| Young Sun Hong | 8 Articles |
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[English]
This paper aims to describe an outcome-based curriculum development process at a medical school that has difficulty in advancement from the higher stage outcomes to the individual lesson outcomes, and to propose a way to implement it practically. We reviewed the objectives, strategies and previous products of the school's taskforce activities and suggested the principle of bidirectional approaches of outcome based curriculum development. The developing strategy identified such as firstly, the evaluation of present curriculum and then, the review of the outcomes developed previously with considering the nation-wide environmental change in medical education. Then, we selected one example course which was focused the resources of the school to, and finally the product of the example course was propagated to the other courses with central monitoring. Bidirectional model of ‘Top-down’ plus ‘Bottom-up’ approaches could be an efficient way to develop the outcome-based curriculum in a medical school, which has difficulties to advance the developing process due to various reasons including limited resources.
[English]
Localized granulomatosis with polyangiitis (loc-GPA) is a milder disease state of GPA restricted to the respiratory tract. Transition from localized form to systemic/generalized disease is predicted to occur in approximately 10% of the patients. We report an unusual case of loc-GPA involving multiple cranial nerves, which in 3 years progressed into systemic disease involving pituitary gland. Initially antineutrophil cytoplasmic antibody (ANCA) was negative, but as symptoms of diabetes insipidus started, ANCA became positive. Clinical course of ANCA negative loc-GPA should be carefully monitored for development of systemic disease. ANCA may be a useful marker for detecting transition from localized to systemic disease.
[English]
Propylthiouracil(PTU) is a commonly used antithyroid drug in the management of hyperthyroidism. However, it is associated with a variety of side effects. Antineutrophil cytoplasmic antibody( ANCA)-positive vasculitis is an extremely rare side effect of PTU. We report a case of a patient with diffuse pulmonary hemorrhage while being treated with PTU. A 28-year-old woman was admitted due to fever and abdominal pain. She was diagnosed as Graves' disease 4 years before the admission, and was taking PTU intermittently. Thyroid storm was suspected and we treated her with PTU, hydrocortisone, lugol solution and propranolol. However, coughing was aggravated, with chest X-ray and computed tomography revealing diffuse alveolar hemorrhage. Perinuclear-ANCA was positive. After discontinuation of PTU, all symptoms resolved. In conclusion, ANCA-positive diffuse alveolar hemorrhage is a rare but a potential side-effect of PTU. Therefore, early awareness of this complication is important.
[English]
The aim of this study was to analyze the diskibution pattern of the 38 mineral elements in the patients with chronic urogenital diseases such as benign prostatic hyperplasia(BPH), andropause, erectile dysfunction, menopause, overactive bladder and stress urinary incontinence, which were appeared as the result of various life factors including the ageing. Hairs were collected in the occipital scalp area and analyzed mineral status in theme thod of inductive coupled plasma mass spectroscopy (Trace Element, INC. ; TEI, USA). 15mandatory nourishment minerals, 15 additional minerals,8 heavy metals and the ratio of Ca/P Na/K, Ca/K, Zn/cu, Na/Mg, Ca/Mg, Fe/Cu were measured. The results were classified as each disease and compared. The disease which showed high rate of patient with increased calcium was menopause(85.7%) and overactive bladder (OAB) (61.9%). The disease which showed high rate of patient with increased magnesium was menopause (57.1%). The disease which showed high rate of patient with increased sodium was stress urinary incontinence (SH) (42.9%). Other minerals didn't show particular distribution by the disease. The average ratio of Caf was increased in all diseases and the degree of the increase was high in menopause, OAB and SUI. The average ratio of Zn/Cu was increased only in menopause. The average ratio of Ca/K was increased in all diseases and the degree of the increase was high in menopause, OAB and SH. The average ratio of Zn/Cu was within normal range in all diseases. The average ratio of Na/Mg was increased only in BPH and was decreased in menopause, andropause and OAB. The average ratio of Ca/Mg was increased in all diseases and the degree of the increase was the highest in OAB. The distribution pattern of mineral elements according to chronic urogenital diseases was distinctive. Thus we consider that mineral supplement remedies suitable to the eachdisease can be recommended.
