PURPOSE: The debate is still on-going as to whether a transthoracic esophagectomy (TTE) or a transhiatal esophagectomy (THE) is the proper treatment for patients with cardia and esophageal cancers. This study tries to demonstrate and assess the efficacy and the validity of both surgeries. MATERIALS AND METHODS: In a retrospective study, data from 52 cases of patients with esophageal and/or cardia cancer who received a surgical operation during the last decade were analyzed. RESULTS: A TTE was done in 20 cases and a THE in 32 cases. The average times for the operations were 558.0 min for a TTE and 451.7 min for a THE (P>0.05). The estimated blood loss was 1,825.0 ml in a TTE and 1459.4 ml in a THE (P>0.05). The amounts of transfusion during the operations were 3.9 units in a TTE and 2.6 units in a THE (P<0.05). Post-operative complications occurred in 15 cases of TTE and 23 cases of THE. The average length of stay in the hospital was 25.6 days for a TTE and 20.6 days for a THE. The 5-year survival rate was 10% for TTE patients and 28% for THE patients (P>0.05). CONCLUSION: For most factors, including morbidity and mortality, there was no statistically significant difference between a TTE and a THE. However, a THE is expected to be more convenient, leading to a shorter operative duration, a shorter post-operative hospitalization and lesser amounts of hemorrhage and transfusion. Hence, the THE may be a more valid or efficient surgical method for those patients with cardia and esophagus cancer who require a resection of the esophagus.
Cardia* ; Esophageal Neoplasms* ; Esophagectomy* ; Esophagus ; Hemorrhage ; Hospitalization ; Humans ; Length of Stay ; Mortality ; Retrospective Studies ; Survival Rate

OBJECTIVES: To summarize the evidence regarding the association of parity and breast feeding duration with the risk of osteoporosis in postmenopausal Korean women. This was because studies have been inconsistent regarding the effect of parity and breast feeding duration on the risk of osteoporosis. METHODS: A systematic literature search of relevant studies published by December 26, 2018 was conducted in PubMed, EMBASE, the Cochrane Library, CINAHL, RISS, KISS, KMbase, and KoreaMed. Outcome estimates of odds ratio (OR) or standardized mean difference were pooled with fixed or random-effect model. In case of heterogeneity, subgroup analysis was conducted. RESULTS: Seven cross-sectional studies (with 3,813 subjects) were included in the analysis. OR for osteoporosis was 1.43 (95% confidence interval [CI] = 1.09–1.88, P = 0.010) in postmenopausal women with higher parity compared to those with less parity. Moreover, OR for osteoporosis was 1.93 (95% CI = 1.28–2.93, P = 0.002) in postmenopausal women with longer durations of breast feeding than in those with shorter durations of breast feeding. CONCLUSIONS: This study revealed that duration of breast feeding increased the risk of osteoporosis in postmenopausal Korean women. More cohort studies with high quality research designs are needed to confirm our results.
Bone Density ; Breast Feeding ; Breast ; Cohort Studies ; Cross-Sectional Studies ; Female ; Humans ; Odds Ratio ; Osteoporosis ; Parity ; Population Characteristics ; Postmenopause ; Research Design

No abstract available.

BACKGROUND: We evaluated the value of neutrophil-lymphocyte count ratio (NLCR) in patients admitted to the Emergency Department (ED) with suspected nursing home acquired pneumonia (NHAP). METHODS: From May 2011 to January 2013, 116 patients admitted to the ED with suspected NHAP were retrospectively studied. The clinical characteristics, C-reactive protein (CRP), white blood cell count, neutrophil count, lymphocyte count, and NLCR were assessed. CURB-65 score was used to calculate disease severity. General ward or intensive care unit (ICU) admissions, and 72-hour and 30-day mortality for each infection marker was assessed. RESULTS: The 116 patients had a median age of 77 years. As the CURB-65 score increased from 0-1 (low risk), to 2-3 (moderate risk), and to 4-5 (high risk), the NLCR consistently increased (mean, 6.9, 8.89, and 16.22, respectively). The difference between the moderate and high risk groups was significant (p=0.008). The NLCR (mean+/-standard deviation) was high in patients with NHAP (10.28+/-8.81) and increased even more for patients admitted to the ICU (15.69+/-14.81) or who died within 72-hour (15.63+/-9.57). NLCR showed the trend of higher value in ICU admission (p=0.072), and CRP was significantly different between ICU and general ward admission (p=0.007). CONCLUSION: NLCR at ED admission correlated with NHAP severity and was comparable to the traditional infection marker. NLCR can be assessed simply and added to the assessment tools to determine the severity of pneumonia during ED admission.
C-Reactive Protein ; Emergencies ; Humans ; Intensive Care Units ; Leukocyte Count ; Lymphocyte Count ; Mortality ; Neutrophils ; Nursing Homes* ; Nursing* ; Patients' Rooms ; Pneumonia* ; Retrospective Studies

