A solitary cutaneous myxoma, referred to as superficial angiomyxomas, is relatively uncommon benign myxoid soft tissue tumors. The lesion usually present on the head, neck, and trunk of adults as a slowly growing asymptomatic nodule. Herein, we describe a case of a pedunculated solitary cutaneous myxoma arising on the vertex of a 48-year-old man, but with no evidence of Carney syndrome. Histologically, the tumor was composed of vascular, mucinous matrix with a network of fine collagen and reticulin fibers, containing stellate and spindle-shaped fibroblasts. There was no evidence of malignancy
Adult ; Carney Complex ; Collagen ; Fibroblasts ; Head ; Humans ; Middle Aged ; Mucins ; Myxoma* ; Neck ; Reticulin

BACKGROUND: Improved diagnostic and therapeutic strategies for infective for infective endocarditis such as proposed diagnostic criteria, Duke criteria and echocardiography resulted to increased life-spans of patients. METHODS: Retrospective analysis of medical records including medical history, laboratory data such as echocardiographic data and blood culture, and clinical outcomes was done for 106 patients with clinical diagnosis of infective endocarditis at Seoul National University Hospital from January 1990 to May 2000. Then we analysed differences of clinical features between elderly patients aged > or =60-years and the adult patients aged <60-years with infective endocarditis. RESULTS: The elderly patients >or=60-year are cases of 14%(15/106) and the mean ages are 67+/-8 years in elderly patient, 38+/-12 years in the adults patients respectively. Valvular heart disease was the most common predisposing heart disease with 9 cases(40%) followed by prosthetic valve endocarditis 2 cases (13%) in elderly patients, and there was no significant difference of frequencies with adult patients (valvular heart diseases, 33%; prosthetic valvular heart diseases, 25%). Although culture positive rates were not different with two groups: 47%(7/15) in elderly patients and 45%(41/91) in adult patients, the most common pathogen was staphylococcal species in elderly patients(27%, 4/15) but streptococcus species, in the adult patients(25%, 26/106, p<0.05). The frequencies of embolic complication were not different between two groups(20%, 3/15 vs 22%, 20/91: Elderly vs adult, respectively), but congestive heart failure was more developed in elderly patients, 33%(5/15) than in adult patients, 10%(9/91, p<0.05). Surgical intervention was more required in the elderly(47%, 7/15) than in adult patients(22%, 20/91, p<0.05). Out of 106 patients, 11 died and the overall mortality was 10.4%(11/106). In-hospital death was more common in the elderly than in adult patients: 4 cases(27%) vs 8%(7/91), p<0.05. Determinants of in-hospital death were patients with 60 years of age and older, Staphylococcus aureus endocarditis, and the presence of congestive heart failure(p<0.05) in univariate analysis. CONCLUSION: Infective endocarditis in elderly patients(age> or =60) had more poor outcomes than adult patients(age<60) such as the development of congestive heart failure, the need of surgical intervention, and the high mortality rate.
Adult ; Aged* ; Diagnosis ; Echocardiography ; Endocarditis* ; Estrogens, Conjugated (USP) ; Heart ; Heart Diseases ; Heart Failure ; Heart Valve Diseases ; Humans ; Medical Records ; Mortality ; Retrospective Studies ; Seoul ; Staphylococcus aureus ; Streptococcus

No abstract available.
Mitral Valve*

Health systems science is a new medical educational field added to the traditional medical education curricula of basic and clinical sciences. Health systems science emphasizes a more comprehensive approach utilizing systems thinking to care for patients, including interactions between multiple healthcare systems. In this review, I explore how health systems science education can be applied when medical instructors teach students in clinical clerkships through representative case studies. This study first looks at examples of health systems science education in clinical clerkship in the United States and suggests how to develop the curriculum of health systems science for clinical learning environments in Korea by combining Kotter’s 8-step change management model and Kern’s 6-step curriculum development model. Finally, based on practical examples from actual clinical practice education situations, suggestions are made regarding how to develop the entire educational program of a medical school from the stage of applying health systems science at the individual level to clinical practice education.

