Epithelioid smooth muscle tumor is relatively rare and potentially malignant, especially in retroperitoneum. Distinct criteria for malignancy still have not been clarified in this epithelioid variant arising in retroperitoneum. We report a deceptively benign-appearing epithelioid leiomyosarcoma in a 50-year-old female. She was admitted with abdominal discomfort and dysuria. Abdominal CT showed a well-demarcated, 10 10 cm sized, solid mass in retroperitoneum. Concomitant metastatic lesions were noted in right lung field. Surgical excision of retroperitoneal mass and right lung lobectomy were performed. The retroperitoneal mass showed yellowish-tan, well-delineated and lobulated appearance. Histologically, this tumor was composed of predominantly epithelioid, round to oval cells with distinct clear cytoplasm and slightly atypical nuclei. Mitosis was rare (0~1/50 HPF). Lung lesions were morphologically similar to that of retroperitoneum.
Cytoplasm ; Dysuria ; Female ; Humans ; Leiomyosarcoma* ; Lung ; Middle Aged ; Mitosis ; Smooth Muscle Tumor ; Tomography, X-Ray Computed

PURPOSE: The purposes of this study were to examine the amount of daily fluid intake among nursing home residents and to explore the caregiver's perceived barriers to elderly's fluid intake. METHOD: Data was collected from 111 nursing home residents and 64 caregiver's in 4 nursing homes. A random, non-consecutive three days of 24 hour fluid intake was measured and recorded. The caregiver's perceived barriers to elderly's fluid intake was assessed using a structured questionnaire. RESULTS: The average amount of daily fluid intake was 1,035(SD=359)ml with the range of 210ml to 2,050ml. About 52% (n=58) of the subjects had a less than adequate fluid intake. The amount of daily fluid intake was significantly associated with age, mental status, physical functioning, and the number of oral medications ordered. The most frequently mentioned caregiver's perceived barrier was elderly's concern about incontinence with increased fluid intake. CONCLUSION: Inadequate fluid intake among nursing home residents is prevalent. To enhance adequate hydration of nursing home residents, an institution wide nursing intervention is necessary.
Aged ; Aged, 80 and over ; Caregivers/*psychology ; *Drinking ; Female ; *Frail Elderly ; Humans ; Male ; *Nursing Homes ; Urinary Incontinence/psychology

Acral lentiginous melanoma is a rare variant of malignant melanoma and is characterized by a lentiginous (radial) growth phase that evolves over months or years to a dermal (vertical) invasive stage. Clinical and pathological features were reviewed in 3 cases of acral lentiginous melanoma of the soles. The first case was a 59-year-old female. On gross examination, there was a black, nodular, round, and ulcerated mass, 1.5 x 1.5 cm, on the posterior portion of the left sole. This mass was accompanied by peripheral pigmented macules. Histologically, the macular lesion revealed the pattern of a lentiginous growth phase, with a diffuse hyperplasia of atypical melamocytes in the basal layer of the epidermis. In the vertical growth component, atypical melanocytes (predominantly spindle cell) infiltrated the dermis, showing level 3 invasion. The second case was a 47-year-old male. On gross examination, there was a dark brown to black, nodular, hemorrhagic and ulcerated mass, 7x7 cm, on the middle portion of the right sole. This mass grew radially into neighboring tissue. Histologically, the radial growth component revealed atypical melanocytes which were distributed in the basal portion of epidermis. In the vertical growth component, atypical melanocytes (spindle, round, or polygonal cells) infiltrated the dermis, showing level 4 invasion. The third case was a 87-year-old female. There was a formation of satellite pigmented macules, up to 2x0.5 cm, on the right sole. The color of macules was usually not uniform but was likely to be scattered radially, being grayish brown, bluish black, or black. Histologically, the peripheral, macular, hyperpigmented lesion revaled the pattern of a lentiginous growth phase. In the vertical growth component, atypical melanocytes (predominently polygonal cells) infiltrated the dermis, showing level 13 invasion.
Female ; Humans

PURPOSE: Communication skills are essential skills which medical students need to acquire in order to become a doctor. More attention is being given to the subject but not many studies have been done in the medical education field. As communication skills are provided to students as a subject in medical educational curriculum, the assessment of its effectiveness needs to be undertaken. METHODS: In the year 2005 and 2006, second year pre-medical students at The Catholic University College of Medicine took 'Communication Skills' course in total, 180 second year pre-medical students' survey results were used in the evaluation of the study question. The instrument used in the study was the modified and translated version of 'Beyer-Fetzer's Essential Elements of Communication Skills Assessment Sheet.' The assessment sheets were used as the pre-test and post-test to analyse the differences, which were put through the paired t-test. RESULTS: All categories of communication skills showed an improvement. For year 2005, meaningful differences were shown in 'opening the discussion (p=.005)' and 'sharing information (p=.008)', whereas in 2006, improvements were shown in all areas. CONCLUSION: From the result, it is clear that in order to create an effective communication skills program, the content should be more structured and focused on the program objectives.
Curriculum ; Education, Medical ; Humans ; Students, Medical

