PURPOSE: The purpose of this study is to evaluate findings in MRI which maybe useful in differential diagnosis of cervical lymph node enlargement. MATERIALS AND METHODS: We retrospectively analyzed the MRI findings of cervical lymph node enlargement in surgically proven 13 patients. We analyzed the location, size and shape, signal intensity, margin between node and surrounding structures degree and patterns of contrast enhancement RESULTS: No disease specificity in location and size of lymphadenopathy. was demonstrated in MRI. Most lymph nodes shows isointensity or slightly increased signal intensity to adjacent muscle on T1WI and high signal intensity on T2WI. Most of the cases showed contrast enhancement with metastatic lymph nodes showing ring-like and/or patchy enhancement. Tuberculous lymphadenopathy showed homogeneous or rather thick walled ring-like enhancement and one or multiple central nonenhancing portions of eccentrical location in the node. Relatively homogeneous enhancements were noted on reactive lymphold hyperplasia, Lymphoma and Castleman's disease. CONCLUSION: MR imaging was helpful in differentiation of cervical lymph node enlargements. Tuberculous lymphadenopathy showed characteristic findings of rather spherical shaped, thick walled ring enhancement and multiple eccentrically located central nonenhancing portions.
Diagnosis, Differential ; Giant Lymph Node Hyperplasia ; Humans ; Hyperplasia ; Lymph Nodes ; Lymphatic Diseases* ; Lymphoma ; Magnetic Resonance Imaging* ; Retrospective Studies ; Sensitivity and Specificity

BACKGROUND: The Samsung Dementia Questionnaire (SDQ) has recently been developed for screening dementia. Objectives of this study are to develop a short form of SDQ (S-SDQ) and to cross-validate S-SDQ in a new sample. METHODS: Factorial analysis of SDQ items was used to develop the S-SDQ. The S-SDQ was administered to informants of 100 dementia patients (61 Alzheimer's disease, 39 vascular dementia) and to those of 100 hospital control subjects. Two groups were matched in terms of age and sex. The retest of S-SDQ was conducted in 75 informants to determine the reliability of tests and retests which were spanned average 23.9 days. RESULTS: The S-SDQ was not influenced by education, age or sex. S-SDQ scores negatively correlated with the K-MMSE (r=-0.84). The S-SDQ showed stepwise scaling with dementia severity. The area under the ROC curve for the S-SDQ was 0.974 (S.E.=0.084). With respect to a diagnosis of dementia, the SDQ (cut-off point 8) had a sensitivity of 94% and a specificity of 90%. The S-SDQ was found to have a high test-retest reliability (r=0.97). CONCLUSIONS: An abbreviated version of SDQ (S-SDQ) had high sensitivity, specificity and test-retest reliability which were comparable to those of original SDQ. Thus, the S-SDQ can be a useful, brief dementia screening questionnaire.
Alzheimer Disease ; Dementia* ; Diagnosis ; Education ; Humans ; Mass Screening ; Surveys and Questionnaires* ; ROC Curve ; Sensitivity and Specificity

Gastric submucosal tumors are occasionally symptomatic (bleeding) but usually found incidentally at endoscopy. To evaluate comparisons of gastric endoscopy and upper gastrointestinal series in the submucosal tumor, we studied 50 patients which were diagnosed as submucosal tumor at SNUH from 1985 to 1988. The results were as follow: 1) Gastric submucosal tumors occupied 2.2% of the stomach cancer. (continue...)
Endoscopy* ; Humans ; Stomach Neoplasms

BACKGROUND/AIMS: When undergoing endoscopic submucosal dissection (ESD), patients with liver cirrhosis (LC) may suffer from a high risk of bleeding, bacteremia and tissue vulnerability. There have been few reports evaluating the efficacy and safety of ESD in patients with LC. METHODS: From January 2004 to March 2010, 23 patients with LC (cirrhosis group) underwent ESD for superficial gastric neoplastic lesions. The number of patients with a liver function in the Child-Pugh classes A and B were 20 and 3, respectively. The clinical outcomes and complications were compared with 69 patients without LC (control group) that were matched for age and sex. RESULTS: The en bloc resection, R0 resection and en bloc plus R0 resection rates of the cirrhosis group were 82.6%, 91.3%, and 82.6%, respectively, and did not show significant differences from the rates of the control group. No local recurrence was found in either group during the follow-up period. The procedure length of time (41.0 vs 39.0 minutes), rate of bleeding (4.3% vs 7.2%) and rate of perforation (0.0% vs 1.4%) in the cirrhosis group were also comparable to the results from the control group. CONCLUSIONS: ESD was safely performed in patients with LC, and satisfactory outcomes were achieved with high en bloc and R0 resection rates for superficial gastric neoplastic lesions.
Bacteremia ; Fibrosis ; Follow-Up Studies ; Hemorrhage ; Humans ; Liver ; Liver Cirrhosis ; Recurrence ; Retrospective Studies

