Responses of Medical Students to Using Smartphone Video at Clinical Performance Examination / 의료커뮤니케이션

BACKGROUND: There are practical difficulties to show exact clinical symptoms such as seizure to medical students at Clinical Performance Examination (CPX). We developed a new CPX case of child's seizure on video using smartphone.METHODS: A total of 356 4th-year students of five universities in Daegue-Gyeongbuk and Gyeongnam area took the clinical skill examination from June 13th to 17th in 2016. Among them, 72 students took the new CPX case in June 15th and 71 students filled out the questionnaire on whether the new CPX with smartphone video is helpful, authentic, difficult, and necessary for other CPX. All the questions were measured on 5-Likert scale.RESULTS: Mean score of the new CPX was 57.1, lower than the mean scores of the other 11 CPX cases, 62.8. For the question “Smartphone videos helped to solve the problem”, 45 students (63.4%) answered ‘Very much’. For the question “Is it realistic compared to other questions?” 30 students (42.3%) and 25 students (35.2%) answered ‘Very much’ and ‘Much’. For the question “Is it difficult compared with other questions?” 18 students (25.4%) and 26 students (36.6%) answered ‘Very much’ and ‘Much’. As for the question “I would like to have more tests using smartphone video”, 26 students (36.6%) answered ‘So and so’.CONCLUSION: A majority of students responded that video presentation was helpful and authentic to figure out the CPX, whereas they assessed smartphone video was more difficult compared with other CPXs. Further, students were negative toward using smartphone video for the other CPXs.

Current Medical Therapy for Uterine Leiomyomas / 고신대학교의과대학학술지

Uterine leiomyomas are benign tumors arising from the myometrium and largely prevalent in the woman's reproductive years. The majority of women with leiomyomas either remain asymptomatic or develop symptoms gradually over time. When patients are symptomatic, the nature of their complaints is often attributable to the number, size, and/or location of their fibroids. Depending on a patient's symptomatology and reproductive plans, treatment options include expectant management, medical management (hormonal and non-hormonal), or surgical management (myomectomy or hysterectomy).

Clinical value of routine serum squamous cell carcinoma antigen in follow-up of patients with locally advanced cervical cancer treated with radiation or chemoradiation

OBJECTIVE: The objective of this study was to evaluate the clinical benefits of routine squamous cell carcinoma antigen (SCC-Ag) monitoring of patients with locally advanced cervical squamous cell carcinoma treated with radiation or chemoradiation. METHODS: A total of 53 patients with recurrent cervical squamous cell carcinoma treated with radiotherapy or chemoradiation were enrolled in this study. A retrospective review of medical records was conducted. The role of routine monitoring of serum SCC-Ag was evaluated in terms of cost effectiveness and effect on survival after diagnosis of recurrence. RESULTS: Serum SCC-Ag abnormality (≥2.5 ng/mL) was observed in 62.3% of patients when recurrent disease was diagnosed. The first indicator of relapse was abnormal serum SCC-Ag level in 21 patients (39.6%), 10 of whom had asymptomatic recurrent disease amenable to salvage therapy. Adding SCC-Ag measurement to the basic follow up protocol improved the sensitivity for detecting recurrence (The sensitivity of the basic protocol vs. addition of SCC-Ag: 49.1% vs. 88.7%, P<0.001). Twenty-three patients who were candidates for salvage therapy with curative intent showed better survival compared with those who were not candidates for therapy (5-year survival: 36.6% vs. 0%, P=0.012). CONCLUSION: Surveillance with routine serum SCC-Ag monitoring can better detect asymptomatic recurrent disease that is potentially amenable to salvage therapy with curative intent. Early diagnosis of recurrent disease that can be treated with salvage therapy may lead to better survival.

Intrapelvic dissemination of early low-grade endometrioid stromal sarcoma due to electronic morcellation

Endometrioid stromal sarcoma is a rare malignancy that originates from mesenchymal cells. It is classified into low-grade endometrioid stromal sarcoma (LGESS) and high-grade endometrioid stromal sarcoma. Ultrasonographic findings of LGESS resemble those of submucosal myomas, leading to the possible preoperative misdiagnosis of LGESS as uterine leiomyoma. Electronic morcellation during laparoscopic surgery in women with LGESS can result in iatrogenic intraabdominal dissemination and a poorer prognosis. Here, we report a patient with LGESS who underwent a supracervical hysterectomy and electronic morcellation for a presumed myoma in another hospital. Disseminated metastatic lesions of LGESS in the posterior cul-de-sac and rectal serosal surface were absent on primary surgery, but found during reexploration. In conclusion, when LGESS is found incidentally following previous morcellation during laparoscopic surgery for presumed benign uterine disease, we highly recommend surgical reexploration, even when there is no evidence of a metastatic lesion in imaging studies.

