Polypoid endometriosis is a rare form of endometriosis. It is a benign variant but its radiologic findings trick clinicians into concern about the tumor being malignant. A 42-year-old patient with a history of dysmenorrhea and adenomyosis presented a 60 mm-sized mass in the Douglas pouch with irregular echogenicity. The patient went under the first surgery for tumor removal, and its histopathologic diagnosis was endometriosis. We started daily dienogest medication to suppress tumor recurrence, but after 10 months we decided to stop the medication due to the side effects. Four months after the cessation, a new tumor recurred and after few months of observation, we performed the second surgery of tumor removal and total hysterectomy because of adenomyosis. The tumor was located in the retroperitoneal space in the Douglas pouch with severe adhesions. After the second surgery, the tumor marker Cancer antigen-125 level was normalized and the histopathologic result was endometriosis, which we concluded as polypoid endometriosis.

BACKGROUND: We compared currently available four antimicrobial susceptibility test methods for H.pylori to find out a practical method suitable for testing a few strains of H.pylori at a time in the clinical microbiology laboratory. METHODS: With 37 clinical isolates of H.pylori, antimicrobial susceptibility tests were performed against amoxicillin (AMX), clarithromycin (CLR), and metronidazole (MTZ) using disk diffusion method with egg yolk emulsion (EYE) media, E test with EYE and Mueller Hinton blood agar plate (MH BAP), and modified broth microdilution methods (mBMD). RESULTS: The results of AMX and CLR showed a complete agreement between the four methods. For MTZ, however, a significant discrepancy was observed between the results obtained by the four methods. In four strains exhibiting high minimal inhibitory concentrations (MIC, > or =32 mg/L) to MTZ, category agreement was excellent, but correlation was not good in 13 strains with the MTZ MICs of 8 to 16 mg/L. In 20 strains with MTZ MICs between 0.25 mg/L and 4 mg/L, category agreement was excellent, but correlation between MICs or inhibitory zone diameters was not good. Etest EYE and Etest MH BAP methods showed a 100% agreement in the susceptibility category of MTZ. CONCLUSION: In routine practice, the most practical method for testing susceptibility of H.pylori to AMX and CLR seems to be the disk diffusion method with EYE or MH BAP. But for MTZ, a duplicate test using both Etest and disk diffusion test is recommended until more standardized, economical, and technically easier test methods become available.
Agar ; Amoxicillin ; Clarithromycin ; Diffusion ; Egg Yolk ; Helicobacter pylori* ; Helicobacter* ; Metronidazole

OBJECTIVE: The objective of this research is to design and develop an integrated pharmaceutical supply chain management(SCM) system for optimizing inventory control and reducing material handling costs based on B2B collaboration and information sharing. METHODS: We have analyzed business processes of material handling in hospitals and reviewed system requirements for efficient supply chain management. VMI(Vendor-Managed Inventory), which is one of important applications of SCM, has been adopted. Online procurement system and Web-based information sharing system are developed for the integration of the SCM. RESULTS: The SCM system composed of VMI, CAO(Computer Aided Ordering), and Web-based information sharing system enables hospitals to optimize the procurement processes and inventory control of pharmaceutical products. By sharing information with hospitals, the wholesaler can get information more timely and use exact data about inventory status and drug usage volumes of hospitals, so that it can forecast future demand more accurately, which facilitates needed products to be supplied timely and cost-effectively. CONCLUSION: By the B2B collaborations and information sharing among SCM participants, the SCM system have been implemented successfully in the medical center. It improves material handling of hospitals, reducing inventory management costs and ultimately improving quality of patient care.
Commerce ; Cooperative Behavior* ; Information Dissemination* ; Patient Care ; Pharmaceutical Preparations

BACKGROUND: Previous studies indicated that a recently approved synthetic HMG-CoA reductase inhibitor, atorvastatin, reduces LDL cholesterol and triglyceride. To assess the efficacy on the level of serum LDL cholesterol and other lipoprotein fractions and its safety, we investigated 59 patients for lipid and side effect profile. METHOD: In patients with hypercholesterolemia, who showed 12-hours fasting serum LDL cholesterol>145 mg/dl and <250 mg/dl and triglyceride levels<400 mg/dl were enrolled to diet therapy for 4 weeks. After 4 weeks of diet therapy, serum lipid profile were reevaluated and patients with LDL cholesterol > or =130 mg/dl were assigned to receive 10 mg dose of atorvastatin once daily for 4weeks. After 4 weeks of drug therapy, serum lipid profile were rechecked, if showed LDL cholesterol level> or =130 mg/dl, assigned to receive 20 mg dose of atorvastatin once daily until 8 weeks. RESULTS: Of the 59 patients were assigned to receive atorvastatin therapy, 52 patients completed the study. Among lipid profiles, total cholesterol, triglyceride, LDL-cholesterol and apolipoprotein B levels showed significant reduction with mean reduction rate of 28%, 13%, 38%, 32% respectively after 4 weeks and 31%, 13%, 41% and 34% respectively after 8 weeks. HDL-Cholesterol and lipoprotein (a) level did not show significant change after 8 weeks of therapy. Nine patients had mild adverse events, such as elevated ALT, epigastric pain, insomnia, thumb pain. postural hypotension, palpitation and constipation. Only three patients of fifty-nine withdrew from the study due to adverse events related to drug treatment. CONCLUSION: The atorvastatin was highly effective and generally well tolerated with an acceptable safety profile in patients with primary hypercholestelemia.
Apolipoproteins ; Cholesterol ; Cholesterol, LDL ; Constipation ; Diet Therapy ; Drug Therapy ; Fasting ; Humans ; Hypercholesterolemia* ; Hypotension, Orthostatic ; Lipoprotein(a) ; Lipoproteins ; Oxidoreductases ; Sleep Initiation and Maintenance Disorders ; Thumb ; Triglycerides ; Atorvastatin Calcium

