Medical education in Je Joong Won was proposed and initiated by Dr. HN Allen. In his proposal of building a new hospital, submitted to the king in 1885, he expressed his wish to teach Western medicine to young Koreans at the hospital. The king welcomed his proposal and the plan was soon realized. Je Joon Won, the first modern hospital in Korea, opened on April 10th, 1885. The following year, on March 29th, Dr. Allen began medical school attached to the hospital. Many applicants were recruited by the government and 16 students were selected through the entrance examination. At first, they were taught English and finally 12 students out of them were selected after three months of teaching. The selected students were taught arithmetic, physics, chemistry, anatomy and physiology. The medical education at this period cannot be evaluated entirely successful since none of the 12 students was presumed to have worked as a practitioner.
Education, Medical/*history ; English Abstract ; History of Medicine, 19th Cent. ; History of Medicine, 20th Cent. ; Hospitals/history ; Korea ; Mentors/*history ; Missions and Missionaries/*history ; United States ; Western World

OBJECTIVES: To assess innate and humoral immune responses in middle ear effusion of obese pediatric patients with otitis media with effusion (OME). METHODS: We evaluated 219 children with OME, of whom 21 were obese and 198 were non-obese. We compared the expression in middle ear effusion of mRNAs encoding toll-like receptors (TLR) 2, 4, 5, and 9; nucleotide-binding oligomerization domains (NOD) 1 and 2; retinoic acid-inducible gene (RIG)-I; interleukins (IL)-6, -10, and -12; interferon (IFN)-gamma; and tumor necrosis factor (TNF)-alpha mRNAs. We also compared the expression of immunoglobulins IgG, IgA, and IgM and the bacterial detection rate in the two groups. RESULTS: TLR2-mediated expression of IL-6 mRNA, TLR4-mediated expression of IL-6 and IL-10 mRNA, TLR5-mediated expression of IL-6, IL-10, and TNF-alpha mRNA, TLR9-mediated expression of IL-6 mRNA, and NOD2-mediated expression of IL-6, IL-12, and TNF-alpha mRNA were significantly lower in obese than in non-obese children (P<0.05). However, concentrations of IgG, IgA, and IgM in middle ear effusion were lower in obese than in non-obese children, but none of these differences was significant (P>0.05). CONCLUSION: Mean body mass index was higher and pattern-recognition receptor-mediated cytokine mRNA expression was lower in obese than in non-obese children with OME.
Bacteria ; Body Mass Index ; Child* ; Humans ; Immunity, Humoral ; Immunoglobulin A ; Immunoglobulin G ; Immunoglobulin M ; Immunoglobulins ; Interferons ; Interleukin-10 ; Interleukin-12 ; Interleukin-6 ; Interleukins ; Obesity ; Otitis Media with Effusion* ; Otitis Media* ; Otitis* ; RNA, Messenger* ; Toll-Like Receptors ; Tumor Necrosis Factor-alpha

PURPOSE: This prospective study aimed to evaluate the safety and efficacy of potassium-exchange resin (PER, Kalimate(R) or Argamate(R)) for managing hyperkalemia induced by Renin-Angiotensin System (RAS) blockers in chronic kidney disease (CKD) patients without their discontinuation. METHODS: Besides conservative remedies including low-potassium diet, all hyperkalemic CKD patients (n=21, [K] > or =5.6 mEq/L) received PER added on angiotensin-converting enzyme inhibitor (Moexipril, n=2) or angiotensin-receptor blocker (Irbesartan, n=19) with, at least, weekly monitoring of serum [K] if its level remains more than 5.5 mEq/L for more than 2 months (mean+/-SD, 6.8+/-5.9 mon; range, 2-26 mon). RESULTS: Baseline serum [K] on RAS blocker alone (5.1+/-0.4 mEq/L; 4.2-6.3 mEq/L) increased to 6.0 +/-0.4 mEq/L (p<0.05) before adding PER, and then it was significantly decreased to 5.3+/-0.6 mEq/L at the first clinic visit (p<0.05) and to 5.0+/-0.7 mEq/L at the last clinic visit (p<0.05) following the administration of PER added on RAS blocker. During the study period, GFR, serum creatinine and urinary protein excretion didn't change significantly. CONCLUSION: The development of hyperkalemia on RAS blockers in CKD patients doesn't necessarily lead to withdrawal of RAS blockers when the cautious add-on therapy of potassium-exchange resin with other conservative remedies launches, unless severe refractory hyperkalemia persists.
Ambulatory Care ; Angiotensin II Type 1 Receptor Blockers ; Angiotensin-Converting Enzyme Inhibitors ; Creatinine ; Diet ; Humans ; Hyperkalemia ; Prospective Studies ; Renal Insufficiency ; Renal Insufficiency, Chronic* ; Renin-Angiotensin System*

