Since mid-20th century, many environmental changes in medicine have challenged the traditional role of doctors and the movement to outcome-based education (OBE) has progressed gradually but significantly. Over decades bilateral progression of defining the global doctor's role and developing OBE with implementation to medical schools has been spread world-widely. In this paper, we explored the history and contents of the doctor's role and OBE at various levels-international, national, institutional and medical schools. We conclude that the global doctor's role is composed of patient care, communication and professionals added by others related to their peculiar situation and should be linked to the outcomes of undergraduate, postgraduate and continuous medical education which are developed and implemented to the curriculum and program at any country in order to cope with the global challenges of the future.
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Moyamoya disease is a cerebrovascular disease of unknown etiology, which is characterized by bilateral stenosis or occlusion at terminal portion of internal carotid artery and at proximal portion of anterior cerebral artery and/or middle cerebral artery and abnormal vascular network in the vicinity of the arterial occlusions. It occurs frequently in Asian countries, particularly in Korea and Japan, but is rare in Western countries. To establish the etiology of moyamoya disease, much about the pathology from autopsies, factors involved in its pathogenesis, and its genetics have been studied. It may occur at any age from childhood to adulthood and in general, initial manifestation is cerebral ischemic symptoms in children and intracranial hemorrhage symptoms in adults. Because it progress and cause recurrent stroke, early diagnosis and proper management has been recognized. Cerebral angiography is essential for definitive diagnosis and treatment plan. Magnetic resonance imaging/magnetic resonance angiography is useful for diagnosis and follow-up tools after revascularization. Evaluation of the cerebral hemodynamics by single photon emission computed tomography and positron emission tomography is useful for diagnosis and assessment of the severity of cerebral ischemia in moyamoya patients. Surgical revascularization is effective for moyamoya disease manifesting as ischemic symptoms, to prevent further ischemia and infarction. In hemorrhagic type moyamoya disease, revascularization can be considered. Direct bypass, indirect synangiosis and combined methods are used. Outcomes of revascularization are excellent in preventing transient ischemic attacks in most patients.
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, Kyu Won Chung, Sun Young Yi To investigate clinicopathologic findings and gallbladder (GB) function in patients with endoscopic bile reflux at outpatients clinic.
We classified endoscopic bile reflux into two groups by bile reflux index (BRI). Those who scored above 14 were the BRI (+) group, and those below 14 were the BRI (-) group. We analyzed clinical characteristics, endoscopic findings including
Endoscopic bile reflux identified in 9.7% of all cases with gastrointestinal symptoms. There are cholecystectomy in 6.7%, gastrectomy in 2.7%, and GB dysfunction in 20.0%. They had prominent gastrointestinal symptoms with variable endoscopic findings. Foveolar hyperplasia is the most common pathologic finding and
Endoscopic bile reflux was common findings with young adults (30's) at outpatients clinic. Foveolar hyperplasia is common pathologic finding. GB dysfunction were identified as significant risk factors for BRI (+) group.
, In Sook Kang, Kihwan Kwon, Wook Bum Pyun, Gil Ja Shin This study designed to find the differences of left ventricular (LV) geometry in acute myocardial infarction (AMI) between ST elevation myocardial infarction (STEMI) and non ST elevation myocardial infarction (NSTEMI) and the occurrences of adverse outcome according to the LV geometry.
Comprehensive echocardiographic analyses were performed in 256 patients with AMI. The left ventricular mass index (LVMI) and relative wall thickness (RWT) were calculated. LV geometry were classified into 4 groups based on RWT and LVMI: normal geometry (normal LVMI and normal RWT), concentric remodeling (normal LVMI and increased RWT), eccentric hypertrophy (increased LVMI and normal RWT), and concentric hypertrophy (increased LVMI and increased RWT). Cox proportional hazards models were used to evaluate the relationships among LV geometry and clinical outcomes.
