.6 cm). Multiple lesions were found in 6 patients. The shapes of the tumors were ovoid in 12 patients and irregular in 4 patients. Most lesions had poorly-defined margins (13/16) and invaded adjacent bony structures (5/16). On the pre-contrast CT images, the masses were iso- (5/8) or low-density (3/8) in comparison with muscle. The MRI, which was obtained in one patient in this study, showed that the mass was iso-signal intensity on T1-weighted images and iso-signal intensity on T2-weighted images compared to the gray matter of the brain. On the post-contrast CT images, there was homogenesous (n=12) or heterogeneous (n=4) enhancement, with mild (n=10), moderate (n=4), and marked (n=2) enhancement in the solid portions of the lesions. CONCLUSION: Although rare, granulocytic sarcomas arise in various locations in the head and neck area (most commonly in the orbit) in the form of well-demarcated, and mildly- and homogenously-enhancing masses with adjacent bony invasion.
Biopsy ; Bone Marrow ; Brain ; Head ; Humans ; Lymph Nodes ; Magnetic Resonance Spectroscopy ; Male ; Muscles ; Neck ; Orbit ; Palatine Tonsil ; Retrospective Studies ; Sarcoma, Myeloid

PURPOSE: Nocodazole, a microtubule disrupting reagent, is known to arrest cells in the M phase, To gain insight on the regulatory mechanism of H2B histone gene expression by nocodazole in HL-60 cell, the binding pattern of nuclear proteins to cis element in the human H2B histone gene promoter has been investigated with DNase I footprinting and DNA mobility shift assay. MATERIALS AND METHODS: Northern blot hybridization was performed by the method of Virca et al. A Hinc II-Sac I fragment of pSPH28 was used as probe for Northern blot analysis of H2B histone mRNA. DNase I footprinting and DNA mobility shift assay were performed by the method of Lim et al. End labeled DNA oligomer (upper strand, 5'-CTTCACCTTATTTGCATAA GCGATTC-3') for octamer binding activity was mixed with nuclear extracts in a 20 ul reaction volume containing 60 mM KC1, 12 mM HEPES, pH 7.9, 5 mM MgCl2, 0.2 mM EDTA, 0.2 mM DTT, 12% glycerol, and 2 ug of poly [dI-dC]. RESULTS: The level of H2B histone mRNA rapidly was reduced at 24 hours in nocodazole-treated HL-60 cells and the mRNA was repressed in proportion to the concentration of nocodazole. Nocodazole-dependent repression of H2B histone gene was restored by replacement with nocodazole-free media. In DNase I footprinting analysis, one nuclear factor bound at 42 bp site (octamer motif) in the absence of nocodazole. In the presence of nocodazole, the binding of nuclear factor on octamer motif partially vanished. In DNA mobility shift assay, one DNA-protein complex (Octl) was formed when octamer motif was incubated with nuclear extract of HL-60 cell. After nocodazole treatment, Octl binding activity was reduced by time dependent manner. CONCLUSION: These results suggest that nocodazole-dependent repression of H2B histone gene is correlated with reduction of Octl binding activity in HL-60 cell.
Blotting, Northern ; Cell Division ; Deoxyribonuclease I ; DNA ; Edetic Acid ; Electrophoretic Mobility Shift Assay ; Gene Expression* ; Glycerol ; HEPES ; Histones* ; HL-60 Cells* ; Humans ; Hydrogen-Ion Concentration ; Magnesium Chloride ; Microtubules ; Nocodazole* ; Nuclear Proteins ; Repression, Psychology ; RNA, Messenger

