OBJECTIVES: This study aimed to investigate the psychosocial characteristics of functional gastrointestinal disorder (FGID) in patients with psychiatric disorders. METHODS: This study was conducted with 144 outpatients visiting the psychiatric clinic at a university hospital. FGIDs were screened according to the Rome III questionnaire-Korean version. Demographic factors were investigated, and psychosocial factors were evaluated using the Hospital Anxiety Depression Scale, Patient Health Questionnaire-15, Childhood Trauma Questionnaire-Korean, and State-Trait Anger Expression Inventory. Chi-squared test and student's t-test were used as statistical analysis methods. RESULTS: There were differences in education level between two groups divided according to FGID status (χ²=10.139, p=0.017). Comparing the psychiatric disorder by FGID group, irritable bowel syndrome (IBS) group showed significant differences (χ²=11.408, p=0.022). According to FGID status, IBS group showed significant differences for anxiety (t=−3.106, p=0.002), depressive symptom (t=−2.105, p=0.037), somatic symptom (t=−3.565, p < 0.001), trait anger (t=−3.683, p < 0.001), anger-in (t=−2.463, p=0.015), and anger-out (t=− 2.355, p=0.020). Functional dyspepsia group showed significant differences for anxiety (t=−4.893, p < 0.001), depressive symptom (t=−3.459, p < 0.001), somatic symptom (t=−7.906, p < 0.001), trait-anger (t=−4.148, p < 0.001), state-anger (t=−2.181, p=0.031), anger-in (t=−2.684, p=0.008), and anger-out (t=−3.005, p=0.003). Nonerosive reflux disease group showed significant differences for anxiety (t=−4.286, p < 0.001), depressive symptom (t=−3.402, p < 0.001), somatic symptom (t=−7.162, p < 0.001), trait anger (t=−2.994, p=0.003), state anger (t=−2.259, p=0.025), anger-in (t=−2.772, p=0.006), and anger-out (t=−2.958, p=0.004). CONCLUSIONS: Patients with psychiatric disorders had a high prevalence of FGID, and various psychosocial factors contributed to such differences. Therefore, the psychiatric approach can offer better understandings and treatments to patients with FGID.
Anger ; Anxiety ; Demography ; Depression ; Dyspepsia ; Education ; Gastrointestinal Diseases ; Humans ; Irritable Bowel Syndrome ; Outpatients ; Prevalence ; Psychology

Sodium picosulfate/magnesium citrate (Picolight Powder), which is used as a bowel preparation for the colon and the rectum, can cause a severe electrolyte imbalance like hyponatremia. When hyponatremia gets severe or occurs rapidly, it can lead to death due to associated complications. We have experienced a case of hyponatremia associated with seizure and loss of consciousness in a 76-year-old woman, who took sodium picosulfate/magnesium citrate as a bowel preparation for colonoscopy. She was taking thiazide and synthroid for the treatment of hypertension and hypothyroidism, respectively, and she had other underlying medical conditions such as a history of seizure and dementia. Following the diagnosis of hyponatremia, we used an intravenous injection of 3% NaCl to normalize the sodium level in her serum, and her associated symptoms soon disappeared.
Aged ; Citric Acid* ; Colon ; Colonoscopy ; Dementia ; Diagnosis ; Female ; Humans ; Hypertension ; Hyponatremia* ; Hypothyroidism ; Injections, Intravenous ; Rectum ; Seizures* ; Sodium* ; Thyroxine ; Unconsciousness

The pneumonia severity index (PSI) and CURB-65 are widely used tools for the prediction of community-acquired pneumonia (CAP). This study was conducted to evaluate validation of severity scoring system including the PSI and CURB-65 scores of Korean CAP patients. In the prospective CAP cohort (participated in by 14 hospitals in Korea from January 2009 to September 2011), 883 patients aged over 18 yr were studied. The 30-day mortalities of all patients were calculated with their PSI index classes and CURB scores. The overall mortality rate was 4.5% (40/883). The mortality rates per CURB-65 score were as follows: score 0, 2.3% (6/260); score 1, 4.0% (12/300); score 2, 6.0% (13/216); score 3, 5.7% (5/88); score 4, 23.5% (4/17); and score 5, 0% (0/2). Mortality rate with PSI risk class were as follows: I, 2.3% (4/174); II, 2.7% (5/182); III, 2.3% (5/213); IV, 4.5% (11/245); and V, 21.7% (15/69). The subgroup mortality rate of Korean CAP patients varies based on the severity scores and CURB-65 is more valid for the lower scores, and PSI, for the higher scores. Thus, these variations must be considered when using PSI and CURB-65 for CAP in Korean patients.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Cohort Studies ; Community-Acquired Infections/*mortality ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Pneumonia/*mortality ; Prospective Studies ; Republic of Korea ; *Severity of Illness Index ; Young Adult

