150 Years of Medical History Education in Japan: History and Challenges / 의사학

This paper is the first attempt to get a broad view of the history of modern medical history education in Japan, from the origin of medical history education in the Meiji era to its current state in medical schools. By correcting errors related to the first university lectures on medical history in Japan and historically contextualizing the challenges of medical history education and the academic community’s responses, this paper aims to examine both the historical significance and practical implications.The history of medical history education in Japan is relatively long. Medical history lectures in a medical school were first planned in 1876, and contrary to popular belief, the actual lecture started in December 1882 under Imamura Ryō’s charge and continues to this day. However, despite its relatively long history, the substance of medical history education in Japan is lacking in both quality and quantity. The absence of full-time professors of medical history education and related departments has led to a vicious cycle of failure in producing experts and a decline in medical education.Medical history education in Japan failed to take advantage of the fact that it began early despite the absence of tradition. The status of medical history education greatly increased in the 1930s, but the opportunity to expand its base was not utilized during the postwar reorganization of medical education and the student movement in the late 1960s. Falling into amateurism, evasion of real issues, and a lack of collective academic responses have hindered the understanding of these phenomena and problem-solving.The history of medical history education in Japan provides significant implications for the current reality of medical history education in Korea. The Korean medical history community must also confront and adapt proactively and organizationally within the evolving landscape of medical education. If the community settles for the present, Japan’s past will become Korea’s future.

The Cholera Epidemic of 1907 and the Formation of Colonial Epidemic Control Systems in Korea / 의사학

It was in 1907 when Korea was annexed by Japan in the field of health care systems as the Gwangje Hospital, Uihakgyo the National Medical School and the Korean Red Cross Hospital were merged into the colonial Daehan Hospital, and massive cholera epidemic controls by the Japanese Army were enforced.However, despite their importance, the cholera epidemic of 1907 in Korea and preventive measures taken at that time have not yet been studied extensively as a single research subject. The purpose of this paper is to contribute to a more concrete and broader understanding of the Korea-Japan annexation of health care systems under the rule of the Japanese Resident-General of Korea by revealing new facts and correcting existing errors.In 1907, cholera was transmitted to Korea from China and Japan and spread across the Korean Peninsula, resulting in a major public health crisis, perhaps one of the most serious cholera outbreaks in the twentieth century Korea. Although Busan and Pyeongyang were the cities most infected with cholera, the targets for the most intensive interventions were Gyeongseong (Seoul) and Incheon, where the Japanese Crown Prince were supposed to make a visit. The Japanese police commissioner took several anti-cholera preventive measures in Gyeongseong, including searching out patients, disinfecting and blocking infected areas, and isolating the confirmed or suspected. Nevertheless, cholera was about to be rampant especially among Japanese residents.In this situation, Itō Hirobumi, the first Resident-General of Korea, organized the temporary cholera control headquarters to push ahead the visit of the Japanese Crown Prince for his political purposes to colonize Korea. To dispel Emperor Meiji’s concerns, Itō had to appoint Satō Susumu, the famous Japanese Army Surgeon General, as an advisor, since he had much credit at Court. In addition, as the Japanese-led Korean police lacked epidemic control ability and experience, the headquarters became an improvised organization commanded by the Japanese Army in Korea and wielded great influence on the formation of the colonial disease control systems. Its activities were forced, violent, and negligent, and many Korean people were quite uncooperative in some anti-cholera measures.As a result, the Japanese Army in Korea took the initiative away from the Korean police in epidemic controls, serving the heavy-handed military policy of early colonial period. In short, the cholera epidemic and its control in 1907 were important events that shaped the direction of Japan’s colonial rule.

The Relation between Care Worker’s Empathic Response and Specificity of Autobiographic Memory in Health Elderly Living Alone

Objective@#This study aimed to investigate relation between empathic response of care workers and specificity of autobio-graphic memory of the elderly living alone. @*Methods@#An interview of autobiographical memory was conducted on 66 physically and mentally healthy elderly people living alone in the community. The transcript was used to evaluate the empathic responses of the care workers and to classify thespecificity of the autobiographical memory into four categories: episodic, categoric, semantic, and error. Logistic regression was used for investigation relation between empathic response of care workers and specificity of autobiographic memory of the elder-ly living alone. @*Results@#More than half of the elderly reported specific autobiographical memories, and the interviewers showed a high level of empathic response when the elderly reported specific memories. Episodic and categoric autobiographical memory had a high empathic response of interviewer, and semantic memory or error type memory had a low empathic response. Empathy enhance-ment program experience showed not significantly association with empathic response of interviewer. @*Conclusion@#Further research is needed on interview techniques that can easily and conveniently talk about specific autobio-graphical memories.