Management of skin lesion of female external genitalia / 대한산부인과학회지

Patients with vulval symptoms are met frequently in gynaecological practice. The complaint is often long-standing and distressing and frequently induces a feeling of despair in both patient and doctor. The diagnosis and management of vulval dermatoses require such a multidisciplinary approach and the importance of this has been amply demonstrated by the evolution of combined clinics. Vulval disease in many societies can be the subject of unnecessary and exaggerated shame and embarrassment, hence their frequency and importance have been underestimated.

Disseminated peritoneal leiomyomatosis arising after laparoscopic myomectomy / 대한산부인과학회지

Disseminated peritoneal leiomyomatosis is rare condition characterized by multiple subperitoneal nodules of benign smooth muscle proliferations. It is associated with high level of estrogen such as pregnancy, oral contraceptives or estrogen producing ovarian tumor, and occasionally associated with operation history of myomectomy or hysterectomy. Clinical course of disseminated peritoneal leiomyomatosis is usually benign, but malignant changes also rarely have been reported. We experienced a case of disseminated peritoneal leiomyomatosis who has history of laparoscopic myomectomy 10 years ago. The patient was a 35-year-old woman, and her chief complaint was palpable masses in lower abdomen. She underwent laparoscopic surgery which revealed numerous solid masses on the surface of peritoneum, descending colon, rectosigmoid colon, uterus, round ligament, and broad ligament. We present it with a brief review of literature.

A case of multiple metastatic low-grade endometrial stromal sarcoma arising from an ovarian endometriotic lesion / 부인종양

The development of endometrial stromal sarcomas (ESSs) in foci of endometriosis is extremely rare, and few cases have been reported in the literature to date, particularly with regard to multiple extrauterine ESS. Here we report a case of endometrial stromal sarcoma with multiple metastasis that arose from an ovarian endometriotic lesion. The literature is also briefly reviewed.

The Correlation between the Scores of Written Examination, the Clinical Clerkship Examination, the Clinical Skill Assessment, and the Graduation Examination of the Medical Students / 한국의학교육

PURPOSE: The aim of this study was to investigate correlations between medical student scores on 4 examinations: the written examination, clinical clerkship examination, clinical skill assessment, and graduation examination. METHODS: Scores for 51 students who entered Daegu Catholic Medical School in 2005 on the written examination, clinical clerkship examination, clinical skill assessment, and graduation examination were included. Correlations between the scores were analyzed statistically. RESULTS: The scores on the written examination showed a strong correlation with those of the clinical clerkship assessment (0.833) and graduation examination (0.821). The clinical clerkship assessment scores correlated significantly with graduation examination scores (0.907). In addition, clinical skill assessment scores correlated with the written examination (0.579), clinical clerkship examination (0.570), and graduation examination (0.465) scores. CONCLUSION: Overall, the correlation between the scores on the clinical clerkship examination and the written examination was more significant than the correlation between scores on the clinical clerkship examination and clinical skill assessment. Therefore, we need to improve the evaluation method for the clinical clerkship examination and clinical skill assessment.

Comparison of concurrent chemoradiotherapy with cisplatin plus 5-fluorouracil versus cisplatin plus paclitaxel in patients with locally advanced cervical carcinoma / 부인종양

