There are many causes of sudden cardiac arrest. The main cause of sudden cardiac death (SCD) is coronary heart disease. However, the frequency of coronary heart disease is much lower in sudden cardiac arrest occurring below the age of 30-40. Congenital anomalous origin of the coronary arteries is a rare, but well-described, cause of myocardial ischemia and sudden death in young adults. Here, we report the case of a 23-year-old man with sudden cardiac arrest due to ventricular fibrillation associated with an anomalous origin of the right coronary artery. The patient was diagnosed using multi-detector computed tomography and successfully treated with surgical correction.
Coronary Disease ; Coronary Vessel Anomalies ; Coronary Vessels ; Death, Sudden ; Death, Sudden, Cardiac ; Humans ; Myocardial Ischemia ; Ventricular Fibrillation ; Young Adult

Systemic sclerosis is an autoimmune disease characterized by progressive fibrosis of the skin and visceral organs. Myasthenia gravis is also an autoimmune disease characterized by weakness and fatigue of skeletal muscles. The symptoms of systemic sclerosis and myasthenia gravis overlap clinically, so the recognition of disease co-occurrence may be delayed. Co-occurrence of myasthenia gravis and systemic sclerosis is very uncommon and usually diagnosed after use of D-penicillamine for treating the systemic sclerosis. We report a case of a 49-year-old female patient who complained of general weakness and was diagnosed with myasthenia gravis. Four months earlier she was diagnosed with systemic sclerosis with Sjogren's syndrome and her medications did not include D-penicillamine.
Autoimmune Diseases ; Fatigue ; Female ; Fibrosis ; Humans ; Middle Aged ; Muscle, Skeletal ; Myasthenia Gravis ; Penicillamine ; Scleroderma, Systemic ; Sjogren's Syndrome ; Skin

Artificial intelligence is likely to perform several roles currently performed by humans, and the adoption of artificial intelligence-based medicine in gastroenterology practice is expected in the near future. Medical image-based diagnoses, such as pathology, radiology, and endoscopy, are expected to be the first in the medical field to be affected by artificial intelligence. A convolutional neural network, a kind of deep-learning method with multilayer perceptrons designed to use minimal preprocessing, was recently reported as being highly beneficial in the field of endoscopy, including esophagogastroduodenoscopy, colonoscopy, and capsule endoscopy. A convolutional neural network-based diagnostic program was challenged to recognize anatomical locations in esophagogastroduodenoscopy images, Helicobacter pylori infection, and gastric cancer for esophagogastroduodenoscopy; to detect and classify colorectal polyps; to recognize celiac disease and hookworm; and to perform small intestine motility characterization of capsule endoscopy images. Artificial intelligence is expected to help endoscopists provide a more accurate diagnosis by automatically detecting and classifying lesions; therefore, it is essential that endoscopists focus on this novel technology. In this review, we describe the effects of artificial intelligence on gastroenterology with a special focus on automatic diagnosis, based on endoscopic findings.
Ancylostomatoidea ; Artificial Intelligence ; Capsule Endoscopy ; Celiac Disease ; Colonoscopy ; Diagnosis ; Diagnosis, Computer-Assisted ; Endoscopy ; Endoscopy, Digestive System ; Endoscopy, Gastrointestinal ; Gastroenterology ; Helicobacter pylori ; Humans ; Intestine, Small ; Learning ; Methods ; Neural Networks (Computer) ; Pathology ; Polyps ; Stomach Neoplasms

No abstract available.
Heart Neoplasms*

Background/Aims: Only a few studies have examined perceptions of the incidence and prognosis of colorectal cancer (CRC) in the general Korean population. The aim of this study was to determine public perceptions of the lifetime incidence rate and survival of CRC. Methods: All adults older than 50 years who visited the Kyung Hee University Hospital at Gangdong were invited to participate in this survey for 5 months in 2021. During the study period, eligible individuals participated in this survey through a link or quick response code on a poster posted in the hospital, which was linked to a web-based questionnaire. The questionnaire used for this survey included demographic and socioeconomic data, perceptions of CRC, and awareness of the CRC incidence and 5-year survival rate. Results: Among 203 respondents, 196 answers were analyzed after the exclusion of seven incomplete answers. In our survey, half of the respondents (49.5%) answered the expected lifetime incidence rate of CRC as 0% to 4.9%. Koreans perceived CRC as a more fatal disease than epidemiological data, as 70.9% of the respondents expected the 5-year survival rate of CRC to be less than 70% for the general population. However, Koreans perceived stage IV CRC as a less fatal disease than epidemiological data, because only 20.9% of the respondents expected the 5-year survival rate of stage IV CRC to be less than 10% for general population. Conclusions Koreans recognized CRC as a more common and fatal disease than actual epidemiological data of CRC. Therefore, more efforts should be made to provide more correct information on CRC for better decision-making and communication.

