No abstract available.
Endocardial Cushion Defects* ; Endocardial Cushions* ; Hernia, Diaphragmatic*

PURPOSE: The aim of the study was to introduce our experience of establish task-based learning outcomes for core clinical clerkships. METHODS: We first define our educational goal and objectives of the clinical clerkship curriculum according to knowledge, cognitive function and skill, and attitude. We selected clinical presentations and related diseases with expert panels and allocated them to core clinical departments. We classified doctor's tasks into 6 categories: history taking, physical examination, diagnostic plan, therapeutic plan, acute and emergent management, and prevention and patient education. We described learning outcomes by task using behavioral terms. RESULTS: We established goals and objectives for students to achieve clinical competency on a primary care level. We selected 75 clinical presentations and described 377 learning outcomes. CONCLUSION: Our process can benefit medical schools that offer outcome-based medical education, especially for clinical clerkships. To drive effective clerkships, a supportive system including assessment and faculty development should be implemented.
Clinical Clerkship ; Curriculum ; Education, Medical ; Humans ; Learning ; Patient Education as Topic ; Physical Examination ; Primary Health Care ; Schools, Medical

The synovium is lined by a layer of intimal cells which have been classified on ultrastructural criteria into type A and B synoviocytes. The functionally important lining cells of the synovium(type A and B synoviocytes) are the subjects of many study but have presented problems with their characterization and microscopical identification. Synovial sarcoma is a distinct and generally recognized soft tissue tumor that its origin still raises controversy. In this study, 12 cases of nonspecifically proliferative and resting human synoviocytes have been obtained from the synovium of knee and hip joints, and 3 cases of synovial sarcoma which have arisen in the left thigh, left buttock and right inguinal region were examined with light microscopy, immunohistochemical observation, and electron microscopy. In light microscopic level, it was difficult to differentiate the type A synoviocytes from type B synoviocytes morphologically. The reactive type B synoviocytes were positive for the protein of cytoskeleton such as pancytokeratin, CK1, CK8, CEA, and vimentin. The resting type B synoviocytes showed positive reactions for pancytokeratin, CK1, and CK8. The markers for the monocytes/histiocytes(CD15, CD68, lysozyme, Al-AT, Al-ACT) were reactive in resting and reactive type A synoviocytes. Also, MHC class II antigen was reactive in type A synoviocytes. Three cases of primary synovial sarcoma were 2 fibrous monophasic and 1 biphasic. Spindle-shaped cell in fibrous monophasic synovial sarcoma showed reactivity for CK7 and pancytokeratin, and epithelial cells (lining the glands) in biphasic synovial sarcoma were reactive for CK 7, pancytokeratin, EMA, and focally CEA, but only spindle cells reactive for vimentin, By electron microscopy, fibrous monophasic synovial sarcoma showed pseudogland formation with intercellular junctions of paired subplasmalemmal density and discontinuous basal lamina. These results suggest that the reactive type B synoviocytes and synovial sarcoma show an aberrant expression of the vimentin and CEA. The expression of CK on the resting and reactive type B synoviocytes and fibrous monophasic and biphasic synovial sarcomas are different. Type A synoviocytes expressing the MHC class II molecule and monocyte/histiocyte markers suggest a member of the mononuclear phagocytic system. The reasons of the aberrant expression of the intermediate filament, vimentin and oncofetal antigen, and CEA in reactively proliferative type B synoviocytes and synovial sarcoma and the different expression of cytokeratin on the resting, reactive type B synoviocyte and synovial sarcoma should be further evaluated.
Basement Membrane ; Buttocks ; Cytoskeleton ; Epithelial Cells ; Hip Joint ; Histocompatibility Antigens Class II ; Humans* ; Immunohistochemistry ; Intercellular Junctions ; Intermediate Filaments ; Keratins ; Knee ; Microscopy ; Microscopy, Electron ; Muramidase ; Sarcoma, Synovial* ; Synovial Membrane ; Thigh ; Vimentin