Background/Aims: Few studies have investigated the long-term outcomes of endoscopic resection for early gastric cancer (EGC) in very elderly patients. The aim of this study was to determine the appropriate treatment strategy and identify the risk factors for mortality in these patients. Methods: Patients with EGC who underwent endoscopic resection from 2006 to 2017 were iden-tified using National Health Insurance Data and divided into three age groups: very elderly (≥85 years), elderly (65 to 84 years), and non-elderly (≤64 years). Their long- and short-term outcomes were compared in the three age groups, and the survival in the groups was compared with that in the control group, matched by age and sex. We also evaluated the risk factors for long- and short-term outcomes. Results: A total of 8,426 patients were included in our study: 118 very elderly, 4,583 elderly, and 3,725 non-elderly. The overall survival and cancer-specific survival rates were significantly lower in the very elderly group than in the elderly and the non-elderly groups. Congestive heart failure was negatively associated with cancer-specific survival. A significantly decreased risk for mortality was observed in all groups (p<0.001). The very elderly group had significantly higher readmission and mortality rates within 3 months of endoscopic resection than the non-elderly and elderly groups. Furthermore, the cerebrovascular disease was associated with mortality within 3 months after endoscopic resection. Conclusions Endoscopic resection for EGC can be helpful for very elderly patients, and it may play a role in achieving overall survival comparable to that of the control group.

Functional dyspepsia (FD) is defined as the presence of symptoms thought to originate in the gastroduodenal area, in the absence of any organic, systemic, or metabolic disease that is likely to explain the symptoms. Based on the available evidence and consensus opinion, thirteen consensus statements for the treatment of FD were developed using the modified Delphi approach. Proton pump inhibitor, prokinetics, and histamine 2 receptor antagonists are effective for the treatment of FD. Mucosal protecting agents, fundus relaxant, and drugs for visceral hypersensitivity can improve symptoms in FD. Antacids and antidepressants may help improving symptoms in FD. Comparing endoscopy with 'test and treat' of Helicobacter pylori, endoscopy may be more effective initial strategy for managing patients with FD in Korea given high incidence of gastric cancer and low cost of endoscopy. Helicobacter pylori eradication can be one of the therapeutic options for patients with FD. Psychotherapy is effective for those who have severe symptoms and refractoriness. Further studies are strongly needed to develop better treatment strategies for Korean patients with FD.
Antacids/therapeutic use ; Anti-Ulcer Agents/therapeutic use ; Antidepressive Agents/therapeutic use ; Dyspepsia/diet therapy/*therapy ; Gastroscopy ; Helicobacter Infections/drug therapy ; Helicobacter pylori ; Histamine H2 Antagonists/therapeutic use ; Humans ; Proton Pump Inhibitors/therapeutic use ; Psychotherapy ; Serotonin 5-HT3 Receptor Antagonists/therapeutic use ; Vasoconstrictor Agents/therapeutic use

PURPOSE: Colorectal cancer is believed to progress through an adenoma-carcinoma sequence. However, recent evidence increasingly supports the existence of an alternative route for colorectal carcinogenesis through a serrated adenoma, which combines the architectural features of hyperplastic polyps with the cytological features of traditional adenomas. We assessed the characteristics and the endoscopic features of serrated adenomas and compared them with those of hyperplastic polyps and traditional adenomas in Korea. METHODS: The medical records of 344 consecutive patients who underwent a colonoscopic biopsy or polypectomy from January 2003 through August 2004 at Gyeongsang National University Hospital were analyzed retrospectively. RESULTS: Serrated adenomas were seen in 12 cases (3.4%), and the most common site was the rectum (50%). Endoscopically in most cases, the serrated adenomas had small diameters (< or = 0.5 cm) and were single polyps. Morphologically, the serrated adenomas were flat and non-pedunculated. The coincidental rate of the carcinomas was 8.3%. CONCLUSIONS: According to this study, serrated adenomas are generally single, sessile adenomas with diameters less than 5 mm, and they are commonly observed in the left colon, especially in the rectum.
Adenoma* ; Biopsy ; Carcinogenesis ; Colon ; Colorectal Neoplasms ; Humans ; Korea ; Medical Records ; Polyps ; Rectum ; Retrospective Studies