Metachronous Development of Peritoneal Carcinomatosis in a Patient with Autoimmune Pancreatitis / 대한소화기학회지

Autoimmune pancreatitis (AIP) is a rare and unique type of chronic pancreatitis. The prognosis of AIP, particularly when associated with pancreatic cancer or a related malignancy, is not known. Only a few cases, where metachronous pancreas-related cancer developed during follow-up, have been reported. Most of these patients either underwent surgery or steroid therapy. This paper reports a case of a 66-year-old woman with untreated type I AIP who developed peritoneal carcinomatosis more than 2 years later. Initially, the patient had a markedly elevated serum IgG4 level and a diffuse, infiltrative mass-like lesion in the pancreatic head, in which the biopsy results were consistent with type I AIP. The patient was not treated with steroids because of a cerebellar infarction. Twenty-eight months after the diagnosis of AIP, peritoneal carcinomatosis developed without noticeable changes in the pancreas from the initial findings.

Effect of Korean Herbal Formula (Modified Ojayeonjonghwan) on Androgen Receptor Expression in an Aging Rat Model of Late Onset Hypogonadism

PURPOSE: Testosterone replacement therapy is an effective treatment for late-onset hypogonadism (LOH) despite a few contraindications and side-effects. The aim of this study was to determine whether modified Ojayeonjonghwan (KH-204, Korean herbal formula) improved LOH. KH-204 is a strong antioxidant herbal formula. We evaluated the effect of Korean herbal prescription on androgen receptor (AR) expression in an aged rat model of LOH. MATERIALS AND METHODS: Eighteen-month-old rats were used as aged LOH rat models. Eighteen Sprague-Dawley rats were randomly divided into three equal groups of six animals each and treated with one of the following: 1) normal control group (oral administration with distilled water, n=6), 2) KH-204 200 group (oral administration with 200 mg/kg of KH-204, n=6), and 3) KH-204 400 group (oral administration with 400 mg/kg of KH-204, n=6). After four weeks of treatment (once daily, distilled water or KH-204), serum testosterone levels, changes in testicular and epididymal weight, Western blotting analysis of AR expression and measurement of oxidative stress were examined. RESULTS: Treatment with the herbal formulation KH-204 200 mg/kg and 400 mg/kg (1) increased the weights of testis and epididymis; (2) increased the level of serum testosterone; (3) increased the level of superoxide dismutase and reduced the level of 8-hydroxy-20-deoxyguanosine; and (4) upregulated AR expression in testicular tissue. CONCLUSIONS: KH-204 might be an effective alternative for LOH. It improves antioxidant mechanisms and increases testicular AR expression without side-effects.

Korean Red Cross Hospital (1905–1907): Focused on its Establishment, Management and Abolition / 의사학

The Korean Empire, its state sovereignty threatened by the Empire of Japan, joined the Geneva Conventions in 1903 for the purpose of neutral diplomacy and established the imperial Korean Red Cross Hospital in 1905. This hospital was a result of the effort of the Korean Empire to seek a new medical system based on the Western medicine. However, after the Russo-Japanese War, Japan interfered straightforwardly in the domestic affairs of Korea and eventually abolished the Korean Red Cross Hospital in 1907 to create Daehan Hospital under Japanese colonial rule. With newly-found historical records, this study investigates the whole process of the Korean Red Cross Hospital, which has remained unknown so far, despite its importance. From the very beginning, the Korean Red Cross Hospital was under strong influence of the Empire of Japan. The site for the hospital was chosen by a Japanese army doctor, Junryō Yoshimoto, and the construction was supervised by Rokurō Katsumata, who also later on are involved in the construction of Daehan Hospital. Moreover, all the main positions for medical treatments were held by Japanese practitioners such as Gorō Tatami and Kaneko Yano. Nevertheless, the Korean government had to shoulder the all operating costs. The office of the Korean Red Cross was relocated away from the Korean Red Cross Hospital, and the government of the Korean Empire was not willing to burden the expenses of the Hospital. Moreover, the list of employees of the Korean Red Cross and that of the Korean Red Cross Hospital were drawn up separately: the former is left only in Korea and the latter in Japan. These facts suggest that those two institutes were managed dualistically unlike any other nation, implying that this may have been a means to support the Daehan Hospital project. According to the statistics, health care services in the Korean Red Cross Hospital seems to have been carried out successfully. There had been an increase in the number of patients, and the ratio of female patients was relatively high (26.4%). Only Western medications were prescribed and surgical operations with anesthesia were performed routinely. The approach to Western medicine in Korea was changing during that period. The rise and fall of the Korean Red Cross Hospital represent the urgent situation of the Korean Empire as well as the imperialistic methodology of the Empire of Japan to use medicine as a tool for colonization. Although the transition process of medical policy by the Japanese Resident-General of Korea still remains to be fully elucidated, this paper contributes to a better understanding of the history of modern medicine in Korea.

