Gastric subepithelial tumors (SETs) are usually asymptomatic and are often detected incidentally during screening endoscopy. A gastric inverted hyperplastic polyp (IHP) is characterized by downward growth of hyperplastic mucosa into the submucosal layer. Owing to these characteristics, a gastric IHP is frequently misdiagnosed as a SET. Gastric IHPs are asymptomatic in most cases and are discovered incidentally. Notably, IHPs may be accompanied by an adenocarcinoma or anemia owing to chronic bleeding associated with this lesion; therefore, endoscopic submucosal dissection is recommended for complete excision of IHPs measuring > 2 cm. We report a case of gastric IHP that was diagnosed during screening endoscopy in an asymptomatic patient. We observed a whitish purulent exudate expressed from the SET, and endoscopic ultrasonography revealed a SET originating from the muscularis mucosa. Endoscopic submucosal dissection was performed to remove the SET, and final histopathological findings revealed a gastric IHP. This case report highlights that IHPs should be suspected in patients with a SET associated with whitish exudates.

Purpose: We assessed prenatal detection rates of congenital heart disease (CHD) and associations between maternal serum biomarkers and non-chromosomal CHD in singleton pregnancies. Materials and Methods: This study was conducted as a secondary analysis of data obtained during a multicenter prospective cohort study that investigated the cost-effectiveness of prenatal testing for fetal aneuploidy. We analyzed the prenatal detection rate and accuracy for CHD screening via ultrasound during the second trimester, as well as associations between serum biomarkers and CHDs, in singleton newborns without chromosomal abnormalities. Results: Among 6715 women, 142 (2.1%) newborns were born with CHDs, of which 67 (1.0%) newborns had major CHDs. The prenatal detection rate for all CHDs and major CHDs were 34.5% and 58.2%, respectively. After excluding isolated ventricular septal defects, the detection rate for critical CHDs was 85.9%. Women with low pregnancy-associated plasma protein A (PAPP-A) (<0.4 multiples of the median, MOM) face increased risks of non-chromosomal CHDs [adjusted odds ratio (aOR) 2.76; 95% confidence interval (CI) 1.36–5.13] and major CHDs (aOR 7.30; 95% CI 3.18–15.59), compared to those without CHDs. A higher inhibin A level (≥2.5 MOM; aOR 4.84; 95% CI 1.42–12.46) was associated with non-chromosomal major CHDs. Conclusion Ultrasonography performed during the second trimester by obstetricians detected over 85% of critical CHDs. Low maternal serum PAPP-A or high inhibin-A was associated with non-chromosomal CHDs. These results may contribute to an improvement in prenatal diagnosis of CHDs.

Polymorphic ventricular tachycardia (PVT) is a fatal arrhythmia that can occur during the treadmill test. This report documents an instance of PVT by the R-on-T phenomenon during an exercise stress test in a 61-year-old male with stable angina pectoris. The subject performed the treadmill test for 581 seconds, and stopped after reaching 115% of the target heart rate. Ischemic ST changes were observed in leads II, III, aVF, and V3-V6 from stage 3. Premature ventricular complexes were noted during the recovery period, with an occurrence of pulseless PVT, reflective of the R-on-T phenomenon. Spontaneous circulation was resumed after unsynchronized cardioversion at 200 J and 2 minutes of cardiopulmonary resuscitation. Emergency coronary angiography revealed 95% stenosis of the proximal right coronary artery, which was fully dilated after percutaneous coronary intervention with a drug-eluting stent. The patient was discharged without any neurologic sequelae.