OBJECTIVE: The aim of this study was to compare survival outcomes and toxicities between concurrent radiotherapy with cisplatin plus 5-fluorouracil and that with cisplatin plus paclitaxel in patients with locally advanced cervical carcinoma. METHODS: We retrospectively reviewed data from 93 locally advanced cervical carcinoma patients (stage IB to IVA) who had been treated by concurrent radiotherapy with cisplatin plus 5-fluorouracil (CF, n=45) vs. cisplatin plus paclitaxel (CP, n=48) as primary therapy. Toxicities and survival outcomes were compared. RESULTS: In the CP group, there were higher frequencies of severe (grade 3 or 4) leukopenia (79.2%, as compared to 11.1% in the CF group), severe neutropenia (77.1%, as compared to 8.9% in the CF group) and severe peripheral neuropathy (12.5%, as compared to 2.2% in the CF group). In the CF group, there were higher frequencies of severe nausea (33.3%, as compared to 14.6% in the CP group) and severe hyponatremia (11.1%, as compared to 0% in the CP group). Five-year DFS of the CF and CP groups was 67.4% and 79.1%, respectively (p=NS). Five year OS of the CF and CP groups was 79.6% and 80.9%, respectively (p=NS). CONCLUSION: Concurrent radiotherapy with cisplatin plus paclitaxel showed increased leukopenia, neutropenia and peripheral neuropathy, but less gastrointestinal toxicity (nausea) than that with cisplatin plus 5-fluorouracil. Survival outcome between these two groups was not statistically different in this study. Large prospective randomized controlled studies will be needed to confirm this result.

Comparison of Urethral Length and Anterior Vaginal Wall Thickness between Continent and Incontinent Women / 대한비뇨기과학회지

PURPOSE: Few studies are available on the role of female urethral length (UL) and anterior vaginal wall thickness (AVWT) in stress urinary incontinence (SUI). The aim of this study was to evaluate the usefulness of characterization of female UL and AVWT associated with SUI. MATERIALS AND METHODS: Between May 2006 and October 2006, a total of 53 women with or without SUI were included in this study. Twenty-three women with SUI and 30 healthy volunteers serving as controls underwent transvaginal ultrasound with use of a 7.5MHz transrectal probe. Measurement comprised UL and three portions of AVWT classified as proximal, middle, and distal according to the location against the urethra. RESULTS: The women's median age was 51.1 (range: 30-73) years. The UL (mm, mean+/-SD) was significantly shorter in women with SUI than in women without SUI (28.7+/-2.8 vs 31.2+/-4.5, respectively, p=0.02). The AVWT of women with SUI (mm, mean+/-SD) was 16.2+/-2.8 in the proximal, 10.7+/-1.9 in the middle, and 9.3+/-2.0 in the distal portion, and those of women without SUI were 16.8+/-3.2, 10.1+/-1.8, and 6.9+/-1.3, respectively. Distal AVWT was significantly thicker in women with SUI than in women without SUI (p=0.01). There were no significant differences in AVWT or UL between pre- and postmenopausal women. A significant positive correlation was found between advancing in age and decrease in UL (p=0.03). Body mass index and parity showed no correlation with UL or any AVWT (p>0.05). CONCLUSIONS: These results suggest that women with shorter UL and thicker distal AVWT are likely to have SUI. Furthermore, UL was shorter in older women.

A case of non-gestational choriocarcinoma arising in the ovary of a postmenopausal woman / 부인종양

Primary ovarian choriocarcinoma arising from a germ cell is an extremely rare occurrence, especially in postmenopausal women, and the prognosis is poor. Non-gestational choriocarcinoma of the ovary (NGCO) accounts for 0.6% or less of all ovarian neoplasms. It is important to distinguish gestational choriocarcinomas of the ovary (GCO) from other carcinomas because of the poor prognosis of NGCO. We describe a case of NGCO with lung metastasis in a 55 year old woman, which we present together with a brief review of the literature.

A case of sequent occurrence of mature and immature teratomas in same patient / 대한산부인과학회지

Ovarian teratomas are the most common germ cell neoplasm. They include mature cystic teratomas, monodermal teratomas (neural tumors, struma ovarii, carcinoid tumors) and immature teratomas. Malignant transformation of mature teratoma is very rare event and a case of sequence occurance of mature teratoma and immature teratoma in same patient is not reported yet in Korea. A 17-year-old female was found to have a huge mature teratoma of the right ovary 3 years ago. That was treated with surgery. Three years later, Immature teratoma was discovered in left ovary and treated with surgery followed by chemotherapy. We experienced one case of sequent occurrence of mature teratoma and immature teratoma on both ovary in same patient. We present it with a brief of literature.