Hepatogastric fistula as a rare complication of pyogenic liver abscess

Hepatogastric fistula following a pyogenic liver abscess is extremely rare, and only a handful of cases have been reported. An 88-year-old female presented with generalized weakness, fever and chills. An abdominal computed tomography scan revealed a 5cm-sized hypodense lesion with internal septa in the left lateral section of the liver. Due to initial suspicion of early liver abscess, she was treated with empirical intravenous antibiotics. Initially, aspiration or drainage of the liver abscess was not performed due to immature lesion characteristics. An ultrasonography-guided percutaneous drainage of the liver abscess was performed 17 days after hospitalization due to a more mature lesion appearance on follow-up imaging. On tubography, contrast media leakage through the fistulous tract was visualized. Surgical management was performed, and she was discharged 2 weeks after surgery.

Administration of Goji (Lycium chinense Mill.) Extracts Improves Erectile Function in Old Aged Rat Model

PURPOSE: This study investigated the effect of goji (Lycium chinense Mill.) on erectile dysfunction in old-aged rats. MATERIALS AND METHODS: Twenty-four 18-month-old male Sprague-Dawley rats (defined as old-aged rats) were used. Treatment groups contained eight rats each: a control group, goji extract of 150 mg/kg/day group, and goji extract of 300 mg/kg/day group. Treatment was by orogastric tube once daily for 6 weeks. After 6 weeks of treatment, testes weight, serum testosterone, superoxide dismutase, nitric oxide (NO)-cyclic guanosine monophosphate (cGMP)-related parameters, intracavernous pressure/mean arterial pressure, and histological changes were examined. RESULTS: Treatments with goji extracts increased serum testosterone level, increased the expression of endothelial NO synthase, neuronal NO synthase, and cGMP, improved the oxidative stress marker, and decreased corporal fibrosis. CONCLUSIONS: Our results indicate that goji extract may have a positive effect on erectile dysfunction via its antioxidant effects.

Changes in Nocturia and Lower Urinary Tract Symptoms after Radical Prostatectomy

PURPOSE: The goal of this study was to evaluate changes in nocturia and other lower urinary tract symptoms (LUTS) after laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic radical prostatectomy (RALP). MATERIALS AND METHODS: We reviewed the medical records of 96 patients who underwent LRP or RALP for clinically localized prostate cancer and completed the International Prostate Symptom Score (IPSS) questionnaire, which provided a basis for assessing their symptoms. We also evaluated maximal flow rate and post-void residual urine volume over a follow-up period of at least 24 months. We divided the patients into three groups according to postoperative changes in the frequency of nocturia. RESULTS: Voiding symptoms significantly improved over the course of 24 months in patients who underwent LRP or RALP. However, most patients showed persistent or increased nocturia after LRP or RALP. Moreover, more than one third of the patients (33/96) presented with exacerbated nocturia (1.0+/-0.9 episodes of preoperative nocturia vs. 3.0+/-1.3 episodes of postoperative nocturia). Multiple regression analysis showed that preoperative IPSS storage sub-score had negative association with the nocturia after radical prostatectomy (p=0.005). However, patients' age, body mass index, preoperative prostate specific antigen, Gleason score, T-stage, and prostate volume had no association. CONCLUSIONS: The present study showed that nocturia was influenced by a range of factors, including other storage LUTS and the relief of bladder outlet obstruction after radical prostatectomy. Moreover, the preoperative storage symptoms are regarded as an important factor which influences the changes of nocturia after radical prostatectomy.