BACKGROUND AND OBJECTIVES: The present study evaluated the results of skin prick test using 55 allergens at 20 centers in the Republic of Korea in 2006, 2010, and 2014–2015. The aim was to assess changes in the positive rate of allergens according to temporal, regional, and environmental factors. MATERIALS AND METHODS: In total, 20 hospitals were selected based on the population distribution in the Republic of Korea. A skin prick test panel comprising 55 aeroallergens was distributed to 18 hospitals for this prospective study. The 2006 and 2010 skin prick test results were collected and analyzed retrospectively from 20 hospitals, while the 2014/2015 skin prick test results (from June 2014 to May 2015) were collected prospectively from 18 hospitals. RESULTS: A total of 14,897 SPT test results were analyzed: 4,319 in 2006, 7,431 in 2010, and 1,852 in 2014/2015. The overall rate of skin prick test positivity to more than two allergens was significantly higher in males than females. The positive rates of alder pollens and birch, oak and ragweed pollen positivity were increased in older patients. Several positive rates were increased according to the temperature in spring. The positive rates for beech pollen, birch pollen, hazel pollen, oak pollen, Tyrophagus putrescentiae, mugwort, cat, Acarus siro, Lepidoglyphus destructor and Tyrophagus putrescentiae were significantly increased, while those of Cult rye pollen and dandelion were significantly decreased over the three test periods. The overall positive rate for allergens in Jeju province varied significantly from Seoul and other cities. CONCLUSION: Change in the positive rate of multiple aeroallergens was evaluated in the Republic of Korea over time. Our findings can be used to recommend aeroallergens suitable for inclusion in skin prick test panels in the Republic of Korea and will facilitate further investigation of changes in the patterns of allergic diseases.
Allergens* ; Alnus ; Ambrosia ; Animals ; Artemisia ; Betula ; Cats ; Demography ; Fagus ; Female ; Humans ; Korea* ; Male ; Mites ; Pollen ; Prospective Studies ; Republic of Korea ; Retrospective Studies ; Secale ; Seoul ; Skin* ; Taraxacum

PURPOSE: As the usage rate of all-terrain vehicles (ATV) the number of injuries caused by ATVs is also surging. This has led to an increase in social attention to the safety of ATVs and the law for ATV safety standards was revised in 2009 and 2011. The purpose of this study was to evaluate the characteristics of ATV injury compared with motorbike injury after implementation of the ATV safety policy. METHODS: A retrospective cross-sectional observation study was conducted using emergent department (ED)-based indepth injury surveillance system data from 2011 January to 2014 December. Demographics, injury-related characteristics, injury severity, and outcomes of patients related to ATV and motorbike injury visiting our ED were analyzed. Multivariate logistic regression was used for major adverse event (MAE), which was defined as any intensive care, emergent operation, or death between ATV and motorbike related injury adjusted for covariates. RESULTS: During the study period, there were 101 ATV- and 584 motorbike-related injuries. Females had more ATV-related injuries (63.4% vs 32.9%, p<0.001) during leisure activities (93.1%) with higher helmet usage (73.3% vs 62.0%, p=0.01) and lower usage in terms of emergency medical service (23.8% vs 46.4%, p<0.001), automobile insurance (10.9% vs 54.1%, p<0.001) compared with motorbike-related injuries. MAE in ATV-related injuries was less likely in a univariate logistic model (unadjusted odd ratios [ORs] 0.489, 95% confidential intervals [Cis] 0.282 to 0.848), but the multivariate logistic model showed no significant difference (adjusted ORs 1.018, 95% CIs 0.376 to 1.414). CONCLUSION: Results of this study showed no significant difference in occurrence of clinical major adverse events between motorbikes and ATVs-related injury on Jeju Island. However, considering the high injury prevalence in young age, female, and passengers during leisure activities, development of an education and injury prevention program will be needed for this vulnerable population.
Automobiles ; Demography ; Education ; Emergency Medical Services ; Female ; Head Protective Devices ; Humans ; Insurance ; Critical Care ; Jurisprudence ; Leisure Activities ; Logistic Models ; Motorcycles ; Off-Road Motor Vehicles* ; Prevalence ; Retrospective Studies ; Vulnerable Populations ; Wounds and Injuries

OBJECTIVE: The cardiovascular system maintains homeostasis through a series of adaptive responses to physiological requirements. However, little is known about the adaptation of fetal cardiac function to gravity, according to gestational age. In the present study, we aimed to evaluate the adaptive responses of cardiac function to postural changes, using Tei index measurements. METHODS: Fetal echocardiography and Doppler examination were performed on 114 women with vertex singleton pregnancies at 19 to 40 weeks' gestation. Participants were placed in an upright seated position, and the Tei index for fetal left ventricular cardiac function was measured. The women were then moved into a supine position and the Tei index was re-measured. RESULTS: The mean Tei index when measured in an upright seated position was significantly lower than that measured in a supine positioning for all fetuses (0.528±0.103 vs. 0.555±0.106, P=0.014, respectively). This difference was also noted in fetuses with a gestational age of 28–40 weeks (0.539±0.107 vs. 0.574±0.102, P=0.011, respectively). However, there was no difference in the Tei index between an upright seated and a supine position among fetuses with a gestational age of <28 weeks (0.505±0.091 vs. 0.516±0.103, P=0.571, respectively). CONCLUSION: Postural changes from an upright seated to a supine position result in an increased Tei index after a gestational age of 28 weeks. This appears to reflect maturation in the adaptive responses of the fetal cardiovascular system to postural changes.
Cardiovascular System ; Echocardiography ; Female ; Fetus ; Gestational Age* ; Gravitation ; Homeostasis ; Humans ; Posture ; Pregnancy ; Supine Position

