In Korea, most of college of medicine have runned integrated curriculum of system-centered or organ-centered subjects until now. But after graduation, medical students practically face on the patients who have symptoms, real problems. At that time, to resolve real problems of the patients, medical students need clinical reasoning and problem solving ability. After gradua-tion, through integrated curriculum of system-centered or organ-centered subjects, most medical students didn’t have a suit-able clinical competency to solve the real problems such as headache, epigastric pain, depression. So we need a new curricu-lum such as a clinical presentation curriculum to evoke more clinical reasoning and problem solving ability. The Korean Association of Medical Colleges (KAMC) selected 105 clinical presentations of the patients and published the learning out-comes of basic medical educations to have a clinical competency as primary physicians after graduation of medical school. So we have to learn the history taking, physical examination, possible diagnoses, appropriate investigation, natural history, prognosis and complications of the diagnosed conditions and prevention, treatment and management complications of treat-ment of 105 clinical presentations. Now, I will investigate the Objectives for the Qualifying Examination of Medical Council of CANADA and review the existing medical literature to provide practical insight into the clinical presentation curriculum introduced by University of Calgary. And I will suggest a model of a new curriculum as a clinical presentation curriculum of our university.

The goals of this study were to investigate image quality of coronary CT angiography (CCTA) and change of radiation dose by using Adaptive Statistical Iterative Reconstruction (ASIR) technique. 40 subjects with BMI≥25 (A, C groups), 40 subjects with BMI<25 (B, D groups), Groups without ASIR (A, B groups), and with ASIR (C, D groups) were included. There were no statistical differences in image qualities (p>0.05). Radiation doses with application of ASIR were significantly lower than those of ASIR (51-53%, p<0.05). In CCTA scan-nings, ASIR technique helps to reduce radiation dose with preserved image quality.

Detection of oral cancer is only depend on biopsy. We analyzed the usefulness of smear cytology in the detection of the squamous epithelial lesions of the oral cavity. The author collected a total of 54 cases of oral cytology and some corresponding biopsies from the patients who had a leukoplakia or ulceration of the oral mucosa over 12 months. Cytology slides were prepared using ThinPrep method and stained with Papanicolaou stain. The cytologic diagnoses were categorized based on The Bethesda System and the histologic diagnoses were classified as negative, oral intraepithelial neoplasia (OIN) I, OIN II, OIN III, or squamous cell carcinoma. Cytohistologic correlations were reviewed. Three cases of invasive squamous cell carcinoma, 5 cases of OIN III, and 46 cases of non-neoplastic benign lesions (including 7 cases of reactive atypia and 39 cases of within normal limit) were detected. Three cases of reactive atypia and 1 case of OIN III were confirmed as OIN I through follow-up biopsy. The cause of error was interpretation error in all cases. The concordance rate of oral cytology and biopsy was 92.6%. Oral cytology is a useful primary screen of OIN and oral cancer.

We evaluated the efficacy and safety of plasmakinetic transurethral enucleation and resection (TUERP) for benign prostatic hyperplasia (BPH) more than 80g. From January 2011 to December 2013, 37 patients with BPH larger than 80 g who underwent plasmakinetic TUERP were retrospectively assessed. The postoperative outcomes such as operative time, resected adenoma weight, resection rate, catheterization time, postoperative hospital stay and complications were reviewed. Patients were followed up at 1, 3, 6 months postoperatively. The mean prostate volume was 108.7 ± 21.7 g (range, 80 to 200 g), The mean resection chip weight was 53.5 ± 15.7 g (range, 29 to 101 g), The mean resection ratio was 82.0 ± 12.9%. Catheterization time and hospital stay was 2.4 ± 1.6 days and 3.4 ± 1.6 days respectively. Perioperative loss of hemoglobin and serum sodium was 1.5 ± 0.8 g/dL and 2.3 ±2.0 mmol/L respectively. International Prostate Symptom Score (IPSS), quality of life (QOL) score, maximum flow rate (Qmax), post void residual urine volume (PVR) were significantly improved at all followup intervals compared with baseline. No major complication including TUR syndrome was developed. Plasmakinetic TUERP is considered a safe, effective and technically feasible procedure for the large volume BPH more than 80 g at shortterm followup.