Cauda equina syndrome(CES) and disc rupture have been implicated as a potential complication of spinal manipulation. A review of the literature from 1911 to 1996 received 61 reported cases of cauda equina syndrome or disc rupture in patients undergoing manipulation. This article presents four new cases, where a temporal association was found between the onset of cauda equina symptoms or disc rupture and lumbar manipulation. The type of manipulation administered and the relationship between the treatment and symptoms is reviewed. Our patients symptoms suggest that acute herniation was caused, or at least precipitated by spinal manipulation. In each of these cases the chiropractitioner failed to comprehend the nature of the problem and take appropriate action. As a consequence, the patient went untreated for several days. Many chiropractic therapists assumed the incidence of CES caused by manipulation to be approximately one in many millions of treatments. However, we assumed that CES or disc rupture is far more common than the literature would reflect. It is therefore essential that persons practicing or prescribing manipulation would be aware of these complications.
Cauda Equina ; Chiropractic ; Humans ; Incidence ; Manipulation, Spinal ; Polyradiculopathy ; Rupture ; Spine*

This case report describes a variation of the flexor digitorum brevis (FDB) with a separated muscle belly and tendon at the fifth toe. The narrow tendon and muscle belly for the fifth toe arose from the intermuscular septum between the FDB and abductor digiti minimi adjacent to the arising fibers of the FDB, separating from its other fibers. The tendon and muscle belly for the fifth toe became wider at the base of the metatarsal bones and narrower as it coursed toward the toes in a fusiform shape. The tendon and muscle belly for the fifth toe became thin at the midfoot and coursed just beneath the flexor digitorum longus tendon and entered the digital tendinous sheath. FDB variations including that described herein should be considered when performing various surgical procedures and evaluating the biomechanics of the foot.

PURPOSE: From 2009, the Korean Medical Licensure Exam implemented a clinical performance examination (CPX) that highlighted the importance of good patient-physician relationships in medical education. This study aimed to examine changes in medical students' attitudes before and after implementation of the CPX in their medical education curriculum. METHODS: In 2006 and 2009, 236 fourth-year medial students of C College of Medicine took the Patient Practitioner Orientation Scale (PPOS) by Krupet et al. (2000), which measures patient-centered attitudes in patient-physician relationships. The data were analyzed by independent t-test and two-way analysis of variance using SPSS 21.0. RESULTS: The PPOS scores of year 2006 students were 3.88+/-0.25 for males and 3.98+/-0.38 for females. For year 2009 students, males scored 3.81+/-0.42 and females scored 4.01+/-0.48. All students had higher Care scores than Share scores (2006: Share, 3.67+/-0.47 vs. Care, 4.19+/-0.51; 2009: Share, 3.56+/-0.34 vs. Care, 4.18+/-0.53). There were significant differences in PPOS and Share scores by gender before and after the CPX. With regard to Care scores, female students' scores tended to rise and males' scores declined over time. CONCLUSION: An educational program is needed for students to foster patient-centered attitudes, but gender differences should be taken into account.
Curriculum ; Education, Medical ; Female ; Humans ; Licensure, Medical ; Male ; Physician-Patient Relations ; Students, Medical

Distal thumb injuries are a common and difficult problem for hand surgeons. Coverage of soft tissue on the fingers may be difficult due to the size of the defect or the limitation of local flap mobilization. However, the variable anatomy of the dorsal hand vascular system sometimes prevents successful flap harvest. The purpose of this study was to clarify the vascular anatomy of the dorsal side of the thumb and the first web for the flaps. Twenty six hands (13 right and 13 left hands) from Korean embalmed cadavers were dissected. A catheter was inserted into the radial artery in the forearm, and the red colored latex (Latex 671, Dupont Industry, France) was injected until the dorsum of the hand was colored. The arrangement of the first dorsal metacarpal artery (FDMA) and its branches were vary and classified into three categories according to their branching patterns; Both dorso-ulnar thumb branch (DUTB) and dorso-radial index branch (DRIB) arose from the FDMA (10 cases, 38.5%). Each DUTB and DRIB arose separately from the radial artery (5 cases, 19.2%). The DUTB and the DRIB originated from the princeps pollicis artery and the radial artery, respectively (11 cases, 42.3%). The typical course of the FDMA and its branches ran overlying the first dorsal interosseous muscle in 17 cases of the 26 specimens (65.4%). However, in nine cases (34.6%) the DRIB ran on the first dorsal interosseous muscle and the DUTB had a deep course within the substance of the first dorsal interosseous muscle. The FDMA flap represents a good option to cover defects for the thumb. These anatomical findings in the present study could provide useful knowledge of flaps for dorsal aspect of the thumb and the first web.
Arteries ; Cadaver ; Catheters ; Fingers ; Forearm ; Hand ; Latex ; Muscles ; Radial Artery ; Thumb