Patients with NSTEMI were more likely to have diabetes mellitus, hypertension, heart failure, stroke and previous myocardial infarction. By the geometric type, patients with NSTEMI were more likely to have eccentric hypertrophy (n=51, 34.7% vs. n=24, 22.0%, P=0.028). There was no significantly different adverse outcome between STEMI and NSTEMI patients. Fifteen patients (5.9%, 7 female [46.7%]) died and the median duration of survival was 10 days (range, 1 to 386 days). Concentric hypertrophy carried the greatest risk of all cause mortality (hazard ratios, 5.83; 95% confidence interval, 1.04 to 32.7).
NSTEMI patients had more likely to have eccentric hypertrophy but adverse outcome after AMI was not different between STEMI and NSTEMI patients. Concentric hypertrophy had the greatest risk of short term mortality.
, Jung Hyun Kwon, Hae Soon Kim, Sejung Sohn, Young Mi Hong The etiology for Kawasaki disease (KD) remains unknown, but several studies have suggested the involvement of immune dysregulation and genetic factors. The purpose of this study is to compare gene expressions before and after an infusion of intravenous immunoglobulin (IVIG) in KD patients.
Blood was obtained from both acute and sub-acute phases of 4 patients with KD and febrile control children. Blood was collected in PAXgene blood RNA tubes and RNA was extracted using a PAXgene blood RNA isolation kit. Labeled RNAs were analyzed using Roche NimbleGen human whole genome 12-plex array.
KD patients prior to IVIG injection showed more than a two-fold increase in the expression of 88 genes and more than a two-fold decrease in the expression of 98 genes compared to the control group. They also showed more than two-fold increase in the expression of 226 genes and more than a two-fold decrease in 117 genes in KD patients after IVIG treatment compared to the patients before IVIG injection. Through microarray evaluation, the expressions of genes involved in proliferation, translation, inflammatory response, immune response, cell adhesion, cell migration, cell differentiation, apoptosis, cell growth, transport, cell cycle, transcription, signal transduction and metastasis were observed.
Changes in gene expressions in pediatric patients with KD before and after IVIG were observed via microarray evaluation.
Anterior microforaminotomy (AMF) is an alternative procedure to treat unilateral cervical pathology. Although the results have been reported favorable in the previous studies, postoperative degeneration may occur. We analyze long-term outcome to determine the critical size of AMF.
A retrospective study was performed. Clinical data with chart review, radiologic data with picture archiving and communication system (PACS) images were obtained. Long-term clinical outcomes were accessed by a questionnaire, including visual analogue scale (VAS) and neck disability index (NDI). Various clinical, radiological data were statistically analyzed.
Eight-two patients were enrolled in this study. Main pathology was spondylotic spur (53.7%), soft disc herniation (36%). Mean age was 49 years old. There was no surgery-related complication. Mean follow-up was 6.1 years. 90.3% showed favorable clinical outcome. Mean VAS score was decreased from 8.2 to 2.9, and NDI score was decreased from 24.5 to 6.7 (P<0.05). 88.7% showed decrease of disc height (DH), and mean change was 1 mm. DH change was correlated positively with the disc invasion and AMF diameter (P<0.05). Mean diameter of AMF was 5.2 mm. According to statistical analysis, the critical diameter of AMF was 4.7 mm, directly affecting DH decrease. Any radiological parameters did not affect the clinical outcome.
AMF was an effective procedure to treat unilateral cervical pathology. Critical DH decreases and/or disc invasion may be the trigger of sequential degeneration. To preserve DH, AMF diameter should be small and disc invasion should be avoided.
, Ryung-Ah Lee, Soon-Sup Chung, Kwang Ho Kim The EGFR plays an important role in tumorigenesis and tumor progression of colorectal cancer, and leads to the activation of intracellular signaling pathways. The use of anti-EGFR-targeted therapy has increased for patients with colorectal cancer, but patients with EGFR mutations will be resistant to anti-EGFR-targeted therapy. The identification of gene mutations is critical in cancer treatment; therefore, the aim of this study is to investigate the incidences of EGFR mutations in colorectal cancer patients in Korea.