Dasatinib, a tyrosine kinase inhibitor, is widely used for patients with chronic myeloid leukemia and Philadelphia chromosome-positive acute lymphoblastic leukemia. Although the drug has a potent immunosuppressive effect, infectious complications during dasatinib treatment have been reported rarely. We describe five patients who developed cytomegalovirus (CMV) colitis during dasatinib treatment, in whom the colitis was initially confused with other causes. The patients, three with chronic myeloid leukemia, and two with acute lymphoblastic leukemia, were diagnosed with CMV colitis based on endoscopic and histologic findings. The patients who examined blood CMV polymerase chain reaction were all positive. The patients received antiviral therapy in the form of either ganciclovir or valganciclovir, and the overall treatment outcome was fair. These cases suggest that physicians should consider the possibility of CMV reactivation when treating diarrhea and/or hematochezia in patients on dasatinib.
Colitis* ; Cytomegalovirus* ; Dasatinib* ; Diarrhea ; Ganciclovir ; Gastrointestinal Hemorrhage ; Hematologic Neoplasms* ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Polymerase Chain Reaction ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Protein-Tyrosine Kinases ; Treatment Outcome

Dasatinib, a tyrosine kinase inhibitor, is widely used for patients with chronic myeloid leukemia and Philadelphia chromosome-positive acute lymphoblastic leukemia. Although the drug has a potent immunosuppressive effect, infectious complications during dasatinib treatment have been reported rarely. We describe five patients who developed cytomegalovirus (CMV) colitis during dasatinib treatment, in whom the colitis was initially confused with other causes. The patients, three with chronic myeloid leukemia, and two with acute lymphoblastic leukemia, were diagnosed with CMV colitis based on endoscopic and histologic findings. The patients who examined blood CMV polymerase chain reaction were all positive. The patients received antiviral therapy in the form of either ganciclovir or valganciclovir, and the overall treatment outcome was fair. These cases suggest that physicians should consider the possibility of CMV reactivation when treating diarrhea and/or hematochezia in patients on dasatinib.
Colitis* ; Cytomegalovirus* ; Dasatinib* ; Diarrhea ; Ganciclovir ; Gastrointestinal Hemorrhage ; Hematologic Neoplasms* ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Polymerase Chain Reaction ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Protein-Tyrosine Kinases ; Treatment Outcome

PURPOSE: This study aimed to identify the factors influencing human papillomavirus (HPV) vaccination adoption stages using the Precaution Adoption Process model. METHODS: A total of 173 female university students from B metropolitan city participated. Demographics, factors contributing to action, knowledge, health beliefs, and self-efficacy related to the HPV vaccination were measured. The collected data were analyzed using descriptive statistics and multiple logistic regression analysis using SPSS for Windows version 21.0. RESULTS: Factors that contributed to the transition from the unaware and unengaged stages to the undecided about action stage included age, economic status, experience of recommendation from doctors, perceived severity of cervical cancer, and perceived barriers. Factors that contributed to the transition from the undecided about action stage to the deciding to act stage were perceived benefit and self-efficacy of the HPV vaccination. Factors that contributed to the transition from the deciding to act stage to the acting and maintenance stages were experience of recommendation from doctors and perceived severity of cervical cancer. CONCLUSION: These results suggest that aggressive HPV vaccination campaigns increase awareness. Further studies should develop tailored strategies for promoting HPV vaccination that emphasize health beliefs and self-efficacy.
Demography ; Female ; Humans ; Logistic Models ; Papillomavirus Vaccines ; Uterine Cervical Neoplasms ; Vaccination*