Purpose: During diverting ileostomy reversal for rectal cancer patients who underwent previous sphincter-saving surgery, the extent of adhesion formation around the ileostomy site affects operative and postoperative outcomes. Anchoring sutures placed at the time of the ileostomy procedure may reduce adhesions around the ileostomy. This study aimed to evaluate the effects of anchoring sutures on the degree of adhesion formation and the postoperative course at the time of ileostomy reversal. Methods: Patients who underwent sphincter-saving surgery with diverting ileostomy for rectal cancer between January 2013 and December 2017 were enrolled. Variables including the peritoneal adhesion index (PAI) score, operation time, the length of resected small bowel, operative complications, and postoperative hospital stay were collected prospectively and compared between the anchoring group (AG) and non-anchoring group (NAG). Results: A total of 90 patients were included in this study, with 60 and 30 patients in the AG and NAG, respectively. The AG had shorter mean operation time (46.88 ± 16.37 minutes vs. 61.53 ± 19.36 minutes, P = 0.001) and lower mean PAI score (3.02 ± 2.53 vs. 5.80 ± 2.60, P = 0.001), compared with the NAG. There was no significant difference in the incidence of postoperative complications between the AG and NAG (5.0% vs. 13.3%, respectively; P = 0.240). Conclusion Anchoring sutures at the formation of a diverting ileostomy could decrease the adhesion score and operation time at ileostomy reversal, thus may be effective in improving perioperative outcomes.

BACKGROUND: Gastroesophageal reflux disease (GERD) is considered to be less common in the Orient compared to the West, but epidemiological data on GERD in Korea are rare. The aim of this study was to determine the prevalence of symptoms of gastroesophageal reflux in routine check-up subjects. METHODS: We analyzed 2243 subjects (male 716, female 1527; age range 20-69 yr) visited health promotion center for routine check-up. Subjects were given a validated self-reported questionnaire, which measured the presence, duration and severity of typical symptoms (heartburn, acid regurgitation); and the presence of atypical symptoms. At least weekly symptoms of heartburn and/or acid regurgitation were characterized as the definition of GERD. RESULTS: The prevalence of heartburn for at least monthly, at least weekly and at least daily episodes was 6.2%, 3.4% and 3.1%, respectively. The corresponding figures for acid regurgitation were 6.1%, 2.1% and 0.7%. The prevalence of GERD was 8.5%, and was more common in female (p< 0.01). Sixty eight percent of subjects with GERD reported the symptoms as having been present for less than 5 years. Seventy four percent of subjects with GERD reported these symptoms to be mild to moderate in severity. Heartburn and acid regurgitation were significantly associated with dyspepsia, chest pain, dysphagia and globus sensation (p< 0.01), but not with hoarseness or chronic cough. CONCLUSION: The prevalence of heartburn and/or acid regurgitation experienced at least weekly is 8.5% in routine check-up subjects. Heartburn and acid regurgitation were associated with epigastric pain, chest pain, dysphagia and globus sensation.
Chest Pain ; Cough ; Deglutition Disorders ; Dyspepsia ; Epidemiology ; Female ; Gastroesophageal Reflux* ; Health Promotion ; Heartburn ; Hoarseness ; Humans ; Korea ; Prevalence* ; Sensation ; Surveys and Questionnaires

BACKGROUND/AIMS: Multiple passages of biopsy forceps increase wear and tear on both the channel of endoscope and forceps. The two-bite technique can save time in obtaining sufficient specimens and also reduce the wear of the instruments. The aim of this study was to assess prospectively the efficacy of two-bite forceps technique in relation to time-saving. METHODS: A total 84 patients needed histopathologic diagnosis for Helicobacter pylori were randomized into two groups (one-bite technique: 41 patients, two-bite technique: 43 patients). An experienced endoscopist carried out upper endoscopy and used same biopsy forceps (FB-25K(R), Olympus, Tokyo, Japan). Mucosal biopsy specimens were obtained as follow: two from the antrum followed by two from the body. Rebiopsy was done when biopsy specimen was lost. The mean time in obtaining specimens and missing rate were analyzed. An experienced pathologist blinded to the technique of obtaining the samples evaluated the specimens for diameter, depth, crush artifact, and adequacy for histopathologic diagnosis. RESULTS: A total 336 specimens were obtained from 84 patients. Of these, 12 (7.0%) samples were missed with the two-bite technique but only 1 (0.6%) with the one-bite technique (p=0.003). Regarding histopathologic evaluation, there were no significant differences between samples taken with the two-bite technique and the one-bite technique. The mean time with two-bite technique (47.6 sec) was compared with one-bite technique (62.6 sec)(p<0.001). But there was no significant time difference if samples were missing during the process (62.5 sec). CONCLUSIONS: Although two- bite technique saves the time for biopsy, the main limitation is that there is a significant risk of losing samples.
Artifacts ; Biopsy ; Diagnosis ; Endoscopes ; Endoscopy ; Helicobacter pylori* ; Helicobacter* ; Humans ; Prospective Studies ; Surgical Instruments