OBJECTIVE: To determine which mode of ultrasonography (US), among the conventional, spatial compound, and tissue-harmonic methods, exhibits the best performance for the detection of Implanon(R) with respect to generation of posterior acoustic shadowing (PAS). MATERIALS AND METHODS: A total of 21 patients, referred for localization of impalpable Implanon(R), underwent US, using the three modes with default settings (i.e., wide focal zone). Representative transverse images of the rods, according to each mode for all patients, were obtained. The resulting 63 images were reviewed by four observers. The observers provided a confidence score for the presence of PAS, using a five-point scale ranging from 1 (definitely absent) to 5 (definitely present), with scores of 4 or 5 for PAS being considered as detection. The average scores of PAS, obtained from the three different modes for each observer, were compared using one-way repeated measure ANOVA. The detection rates were compared using a weighted least square method. RESULTS: Statistically, the tissue harmonic mode was significantly superior to the other two modes, when comparing the average scores of PAS for all observers (p < 0.00-1). The detection rate was also highest for the tissue harmonic mode (p < 0.001). CONCLUSION: Tissue harmonic mode in uS appears to be the most suitable in detecting subdermal contraceptive implant rods.
Adult ; Analysis of Variance ; Arm/*ultrasonography ; *Contraceptive Agents, Female ; *Desogestrel ; Female ; Foreign Bodies/*ultrasonography ; Humans ; Middle Aged ; Ultrasonography/*methods

BACKGROUND/AIMS: The adenoma detection rate (ADR) has been proposed as a quality indicator of colonoscopy; however, ADR cannot be measured easily with commonly used endoscopy reporting systems because substantial time and effort is required to acquire data from histologic assessments. The purpose of this study was to determine if polyp detection rate (PDR) could be used as a valid proxy for ADR. METHODS: A total of 1,156 consecutive, asymptomatic, individuals of average risk between 50 and 75 years-of-age who underwent screening colonoscopies at four tertiary medical centers by 27 gastroenterologists were included in this study. Each individual endoscopist performed at least 10 colonoscopies during the study period. The ADR and PDR were calculated as the proportion of an endoscopist's cases with an adenoma or polyp divided by the total number of colonoscopies. Pearson's correlation coefficient and the intraclass correlation coefficient were used to determine the level of agreement between ADR and PDR. RESULTS: The mean PDR and ADR for endoscopists was 47.4% (range, 21.7-75.0) and 36.5% (range, 13.0-66.7), respectively. There was a strong correlation between PDR and ADR (Pearson's correlation coefficient 0.94, P<0.001) and there was also good agreement between performance quintiles defined by ADR and PDR (intraclass correlation coefficient 0.94, P<0.001). CONCLUSIONS: PDR is a valid proxy for ADR and may be useful for quality assurance at centers where ADR cannot be easily measured.
Adenoma ; Colonoscopy ; Endoscopy ; Humans ; Mass Screening ; Polyps ; Proxy ; Quality Indicators, Health Care