A fifty-five year old male was admitted because of fever and chill for one month. He complained of upper abdominal pain, malaise, anorexia and weight loss. So diagnostic procedures were performed: stool exam., bload chemistry testing, ultrasonography, radionuclide scintigraphy. ERCP, abdominal CT, and sonoguided liver aspiration, which revealed intrahepatic cholangiocarcinoma associated with clonorchiasis.
Abdominal Pain ; Anorexia ; Chemistry ; Cholangiocarcinoma* ; Cholangiopancreatography, Endoscopic Retrograde ; Clonorchiasis* ; Fever ; Humans ; Liver ; Male ; Radionuclide Imaging ; Tomography, X-Ray Computed ; Ultrasonography ; Weight Loss ; Cholangiocarcinoma

The surgical and anesthetic management for giant cerebral aneurysm is difficult because of their great size or lack of an anatomic neck. Recently, total circulatory arrest, profound hypothermia using cardiopulmonary bypass and the cerebral protection of barbiturate are able to manage the difficult cerebral aneurysm operation due to the ease of the surgical approach and the decreased post operative neurological injury. These techniques were successfully utilized in the patient of the diamerer-3 cm sized giant cerebral aneurysm located at the bifurcation between the right internal carotid artery and the anterior cerebral artery, and the surgical and anesthetic considerations are reviewed.
Anterior Cerebral Artery ; Cardiopulmonary Bypass ; Carotid Artery, Internal ; Humans ; Hypothermia* ; Intracranial Aneurysm* ; Neck

PURPOSE: Recent years have witness a dramatic increase in public awareness of the health risks associated with lead exposure-particularly concerning young children. The lead poisoning in children was considered a rarity, usually resulting from unique circumstances such as in appropriate use of lead-based body cosmetics or direct administration of lead-containing folk medicine or contaminated atmosphere. The increasing concern about children with lower levels of lead exposure has developed, but there are no data regarding the mean blood lead levels and the incidence of lead poisoning in Korean children. So, this study was conducted to measure the blood lead and ZPP(zinc protoporphyrin) levels of 125 children around Cheonan city. METHODS: 125 children around Cheonan city (from 1 month to 15 year-old, 68 males and 57 females) were studied. We analyzed the mean blood Zinc Protoporphyrin(ZPP) and lead values and excluded children with hematologic disorders in this study. RESULTS: 1) The mean blood lead level was 4.15 microgram/dl (95% CI: 3.82-4.488) and the mean ZPP level was 53.48 microgram/dl (95% CI: 48.44-58.52). Both were within normal range. 2) The mean blood lead level of 68 males was 4.23 microgram/dl and 4.06 microgram/dl in 57 females. The mean blood ZPP level was 49.88 microgram/dl in males and 57.77 microgram/dl in females. There was no significant difference in males and females. 3) There was no siginificant correlation between blood lead and ZPP concentration. CONCLUSIONS: We concluded that the mean blood lead level of 125 children around Cheonan city was 4.15 microgram/dl. That was within normal range and the same values with United States. It is important that there must be a national counter plan and that pediatricians continue to pay attention to lead poisoning in children.
Adolescent ; Atmosphere ; Child* ; Chungcheongnam-do* ; Female ; Humans ; Incidence ; Lead Poisoning ; Male ; Medicine, Traditional ; Reference Values ; United States ; Zinc

DiGeorge syndrome is the developmental anomalies of the third and fourth pharngeal pouches. Recently, damages or abnormal development of the neural crest is suggested as a possible pathogenetic factor, because neural crest cells play a crucial role in development of pharyngeal pouch derivatives, e.g. thymus and parathyroid glands, as well as the aortic arches and conotruncal part of the heat. Most cases have abnormal findings of chromosome 22 and are sporadic, but familial cases have been described. Typical features of DiGeorge syndrome are congenital heart disease, aplasia or hypoplasia of the thymus and parathyroid glands and facial dysmorphism. The main problems and cause of death are severe congestive heart failure due to cardiac anomlies, hypocalcemic complications or immunocompromised conditions. As these results, most cases were expired at infantal period or early childhood. Recently, we have a case of Digeorge syndrome which was associated with complex cardiovascular anomalies(tetralogy of Fallot, atrial septal defect, right aortic arch, left hemitruncus), severe hypocalcemia, aplasia of thymus and facial dysmorphism.
Aorta, Thoracic ; Cause of Death ; Chromosomes, Human, Pair 22 ; DiGeorge Syndrome* ; Heart Defects, Congenital ; Heart Failure ; Heart Septal Defects, Atrial ; Hot Temperature ; Humans ; Hypocalcemia ; Infant ; Neural Crest ; Parathyroid Glands ; Thymus Gland

