Twin Rectal Tonsils Mimicking Carcinoid or Mucosa-Associated Lymphoid Tissue Lymphoma

The rectal tonsil is a rare polypoid lesion exclusively found in the rectum and is considered a reactive proliferation of the lymphoid tissue. Although this lesion is benign, we recommend that it should be differentiated from carcinoid or polypoid type of mucosa-associated lymphoid tissue lymphomas, based on gross findings. In this case report, we describe a case of rectal lesions with a unique appearance in a 41-year-old man. Colonoscopy revealed two 5-mm-sized nodules located opposite from each other on the left and right sides of the lower rectum. Endoscopic mucosal resection was conducted. Histopathologically, both lesions were mainly located in the submucosa and consisted of prominent lymphoid follicles with germinal centers of various sizes. No immunoreactivity of Bcl-2 was seen in the germinal centers. Immunohistochemical staining for kappa and lambda light chains revealed a polyclonal pattern. Therefore, these lesions were diagnosed as rectal tonsils.

The impacts of computer adaptive testing from a variety of perspectives / 보건의료교육평가

Computer adaptive testing (CAT) is a kind of tailored testing, in that it is a form of computer-based testing that is adaptive to each test-taker's ability level. In this review, the impacts of CAT are discussed from different perspectives in order to illustrate crucial points to keep in mind during the development and implementation of CAT. Test developers and psychometricians often emphasize the efficiency and accuracy of CAT in comparison to traditional linear tests. However, many test-takers report feeling discouraged after taking CATs, and this feeling can reduce learning self-efficacy and motivation. A trade-off must be made between the psychological experiences of test-takers and measurement efficiency. From the perspective of educators and subject matter experts, nonstatistical specifications, such as content coverage, content balance, and form length are major concerns. Thus, accreditation bodies may be faced with a discrepancy between the perspectives of psychometricians and those of subject matter experts. In order to improve test-takers' impressions of CAT, the author proposes increasing the target probability of answering correctly in the item selection algorithm even if doing so consequently decreases measurement efficiency. Two different methods, CAT with a shadow test approach and computerized multistage testing, have been developed in order to ensure the satisfaction of subject matter experts. In the shadow test approach, a full-length test is assembled that meets the constraints and provides maximum information at the current ability estimate, while computerized multistage testing gives subject matter experts an opportunity to review all test forms prior to administration.

Endoscopic Management of Nonvariceal Upper Gastrointestinal Bleeding: State of the Art

Nonvariceal upper gastrointestinal (GI) bleeding is one of the most common reasons for hospitalization and a major cause of morbidity and mortality worldwide. Recently developed endoscopic devices and supporting apparatuses can achieve endoscopic hemostasis with greater safety and efficiency. With these advancements in technology and technique, gastroenterologists should have no concerns regarding the management of acute upper GI bleeding, provided that they are well prepared and trained. However, when endoscopic hemostasis fails, endoscopy should not be continued. Rather, endoscopists should refer patients to radiologists and surgeons without any delay for evaluation regarding the appropriateness of emergency interventional radiology or surgery.