No abstract available.

Xanthogranulomatous pyelonephritis, an uncommon chronic inflammatory renal disorder of middle-aged women, is rarely seen in childhood. A 10 year-old boy with focal type of this disease in upper and lower pole was experienced. Patient had a intermittent fever and right flank pain without palpable mass. The blood analysis only revealed ESR increase but no anemia, no leukocytosis. There was no history or signs of urinary tract infection or calculi. The urine analysis and culture showed nothing abnormal. An intravenous pyelogram, ultrasonogram, abdominal CT and selective renal arteriography only demonstrated a non functioning upper pole of right kidney. During operation, a gross finding and frozen section strongly showed xanthogranulomatous pyelonephritis and diagnosis was made on histological examination, After nephrectomy, there had been no evidence of disease recurrence during 2 years follow-up period.
Anemia ; Angiography ; Calculi ; Child* ; Diagnosis ; Female ; Fever ; Flank Pain ; Follow-Up Studies ; Frozen Sections ; Humans ; Kidney ; Leukocytosis ; Male ; Nephrectomy ; Pyelonephritis, Xanthogranulomatous* ; Recurrence ; Tomography, X-Ray Computed ; Ultrasonography ; Urinary Tract Infections

Congenital lymphedema is a rare disorder of unknown etiology which affects the extremities, preponderantly the lower extremities, at or immediately after birth. We experienced a case of congenital lymphedema in a newborn with generalized edema on the left lower extremity. We performed lymphangioscintigraphy and MRI for diagnosis. Microlymphaticovenous anastomosis was done on 16 days after birth and the patient showed clinical improvement. We report this case with brief review of the related literature.
Diagnosis ; Edema ; Extremities ; Humans ; Infant, Newborn ; Lower Extremity ; Lymphedema* ; Magnetic Resonance Imaging ; Parturition

PURPOSE: Simple instructional systems design (ISD) model is based on a fast development, usability test, and continuos feedback, which are necessary for educational program development in medical school. This study aims to figure out the usability of Simple ISD model for a medical ethics education program by describing a developmental details of each phase and its evaluation results. METHODS: Research has been conducted in two steps. First, while researchers participated in the program development by using Simple ISD model, we collected empirical data of each development activities. Second, the developed program was evaluated by students' web-based usability test, a 8-students' focus group interview and 5 faculty members' individual interviews in 4 domains; learning contents, instructional methods and strategies, achievement evaluation, and self-evaluation. RESULTS: Following the circular process of analysis, design, development, and usability test of Simple ISD model, a 10-week medical ethics program covering 9 instructional topics was developed. The average points of response on the developed medical ethics program in 2008 and 2009 are increased from 3.96 to 4.59 and 4.41, respectively. The prospects and limitations of the program are discussed. CONCLUSION: From a development study of the medical ethics program by using Simple ISD model, we could implement a more usable medical ethics program, and found 4 different usability of the Simple ISD model; the rapid development of educational program, program improvement by continuous feedback, faculty members' engagement in instructional design, and professional development of the faculty members.
Achievement ; Ethics, Medical ; Focus Groups ; Learning ; Program Development ; Schools, Medical

We have treated total 37 cases of femoral neck fracture in children who were under the 16 years old in age at the Catholic University Medical College since 1985, followed them for average 21 months to analyse their types of fracture and treatment, complications and prevention of complications, and obtained the following results. 1. According to the Delbet's classification, type I was 1 case, II were 18(49%), most common, III were 10 and IV were 8 cases. Their ages were average 8.2 years and boys were predominant in 27 cases. 2. Thirty-six cases were treated with open reduction and internal fixation within 1-13 days after fracture, but only one type IV was treated with closed reduction, followed by hip spica cast for 6 to 9 weeks in all. 3. The fixation devises were removed at average 8.7 months after operatio. 4. fifteen complications were observed in 11 cases(37%), that were AVN(3 cases), early physeal closure(8 cases), coxa vara(3 cases), coxa valga and limb shortening(each 1 case), and their causes were severe fracture displacement(2 cases), penetration of fixation devices to physis(8 cases), incomplete reduction and loss of initial reductio (1 case) etc, but were not correlated with their method of fracture treatment. Conclusively, the femur neck fracture in children could favorably be treated with open reduction and internal fixation to reduce their complications. Physeal early closures due to penetration of screws and pin were most common cause of complications, and their long-term follow-up should be necessary.
Child ; Classification ; Coxa Valga ; Extremities ; Femoral Neck Fractures ; Femur Neck ; Femur ; Follow-Up Studies ; Hip ; Humans ; Methods