OBJECTIVE: We evaluated the effects of epidural analgesia on labor progress and perinatal outcomes in nulliparous women. METHODS: Between June 2004 and December 2004, we included total one hundred and thirty-two normal near term nulliparous women in early spontaneous labor or rupture of membranes for a prospective analysis. Patients were divided into those who received epidural analgesia (study group n=66) and those who did not (control group n=66). In order to evaluate the effects of epidural analgesia on labor progress, we compared the duration of active phase of labor and second stage of labor, cervical dilatation on admission, Bishop score and labor interval between the groups. We also compared perinatal outcomes between the two groups. RESULTS: The duration of active phase of labor was 4.7+/-2.0 hours in the study group and 3.6+/-1.9 hours in the control group showing a statistically significant prolongation in the duration of active phase of labor and significant slowing in the rate of cervical dilatation (p<0.05). The second stage of labor was also prolonged slightly in the study group (65.1+/-39.0 minutes) compared to the control group (54.1+/-33.5 minutes) but no statistical significance was noted. There was no significant difference in perinatal outcomes. CONCLUSION: Epidural analgesia may prolong active phase of labor. Therefore, we should always consider the effect of epidural analgesia before we decide to perform cesarean section.
Analgesia, Epidural* ; Cesarean Section ; Female ; Humans ; Labor Stage, First ; Membranes ; Pregnancy ; Prospective Studies ; Rupture

OBJECTIVE: Survivin is an inhibitor of apoptosis protein(IAP), which inhibits apoptosis through a pathway distinct from the Bcl-2 family members. Overexpression of survivin and Bcl-2 have been commonly reported in human neoplasms. The authors investigate whether there is a synergistic effect on the anti-apoptosis rate of primary brain tumors "in situ" based on the co-expression of survivin and Bcl-2. METHODS: One hundred and two brain tumor patients who had been resected were included in this study. Survivin and Bcl-2 were detected by Western blotting analysis, while apoptosis was examined by DNA fragmentation analysis. An anti-apoptotic rate was assessed in these brain tumor samples based on the expression of survivin and Bcl-2 or co-expression of both. RESULTS: Survivin and Bcl-2 were expressed in 57(55.9%) and 53(52.0%) of 102 brain tumor samples studied respectively, and co-expressed in 31(30.4%). The percentage of astrocytic and meningeal tumors expressing survivin was significantly correlated with histological grades; however, Bcl-2 was not correlated (p=0.106). The anti-apoptotic rate in primary brain tumors with survivin, Bcl-2, and both was detected in 49(86.0%) of 57 samples, 42(79.9%) of 53 samples, and 27(87.1%) of 31 samples, respectively. Their difference in the frequency of anti-apoptosis was not significant. CONCLUSION: Survivin or Bcl-2 is involved in the anti-apoptosis. However, it suggests that co-expression of survivin and Bcl-2, together, have no synergistic effect on the anti-apoptotic properties of the primary brain tumors.
Apoptosis ; Blotting, Western ; Brain Neoplasms* ; DNA Fragmentation ; Humans ; Meningeal Neoplasms

Human embryonic stem (ES) cells can be induced to differentiate into hematopoietic precursor cells via two methods: the formation of embryoid bodies (EBs) and co-culture with mouse bone marrow (BM) stromal cells. In this study, the above two methods have been combined by co-culture of human ES-cell-derived EBs with human BM stromal cells. The efficacy of this method was compared with that using EB formation alone. The undifferentiated human ES cell line SNUhES3 was allowed to form EBs for two days, then EBs were induced to differentiate in the presence of a different serum concentration (EB and EB/high FBS group), or co- cultured with human BM stromal cells (EB/BM co-culture group). Flow cytometry and hematopoietic colony-forming assays were used to assess hematopoietic differentiation in the three groups. While no significant increase of CD34+/CD45- or CD34+/CD38- cells was noted in the three groups on days 3 and 5, the percentage of CD34+/CD45- cells and CD34+/ CD38- cells was significantly higher in the EB/BM co-culture group than in the EB and EB/high FBS groups on day 10. The number of colony-forming cells (CFCs) was increased in the EB/BM co-culture group on days 7 and 10, implying a possible role for human BM stromal cells in supporting hematopoietic differentiation from human ES cell-derived EBs. These results demonstrate that co-culture of human ES-cell-derived EBs with human BM stromal cells might lead to more efficient hematopoietic differentiation from human ES cells cultured alone. Further study is warranted to evaluate the underlying mechanism.
Stromal Cells/physiology ; Stem Cells/*cytology ; Humans ; Hematopoietic Stem Cells/*cytology ; Embryo/*cytology ; Coculture Techniques ; Cells, Cultured ; *Cell Differentiation ; Bone Marrow Cells/*cytology ; Antigens, CD45/analysis ; Antigens, CD38/analysis ; Antigens, CD34/analysis