Introduction of Objective Structured Clinical Examination (OSCE) to Residency Examination / 한국의학교육

PURPOSE: The purpose of this study is to analyze the development and implementation of the Objective Structured Clinical Examination (OSCE) for the residency applicant examination at Daegu-Catholic Hospital. METHODS: Fifty-four Daegu-Catholic residency applicants were evaluated by written examination, internship scores, and OSCE. The correlation between written examination scores, internship scores, and OSCE scores was assessed. RESULTS: The correlation between OSCE and internship scores showed a tendency to be more significant than that between the written test and internship scores, but OSCE-internship correlation coefficients and written test and internship correlation coefficients was not statistically significant. The distribution of OSCE and internship scores on a graph corroborated this relationship between the two variables. CONCLUSION: The OSCE presents more objective criteria for residency application tests.

The relationship between serum p53 autoantibodies and prognostic relevance of epithelial ovarian cancer / 대한산부인과학회지

OBJECTIVE: The aim of this study was to determine whether a significant in preoperative serum p53 autoantibodies in epithelial ovarian cancer. METHODS: Serum autoantibodies against the p53 protein (p53 AAb) were analysed with a newly developed enzyme-linked immunosorbent assay (ELISA) based on highly purified and renatured p53. In a hospital -based retrospective study, preoperative sera from 17 patients with epithelial ovarian cancer and 15 patients with benign tumors of the ovaries, 15 healthy women were studies. RESULTS: The prevalence of p53 AAb in patients with epithelial ovarian cancer was 35.3% (6/17). No p53 AAb were found in patients with benign tumors and healthy women. Presence of p53 AAb positively correlated with older age, poor response of chemotherapy. But the differences in the tumor stage, grade, poor progression free survival rate were not statistically significant. CONCLUSIONS: The assessment of preoperative serum p53 AAb seems to have a limited clinical value in the epithelial ovarian cancer.

Prevalence and distribution of single and multiple HPV infections in cervical cancer and precancerous lesion from Daegu and Gyeongbuk province / 대한산부인과학회지

OBJECTIVE: We analysed subtype of HPV infection in cervical cancer and precancerous lesion among women who lived in Daegu and Gyeongbuk province. METHODS: We recruited total of 441 women diagnosed with cytologically abnormal cervical samples between Dec. 2004 and Dec. 2006. We investigated the distribution of HPV subtype and multiple infection according to cervical lesion and age. RESULTS: The most prevalent HPV subtypes in cervical cancer and precancerous lesion were HPV 16, 58, 18, 31, 56 in ASCUS, HPV 16, 58, 52, 66, 18 in LSIL, HPV 16, 58, 33, 52, 18 in HSIL, HPV 16, 58, 33, 52, 53 in IC each other. IC was less multiple infection than ASCUS, LSIL, HSIL. There was strong correlation between the incidence of multiple HPV infection and cervical lesion in young women (<25 years). CONCLUSION: The types of HPV 16, 58, 52, 18 were common in cervical cancer and precancerous lesion from Daegu and Gyeongbuk province. Multiple infections were more common in women under 25 years of age than above age and precancerous lesion.

Two cases of primary serous surface papillary carcinoma of ovary / 대한산부인과학회지

Serous surface papillary carcinoma (SSPC) of ovary is a rare malignant epithelial tumor that is histologically indistinguishable from serous ovarian papillary carcinoma. SSPC is defined as an exophytic papillary tumor originating from the surface epithelium of the ovary. It has been included in the World Health Organization classification of ovarian tumors. SSPC is believed to be a distinct subtype of serous papillary carcinoma of the ovary, and the prognosis is worse than that for serous ovarian papillary carcinoma. Clinically, SSPC usually presents with rapidly progressive intraperitoneal spread at the time of diagnosis. One woman with SSPC and malignant pleural effusion was 56 years old and presented with coughing and dyspnea. The other women was 61 years old and presented with abdominal distension. Their preoperative serum CA 125 level were 982.7 IU/mL and 4387 IU/mL. We experienced two cases of SSPC. In this case report, we present histologic findings, therapeutic modalities of SSPC with a brief review of literatures.

A case of pelvic and abdominal actinomycosis after hysterectomy / 대한산부인과학회지

Pelvic and abdominal actinomycosis is a chronic granulomatous supurative disease usually caused by an anaerobic Gram positive organism Actinomyces israelii. Its presentation is usually considered to be malignancy rather than an infective process and was once described as 'the most misdiagnosed disease'. They are normal commensal inhabitants of the human bronchial and gastrointestinal tracts and seem to only cause pathological infection after preceding mucosal breakdown. Infection spreads by direct extension. Hematogenous spread can occur but lymphatic spread is unknown. We experienced a pelvic and abdominal actinomycosis after total abdominal hysterectomy. This case illustrates the importance of considering the possibility of actinomycosis when we met a vague abdominal pain and mass after hysterectomy.