Background/Aims: The global trend of an expanding aged population has increased concerns about complications correlated with gastrointestinal (GI) endoscopy in elderly patients; however, there have been few reports published on this issue. Methods: In this retrospective, observational cohort study performed between 2012 and 2017, serious complications of esophagogastroduodenoscopy (EGD), colonoscopy, and colonoscopicpolypectomy were compared between patients according to age (≥65 years vs 18–64 years). Weused the Health Insurance Review and Assessment-National Patient Samples database, previously converted to the standardized Observational Medical Outcomes Partnership-Common Data Model. Serious complications within 30 days of the procedure included both GI complications (bleeding and perforation) and non-GI complications (cerebrovascular accident [CVA], acute myocardial infarction [AMI], congestive heart failure [CHF], and death). Results: A total of 387,647 patients who underwent EGD, 241,094 who underwent colonoscopy, and 89,059 who underwent colonoscopic polypectomy were assessed as part of this investiga-tion. During the study period, endoscopic procedures in the older group steadily increased in number in all endoscopy groups (all p<0.001). Further, pooled complication rates of bleeding, CVA, AMI, CHF, and death were approximately three times higher among older patients who underwent EGD or colonoscopy. Moreover, pooled complication rates of CVA, AMI, CHF, and death were approximately 2.2 to 5.0 times higher among older patients who underwent colonoscopic polypectomy. Conclusions Elderly patients experienced approximately three times more GI and non-GI complications after EGD or colonoscopy than young patients. Physicians should pay attention to the potential risks of GI endoscopy in elderly patients.

Background/Aims: The global trend of an expanding aged population has increased concerns about complications correlated with gastrointestinal (GI) endoscopy in elderly patients; however, there have been few reports published on this issue. Methods: In this retrospective, observational cohort study performed between 2012 and 2017, serious complications of esophagogastroduodenoscopy (EGD), colonoscopy, and colonoscopicpolypectomy were compared between patients according to age (≥65 years vs 18–64 years). Weused the Health Insurance Review and Assessment-National Patient Samples database, previously converted to the standardized Observational Medical Outcomes Partnership-Common Data Model. Serious complications within 30 days of the procedure included both GI complications (bleeding and perforation) and non-GI complications (cerebrovascular accident [CVA], acute myocardial infarction [AMI], congestive heart failure [CHF], and death). Results: A total of 387,647 patients who underwent EGD, 241,094 who underwent colonoscopy, and 89,059 who underwent colonoscopic polypectomy were assessed as part of this investiga-tion. During the study period, endoscopic procedures in the older group steadily increased in number in all endoscopy groups (all p<0.001). Further, pooled complication rates of bleeding, CVA, AMI, CHF, and death were approximately three times higher among older patients who underwent EGD or colonoscopy. Moreover, pooled complication rates of CVA, AMI, CHF, and death were approximately 2.2 to 5.0 times higher among older patients who underwent colonoscopic polypectomy. Conclusions Elderly patients experienced approximately three times more GI and non-GI complications after EGD or colonoscopy than young patients. Physicians should pay attention to the potential risks of GI endoscopy in elderly patients.