PURPOSE: A number of studies have examined the B-type natriuretic peptide level in dialysis patients and in patients with lesser degrees of renal insufficiency. However, relationships between BNP and renal function are unknown. We sought to assess the diagnostic utility of BNP in differentiating congestive heart failure (CHF) from non-congestive heart failure (non-CHF) in patients with renal insufficiency. METHODS: BNP levels were obtained in 395 patients presenting to our emergency department with dyspnea. Of those 395 patients, 48 patients showed renal insufficiency. Patients transferred to other hospitals and those in a donot- resuscitate state were excluded. RESULTS: In patients with acute renal failure, patients with CHF (n=8) had BNP levels of 360+/-254 pg/ml whereas patients with non-CHF (n=3) had BNP levels of 114+/-103 pg/ml; however, this difference was not statistically significant. In patients with chronic renal failure, patients with CHF (n=22) had BNP levels of 1147+/-635 pg/ml, which was significantly higher than the BNP levels of 459+/-508 pg/ml for patients with non-CHF (n=7) (p=0.01). The area under the receiver operating curve, which plots sensitivity versus specificity for BNP levels in separating congestive heart failure from non-congestive heart failure in patients with chronic renal failure, was 0.805 (p=0.01). The diagnostic accuracy of BNP at a cutoff of 600 pg/ml was 76 %. CONCLUSION: The BNP cut-off value for diagnosis of CHF in patients with chronic renal failure is 600 pg/ml.
Acute Kidney Injury ; Diagnosis* ; Dialysis ; Dyspnea ; Emergency Service, Hospital ; Estrogens, Conjugated (USP)* ; Heart Failure* ; Humans ; Kidney Failure, Chronic ; Natriuretic Peptide, Brain* ; Renal Insufficiency ; Sensitivity and Specificity

PURPOSE: To assess the refractive change and prediction error after temporary intraocular lens (IOL) removal in temporary polypseudophakic eyes using IOL power calculation formulas and Gills' formula. METHODS: Four consecutive patients (7 eyes) who underwent temporary IOL explantation were enrolled. Postoperative refractions calculated using IOL power calculation formulas (SRK-II, SRK-T, Hoffer-Q, Holladay, and the modified Gills' formula for residual myopia and residual hyperopia) were compared to the manifest spherical equivalents checked at 1 month postoperatively. RESULTS: The mean ages of temporary piggyback IOL implantation and IOL removal were 6.71 +/- 3.68 months (range, 3 to 12 months) and 51.14 +/- 18.38 months (range, 29 to 74 months), respectively. The average refractive error was -13.11 +/- 3.10 diopters (D) just before IOL removal, and improved to -1.99 +/- 1.04 D after surgery. SRK-T showed the best prediction error of 1.17 +/- 1.00 D. The modified Gills' formula for myopia yielded a relatively good result of 1.47 +/- 1.27 D, with only the variable being axial length. CONCLUSIONS: Formulas to predict refractive change after temporary IOL removal in pediatric polypseudophakia were not as accurate as those used for single IOL implantation in adult eyes. Nonetheless, this study will be helpful in predicting postoperative refraction after temporary IOL removal.
Cataract/*congenital ; *Cataract Extraction ; *Device Removal ; Female ; Humans ; Hyperopia/etiology/*surgery ; Infant ; Lens Implantation, Intraocular/*methods ; Lenses, Intraocular ; Male ; Myopia/etiology/*surgery ; Prospective Studies

PURPOSE: To assess the refractive change and prediction error after temporary intraocular lens (IOL) removal in temporary polypseudophakic eyes using IOL power calculation formulas and Gills' formula. METHODS: Four consecutive patients (7 eyes) who underwent temporary IOL explantation were enrolled. Postoperative refractions calculated using IOL power calculation formulas (SRK-II, SRK-T, Hoffer-Q, Holladay, and the modified Gills' formula for residual myopia and residual hyperopia) were compared to the manifest spherical equivalents checked at 1 month postoperatively. RESULTS: The mean ages of temporary piggyback IOL implantation and IOL removal were 6.71 +/- 3.68 months (range, 3 to 12 months) and 51.14 +/- 18.38 months (range, 29 to 74 months), respectively. The average refractive error was -13.11 +/- 3.10 diopters (D) just before IOL removal, and improved to -1.99 +/- 1.04 D after surgery. SRK-T showed the best prediction error of 1.17 +/- 1.00 D. The modified Gills' formula for myopia yielded a relatively good result of 1.47 +/- 1.27 D, with only the variable being axial length. CONCLUSIONS: Formulas to predict refractive change after temporary IOL removal in pediatric polypseudophakia were not as accurate as those used for single IOL implantation in adult eyes. Nonetheless, this study will be helpful in predicting postoperative refraction after temporary IOL removal.
Cataract/*congenital ; *Cataract Extraction ; *Device Removal ; Female ; Humans ; Hyperopia/etiology/*surgery ; Infant ; Lens Implantation, Intraocular/*methods ; Lenses, Intraocular ; Male ; Myopia/etiology/*surgery ; Prospective Studies