We reviewed 58 colorectal cancer patients who underwent operations between 2003 and 2006, retrospectively. We analyzed their EGFR mutations in 4 loci by DNA sequencing. In addition, we analyzed the correlation between the presence of EGFR mutation and patients' clinicopathologic features.
Of the 58 patients, 35 patients were male and 23 were female. Their mean age was 63.28±11.18 years. Two patients (3.45%) were diagnosed as stage Tis, 7 patients (12.07%) had stage I, 24 patients (41.38%) had stage II, 20 patients (34.48%) had stage III, and 5 patients (8.62%) had stage IV. As a result of mutational analysis, EGFR mutations on exon 20 were detected in 13 patients (22.41%, G→A transitions). EGFR mutations on exon 18, 19 and 21 were not detected. EGFR mutation increased in the earlier stage and the absence of lymph node metastasis (P=0.028).
The incidence of EGFR mutation in Korean colorectal cancer patients is 22.41%. In addition, EGFR mutation significantly increased in the earlier stage and the absence of lymph node metastasis.
, Hye-Kyung Jung, Min-Sun Cho, Min-Jin Lee, Myung-Eun Song, Da-Yeon Oh, Ha Eung Song Sunitinib an inhibitor of the vascular endothelial growth factor receptor, is highly effective against renal cell carcinoma and is now widely used in patients with metastatic disease. Gastroesophageal reflux disease (GERD) is rarely reported as a side effect of sunitinib. We report two cases of GERD with upper gastrointestinal bleeding related to sunitinib administration. Both cases responded well to conservative management. Microscopic findings in both cases showed cellular atypia such as hyperchromasia, increases in nuclear size, and multinucleation. The cellular atypia of the squamous mucosa appears to be associated with reparative processes.
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, Jeong-Mi Lee, Ja Yoon Choi, Dong-Hoon Lew, Ra Ri Cha, Hye Won Oh, Hong-Jun Kim, Hyun Ju Min, Hyun Jin Kim, Woon-Tae Jung, Ok-Jae Lee, Chang Yoon Ha, Sun Young Yi Transcatheter arterial chemoembolization (TACE) has become an effective alternative treatment strategy for patients with inoperable hepatocellular carcinoma (HCC). Although TACE is relatively safe, acute respiratory distress syndrome associated with pulmonary lipiodol embolism is a rare and potentially fatal complication. We report a rare case of acute respiratory distress syndrome after TACE for inoperable HCC. A 75-year-old man, with huge HCC in right lobe, was treated by TACE for the first time. Seven hours after uneventful TACE procedure, he felt dyspneic and his oxygen saturation recorded by pulse oximetry (SpO2) fell to 80% despite of applying non-rebreathing mask. He underwent mechanical ventilation with a protective ventilatory strategy. We experienced a case of acute respiratory distress syndrome after TACE for HCC.
, Sun Kyung Na, Hye-Won Yun, Ha Eng Song, Jung-Hwa Ryu, Dong-Ryeol Ryu Patients with chronic renal failure (CRF) are known to be more susceptible to tuberculosis infection due to impairment of the host defense mechanism. Although extrapulmonary tuberculosis is more prevalent in those subjects and it may induce dismal outcome, its diagnosis has been challenging since there is no specific symptoms of the disease and the clinical course is usually atypical. Herein, We report a case of disseminated tuberculosis diagnosed by ultrasound-guided liver biopsy in a 31-year-old CRF patient presenting sustained fever despite broad-spectrum antimicrobial therapy and progressive cholestatic jaundice.
, Chi Hyo Kim, Youn Jin Kim, Rack Kyung Chung, Hee Seung Lee, Hee Jung Baik, In Kyung Song Polyuria is occasionally observed during general anesthesia. Usually urine output during general anesthesia is decreased because of anesthetic agents. The authors came across with a case of polyruia during sevoflurane anesthesia which occurred after induction of anesthesia. Polyuria is a nonspecific symptom, but can cause many serious complications. Therefore, it is very important to investigate the cause thoroughly and treat patient appropriately.
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