Medical schools have a social accountability to educate competent medical trainees and to improve the quality of medicine. Accreditation Board for Medical Education in Korea was established as an accreditation board in 1993. Now, Korean Institute of Medical Education and Evaluation (KIMEE) was opened and assessed the medical curricula and environments of each medical school which included medical educational contents, teaching-learning methods, assessment, students’ elections, medical facilities and the supporting system. KIMEE will assess each medical school with new items, called ‘ASK 2019’ starting from Year 2019. According to ASK 2019, KIMEE will assess 92 basic items and 51 excellence items which are 9 domains of mission and outcome, educational curriculum, students’ assessment, students, medical professors, educational resources, educational assessment, administration and management of school, continual improvement. We will actively prepare the budget, human resources, new medical curriculum, various teaching-learning and assessment methods, administration supporting system and medical facilities to pass the accreditation of medical education and evaluation.

As the number of clinical studies in Korea is increasing and qualitatively improving, interest in safety and welfare of research subjects, which are subjects of clinical research, is also increasing. Researchers who conduct research on humans should know and follow established laws and regulations in relation to clinical research, be aware of research ethics guidelines, and voluntarily comply with them. We would like to briefly inform the researchers that the IRB (Institutional Review Board) of Chosun University Hospital, which was enacted in June 2016 and revised in September 2018, will be able to fully understand the ‘Ethics Guideline for Research Related Persons in Chosun University Hospital (Version 2.0)’. Therefore, researchers need to understand and comply with domestic laws and regulations regarding clinical research, understand the roles and responsibilities of IRBs in protecting research subjects, and study research ethics guidelines.

Urinary tract infection (UTI) accounts for 15.5% of hospitalizations by infectious disease in over age of 65, second only to pneumonia, and they are responsible for 6.2% of infectious disease related deaths. UTI and asymptomatic bacteriuria (ASB) are very common in elderly. Distinguishing symptomatic urinary tract infection from asymptomatic bacteriuria is often difficult especially in old people living in long-term care facilities due to lack of specific symptoms. As the population is getting older, UTIs and ASB in elderly adults represent a significant health care burden. However, there is no exact data on morbidity of UTIs in elderly persons in Korea. This article reviews the prevalence of ASB and the incidence of symptomatic UTIs.

Korea represents high suicide rate by poisoning. Especially, since a lot of people died by high concentrated paraquat which has extremely high fatality rate, paraquat sales were prohibited in 2012. We investigated to find out how the prohibition of sales affected occurrence of pesticide poisoned patients and what kinds of influences did it have for severity and death rate. By targeting patients who visited emergency room by pesticide poisoning from 2010 to 2014, we researched insecticides poisoned patients and herbicidal poisoned patients grouped into 9 categories. Before and after 2012, We compared A term (2010, 2011) and B term (2013, 2014)’s pesticide occurrence, especially distribution of herbicide occurrence and compared hospitalization rate, hospitalization period, length of stay in ICU (Intensive Care Unit), severity, and death rate. The number of insecticide patients was 219 (37.4%) and the number of herbicide patients was 367 (62.6%) who visited emergency room in five years and the rate was similar every year. In case of paraquat, there was 70.5% decrease by 105 people for A term and 31 people for B term and increase of double for glyphosate, glufosinate, and other herbicides. The death rate was decreased but hospitalization was increased. There weren’t any difference of rate in ICU admission, intubation and ventilator therapy. By prohibition of using paraquat, the death rate by pesticide poisoning was decreased. However, patients who poisoned by other herbicides were increased, so hospitalization rate increased and there weren’t any difference at patient’s severity rates.

In patients with acute cerebral infarction, taranscranial ultrasonography is helpful in assessing blood flow, but in some patients, failure to detect cerebral blood flow through the temporal window is an important problem in expansion of clinical indications for transcranial ultrasonography. This study was performed between May 2016 and September 2016 in patients admitted to the neurology department of Chosun University Hospital with cerebral infarction and underwent transcranial ultrasonography and brain magnetic resonance image. Of the 129 patients, 47 were female (36.4%). The mean age of the patients was 80.7±8.0 years. Fifty patients (38.8%) did not showed any blood flow signal due to poor temporal window. The mean age of patients with temporal window failure (83.8±6.0 years) was significantly higher than without temporal window failure (78.7±8.5), and the temporal window failure was significantly higher in women. In conclusion, temporal window failure was more common in elderly and women in this study. In addition to temporal bone thickness and heterogeneity of temporal bone due to osteoporosis, hyperlipidemia may also be associated with temporal window failure and future prospective studies will be needed.