OBJECTIVES: Toll-like receptor (TLR)-9 recognizes unmethylated cytidine-phosphate-guanosine (CpG) motifs in bacteria. Therefore, the expression of TLR-9 may differ according to the results of bacterial culture, and thus a change in proinflammatory cytokine induction can also be expected. The authors aimed to assess the differences and relationships between the expression of TLR-9, cytokines, and nitric oxide synthase (NOS) in otitis media with effusion (OME) based on bacterial culture results. METHODS: Sixty-eight patients with OME were divided into culture-positive and culture-negative groups based on middle ear culture results. mRNA expression of TLR-9, NOS, and cytokines was measured and analyzed. RESULTS: Bacteria were detected in 38.2% of patients, and the distribution was as follows: coagulase negative Staphylococcus (10.3%), Staphylococcus aureus (8.8%), Streptococcus pneumonia (5.9%), and Bacillus spp. and Haemophilus influenza combined (2.9%). There were no significant differences in epidemiologic characteristics according to the culture results. Down-regulation of TLR-9 was observed in the culture-positive group (P=0.019). Cytokines including interleukin (IL)-12 (r=-0.582), tumor necrosis factor (TNF)-alpha (r=-0.569), interferon (IFN)-gamma (r=-0.442), IL-6 (r=-0.395) and inducible NOS (r=-0.256) tended to decrease with the detection of bacteria. CONCLUSION: The expression of TLR-9 significantly decreased in OME with confirmed bacterial pathogens. IL-12, TNF-alpha, IFN-beta, IL-6 expression tended to decrease with the detection of bacteria. The presence of bacterial pathogens in OME may be related to abnormalities in the innate immune system.
Bacillus ; Bacteria* ; Coagulase ; Cytokines* ; Down-Regulation ; Ear, Middle ; Haemophilus ; Humans ; Immune System ; Immunity, Innate ; Influenza, Human ; Interferons ; Interleukin-12 ; Interleukin-6 ; Interleukins ; Nitric Oxide Synthase ; Otitis Media with Effusion* ; Otitis Media* ; Otitis* ; Pneumonia ; RNA, Messenger ; Staphylococcus ; Staphylococcus aureus ; Streptococcus ; Toll-Like Receptors ; Tumor Necrosis Factor-alpha

Presently talc is one of the agents most commonly used for producing a pleurodesis in patients with either a recurrent pleural effusion or a spontaneous pneumothorax. Talc can be instilled into the pleural space either as an aerosol (insufflation) or as a suspension (slurry) in saline. They are quite effective in producing a pleurodesis. However, they rarely have acute serious adverse effects including acute respiratory distress syndrome, and recently a discussion for using pleurodesis has been reported. We experienced a case of acute respiratory distressed syndrome after talc pleurodesis. A 64 year old man, who was diagnosed lung cancer with a malignant pleural effusion at the same side, was treated by pleurodesis using talc to control the effusion. After 3 days, he suffered fever, chill and breathlessness. The chest PA and CT revealed a bilateral infiltration in both lungs and the blood gas analysis confirmed hypoxemia, which required mechanical ventilation.
Anoxia ; Blood Gas Analysis ; Fever ; Humans ; Lung ; Lung Neoplasms ; Pleural Effusion ; Pleural Effusion, Malignant ; Pleurodesis* ; Pneumothorax ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult ; Talc* ; Thorax

Pregnancy outcomes for women uncontrolled diabetes mellitus are poor. Women with chronic kidney disease and end-stage renal disease, if pregnant, will develop pregnancy-related complications. In the case of severe renal failure and diabetes mellitus, the incidence of prematurity, low birth weight, and neonatal death increases. Despite these risks, there have been few reported cases of successful pregnancy outcomes for these women. Adherence to a schedule of strict glucose monitoring, blood pressure and volume control, correction of anemia, and intensive hemodialysis may play important roles in the management of these women. Successful pregnancy and childbirth in a patient with diabetic kidney disease receiving hemodialysis have not been previously reported in Korea, to our knowledge. Herein, we report a case of a successful pregnancy outcome in a patient with diabetic end-stage renal disease undergoing hemodialysis.
Anemia ; Appointments and Schedules ; Blood Pressure ; Diabetes Mellitus ; Diabetic Nephropathies ; Female ; Glucose ; Humans ; Incidence ; Infant, Low Birth Weight ; Infant, Newborn ; Kidney Failure, Chronic ; Korea ; Parturition ; Pregnancy ; Pregnancy Outcome ; Renal Dialysis ; Renal Insufficiency ; Renal Insufficiency, Chronic