BACKGROUND: Evaluation of acute chest pain in emergency department (ED), using limited resource and time, is still very difficult despite recent development of many diagnostic tools. In this study, we tried to determine the applicability of new semi-automated cardiac function analysis tool, velocity vector imaging (VVI), in the evaluation of the patients with acute chest pain in ED. METHODS: We prospectively enrolled 48 patients, who visited ED with acute chest pain, and store images to analyze VVI from July 2005 to July 2007. RESULTS: In 677 of 768 segments (88%), the analysis by VVI was feasible among 48 patients. Peak systolic radial velocity (V(peak)) and strain significantly decreased according to visual regional wall motion abnormality (V(peak), 3.50 ± 1.34 cm/s for normal vs. 3.46 ± 1.52 cm/s for hypokinesia, 2.51 ± 1.26 for akinesia, p < 0.01; peak systolic radial strain -31.74 ± 9.15% fornormal, -24.33 ± 6.28% for hypokinesia, -20.30 ± 7.78% for akinesia, p < 0.01). However, the velocity vectors at the time of mitral valve opening (MVO) were directed outward in the visually normal myocardium, inward velocity vectors were revealed in the visually akinetic area (V(MVO), -0.85 ± 1.65 cm/s for normal vs. 0.10 ± 1.46 cm/s for akinesia, p < 0.001). At coronary angiography, V(MVO) clearly increased in the ischemic area (V(MVO), -0.88+1.56 cm/s for normal vs. 0.70 + 2.04 cm/s for ischemic area, p < 0.01). CONCLUSION: Regional wall motion assessment using VVI showed could be used to detect significant ischemia in the patient with acute chest pain at ED.
Chest Pain* ; Coronary Angiography ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Hypokinesia ; Ischemia ; Mitral Valve ; Myocardium ; Prospective Studies ; Thorax*

OBJECTIVES: Alcohol drinking, obesity, and reduced physical activity are commonly related to oxidative stress, which induces plasma membrane-bound protein damage in hepatic cells and elevates serum gamma-GTP. We have a hypothesis that a long commuting time may induce oxidative stress. This study was undertaken to investigate the relationship between commuting time and serum gamma-GTP level. METHODS: Questionnaires were administered to 717 male workers who had worked at Kimpo airport until the year 2000,and had then moved to Incheon airport and were working there in 2002. The questionnaire included items concerning commuting time, sleeping time and alcohol consumption. Physical examination and laboratory data were also collected. RESULTS: Serum gamma-GTP level was significantly and positively correlated with commuting time, body mass index, systolic blood pressure,diastolic blood pressure, hemoglobin, glucose, total cholesterol, AST, ALT and alcohol consumption. Multivariate regression analysis demonstrated that serum gamma-GTP level is significantly associated with commuting time, after considering the other covariates. CONCLUSIONS: Commuting time is one of the factors that affects serum gamma-GTP level in male workers.
Airports ; Alcohol Drinking ; Blood Pressure ; Body Mass Index ; Cholesterol ; gamma-Glutamyltransferase* ; Glucose ; Gyeonggi-do ; Hepatocytes ; Humans ; Incheon ; Male* ; Motor Activity ; Obesity ; Oxidative Stress ; Physical Examination ; Plasma ; Questionnaires ; Transportation*

Rhabdomyoma have been found in many areas of the body, though most commonly in the heart. The extracardiac appearance of rhabdomyoma is unusual and the head and neck area is involved most commonly. Affected sites have included the larynx, pharynx, oral cavity, neck, nasopharynx and orbit. Particularly, the larynx is an uncommon site. This neoplasms in the larynx have been reported only 23 cases in the literature so far and not reported in Korea. The diagnosis was based on routine histological and immunohistological staining, and electron microscopy. The extracardiac rhabdomyoma was divided into three types according to histopathological findings: adult, fetal cellular and fetal myxoid type. The differential diagnosis and requisite diagnostic procedure are discussed. The treatment of choice is surgical excision. Recently, we have experienced a rhabdomyoma of the larynx, so we report with a review of literatures.
Adult ; Diagnosis ; Diagnosis, Differential ; Head ; Heart ; Humans ; Korea ; Larynx ; Microscopy, Electron ; Mouth ; Nasopharynx ; Neck ; Orbit ; Pharynx ; Rhabdomyoma*