PURPOSE: Despite the fact that enteroviral meningitis is the most common cause of meningitis in children with signs of meningeal irritation and has benign course, most clinicians routinely perform an invasive lumbar puncture (LP) that result in inadequate antibiotic therapy and unnecessary long-term hospitalization. This study was aimed to compare the clinical characteristics of childhood enteroviral meningitis according to LP. METHODS: Children over 2 years of age who can clearly express signs of meningeal irritation in the pediatric department of Eulji university hospital from July 2013 and August 2016 were enrolled. The patients were diagnosed by reverse transcriptase polymerase chain reaction in stool and/or cerebrospinal fluid. We retrospectively reviewed their clinical records. RESULTS: A total of 257 patients were diagnosed with enterovirus meningitis and median age was 6.3 (2.1–7.9) years. One hundred fifteen patients (44.7%) with confirmed enterovirus in the stools underwent supportive care without LP. Mostly, there was no statistically significant difference in age, sex, clinical symptoms, except gastrointestinal involvement (abdominal pain, diarrhea), and serologic findings when compared with patients who underwent LP. But patients who underwent LP had longer hospital stay (4 vs 3 days, P < 0.001). Four of them (2.8%) were re-admitted with back pain and persistent headache, probably related to LP procedure. All patients were discharged without neurologic complications. CONCLUSION: Rapid detection of enteroviruses in stool specimens that can be easily obtained in children with signs of meningeal irritation may reduce invasive LP.
Back Pain ; Cerebrospinal Fluid ; Child ; Enterovirus ; Headache ; Hospitalization ; Humans ; Length of Stay ; Meningitis* ; Retrospective Studies ; Reverse Transcriptase Polymerase Chain Reaction ; Spinal Puncture*

Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by the presence of antiphospholipid antibodies with vascular thrombosis or increasing pregnancy-related morbidity. The risk of thrombotic events, including cerebral arterial thrombosis, is increased in patients who test positive for lupus anticoagulants. The presentation of neurologic symptoms without a cerebral thromboembolic event is rarely reported in APS. Here, we report a case of primary APS presenting as Bell palsy without cerebral arterial thrombosis. After administration of an anti-viral agent and high-dose steroid therapy, the patient successfully recovered without neurologic complications.
Antibodies, Antiphospholipid ; Anticoagulants ; Antiphospholipid Syndrome* ; Bell Palsy* ; Humans ; Neurologic Manifestations ; Thrombosis*

This study explores the phenomenon of learner reflection in writing. Sixty-nine reflection logs were submitted by students after medical interview role plays. Using thematic analysis methodology, the following three steps were carried out: (1) the entire contents of the logs were analyzed and coded, (2) the coded contents were reclassified and categorized into higher themes, and (3) all reflection logs were re-analyzed to derive the frequency according to their classifications. The learners’ reflection contents were classified into ‘preparation,’ ‘experience,’ and ‘future plan.’ The levels of reflection were ‘simple information and appreciation,’ ‘acquisition and application of knowledge,’ and ‘analysis and criticism.’ The types of reflection were identified only at the level of ‘analysis and criticism’ and could be classified into ‘relativization,’ ‘objectification,’ and ‘internalization.’ Students’ reflection levels were highest in the levels of ‘acquisition and application of knowledge’ (49.3%), and ‘analysis and criticism’ (37.7%). A total of 14.5% of the students showed ‘internalization.’ In order to enable internalized reflection at a critical level, instructional strategies to induce and promote reflection are needed.
Classification ; Humans ; Writing

We use the concept of the “doctor’s role” as a guideline for developing medical education programs for medical students, residents, and doctors. Therefore, we should regularly reflect on the times and social needs to develop a clear sense of that role. The objective of the present study was to understand the knowledge structure related to doctor’s job competencies in Korea. We analyzed research trends related to doctor’s job competencies in Korea Citation Index journals using text network analysis through an integrative approach focusing on identifying social issues. We finally selected 1,354 research papers related to doctor’s job competencies from 2011 to 2020, and we analyzed 2,627 words through data pre-processing with the NetMiner ver. 4.2 program (Cyram Inc., Seongnam, Korea). We conducted keyword centrality analysis, topic modeling, frequency analysis, and linear regression analysis using NetMiner ver. 4.2 (Cyram Inc.) and IBM SPSS ver. 23.0 (IBM Corp., Armonk, NY, USA). As a result of the study, words such as “family,” “revision,” and “rejection” appeared frequently. In topic modeling, we extracted five potential topics: “topic 1: Life and death in medical situations,” “topic 2: Medical practice under the Medical Act,” “topic 3: Medical malpractice and litigation,” “topic 4: Medical professionalism,” and “topic 5: Competency development education for medical students.” Although there were no statistically significant changes in the research trends for each topic over time, it is nonetheless known that social changes could affect the demand for doctor’s job competencies.

Three randomized control trials (RCTs), published in 2013, investigated efficacy of mechanical thrombectomy in large vessel occlusions and did not show better results compared to intravenous (IV) recombinant tissue-type plasminogen activator (tPA) alone. However, most clinicians treating stroke consider mechanical thrombectomy as the standard treatment rather than using IV tPA alone. This paradigm shift was based on five RCTs investigating efficacy of mechanical thrombectomy in acute ischemic stroke conducted from 2010 to 2015. They demonstrated that mechanical thrombectomy was effective and safe in acute ischemic stroke with anterior circulation occlusion when performed within 6 hours of stroke onset. There are four reasons underlying the different results observed between the trials conducted in 2013 and 2015. First, the three RCTs of 2013 used low-efficiency thrombectomy devices. Second, the three RCTs used insufficient image selection criteria. Third, following the initial presentation at the hospital, reperfusion treatment required a long time. Fourth, the three RCTs showed a low rate of successful recanalization. Time is the most important factor in the treatment of acute ischemic stroke. However, current trends utilize advanced imaging techniques, such as diffusion-weighted imaging and multi-channel computer tomographic perfusion, to facilitate the detection of core infarction, penumbra, and collateral flows. These efforts demonstrate that patient selection may overcome the barriers of time in specific cases.