One-step Nucleic Acid Amplification (OSNA): Intraoperative Rapid Molecular Diagnostic Method for the Detection of Sentinel Lymph Node Metastases in Breast Cancer Patients in Korean Cohort / 한국유방암학회지

PURPOSE: Sentinel lymph node (SLN) biopsy has become a standard procedure in breast cancer patient management. Accurate intraoperative assessment of metastasis of SLNs is essential for appropriate selection to avoid unnecessary axillary dissection. The aim of this study was to evaluate the performance of one-step nucleic acid amplification (OSNA) assay for detection of sentinel lymph node metastasis examination in breast cancer patients. METHODS: In this study, we compared intraoperative OSNA to histological investigation with multi-level observation in 284 sentinel lymph nodes of 199 patients. Surgically obtained sentinel lymph nodes were sectioned into 2 mm intervals of up to four pieces, half of which were examined with the OSNA assay. The other half of adjacent pieces were histopathologically examined both intraoperatively and postoperatively. The presence/absence of metastases was judged by observing hematoxylin and eosin staining and cytokeratin (AE1/ AE3) immunohistochemically stained multiple slides from one lymph node. RESULTS: Among 199 patients included, 36 cases were positive on histological examination and 34 cases were positive on OSNA assay. There were 14 discordant cases. The overall concordance with histology was 93.0% (95% confidence interval [CI], 0.86-0.96), with a sensitivity of 77.8% (95% CI, 0.61-0.90), specificity of 96.3% (95% CI, 0.92-0.99), positive predictive value of 82.4% (95% CI, 0.65-0.93) and negative predictive value of 95.2% (95% CI, 0.91-0.98). The kappa statistic analysis indicated substantial agreement of both methods, with a value of 0.76 (95% CI, 0.64-0.88). The average turnaround time was 39.0 minutes. CONCLUSION: The results of this study indicate that the OSNA assay has equivalent accuracy to histopathology in detecting breast cancer metastasis to lymph nodes when each method is assigned two alternate blocks of four blocks sectioned at 2 mm intervals.

Association between Occupational Stress and Depression, Anxiety, and Stress Symptoms among White-collar Male Workers in an Automotive Company / 대한산업의학회지

OBJECTIVES: To investigate the relationship between occupational stress and depression, anxiety, and stress symptoms among white-collar male workers in an automotive company. METHODS: A cross-sectional study involving 286 white-collar male workers was conducted with the Korean Occupational Stress Scales (KOSS) and Depression Anxiety Stress Scales (DASS) questionnaire. RESULTS: According to the DASS cut-off value (> or =78 percentile scores), the prevalence of depression, anxiety and stress symptoms was 57.7%, 37.7% and 42.2%, respectively. By logistic regression analysis, organizational system was the factor most strongly associated with depression (OR=4.83, 95% C.I.=2.43-9.58), while job demand was strongly associated with anxiety (OR=3.21, 95% C.I.=1.77-5.85) and stress (OR=4.66, 95% C.I.=2.53-8.58). CONCLUSIONS: Occupational stress was positively associated with depression, anxiety, and stress symptoms among white-collar male workers in an automotive company. A prospective study is warranted to delineate the causal relationships between job stress and psychiatric disorders.

The Relations between Shiftwork and Sleep Disturbance in a University Hospital Nurses / 대한산업의학회지

OBJECTIVES: Nurses working in a hospital operate in a special environment where patients require a 24-hour day service. In order to meet the need for manpower, nurses in the wards, ICU, and ER work in 3 shifts per day. This study was designed to evaluate their sleeping patterns and the factors that influence them. METHODS: The subjects were 114 female nurses working at a University Hospital in Kyungi-do. To evaluate their sleeping pattern, a survey containing 11 questions was used. Their were differentiated into insomnia, sleep deprivation, daytime sleepiness, and snoring. Statistical analysis was conducted with independent t test, chi-square test and analysis of covariance. RESULTS: A statistical difference was found between shiftworkers and nonshiftworkers, in terms of sleep initiation time (p<0.05). The occurrences of insomnia, sleep deprivation, daytime sleepiness and snoring differed between the two groups, but not significantly. CONCLUSIONS: Of the numerous factors affecting sleeping patterns, shiftwork has the most deteriorative effect.