Usefulness of preoperative CA 125 level in decision making of lymphadenectomy in endometrial cancer patients / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate whether the preoperative serum level of CA 125 in patients with endometrial cancer could provide an additional information on determining the extent of surgical staging and which cutoff value might be optimal in this respect. METHODS: CA 125 levels were measured in 42 patients with endometrial carcinoma who underwent surgery at our institution between March 2000 and December 2004. Operative and postoperative pathologic findings were then correlated with preoperative CA 125 values. Statistical analysis was performed using Mann-Whitney U test, Kruskal-Wallis test, chi-square test and logistic regression model to evaluate the association of preoperative CA 125 levels with various factors. Receiver operating characteristic (ROC) curve was used to determine which cutoff value of the preoperative CA 125 was optimal. RESULTS: Univariate analyses showed that elevated CA 125 levels were significantly correlated with an advanced stage, larger tumor size, increasing depth of the myometrial invasion, extrauterine disease, and lymph node metastasis (P30 U/mL whereas lymph node metastasis can be predicted at the CA 125 level of >50 U/mL.

The Effect of Levofloxacin on the Survival of Ovarian Cancer Cells with or Without Carboplatin Under Hypoxic Condition / 대한산부인과학회잡지

In solid tumor, there is a hypoxic region where oxygen supply is insufficient. In this study, we found that one of the quinolone antibiotics, levofloxacin, made a human ovarian cancer cells, SK-OV-3, resistant to hypoxia, even in the presence of a platinum-based anti-cancer therapeutic, carboplatin; when the cells (2 X 10(5) cells/12 well multi culture dish) were grown in no glucose medium (0 g/l) under hypoxia (1% O2), all the cells became dead after 24 hours of culture in the absence of levofloxacin and carboplatin, whereas the cells still survived, at least, until 36 hours of culture in the presence of levofloxacin (10-100 microgram/ml) alone or in combination with carboplatin. The results might have some implications in treating solid tumor; if cancer patients should be treated for infection with antibiotics, quinolone antibiotics can aggravate tumor by making cancer cells more resistant to hypoxia. This is also true even when a patient is treated with carboplatin. Therefore, the results strongly suggest that we should be careful in choosing antibiotics when they are used for cancer patients. In this regard, our work could be a new guideline in choosing antibiotics when antibiotics are applied for treating cancer patients.

The Relationship between the Expression of Cytokeratins, Ki-67, and the Infection of Human Papillomavirus 16, 18 Type in the Carcinogenic Progression of the Uterine Cervical Epithelium / 대한산부인과학회잡지

OBJECTIVE: To evaluate the relationship between the expression of cytokeratins, Ki-67 and the infection of human papillomavirus 16, 18 type in the carcinogenic progrssion of the uterine cervical epithelium. METHODS: Investigation the expression patterns of CKs and Ki-67 monoclonal antibody, and compared them with the incidence of HPV infection in 120 patients including 30 cases of normal cervical epithelium, 30 cases of LSIL, 30 cases of HSIL and 30 cases of SCC, to possible relationship between them. RESULTS: The expression of CK 14, and Ki-67 increased as the cervical lesions progressed from normal to SILs and SCC. In contrast, CK 13 is decreased as the cervical lesions progressed from normal to SILs and SCC. Statistical analysis revealed significant corelations between the CK 14 and spinal layer, between CK 13 and basal layer, between Ki-67 and all layers. HPV was detected in 16.7% of normal cervical tissue, 50.0% of LSIL, 70.0% of HSIL, 80.0% of SCC with PCR technique. The labelling indices of Ki-67 were significantly higher in HSIL than in normal cervical tissue and LSIL. The labelling indices were also higher in groups with positive reactions to CK 14, 13, and HPV than in groups with negative reactions to them. CONCLUSION: It was postulated that examination of patterns of immunoreactivity of CK 14, 13, and Ki- 67 could be a useful and convenient tool to explain the trasition from normal cervical epithelium to SCC via LSIL and HSIL and thereby predict the differentiation potential of the studies for lesions.