OBJECTIVES: The purpose of this study was to investigate demographic, clinical, behavioral and metabolic-endocrine factors related to weight gain in patients with schizophrenia treated with serotonin-dopamine antagonists(SDA). METHODS: Forty-two in-patients with DSM-IV schizophrenia were recruited from Samsung Seoul Hospital and St. Andrew Neuropsychiatric Hospital. The subjects were first-episode patients or patients who did not take any antipsychotics for the previous two months. All the patients were administered with one of the SDAs for 8 weeks. Body weights and body mass index (BMI) were measured weekly during the treatment period. The mean levels of daytime activities were evaluated at baseline and 4 weeks and 8 weeks after the treatment. To assess the clinical response to the medication, the Krawiecka Rating Scale (KRS) and Clinical Global Impression (CGI) were applied before and after the treatment. Fasting blood levels of glucose, cholesterol, triglyceride (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL), and serum level of prolactin were measured before and after the treatment. RESULTS: The body weight and BMI were significantly increased through the treatment periods. There were significant increases in the blood levels of cholesterol, TG and prolactin after 8 weeks. KRS total score showed significant decrease and the mean level of daytime activities showed significant increase by the treatment. Significant negative correlations were observed between the weight gain indices and the baseline BMI. The level of clinical improvement was significantly correlated with the degree of weight gain. Gender, age, smoking, daily dosages of antipsychotics, level of daytime activity and changes in appetite did not show any association with the weight gain indices. Neither the baseline biochemical variables nor their changes after the treatment were significantly correlated with the indices of weight gain. CONCLUSION: This result implies that low baseline BMI could be a risk factor of weight gain in short-term treatment of schizophrenia with SDAs. And it is also suggested that the effects of SDAs on weight gain and the clinical improvement might be developed through the same pharmacodynamic pathway.
Antipsychotic Agents ; Appetite ; Body Mass Index ; Body Weight ; Cholesterol ; Diagnostic and Statistical Manual of Mental Disorders ; Fasting ; Glucose ; Humans ; Lipoproteins ; Prolactin ; Risk Factors ; Schizophrenia* ; Seoul ; Smoke ; Smoking ; Triglycerides ; Weight Gain*

BACKGROUND: Since the emergence of variant Clostridium difficile strains that fail to produce detectable toxin A, diagnostic kits targeted to detect toxin A only showed a considerable rate of false negative results. The aim of this study was to evaluate a toxins A and B (toxins A/B) detection kit recently marketed in Korea, and to compare toxin positive rates before and after introduction of the new kit. METHODS: The results of 5,783 toxin A assays performed during the 7-year period from 2001 through 2007 were analyzed and compared them to the toxins A/B assay data of 519 samples obtained from January to June 2008 in a university hospital. An enzyme-linked fluorescent immunoassay for toxins A/B (VIDAS C. difficile Toxin A & B, bioMerieux SA, France: VIDAS CDAB) and PCR for toxin genes A/B were performed directly in 102 stool samples from hospitalized patients. RESULTS: The positive rates of toxin A assays tended downward annually from 2001 to 2007 (16.3%, 17.8%, 13.9%, 11.4%, 13.8%, 8.2%, and 5.8%, respectively), but increased to 12.1% in 2008 after changing to the toxin A/B detection kit. The concordant rate of the VIDAS CDAB kit with the PCR method was 82.4%. Compared to the PCR method, the sensitivity and specificity of the toxin A/B kit were 60.7% and 90.5% respectively. CONCLUSION: Testing kits for C. difficile toxin A only could result in a misdiagnosis more frequently than the testing kit for toxins A/B. The sensitivity of the newly launched toxin A/B detection kit from bioMerieux SA needs to be improved, but it showed a good specificity
Clostridium ; Clostridium difficile ; Diagnostic Errors ; Humans ; Immunoassay ; Immunoenzyme Techniques ; Korea ; Polymerase Chain Reaction ; Sensitivity and Specificity