Objective: The utilization of emergency medical services (EMS) varies widely among communities. In this study, we aimed to evaluate the relationship between the use of EMS by patients with ST-elevation myocardial infarction (STEMI) and the individual and neighborhood characteristics of these patients. Methods: We performed a secondary analysis of data from the Cardiovascular Disease Surveillance project, which included patients diagnosed with STEMI at 29 emergency centers in South Korea. Our analysis included only patients living in Seoul, and the primary outcome measured was the use of EMS. While the clinical variables of the patients were collected from the Cardiovascular Disease Surveillance registry, the 2010 National Census data was used to identify neighborhood variables such as population density, income, age, and residence type. We used a 3-level hierarchical logistic regression to estimate the effects of neighborhood-level factors on EMS use by individual patients. Results: We evaluated 1,634 patients with STEMI from 2007 to 2012. The neighborhoods were grouped into 25 counties. The regional rates of EMS use varied from 18.3% to 46.5%. The final adjusted logistic model revealed that the use of EMS was significantly associated with the average number of households (neighborhood level factor) and symptoms of syncope, cardiac arrest, and history of cardiovascular disease (individual level factors). Conclusion The individual levels factors had a greater influence on the use of EMS compared to the neighborhood-level factors.

PURPOSE: As recently reported, the short-term results of the tension-free vaginal tape SECUR(R) (TVT-S) procedure seem to be similar to those of the conventional transobturator tape (TOT) procedure. However, results of efficacy and satisfaction with TVT-S are insufficient in patients with more than 1 year of follow-up. Therefore, we evaluated the results of the TVT-S procedure in women with stress urinary incontinence (SUI) during 2 years. MATERIALS AND METHODS: We evaluated 51 patients with clinical and urodynamic diagnoses of SUI who underwent the TVT-S procedure from March 2008 to February 2009. Preoperative evaluation included a history, cough stress test with full bladder, urodynamic study, and incontinence quality of life (I-QoL) questionnaire. Following the postoperative period, urinary incontinence status was examined through a physical examination and the I-QoL questionnaire was completed in an outpatient setting or by telephone. RESULTS: Data from 2 years of follow-up were available for 46 of 51 patients. The cure rate was 80.4% at 1 month after TVT-S and 76.0% at 2 years after TVT-S. The cure or improvement rate was 93.5% at 1 month after TVT-S and 86.8% at 2 years after TVT-S. The mean total I-QoL score increased by 42 points at 1 month after TVT-S (p<0.026) and by 32 points at 2 years after TVT-S (p<0.013). Most patients reported significant improvements in quality of life. At the 2-year follow-up, there were no significant complications related to TVT-S. CONCLUSIONS: The results of this study suggest that TVT-S is an efficient and safe procedure for the improvement of both the quality of life of the patients and the SUI itself.
Cough ; Exercise Test ; Female ; Follow-Up Studies ; Humans ; Outpatients ; Physical Examination ; Postoperative Period ; Quality of Life ; Suburethral Slings ; Surgical Procedures, Minimally Invasive ; Treatment Outcome ; Urinary Bladder ; Urinary Incontinence ; Urinary Incontinence, Stress ; Urodynamics

BACKGROUND/AIMS: Little is known for the capacity and quality of colonoscopy, and adherence to colonoscopy surveillance guidelines in Korea. This study aimed to investigate the present and potential colonoscopic capacity, colonoscopic quality, and adherence to colonoscopy surveillance guidelines in Korea. METHODS: We surveyed representative endoscopists of 72 endoscopy units from June to August 2015, using a 36-item questionnaire regarding colonoscopic capacity, quality, and adherence to colonoscopy surveillance guidelines of each hospitals. RESULTS: Among the 62 respondents who answered the questionnaire, 51 respondents were analyzed after exclusion of 11 incomplete answers. Only 1 of 3 of endoscopy units can afford to perform additional colonoscopies in addition to current practice, and the potential maximum number of colonoscopies per week was only 42. The quality of colonoscopy was variable as reporting of quality indicators of colonoscopy were considerably variable (29.4%–94.1%) between endoscopy units. Furthermore, there are substantial gaps in the adherence to colonoscopy surveillance guidelines, as concordance rate for guideline recommendation was less than 50% in most scenarios. CONCLUSIONS: The potential capacity and quality of colonoscopy in Korea was suboptimal. Considering suboptimal reporting of colonoscopic quality indicators and low adherence rate for colonoscopy surveillance guidelines, quality improvement of colonoscopy should be underlined in Korea.
Colonoscopy ; Colorectal Neoplasms ; Endoscopy ; Korea ; Quality Improvement ; Surveys and Questionnaires