Purpose: The incidence of pediatric herpes zoster has been increasing year by year. Pediatric herpes zoster is generally known to be less severe than adult cases, but may cause various complications such as secondary bacterial infections, encephalitis, meningitis, and Ramsay Hunt syndrome. In this study, we performed epidemiological and clinical investigations of children and adolescents diagnosed as herpes zoster. The incidence and clinical factors associated with complications of herpes zoster were studied. Methods: This study was retrospectively analyzed the medical records of 62 patients under 18 years who were diagnosed and treated with herpes zoster at Chosun University Hospital from 2007 to 2017. This patients were evaluated with regard to gender, age, dermatomal distributions, accompanying symptoms, underlying disease, treatment and complications. These patients were divided into two groups according to the presence or absence of complications. Results: Children under 18 years old account for 3.2% of all herpes zoster patients who were hospitalized at Chosun University Hospital from 2007 to 2017. The incidence of males was higher than that of females. The number of enrolled patients was increasing according to age. The number and the proportion of pediatric patients has been increasing year by year. Lesions of herpes zoster were most frequently found in the thoracic region, followed by the cervical, trigeminal, lumbar regions. The most common accompanying symptom was pain, followed by pruritus, fever, headache. Among the 62 cases, 27 cases (27.4%) were complicated by herpes zoster. Ramsay Hunt syndrome was the most common (16.1%), followed by meningitis and herpes ophthalmicus. Neither secondary bacterial infection nor postherpetic neuralgia were observed. Skin lesions in the trigeminal dermatomes was associated with complications (p=0.006). The mean of hospitalization period is longer in the group with complications (p=0.003). The patients accompanying symptoms such as headache was more likely to occur complications (p value＜0.05). There was no difference in age, sex, and underlying disease between the two groups. Conclusion: Patients with complications had longer duration of treatment and had more frequent with trigeminal and cervical region. The patients accompanying symptom such as headache were more likely to occur complications.

Background: Patent ductus arteriosus (PDA) is commonly accompanied by premature infants and associated with an increase of comorbidity and mortality. Surgery in the operation room (OR) is more familiar with an anesthesiologist, but transportation of the premature to OR has risks of hypothermia or other unexpected events. These days, PDA ligation in the neonatal intensive care unit (NICU) is highlighted because of its advantages. We compared the postoperative outcome of PDA ligation according to the operating theater in the perspective of an anesthesiologist. Methods: A total of 9 patient who underwent PDA ligation surgery from 2007 to 2018 were enrolled and divided into two groups; Group OR: surgery at the OR, Group NICU: surgery at the NICU. Data of gestational age (GA), body weight (BW), patients’ characteristics, anesthesia and hemodynamic, total hospitalization period, and outcome were collected. Results: There were no significant differences in patient characteristics (GA, BW, PDA size, and comorbidities) and the duration of anesthesia, operation and recovery. Total hospitalization period was shorter in a group OR than NICU, but there were no significant differences in postoperative outcome. Only 1 patient has expired in a group OR. Conclusions: PDA ligation surgery in NICU has the advantage to maintain the body temperature than the surgery in the OR, and there were no significant differences in the outcome of the surgery.

Although the diagnostic rate of organizing hematoma has increased, any crucial characteristic findings are not fully understood and elucidated. Even though it is a non-neoplastic lesion, radiological image findings can range from a benign expansile appearance to a more aggressive form such as bony erosion, which sometimes can make any confusion. Thus, clinician should make a diagnosis thoroughly based on the histopathologic finding. Here, we presented two cases of organizing hematoma of the maxillary sinus mimicking chronic rhinosinusitis.

Focal myositis is a rare disease associated with inflammatory changes invading the skeletal muscles and may be triggered by nerve lesion. We describe a case of 33-year-old woman who was diagnosed focal denervation myositis of piriformis and gluteal muscles associated with sciatic neuropathy because of severe uterine enlargement due to twin pregnancy misdiagnosed as lumbar herniated nucleus pulposus. MRI is one of the key diagnostic tools in the assessment of focal denervation myositis for differential diagnosis. Nonsteroidal anti-inflammatory drugs are commonly used for treatment of focal myositis. Spontaneous regression is obtained in numerous cases.