This study evaluated the pharmacokinetic profile and therapeutic efficacy of piroxicam (PX), a long acting non-steroidal anti-inflammatory drug for the treatment of arthritis, following intra-articular (IA) injection in comparison to the pharmacokinetic profile and therapeutic efficacy of PX after intramuscular (IM) injection. In the pharmacokinetic study in rats, systemic exposure and pharmacokinetic parameters of PX after a single IA dose were compared with systemic exposure and pharmacokinetic parameters of PX after administration of the same dose IM (0.6 mg/kg). The anti-inflammatory and analgesic effects of IA PX were evaluated simultaneously in a monoiodoacetate-induced osteoarthritis rat model. The plasma PX concentration rapidly rose following IA injection, and it was comparable to the plasma PX concentration following IM injection, suggesting the rapid efflux of the drug molecule from the joint cavity. However, in the efficacy study, the IA PX administration significantly reduced the knee swelling by reducing the level of prostaglandin E2 in the joint, compared to that following administration of IA vehicle and after administration of the IM PX dose. In addition, we found that the anti-inflammatory and anti-nociceptive efficacies of IA PX were synergistically increased upon co-treatment with hyaluronic acid (HA), a potent agent for the treatment of osteoarthritis, at the weight ratio of 1:1 or 1:2, and these effects were more pronounced than those following administration of HA or PX alone. In conclusion, this study demonstrated the efficacy of the IA use of PX alone and/or in combination with HA in osteoarthritis.
Animals ; Arthritis ; Dinoprostone ; Hyaluronic Acid ; Injections, Intra-Articular ; Joints ; Knee ; Models, Animal ; Osteoarthritis ; Pharmacokinetics* ; Piroxicam* ; Plasma ; Rats*

Technical advances in prosthetics and Improved surgical techniques have led to the increased use of the penile prosthesis In the rehabilitation with erectile dysfunction. But patients should be carefully selected for this surgery, and proper selection of prosthesis will minimize the number of problems associated with prosthesis. We report a case of management of an inappropriate penile prosthesis that implanted by a plastic surgeon. It is silicone material with the length of loom, hand-made rod. We removed it from the corpus cavernosum, and implanted 18cm Malleable prosthesis.
Erectile Dysfunction ; Humans ; Male ; Penile Prosthesis* ; Prostheses and Implants ; Rehabilitation ; Silicones

PURPOSE: The aim of this study was to evaluate the survival, proliferation, and bone formation of dog mesenchymal stem cells (dMSCs) in the graft material by using Polycaprolactone-tricalcium phosphate (PCL-TCP), auto-fibrin glue (AFG), recombinant human bone morphogenetic protein-2 (rhBMP-2), and dMSCs after a transplantation to the scapula of adult beagle dogs. MATERIALS AND METHODS: The subjects were two beagle dogs. Total dose of rhBMP-2 on each block was 10 microg with 50 microg/mg concentration. The cortical bone of the scapula of the dog was removed which was the same size of PCL-TCP block (Osteopore International Pte, Singapore; 5.0x5.0x8.0 mm in size), and the following graft material then was fixed with orthodontic mini-implant, Dual-top(R) (Titanium alloy, Jeil Co. Seoul, Korea). Four experimental groups were prepared for this study, Group 1: PCL-TCP + aFG; Group 2: PCL-TCP + aFG + dMSCs; Group 3: PCL-TCP + aFG + dMSCs + rhBMP-2; Group 4: PCL-TCP + aFG + dMSCs + rhBMP-2 + PCL membrane. The survival or proliferation of dMSCs cells was identified with an extracted tissue through a fluorescence microscope, H-E staining and Von-Kossa staining in two weeks and four weeks after the transplantation. RESULTS: The survival and proliferation of dMSCs were identified through a fluorescence microscope from both Group 1 and Group 2 in two weeks and four weeks after the transplantation. Histological observation also found that the injected cells were proliferating well in the G2, G3, and G4 scaffolds. CONCLUSION: This study concluded that bone ingrowth occurred in PCL-TCP scaffold which was transplanted with rhBMP-2, and MSCs did not affect bone growth. More sufficient healing time would be needed to recognize effects of dMSCs on bone formation.
Animals ; Bone Morphogenetic Proteins/*pharmacology ; Calcium Phosphates/*pharmacology ; Cell Proliferation/drug effects ; Cell Survival/drug effects ; Cells, Cultured ; Dogs ; Fibrin Tissue Adhesive/pharmacology ; Humans ; Mesenchymal Stem Cell Transplantation ; Mesenchymal Stem Cells/*cytology/*drug effects/physiology ; Microscopy, Fluorescence ; Osteogenesis/*drug effects ; Polyesters/*pharmacology ; Recombinant Proteins/*pharmacology ; Transforming Growth Factor beta/*pharmacology