Sine 1976, 2380 eases of ERCP were performed at the Kwangju Chrietian Hospital. Nighty eight patients with periampullary choledochaduodenal fistula diagnosed at ERCP were revewed, Following result were obtained 1) Cases were most commonly noted from fifth decade to seventh decade, and sex distribution was similar. 2) Right upper quadrant abdominal was most common clinical manifestation, and duration of illness prior to diagnosis were from 2 months to 20 years. Several weeks or days before ERCP, sudden disappearance of pain suggeeted spontaneous extrustion of a stone from the common bile duct to the duodenum with resultant PACD formation. 3) On past history, various types biliay operations had carried out in 26 patients. Subtotal gastrectomy with gastrojejunostomy in 1 patients, operation for CBD ascaris removal in 1 patient. 4) Most PACDF had finding formed recently on ERCP and fibrosis, inflamation, granulation, atrophic change, adhesive stenosis were noted additionally. 5) Most common cause of PACD by ERCP was biliary teact stone. 6) Endoscopic sphincteropapillotomy(EST) were performed in 39 patients with PACDF due to CBD stone and surgical intervention were done in 36 patients due to CBD stone also. It was interesting that EST were performed in 3 patients with old stenotic fistula.
Adhesives ; Ascaris ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Constriction, Pathologic ; Diagnosis ; Duodenum ; Fibrosis ; Fistula* ; Gastrectomy ; Gastric Bypass ; Gwangju ; Humans ; Sex Distribution

A 41-year-old female complaining of easy fatigue, headache, thickened extremities and deepened facial folds was admitted to the hospital. As early as 6 years ago, she had been told by family members that her voice was changed and both hands was thickened. Cranial plain radiography indicated ballooning of sella turcica. Sella MRI disclosed 2.2cm sized pituitary tumor with suprasellar extension. The pituitary tumor with hypothalamic extension was removed via a transsphenoidal approach. The postoperative course was uneventful until hyponatremia with sudden headache and respiratory arrest was developed. The case was due to hyponatremic encephalopathy on the basis of the clinical course and symptoms, and 3% hypertonic saline was infused for 12 hours until the hyponatremia was corrected. We have experienced a mortality case of hyponatremic encephalopathy in which surgieal removal of a pituitary tumor from a female acromegalic patient in menstruant period was followed by the sudden occurrence of hyponatremia, which in turn was later associated with marked brain edema.
Adult ; Brain Edema ; Extremities ; Fatigue ; Female ; Hand ; Headache ; Humans ; Hyponatremia ; Magnetic Resonance Imaging ; Mortality ; Pituitary Neoplasms ; Radiography ; Sella Turcica ; Voice

PURPOSE: To evaluate the efficacy and complication of minimally invasive plate osteosynthesis (MIPO) technique for lateral malleolar fracture. MATERIALS AND METHODS: From January 2001 to December 2003, we had treated 13 cases of lateral malleolar fracture (AO-OTA classification, type A: 4, type B: 9) by MIPO technique and followed them up more than 1 year. Operation time, union time, radiologic alignment, range of motion of the ankle joint, functional results according to criteria of Meyer and complication were evaluated. RESULTS: After the final follow-up, all the fractures were healed without any second procedure, full-weight bearing ambulation was started in average 10 weeks. Any malunion was not observed by the inadequate bending of plate. Two patients felt a discomfort of ankle because the location of plate was lower than the tip of the lateral malleolus, but all the patients had excellent or satisfactory ankle functions. No deep infection or soft tissue compromise were observed at the last follow up. CONCLUSION: Minimally invasive plate osteosynthesis technique is safe and worthwhile method in management of lateral malleous fractures while avoiding the complications associated with conventional open plating methods.
Ankle ; Ankle Fractures ; Ankle Joint ; Classification ; Follow-Up Studies ; Humans ; Range of Motion, Articular ; Walking