The overall incidence of malignancy in a renal transplanted patient is 3 to 5 times higher compared with general population. We report a very rare case of multiple leiomyoma originated from lung after renal transplantation. 33-year-old male underwent renal transplantation in November, 1989. A 5 mm sized pulmonary nodule was found in the left lower lobe incidentally in March, 2001. The size of pulmonary nodule increased and same lesion was found on the opposite side of the lung on chest roentgenogram after one year, so we proceeded with computed tomography of the chest. Variable sized multiple nodules in the whole lung field were noted, which were thought be metastatic lesions, and for detection of the primary site of malignancy, further study including esophagogastroduodenoscope, colon study, abdominal ultrasound, abdominal CT, bone scan and tumor marker were checked, but there was no evidence of primary cancer. After open lung biopsy low malignant potential smooth muscle tumor was noted, and Epstein-barr virus (EBV) DNA was detected. The patient had been maintained on immunosuppressive therapy with cyclosporine and mycophenolate mofetil (MMF), and after the diagnosis of leiomyoma administration of MMF was stoped, and cyclosporine dosage was reduced. With the reduction of immunosuppressants, intravenous immunoglobulin trial was done for the first cycle, but the efficacy of treatment is not clear.
Adult ; Biopsy ; Colon ; Cyclosporine ; Diagnosis ; DNA ; Herpesvirus 4, Human ; Humans ; Immunoglobulins ; Immunosuppressive Agents ; Incidence ; Kidney Transplantation ; Leiomyoma* ; Lung ; Male ; Smooth Muscle Tumor ; Thorax ; Tomography, X-Ray Computed ; Ultrasonography

Fibrodysplasia ossificans progressive (FOP) is an extremely rare disabling disorder characterized by progressive heterotopic ossification associated with congenital digital malformations. The purpose of this study is to delineate the problems in diagnosis and treatment of this rare disease, and to present their solutions. Nine Korean FOP patients have been followed up for average 7.2 years. Their medical records and radiographs were reviewed, and they were reexamined directly or interviewed by telephone. There were 6 female and 3 male patients. The age at the time of this study averaged 13.3 years (range, 4 to 23). In 5 cases, the first clinical manifestation was migrating scalp and neck mass at the age of 1-2 years. The diagnosis was delayed for 3 year and 5 months at average although all the patients had pathognomonic big toe anomaly. Surgical excision of heterotopic ossification in an attempt to increase the joint motion was performed in 4 cases but in vain. Posterior spinal fusion in 1 case failed to prevent progression of scoliosis and trunk decompensation. Disodium etidronate, tried in 3 patients, brought no effective symptom relief. All the patients in their 20's were household ambulators. Understanding the clinical manifestation of this disease enables early diagnosis, by which unnecessary and harmful procedures such as surgical biopsy or excision can be avoided, although no effective treatment has been developed.
Biopsy ; Diagnosis ; Early Diagnosis ; Etidronic Acid ; Family Characteristics ; Female ; Humans ; Joints ; Male ; Medical Records ; Myositis Ossificans* ; Neck ; Ossification, Heterotopic ; Rare Diseases ; Scalp ; Scoliosis ; Spinal Fusion ; Telephone ; Toes

Leiomyosarcomas make up approximately 1 to 3% of all gastric neoplasms. The most prevalent age group was 6th and 7th decades. The main symptoms and signs were abdominal pain and bleeding. They most frequently involve gastric body and often ulcerate and bleed. Diagnosis can be established only by exploratory operation and histologic examination. Leiomyosarcomas rarely invade adjacent viscera and characteristically do not metastasize to lymph nodes, but they may spread to the liver and lungs. The treatment of choice is surgical resection. We report two cases of gastric leiomyosarcoma which was successfully treated surgically.
Abdominal Pain ; Diagnosis ; Hemorrhage ; Humans ; Leiomyosarcoma* ; Liver ; Lung ; Lymph Nodes ; Stomach Neoplasms ; Stomach* ; Ulcer ; Viscera

Biphenotypic acute leukemia (BAL) is a subtype of leukemia of ambiguous lineage in the World Health Organization classification system. About one third of the cases have the Philadelphia chromosome, and some cases are associated with other structural abnormalities involving 11q23. BAL is known to have a poor prognosis in both children and adults. According to the previously reported BAL cases with positive BCR-ABL fusion gene, most of the BCR-ABL mRNA transcript type was e1a2. So, we describe here a 30-year-old adult BAL case with the karyotype 46,XY,t(9;22)(q34;q11.2) resulting in a very rare b3a2 type of BCR-ABL mRNA transcript.
Adult ; Child ; Classification ; Humans ; Karyotype ; Leukemia ; Leukemia, Biphenotypic, Acute* ; Philadelphia Chromosome ; Prognosis ; RNA, Messenger* ; World Health Organization