[English]
Thyroid nodule is a common clinical problem and it is important to distinguish benign from malignant nodule. Although features found on history taking, physical examnation and imaging studies help the diagnosis, fine needle aspiration(FNA) has been accepted as an accurate and reliable diagnostic procedure of thyroid nodule. This study was aimed to assess the values of FNA and needle biopsy in the diagnosis of thyroid nodules. We reviewed the medical records of the 405 patients who underwent FNA and needle biopsy for the diagnosis of thyroid nodule form September 1993 to July 1996. The 414 fine needle aspiration cytologic specimens were obtained from 405 patients(male : 26, female : 379). 390 cases(94.2%) were adequate for cytologic diagnosis. And the diagnosis showed benign in 357(91.5%), malignancy in 20(5.1%) and suspicious malignancy in 13(3.3%). Among the 357 benign cases, 104 cases were benign cysts, 163 cases were adenomatous goiter and 45 cases were follicular adenoma. 46 patients underwent thyroidectomy after FNA and 21 patients(45.7%) were diagnosed as having carcinoma. The sensitivity and specificity of FNA in diagnosing malignancy were 65% and 82%, respectively, with an accuracy of 74%. Of 46 patients, needle biopsy was done in 41. The sensitivity and specificity of the needle biopsy were 79% and 73%, respectively. And the accuracy was 76%. Hoarseness was developed in one patient after FNA and needle biopsy, and small amount of hemoptysis was developed in another patient after FNA. Although it had been expected that needle biopsy may increase the diagnostic accuracy, our study didn't show the superiority of needle biopsy as compared with FNA. FNA has limitations in suspicious and nondiagnostic results but it is a safe, simple, reliable and cost-effective means of evaluating thyroid nodules. It is the preferred initial diagnostic method in all patients with thyroid nodule.
[English]
Cirrhotic patients may exhibit circulatory derangement and renal dysfunction during the clinical course. Renal dysfunction on cirrhosis can occur without specific causative factors. This functional renal failure in cirrhosis is considered as a consequence of renal vasoconstriction. These alteratons of renal hemodynamics are already present in the early phase of the disease, even in the condition that the conventional kidney function tests are normal. A new method for noninvasive evaluation of arterial tone is duplex Doppler sonography. Among the various sonographic indices proposed, the renal resistive index(RI) is the most widely used for the estimation of intrarenal arteriolar vascular resistence. This study was performed to evaluate the role of Doppler sonography in early detection of renal dysfunction and to assess the clinical significance of RI. In 25 cirrhotic patients without overt kidney failure and ten control subjects, the RI of the acurate artery in both kidneys was measured by Doppler sonography. The mean RI of cirrhotic group was significangly higher than that of control subjects(0,68±0.08 vs -0.62±0.05,p<0). Accordiing to Child class, the RI showed increasing tendency from A to C, through witout statistical significance. In this study, the RI was significantly inversely correlated with 24hr urinary sodium amount(r=-0.39, p<0,05)and correlated with serum creatinine(r=6.60,p<0.01). This study indicates that the measurement of RI is a sensitive method to assess intarenal hemodynamics and to detect early changes of the renal dysfunction in cirrhotic patients.
[English]
Pancreatic pseudocyst is one of the most common compications of pancreatitis or pancreatic injury. It can occur at any site in ted abdomen but rarely in the liver. The ultrasound and computed tomography are invaluable imaging techniques for the detection of a pseudocyst We have recently experienced an uncommon case of pseudocyst in 54-year-old man, who had complained of severe epigastric pain and fever. The pseudocyst in the left hepatic lobe was diagnosed by abdominal sonography and computed tomography with clinical and laboratory findings. It was treated successfully by percutaneous catheter drainage.
[English]
The diffuse interstitial lung diseases are a heterogeneous group of diffuse inflammatory disorders of the lower respiratory tract characterized by derangements of the alveolar walls and loss of functional alveolar capillary units. The most common causes of diffuse interstitial lung diseases are idiopathic pulmonary fibrosis, sarcoidosis, collagen vascular disorders, hypersensitivity pneumonitis and pneumoconiosis. Especially, the miliary tuberculosis is also leading cause in Korea, but pulmonary tuberculosis presenting as diffuse interstitial lung disease except miliary tubercuaosis is rare. We report a case of pulmonary tuberculosis presenting as diffuse interstitial lung disease associated with the tyrnphadenopathy of mediastinum and abdomen.
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, Jae Jin Han