PURPOSE: Worldwide data shows that there is an increasing resistance among urinary tract pathogens to the first-line antimicrobial agents used in domestic areas. The objective of this study was to obtain data on the susceptibility patterns of the pathogens responsible for acute uncomplicated cystitis to currently used antimicrobial agents. MATERIALS AND METHODS: This study was carried out with the participation of fifteen hospitals in South Korea. A total of 239 isolates were obtained from female outpatients with acute uncomplicated cystitis. The antimicrobial susceptibilities to ampicillin, ampicillin/sulbactam, ciprofloxacin, gentamicin, trimethoprim/sulfamethoxazole(TMP/SMX) and tobramycin were determined by Vitek(R) antimicrobial susceptibility test systems. RESULTS: The most prevalent causative organism was Escherichia coli(79.9%), followed by coagulase negative Staphylococcus(4.2%), and a combination of other species of Enterobacteriaceae(8.2%). The mean rates of susceptibility were 35.5, 45.0, 85.7, 81.5, 62.1 and 85.3% to ampicillin, ampicillin/sulbactam, ciprofloxacin, gentamicin, TMP/ SMX and tobramycin, respectively. No significant differences were detected in the resistance rates between the results from 4 regional groups. CONCLUSIONS: The high prevalence of resistance to ampicillin, ampicillin/sulbactam, and TMP/SMX suggest these drugs would not provide adequate initial therapy, and therapies other than TMP/SMX may need to be considered. The relatively high prevalence of resistance to ciprofloxacin, compared with other countries, also requires on going surveillance to identify further changes among urinary tract isolates.
Ampicillin ; Anti-Infective Agents ; Ciprofloxacin ; Coagulase ; Cystitis* ; Disease Susceptibility ; Escherichia ; Female ; Gentamicins ; Humans ; Korea ; Outpatients ; Prevalence ; Tobramycin ; Urinary Tract

In Asian double eyelid surgery, there have been two approaches to form a suprapalpebral fold: the buried suture (nonincision) method and the full external incision method. Usually excessive fat tissue in upper eyelid has been removed by using a full external incision method, or 2 to 3 partial incisions with buried suture method. The full external incision method is more invasive than the buried suture method, which is not suitable for patients with excessive orbital fat. From March 1999 to January 2002, we have introduced the single 5 mm-partial incision method to 216 patients. This method is applied to patients who have excessive amount of orbital fat or those who do not have excessive orbital fat but which must be removed for better result. These patients have bulging supra-crease areas when we form suprapalpebral folds with a curved wire loop preoperatively. Excessive orbital fat was removed through a single 5 mm incision in the middle of designed eyelid crease and tarso-dermal suture was performed. At another 2 to 3 points, through skin stab punctures by using 18 gauge needle, full-thickness eyelid tarso-dermal sutures were done. Pretarsal and preseptal orbicularis muscles were preserved. If muscles were removed, that could result in thinning of the overlying skin and could make suprapalpebral fold unnatural. This method has several advantages. First, we could perform the operations safely in patients who have excessive fat tissue, without a full external incision. Second,fat tissue can be removed almost totally by a single 5 mm-partial incision. Third, we can minimize the scar formation, and the possibility of complications, and make healing process and operation time shorter compared to the full incision technique. However a very delicate technique is required in this method. In patients who have a thick orbital septum, a superiorly located fat pad, and a bleeding tendency, exposure of fat tissue could be difficult and injury of levator muscle aponeurosis is possible. The complications of this method are the possibility of disappearing of the crease with the lapse of time(3 percents), and suture granuloma formation(less than 1 percent). In conclusion, patients who have excessive fat tissue in upper eyelid don't have to proceed a full incision, and can have more excellent results with this single 5 mm-partial incision method.
Adipose Tissue ; Asian Continental Ancestry Group ; Cicatrix ; Eyelids* ; Granuloma ; Hemorrhage ; Humans ; Muscles ; Needles ; Orbit ; Punctures ; Skin ; Sutures