Background/Aims: Efficacy of proton pump inhibitors is limited in patients with nonerosive reflux disease (NERD). The aim of this study was to comparatively evaluate the efficacy and safety of esomeprazole with sodium bicarbonate and esomeprazole alone. Methods: This was a multicenter, randomized, double-blind, active-controlled, noninferiority comparative study. A total of 379 patients with NERD were randomly allocated to receive either EsoduoⓇ/sup> (esomeprazole 20 mg with sodium bicarbonate 800 mg) or NexiumⓇ/sup> (esomeprazole 20 mg) once daily for 4 weeks from January 2019 to December 2019. The patients had a history of heartburn for at least 2 days in the week before randomization as well as in the last 3 months and no esophageal mucosal breaks on endoscopy. The primary endpoint was a complete cure of heartburn at week 4. The secondary and exploratory endpoints as well as the safety profiles were compared in the groups at weeks 2 and 4. Results: A total of 355 patients completed the study (180 in the EsoduoⓇ/sup> group and 175 in the NexiumⓇ/sup> group). The proportions of patients without heartburn in the entire 4th week of treatment were not different between the two groups (33.33% in the EsoduoⓇ/sup> group and 35% in the NexiumⓇ/sup> group, p=0.737). There were no significant differences in most of the secondary and exploratory endpoints as well as the safety profiles. Conclusions EsoduoⓇ/sup> is as effective and safe as NexiumⓇ/sup> for managing typical symptoms in patients with NERD (ClinicalTrial.gov identifier: NCT03928470).

Two consecutive surveys for breast surgeons in Korea were conducted to comprehend the practice patterns and perceptions on margin status after breast-conserving surgery. The surveys were conducted online in 2014 (initial) and 2016 (follow-up). A total of 126 and 88 responses were obtained in the initial and follow-up survey, respectively. More than 80% of the respondents replied to routinely apply frozen section biopsy for intraoperative margin assessment in both surveys. Re-excision recommendations of the margin for invasive cancer significantly changed from a close margin to a positive margin over time (p=0.033). Most of the respondents (73.8%) defined a negative margin as “no ink on tumor” in invasive cancer, whereas more diverse responses were observed in ductal carcinoma in situ cases. The influence of guideline establishment for negative margins has been identified. A high uptake rate of intraoperative frozen section biopsy was noted and routine use needs reconsideration.
Biopsy ; