PURPOSE: This study was to evaluate the validity of the Pediatric Index of Mortality II(PIM II). METHOD: The first values on PIM II variables following ICU admission were collected from the patient's charts of 548 admissions retrospectively in three ICUs(medical, surgical, and neurosurgical) at P University Hospital and a cardiac ICU at D University Hospital in Busan from January 1, 2002 to December 31, 2003. Data was analyzed with the SPSSWIN 10.0 program for the descriptive statistics, correlation coefficient, standardized mortality ratio(SMR), validity index(sensitivity, specificity, positive predictive value, negative predictive value), and AUC of ROC curve. RESULT: The mortality rate was 10.9%(60 cases) and the predicted death rate was 9.5%. The correlation coefficient(r) between observed and expected death rates was .929(p<.01) and SMR was 1.15. Se, Sp, pPv, nPv, and the correct classification rate were .80, .96, .70, .98, and 94.0% respectively. In addition, areas under the curve(AUC) of the receiver operating characteristic(ROC) was 0.954(95% CI=0.919~0.989). According to demographic characteristics, mortality was underestimated in the medical group and overestimated in the surgical group. In addition, the AUCs of ROC curve were generally high in all subgroups. CONCLUSION: The PIM II showed a good, so it can be utilized for the subject hospital.
Severity of Illness Index ; Male ; *Intensive Care Units, Pediatric ; Infant, Newborn ; Infant ; Humans ; *Hospital Mortality ; Female ; Child, Preschool ; *Child Mortality ; Child ; Adolescent

BACKGROUND: Gastric cardia cancers are relatively rare neoplasms althougth it is reported that their relative incidence among gastric cancers is increasing. At the time of diagnosis, gastric cardia cancers in many cases are already in a more advanced stage in terms of depth of invasion or metastasis to lymph nodes. The purpose of this study was to evaluate the effect of the proximal resection margin on the survival rates for cardia cancer patients who underwent a total gastrectomy without a thoracotomy. METHODS: We retrospectively analyzed 87 patients who had undergone operations for gastric cardia cancers at Eulji College Hospital during the 8 years from Jan. 1988 to Dec. 1995. RESULTS: The most prevalent age group was in the 6th decade (34.5%) and the male-to-female ratio was 2.2:1.0. The TNM classification showed stage I (13.8%), II (10.3%), III (54%) and IV (21.8%). The overall 5-year survival rate was 35.6%, and the survival rates according to the stage were 83.3% in stage I, 87.5% in stage II, 27.1% in stage III, and 0% in stage IV. The 5-year survival rates according to the length of the proximal resection margin (PRM) for all patients were as follows: 22.0% for PRM< or =2 cm (N=34) and 44.0% for PRM>2 cm (N=52) 44.0% (p=0.0783). The 5-year survival rates according to the length of the PRM for stage III cancers were as follows: 19.7% for PRM< or =2 cm (N=18) and 31.7% for PRM>2 cm (N=28)(p=0.4090). CONCLUSIONS: These results suggest that the length of the proximal resection margin is not significant as a prognostic factor. We believe a total gastrectomy without a thoracotomy is a reasonable and safe alternative to a thoracotomy approach to the dissection of the mediastinal lymph node in cases of gastric cardia cancer.
Cardia* ; Classification ; Diagnosis ; Gastrectomy* ; Humans ; Incidence ; Lymph Nodes ; Neoplasm Metastasis ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate ; Thoracotomy

BACKGROUND/AIMS: There have been several studies showing that retroflexion (RF) in the right colon (RC) could reduce the polyp miss rate of proximal colon during colonoscopy. This study was conducted to evaluate the additional benefit of RF technique in the RC. METHODS: Patients who underwent colonoscopy from May 2008 to April 2011 were enrolled in the study. Data were obtained by retrospectively reviewing the medical records. RF was attempted in every patients undergoing colonoscopy since May 2008 except in cases of small RC vault, co-morbidity, severe diverticulosis, failed RF despite two trials, complaints of severe abdominal pain, or time burden. At first, RC was examined under direct vision. It was then examined by RF to detect missed polyps during the initial observation. Finally, the RC was re-examined with direct view. RESULTS: The cumulative RF success rate in the RC was 78.84% (1,805 of 2,319). The RF success rate increased with the number of cases (50% at 160 cases, 70% at 400 cases, and reached near 90% over 1,000 cases). Few polyps (4.88%) were detected only with RF and the additional adenoma detection rate was 3.32%. The additional polyp/adenoma detection rates were higher in the old age group (p<0.01). There were no RF associated perforation or severe complication. CONCLUSIONS: Using RF examination, additional 4.88% of polyps could be detected in the RC. This technique could be a useful and safe method to detect hidden polyp during colonoscopy.
Adenoma/diagnosis/pathology ; Adult ; Aged ; Colon, Descending/pathology ; Colonic Neoplasms/diagnosis/pathology ; Colonic Polyps/*diagnosis ; *Colonoscopy ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies

BACKGROUND/AIMS: Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), has been reported to have various ophthalmologic manifestations. The aim of this study was to evaluate the prevalence of ophthalmologic manifestations associated with IBD in Korea. METHODS: Sixty-one patients were examined between May 2013 and October 2014. We performed complete ophthalmologic examinations. RESULTS: Findings included 36 patients with CD and 25 with UC. The mean age of the patients was 34±16 years and disease duration was 45.3±23.9 months. Ophthalmologic manifestations were positive in 44 cases. Primary complication was diagnosed in 5 cases, as follows; iritis in 2 cases, episcleritis in one case, iritis with optic neuritis in 1 case, and serous retinal detachment in 1 case, without secondary complications. The most common coincidental complication was dry eye syndrome (DES), in 35 patients (57.4%). The prevalence of DES in the control group was 21.3%. The proportion of DES in patients with IBD was significantly higher than in the control group (P=0.002). CONCLUSIONS: Ophthalmologic manifestations were high (72.1%) in IBD patients. Clinically significant primary ocular inflammation occurred in 8.2% of patients. The most common complication was DES. There was a higher rate of DES in patients with IBD compared to the control group. Evaluation of the eye should be a routine component in patients with IBD.
Colitis, Ulcerative ; Crohn Disease ; Dry Eye Syndromes ; Humans ; Inflammation ; Inflammatory Bowel Diseases* ; Iritis ; Korea ; Ophthalmology ; Optic Neuritis ; Prevalence ; Retinal Detachment ; Scleritis

OBJECTIVE: The aim of this study was to investigate the relationship between follicular blood flow and the follicular fluid vascular endothelial growth factor (VEGF), and nitric oxide (NO) concentrations, and to determine which factor might be a better predictor of the outcome of IVF-ET. METHODS: In our prospective study, forty-seven cycles who underwent in vitro fertilization with tubal factor (25 cycles) and male factor (22 cycles) at the infertility clinic of Pusan National University Hospital from Feb. 2002 to June 2002 were assessed. Follicular blood flow was estimated on the day of hCG administration. Each follicular fluid was collected at the oocyte retrieval and follicular fluid VEGF and NO concentrations were assessed. According to the age of patients, the cause of infertility, and pregnancy rate, follicular blood flow and follicular fluid VEGF and NO concentrations were measured. RESULTS: Of 47 cycles, 18 cycles were pregnant (38.3%). Follicular blood flow was significant higher in the pregnant group compared to the nonpregnant group (p<.05), but there was no statistical significantly difference in the age and infertility cause. Follicular fluid concentrations of VEGF and NO were not statistically different in age, infertility cause, and pregnancy outcome. As follicle size increases, the follicular blood flow and follicular fluid VEGF concentrations increased significantly, but follicular fluid NO concentrations decreased. There was no correlation between VEGF and NO concentrations in follicular fluid by linear regression analysis. CONCLUSION: Our present study showed that follicular blood flow was positively associated with outcome of pregnancy as well as size of follicles, follicular fluid VEGF, but NO had no correlation with patient's age and pregnancy outcome. These results suggest that follicular blood flow might be a more effective prognostic marker of the pregnancy outcome of in vitro fertilization rather than follicular fluid VEGF and NO concentrations.
Busan ; Female ; Fertilization in Vitro ; Follicular Fluid* ; Humans ; Infertility ; Linear Models ; Male ; Nitric Oxide* ; Oocyte Retrieval ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate ; Prospective Studies ; Vascular Endothelial Growth Factor A*

Background/Aims: Inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), is increasing in South Korea. On the other hand, there are no reports of the incidence and prevalence of IBD specific to Jeju Island, prompting the necessity of this study. Methods: In this retrospective design, the medical records of 453 patients diagnosed with IBD at Jeju National University Hospital from January 1990 to December 2019 were analyzed. Results: Of the 453 IBD subjects (165 CD, 288 UC) included, the UC: CD ratio was 1.75:1. The incidence of IBD increased continuously from 0.19/105 in 1990 to 6.39/105 in 2017 and after that decreased to 4.92/105 in 2019. The male:female ratio was 2.24:1 for CD and 1.29:1 for UC. In the CD subjects, the disease activity included remission (33.3%), mild (25.5%), moderate (30.9%), and severe (6.1%). In UC subjects, the disease activity included remission (24.0%), mild (35.4%), moderate (28.8%), and severe (6.2%). According to the Montreal classification, the cases were as follows: CD: terminal ileum (22.4%), colon (9.7%), ileocolon (66.1%), and upper gastrointestinal involvement (27.3%), and perianal fistula/abscess was present in 43.6% of subjects before or at diagnosis: UC: proctitis (43.4%), left-sided colitis (29.1%), and pancolitis (23.3%) at diagnosis. Conclusions The incidence of IBD on Jeju Island has increased steadily for approximately 30 years but has exhibited a decline since 2017. Therefore, the incidence of IBD in Jeju is believed to have plateaued. Further study will be needed for clarification. (Korean J Gastroenterol 2023;81:243-252)

Gene alterations of p53 tumor suppressor gene such as point mutations, deletions or insertions occur in various human cancers. p53 protein overexpression was studied immunohistochemically in 80 gastric adenocarcinomas using an anti-human p53 antibody (Pab 1801) and the avidin-biotin-peroxidase technique. We have also analyzed allele loss of the human p53 gene in 54 cases of gastric adenocarcinoma using polymerase chain reaction and restriction fragment length polymorphism. p53 immunostaining was also demonstrated in 48 of 80 carcinomas (60%). Normal mucosa was always negative. No relation could be found between p53 immunostaining and the degree of differentiation. 21 of the 54 patients(39%) were informative for the p53 exon 4. In ten of these informative cases(47.6%), tumor DNAs showed allele loss when compared with nonmetastatic lymph node DNAs. Seven of the ten(70%) showed p53 immunoreactivity. These findings suggest that mutations of the p53 gene may play a role in the development of gastric adenocarcinoma and that allele loss of p53 frequently occurs in p53 immunoreactive gastric adenocarcinoma.
Adenocarcinoma/*genetics ; *Alleles ; Base Sequence ; DNA, Neoplasm/*analysis ; Gene Expression Regulation, Neoplastic/*genetics ; Genes, p53/*genetics ; Genetic Markers ; Human ; Molecular Sequence Data ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Stomach Neoplasms/*genetics

The introduction of plasma exchange has significantly improved the outcome of thrombotic thrombocytopenic purpura (TTP) and the survival rate was increased from 10 to 80-90%. TTP refractory to plasma exchange therapy, however, is still a therapeutic challenge. We describe here a patient who partially responded to plasma exchange therapy, but remained dependent on plasma infusions. To discontinue plasma therapy, several attempts using agents such as rituximab, vincristine, and cyclosporine A had been tried, but all failed. After splenectomy, serum LDH and blood platelet count were normalized. Plasmapheresis were we able to discontinue after 2 weeks of splenectomy. Steroid and cyclosporine were tapered off after 3 months and 5 months after splenectomy respectively, and the patient has been staying in remission ever since. We suggest that splenectomy is a worthwhile treatment option in patients with refractory TTP.
Antibodies, Monoclonal, Murine-Derived ; Cyclosporine ; Humans ; Plasma ; Plasma Exchange ; Plasmapheresis ; Platelet Count ; Purpura, Thrombotic Thrombocytopenic ; Splenectomy ; Survival Rate ; Thymine Nucleotides ; Vincristine ; Rituximab