BACKGROUND: Recent studies have shown that oncogenes and tumor suppressor genes are involved in tumorigenesis and tumor progression. The inverse role of bcl-2 and p53 in endometrial carcinomas has been debated. Moreover, their roles in angiogenesis as well as the interrelationship between prognostic clinico-pathological factors and angiogenesis have not been elucidated in endometrial carcinomas. METHODS: The expression rates of bcl-2, p53 and vascular endothelial growth factor (VEGF) in thirty-eight cases of surgically removed endometrial carcinomas were investigated using an avidin-biotin complex method of immunohistochemistry. CD34 immunostain for microvessel density (MVD) was also performed. RESULTS: The expression rate of bcl-2 was higher in the endometrioid type carcinoma (43.8%) than in the non-endometriod type carcinoma (16.7%). There was a significantly increased bcl-2 expression in grade I compared to grades II and III (P<0.05). The p53 expression rate was significantly higher in the non-endometriod type carcinoma than in the endometrioid type carcinoma (P<0.05).The VEGF expression rate was higher in the non-endometriod type carcinoma (83.3%) than in the endometrioid carcinoma (28.1%). Differences of MVD according to stages, histological types, grades and bcl-2, p53 and VEGF expressions were not noted. CONCLUSIONS: The expression rate of bcl-2 increases in the low grade endometrial carcinoma more than in the high grade one, so it may be suggested that bcl-2 expression could be used for an ancillary prognosticator. However, p53 and VEGF expressions and microvessel density may not have any prognostic value.
Carcinogenesis ; Carcinoma, Endometrioid ; Endometrial Neoplasms* ; Endometrium ; Female ; Genes, Tumor Suppressor ; Immunohistochemistry ; Microvessels* ; Oncogenes ; Vascular Endothelial Growth Factor A*

OBJECTIVE: To evaluate the effectiveness of aromatase inhibitor (AI) for ovulation induction in polycystic ovary syndrome (PCOS) patients with thin endometrium, hyper-responsiveness after clomiphene citrate (CC) treatment. MATERIAL AND METHODS: A prospective study was performed in 43 PCOS patients (50 cycles) with ovulatory dysfunction between March 2004 and September 2004. AI group (total 36 cycles) included the patients 1) with thin endometrium below 6 mm on hCG day after CC (n=17), 2) with more than 5 ovulatory follicles after 50mg of CC (n=4), 3) who do not want multiple pregnancy (n=14). Patients were treated with Letrozole 2.5mg for days 3 to 7 of the menstrual cycle. CC group (total 14 cycles) were treated with CC 50~100 mg. RESULTS: In PCOS patients, ovulation was occurred 97.2% after AI use. Between AI group and CC group, there was no significant difference in the mean age, duration of infertility, interval of menstruation, basal FSH, prior treatment cycles, and the day of hCG administration. But, the number of mature follicles (> or =15 mm) was lower in the AI group (1.08+/-0.45 vs. 1.64+/-0.75) (p=0.018), and the thickness of endometrium (mm) was significantly thicker in the AI group (10.35+/-1.74 vs. 9.23+/-1.61) (p=0.044), and E2 (pg/ml) concentration on hCG day was lower in the AI group (116.9+/-75.8 vs. 479.5+/-300.8) (p=0.001). Among the AI group, patients with prior thin endometrium (below 6 mm) during CC treatment showed 10.6+/-1.6 mm in the endometrial thickness and 106.6+/-66.8 pg/ml in E2 concentration. Patients with more than 5 ovulatory follicles after CC showed decreased follicle number (1.25+/-0.5) compared to prior CC cycle. CONCLUSIONS: In PCOS patients, AI group showed significantly thicker endometrium, lesser number of mature follicles, and lower E2 concentration on hCG day than CC group. AI might be useful alternative treatment for ovulation induction in PCOS patients with thin endometrium and hyper-responsiveness after CC treatment.
Aromatase* ; Clomiphene* ; Endometrium ; Female ; Humans ; Infertility ; Menstrual Cycle ; Menstruation ; Ovulation ; Ovulation Induction ; Polycystic Ovary Syndrome* ; Pregnancy ; Pregnancy, Multiple ; Prospective Studies