Extravasation is the accidental injection or leakage of fluid into the subcutaneous or perivascular tissues. Some drugs can cause serious injury such as severe tissue injury, necrosis, and etc. Here we report a case of chemical burn by sodium bicarbonate extravasation due to accidental venous puncture during arterial cannulation. A 42-years-old woman has taken emergency laparotomy surgery due to a stab wound to the abdomen. Massive blood loss has developed, and consequently vital signs were unstable and metabolic acidosis has developed. Sodium bicarbonate has administered via a peripheral intravenous line on the dorsal vein of a right hand that runs to the cephalic vein. However, the cephalic vein that runs by the side of the radial artery has punctured accidentally during the attempt of right radial artery cannulation. Second degree superficial and deep chemical burn by sodium bicarbonate extravasation has developed. Skin lesion about 3 × 4 cm2 with erythema and bullae formation has developed. There were no necrotic changes and the digital sensation was intact. Wet dressing and silicon foam dressing were prescribed. After two weeks, she was discharged. Until then, dermis exposure about 1 × 1 cm2 remained although the skin lesions became getting well.

Crohn’s disease is a chronic inflammatory bowel disease, involving gastrointestinal tract and extra-intestinal organs. IgA nephropathy is a rare extra-intestinal manifestation of Crohn’s disease. We describe a case of 21-year old Korean man who was diagnosed with Crohn’s disease 5 years after IgA nephropathy was suspected. At the age of 16, he had gross hematuria and 2 years after he was diagnosed with IgA nephropathy. Three years later, he complained of abdominal pain and diarrhea. He was diagnosed with Crohn’s disease by colonoscopy and histologic exams. There has been increasing evidences of common pathophysiology between the two diseases.

Advanced multidetector CT (MDCT) technology provides 2-dimensional (2D) images with 3-dimensional (3D) images. These 3D images (volume rendered, VR images) demonstrates the surface of the body and cutaneous neurofibromas in pa-tients with neurofibromatosis (NF) are well visualized. MDCT is a very useful imaging modality that represents various findings of neurofibromatosis such as cutaneous neurofibromas, central nervous tumors, skeletal anomalies including verte-bral scalloping and dural ectasia, mediastinal masses, lung parenchymal diseases, vascular anomalies, and complicated dis-eases related with NF. Herein, we report three cases with NF presenting cutaneous neurofibromas diagnosed by MDCT; One is NF patient with dural ectasis and meningocele, second case is a patient with NF and horseshoe kidney, third case is a pa-tient with cutaneous and subcutaneous neurofibromas.

Bacterial meningitis is an uncommon complication of pituitary macroadenoma. Bacterial meningitis can occur in patients with pituitary macroadenoma who have received sphenoidal surgery or had cerebrospinal fluid (CSF) rhinorrhea. A 62-year-old male visited our hospital for headache and fever. Brain magnetic resonance imaging showed a pituitary macroadenoma. CSF study revealed acute bacterial meningitis. Intravenous antibiotics and hydrocortisone replacement therapy were started, and lead to good clinical outcome. Bacterial meningitis should be considered in patients with a pituitary macroadenoma who present with meningitis symptoms, even though in the absence of rhinorrhea or surgical history.

Plexiform schwannoma is a rare benign tumor originated from Schwann cell with low probabilities of becoming malignant. While it has a multi-nodular character compared to the original form, its nature can be confirmed by immunohistochemical studies such as S-100 protein stain. It is rare in the nasal cavity and therefore not many cases were reported in Korea. The authors present a case of plexiform schwannoma on the nasal vestibule with a size of 2 cm.

Toxoplasmosis is a rare but fatal opportunistic infection in immunocompromised patients such as acquired immunodeficien-cy syndrome. We report a case of toxoplasmic encephalitis in a patient with acquired immunodeficiency syndrome (AIDS). A 44-year-old Thai male presented with loss of consciousness from a day ago and fever from 14 days ago. A magnetic reso-nance imaging scan of the brain revealed multiple, variable sized ring-enhancing lesions in the cerebral hemispheres. Toxo-plasma gondii immunoglobulin G antibody was tested positive by a serologic test. We diagnosed the patient as toxoplasmic encephalitis and he received pyrimethamine and sulfadiazine. We report here a rare case of patient with toxoplasmic enceph-alitis.

Osteolipoma is a very rare histologic variant of lipoma that exhibits bone formation. According to the tumor presentation, endosteal, parosteal, and soft tissue variants are reported. Osteolipoma is an extremely rare tumor. They have been found at various sites, with the highest frequency in head and neck regions. We report a case of parosteal osteolipoma in the left distal femur.

Due to the thick cortical structure, subtrochanteric fractures of femur is often caused by high energy trauma and there are only a few report of it from low energy trauma. We have experienced a case of bilateral subtrochanteric fracture which oc-curred after a simple slip down. The fracture was healed with applying intramedullary nail. We believe the fracture may have occurred from prolonged use of steroid which was used to treat underlying rheumatoid arthritis.