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract. Imatinib mesylate is recommended as adjuvant therapy for GIST after surgical resection. However, drug-related adverse events are common. A 74-year-old female with metastatic GIST who was managed with imatinib experienced severe adverse events, including skin rashes, tremor, and alopecia, etc. The imatinib dose was reduced and the size of the metastatic GIST continued to decrease and adverse events showed significant improvement.
Aged ; Antineoplastic Agents/adverse effects/*therapeutic use ; Exanthema/etiology ; Female ; Gastrointestinal Neoplasms/diagnosis/*drug therapy/pathology ; Gastrointestinal Stromal Tumors/diagnosis/*drug therapy/pathology ; Humans ; Imatinib Mesylate/adverse effects/*therapeutic use ; Immunohistochemistry ; Proto-Oncogene Proteins c-kit/metabolism ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Failure of Helicobacter pylori eradication has increased over the past decade and is related to increased antibiotic resistance. The aim of this study was to estimate the eradication rates of H. pylori infection over the past 9 years in a single center. MATERIALS AND METHODS: From 2004 to 2013, a total of 5,715 patients were diagnosed with H. pylori infection and were prescribed first line triple regimens. 2,482 patients underwent tests for assessment of eradication by 13C-urea breath test, rapid urease test or histopathological examinations. RESULTS: The overall eradication rate of first line triple regimen was 80.4% and continually decreased during the study period (P=0.011). Among the triple regimens, the eradication rate of two-week and one-week regimens were 90.1% and 79.3%, each. The two-week regimen was superior to the one-week regimen (P=0.000). The overall eradication rates of second line quadruple regimen was 91.4% and there was no significant decrease in the annual eradication rates (P=0.708). The overall eradication rates of both first line and second line therapy were 81.9% and decreased gradually during the study period (P=0.011). Multivariate analysis revealed sex, age, type of proton pump inhibitor, and duration of eradication to be associated with eradication failure. CONCLUSIONS: The eradication rates of first line triple regimen has decreased gradually; however, the eradication rates of second line regimen remains unchanged. Triple regimens of two-weeks seem to be better than one.
Breath Tests ; Disease Eradication ; Drug Resistance, Microbial ; Helicobacter pylori* ; Humans ; Incheon ; Multivariate Analysis ; Proton Pumps ; Urease

Surgery is a demanding and stressful field in Korea. Occupational stress can adversely affect the quality of care, decrease job satisfaction, and potentially increase medical errors. The aim of this study was to investigate the occupational stress and career satisfaction of Korean surgeons. We have conducted an electronic survey of 621 Korean surgeons for the occupational stress. Sixty-five questions were used to assess practical and personal characteristics and occupational stress using the Korean occupational stress scale (KOSS). The mean KOSS score was 49.31, which was higher than the average of Korean occupational stress (45.86) or that of other specialized professions (46.03). Young age, female gender, long working hours, and frequent night duties were significantly related to the higher KOSS score. Having spouse, having hobby and regular exercise decreased the KOSS score. Multiple linear regression analysis showed that long working hours and regular exercise were the independent factors associated with the KOSS score. Less than 50% of surgeons answered that they would become a surgeon again. Most surgeons (82.5%) did not want to recommend their child follow their career. Korean Surgeons have high occupational stress and low level of career satisfaction.
Adult ; Burnout, Professional/*psychology ; Female ; Humans ; *Job Satisfaction ; Male ; Middle Aged ; Quality of Health Care ; Questionnaires ; Republic of Korea ; Stress, Psychological/*psychology ; Surgeons/*psychology