PURPOSE: To report on the current practices in breast magnetic resonance imaging (MRI) in Korea. MATERIALS AND METHODS: We invited the 68 members of the Korean Society of Breast Imaging who were working in hospitals with available breast MRI to participate in a survey on how they performed and interpreted breast MRI. We asked one member from each hospital to respond to the survey. A total of 22 surveys from 22 hospitals were analyzed. RESULTS: Out of 22 hospitals, 13 (59.1%) performed at least 300 breast MRI examinations per year, and 5 out of 22 (22.7%) performed > 1200 per year. Out of 31 machines, 14 (45.2%) machines were 1.5-T scanners and 17 (54.8%) were 3.0-T scanners. All hospitals did contrast-enhanced breast MRI. Full-time breast radiologists supervised the performance and interpreted breast MRI in 19 of 22 (86.4%) of hospitals. All hospitals used BI-RADS for MRI interpretation. For computer-aided detection (CAD), 13 (59.1%) hospitals sometimes or always use it and 9 (40.9%) hospitals did not use CAD. Two (9.1%) and twelve (54.5%) hospitals never and rarely interpreted breast MRI without correlating the mammography or ultrasound, respectively. The majority of respondents rarely (13/21, 61.9%) or never (5/21, 23.8%) interpreted breast MRI performed at an outside facility. Of the hospitals performing contrast-enhanced examinations, 15 of 22 (68.2%) did not perform MRI-guided interventional procedures. CONCLUSION: Breast MRI is extensively performed in Korea. The indication and practical patterns are diverse. The information from this survey would provide the basis for the development of Korean breast MRI practice guidelines.
Breast Neoplasms ; Breast* ; Diagnosis ; Korea ; Magnetic Resonance Imaging* ; Mammography ; Surveys and Questionnaires ; Ultrasonography

BACKGROUND/AIMS: Spontaneous HBeAg seroconversion occurs frequently in the immune reactive phase in HBeAg-positive chronic hepatitis B (CHB). Therefore, observation for 3-6 months before commencing antiviral therapy is recommended in patients with alanine aminotransferase (ALT) levels that exceed twice the upper limit of normal (ULN). However, HBeAg seroconversion occurs infrequently in patients infected with hepatitis B virus (HBV) genotype C. The aim of the present study was to determine whether the waiting policy is necessary in endemic areas of HBV genotype C infection. METHODS: Ninety patients with HBeAg-positive CHB were followed prospectively without administering antiviral therapy for 6 months. Antiviral therapy was initiated promptly at any time if there was any evidence of biochemical (i.e., acute exacerbation of HBV infection or aggravation of jaundice) or symptomatic deterioration. After 6 months of observation, antiviral therapy was initiated according to the patient's ALT and HBV DNA levels. RESULTS: Only one patient (1.1%) achieved spontaneous HBeAg seroconversion. Biochemical and symptomatic deterioration occurred before 6 months in 17 patients (18.9%) and 5 patients, respectively. High ALT and HBV DNA levels were both independent risk factors for biochemical deterioration. Of 15 patients with HBV DNA > or =5.1x107 IU/mL and ALT > or =5xULN, biochemical deterioration occurred in 7 (46.7%), including 1 patient receiving liver transplantation due to liver failure. CONCLUSIONS: Spontaneous HBeAg seroconversion in patients with HBeAg-positive CHB is rare within 6 months. Biochemical deterioration was common and may lead to liver failure. Immediate antiviral therapy should be considered, especially in patients with high ALT and HBV DNA levels in endemic areas of genotype C infection.
Adult ; Alanine Transaminase/blood ; Antiviral Agents/*therapeutic use ; DNA, Viral/blood ; Female ; Follow-Up Studies ; Genotype ; Guanine/analogs & derivatives/therapeutic use ; Hepatitis B e Antigens/*blood ; Hepatitis B virus/*genetics ; Hepatitis B, Chronic/*drug therapy ; Humans ; Male ; Middle Aged ; Prospective Studies ; Risk Factors