Spinal pain is a symptom caused by changes of the vertebral column or its adnexa. Sometimes spinal pain cannot be treated, especially in case of multiple pain lesions, because of its difficulty in evaluating original causes which contributes to the symptoms. Thus, the precise localization of the lesion causing symptoms is very important for targeted treatment. However, the diagnosis based on limited screening test including physical evaluation and radiological finding may lead to misdiagnosis of the actual lesion causing symptoms, failure of treatment, and unnecessary surgery. From this point of view, nonsurgical interventional for spinal pain can be helpful to diagnose the precise cause of spinal pain. We report several cases that nonsurgical interventional therapy which diagnosed the precise lesion that cause the spinal pain and treated successfully with nonsurgical interventional therapy for diagnostic purposes with therapeutic purpose.

Gastrointestinal stromal tumor (GIST) is the most common soft tissue sarcoma of the gastrointestinal tract. Surgery is the primary treatment of choice for patients with localized or potentially resectable GIST, whereas imatinib is the main treatment for patients with advanced, unresectable, or metastatic GIST. Neoadjuvant treatment with imatinib is not routinely recommended unless there is significant justification for reducing the tumor size in order to improve surgical outcome. The authors describe a case of a 48-year-old man who confirmed huge rectal GIST, and received successful neoadjuvant treatment with imatinib for preserving anal sphincter function followed by transanal excision.

Cold agglutinin disease (CAD) is a rare and poorly understood disorder affecting 15% of patients with autoimmune hemolytic anemia (AIHA). In this case report, we describe a case of CAD mistaken for liver cirrhosis. A 57-year-old male patient was presumptive diagnosed with early liver cirrhosis due to mild hyperbilirubinemia and abdominal sonography finding without other findings as thrombocytopenia or prothrombin time prolongation. After 3 month, the patient was referred to our hospital with agglutination of peripheral red blood cell at room temperature and livedo reticularis of the whole body and finally diagnosed with CAD associated B cell lymphoproliferative disorder.

Primary CNS lymphoma (PCNSL) accounts for 1-5% of all primary brain tumors. Early and accurate diagnosis of PCNSL is crucial for proper management and is more likely if a tumor is observed on imaging. We present the PCNSL case of 77-year-old man who developed abrupt neuropsychiatric features from 5 days ago. This case suggests that clinicians should be alert on the possibility of PCNSL and apply prompt MRI evaluation, when elderly patient with chronic heavy alcohol drinking history present abrupt complex neuropsychiatric symptoms in outpatient clinic.

A primary infection with Toxoplasma gondii is usually asymptomatic, but some patients may have cervical lymphadenopathy and ocular disease. Toxoplasmosis is a common cause of lymphadenopathy. However, histopathologic examination to diagnose it usually does not reveal toxoplasmic cysts. Diagnosis of toxoplasmosis can be established by serological techniques or by direct detection of the parasite. Therefore, it is necessary to recognize the characteristic histopathological findings of toxoplasmic lymphadenitis and to confirm by serological or PCR results for toxoplasmosis. We describe histopathologic features of a case of toxoplasmic lymphadenitis with review of the literature, confirmed by serological evidence in a 50-year-old man.

Elastofibroma is a rare benign tumor that occurs in connective tissue. It mostly arises between the lower scapula and the chest wall of the elderly people with a female predominance. The tumor presents as a slow growing mass and rarely causes pain and scapular snapping. The etiology of the elastofibroma is not known, but it can occur as a reaction to repeated trauma or friction, and it may also be induced by family history or genetic abnormalities. In diagnostic imaging, it is an ill-defined, heterogenous soft tissue mass with similar intensity to that of skeletal muscle. On histopatholgy, it is characterized by the proliferative fibrous tissue containing abnormal elastic fibers and interlaced adipose tissue. Surgical treatment is very limited. In general, infrascapular location, bilaterality and typical imaging features in the elderly women are sufficient for diagnosis of elastofibroma, thus avoiding unnecessary surgical resection. We report a case of a 69-yearold female with bilateral elastofibroma in the scapular region with a review of literature.

In hepatobiliary organs, cases of neuroendocrine neoplasm are extremely rare, comprising less than 1% of all neuroendocrine tumor. Mixed adenoneuroendocrine carcinoma is even more rarer. Since neuroendocrine tumor component of mixed adenoneuroendocrine carcinoma defines the prognosis, it is of great importance to identify them for the practical point of view. Here, we report a case of 83 year-old female with mixed adenoneuroendocrine carcinoma in common bile duct. This lesion showed lymphovascular invasion of tumor cells.