A 32-year-old female who had undergone the silicone oil removal procedure presented with visual disturbance in her left eye. Several months previous, she had cataract surgery in a private clinic, and a month later she had a Nd:YAG laser procedure for posterior capsulotomy. The slit-lamp examination revealed silicone oil droplets that had adhered to the intraocular lens where the posterior capsulotomy was performed. She had experienced high myopia as a manifestation of the resulting refractive changes. We replaced the previous intraocular lens with a new acrylic intraocular lens with resulting improvement to her vision. Here we report the case of a female patient with a history of silicone oil removal surgery where the resulting silicone bubbles had not been removed thoroughly and remained in the vitreous cavity. These bubbles subsequently adhered to the intraocular lens following YAG laser posterior capsulotomy, resulting in refractive changes. We recommend that implanting a silicone intraocular lens in anyone with a history of the silicone oil removal procedure or who has a possible history of silicone oil use should be avoided.
Adult ; Capsulorhexis/*methods ; Female ; Humans ; Laser Therapy/*methods ; Lasers, Solid-State/*therapeutic use ; Lenses, Intraocular/*adverse effects ; Myopia/*chemically induced/physiopathology/surgery ; Prosthesis Failure ; Refraction, Ocular/*drug effects ; Reoperation ; Silicone Oils/*adverse effects

PURPOSE: To detect differentially expressed genes in the patients with uterine cervical cancer during the radiation therapy. MATERIALS AND METHODS: In patients with biopsy proven uterine cervical cancer, we took a tumor tissue just before radiation therapy and at 40 minutes after external irradiation of 1.8 Gy. Total RNAs isolated from non-irradiated and irradiated tumor tissue samples were analyzed using the differential-display reverse transcription-polymerase chain reaction (DDRT-PCR). Complementary DNA (cDNA) fragments corresponding to differentially expressed messenger RNAs(mRNAs) were eluted, and cloned. The differential expression of the corresponding mRNAs was confirmed by reverse northern blot. Differentially expressed cDNA bands were sequenced. Nucleotide sequence data were analyzed in the Gene Bank and EMBL databases via the BLAST network server to identify homologies to known genes or cDNA fragments. Expression pattern of down-regulated clone was examined using RT-PCR in 5 patients undergoing radiotherapy. RESULTS: We identified 18 differentially expressed bands by DDRT-PCR, which were eluted and cloned. There were 10 up-regulated clones and 1 down-regulated clone in reverse northern blot. One cDNA fragment had homology to chemokine receptor CXCR4, four were identified as Human ESTs in the EMBL database in EST clones. Down-regulated CxCa-11 was also down regulated in all patients. CONCLUSION: Using the DDRT-PCR, we have identified 10 up-regulated and 1 down-regulated clone(s) in the patients with uterine cervix cancer during the radiation therapy. The clinical relevance and the functions of these genes will be further investigated.
Base Sequence ; Biopsy ; Blotting, Northern ; Cervix Uteri* ; Clone Cells ; DNA, Complementary ; Expressed Sequence Tags ; Female ; Humans ; Radiotherapy* ; RNA ; RNA, Messenger ; Uterine Cervical Neoplasms

PURPOSE: In the field of ophthalmology, the conjunctival autograft is a useful therapeutic material in many cases, but the small size of the autograft is a disadvantage. Therefore, we evaluated the feasibility of taking an expanded sample of conjunctival tissue using a subtenon's silicone implant. MATERIALS AND METHODS: We included a total of nine rabbits; eight rabbits were operative cases, and one was a control. A portion of conjunctival tissue from the control rabbit, which did not undergo surgery, was dissected and examined to determine whether it was histologically different from the experimental group. The surgical procedure was performed on eight rabbits via a subtenon's insertion of a silicone sponge in the left superior-temporal portion; after surgery, we dropped antibiotics into the eyes. We sacrificed a pair of rabbits every three days (on days 3, 6, 9, and 12) after surgery, removed the expanded conjunctival tissues with the silicone sponge implants, and measured their sizes. RESULTS: The mean size of the expanded conjunctival tissues was 194.4mm(2). On the third day, we were able to harvest a 223.56mm(2) section of conjunctival tissue, which was the most expanded sample of tissue in the study. On the twelfth day, we removed a 160.38mm(2) section of conjunctival tissue, which was the least expanded sample of tissue. Statistically, there were no significant differences in the mean dimensions of the expanded conjunctival tissues for each time period. Microscopic examinations showed no histological differences between the expanded conjunctival tissues and the normal conjunctival tissues. CONCLUSION: The results reveal that this procedure is a useful method to expand the conjunctiva for grafting and transplantation.
Animals ; Conjunctiva/*growth & development/*surgery/transplantation ; Corneal Diseases/surgery ; Feasibility Studies ; Female ; *Prostheses and Implants ; Rabbits ; Silicones ; Tissue Expansion/*methods ; Transplantation, Autologous/methods