BACKGROUND: The emergence of metronidazole (MTZ) resistance among Helicobacter pylori (H. pylori) isolates has compromised the efficacy of the triple therapy. Therefore, special attention should be given toward reliable methods for determining the in vitro susceptibility. But susceptibility testing of H. pylori is not yet either standardized or routinely performed. The purpose of this study was to establish more reliable, but simple to perform and cost-effective antimicrobial susceptibility testing method. METHODS: With 135 clinical isolates of H. pylori, antimicrobial susceptibility tests for MTZ and clarithromycin (CLR) were performed by antibiotic gradient method (E test, AB BIODISK, Sweden) and disk diffusion method (disk method), and the results were compared with the reference modified broth microdilution method (broth method). RESULTS: Resistant rates of Korean isolates of H. pylori for MTZ and CLR were 46.2% and 2.2%, respectively. There was 100% agreements between the E test, disk method and the broth method for CLR. For MTZ, however, agreements between the results obtained by the three methods were variable. Between the E test and broth method, the agreements were 85.1% in terms of susceptibility categories, 80.5% between the disk and broth method, and 93.1% between the E test and disk method. CONCLUSIONS: Routine susceptibility testing of H. pylori to MTZ seems to be required in Korea. The broth method is recommended for MTZ until more accurate, simple and practical alternative method become available. For the CLR, the disk method is recommended, because it is reliable, simple, and economical.
Clarithromycin ; Diffusion* ; Helicobacter pylori* ; Helicobacter* ; Korea ; Metronidazole

OBJECTIVES: The present study explored the reliability and the validity of our newly constructed job stress scale, the Korean version of the Occupational Stress Inventory (K-OSI) METHODS: Through preliminary item-analysis, we constructed 140 items of the Korean version of Occupational Stress Inventory (K-OSI) K-OSI consists of three subscales measuring three sections, 'ORQ'(Occupational Role Questionnaire) 'PSQ'(Personal Strain Questionnaire) and 'PRQ'(Personal Resource Questionnaire) respectively. The normative group consisted of 805 adult workers who represented six major job classes in Korea. RESULTS: The internal consistency coefficients of 'ORQ', 'PSQ', and 'PRQ' ranged from .89 to .92, and of those 14 subscales ranged from .70 to .88. The test-retest reliability coefficients of 8 week duration ranged from .62 to . 79, and bilingual's consistency coefficient ranged from .82 to . 96. The validity of the K-OSI was investigated by factor-analysis, yielding 3 factors of overall job stress and its responses, personal stress coping, psychological, physical, and behavioral responses of job stress. CONCLUSION: The present results indicate that the K-OSI is a reliable and valid measure of job stress.
Adult ; Humans ; Korea ; Reproducibility of Results*

OBJECTIVES: This study examined the effects of demographic variables on the job stress experience and established the norms of the Korean version of Occupational Stress Inventory. METHODS: The normative group consisted of 805 adult workers who represent seven major job class in Korea. K-OSI were administered to normative group and data were analyzed by subjects' demographic variables. RESULTS: To explore the effects of demographic variables on K-OSI, we considered several factors such as age, sex, duration of employment, job class, job position and so on. The results were as follows: 1) We found significant sex difference in K-OSI. Compared with men, women showed higher scores in Role Insufficiency, Role Ambiguity, Social Support, Vocational Strain Scales and men showed higher scores in Role Overload, Responsibility Scales. 2) Generally, a person who was older, earned higher salary, more duration of employment experienced job stress and had more coping resources. 3) In general, white-collar workers, job classes and job position had little effects on job stress. But other workers such as security guards, military officers were different from general white-collar workers in K-OSI. CONCLUSION: Because men and women showed significant difference in K-OSI, we constructed norms according to sex. K-OSI would be an useful instrument to identify one's job stress experience and to develop intervention plan.
Adult ; Employment ; Female ; Humans ; Korea ; Male ; Military Personnel ; Salaries and Fringe Benefits ; Sex Characteristics ; Weights and Measures

Objective: A deep learning-based classification system (DLCS) which uses structural brain magnetic resonance imaging (MRI) to diagnose Alzheimer’s disease (AD) was developed in a previous recent study. Here, we evaluate its performance by conducting a single-center, case-control clinical trial. Methods: We retrospectively collected T1-weighted brain MRI scans of subjects who had an accompanying measure of amyloid-beta (Aβ) positivity based on a 18F-florbetaben positron emission tomography scan. The dataset included 188 Aβ-positive patients with mild cognitive impairment or dementia due to AD, and 162 Aβ-negative controls with normal cognition. We calculated the sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC) of the DLCS in the classification of Aβ-positive AD patients from Aβ-negative controls. Results: The DLCS showed excellent performance, with sensitivity, specificity, positive predictive value, negative predictive value, and AUC of 85.6% (95% confidence interval [CI], 79.8–90.0), 90.1% (95% CI, 84.5–94.2), 91.0% (95% CI, 86.3–94.1), 84.4% (95% CI, 79.2–88.5), and 0.937 (95% CI, 0.911–0.963), respectively. Conclusion The DLCS shows promise in clinical settings where it could be routinely applied to MRI scans regardless of original scan purpose to improve the early detection of AD.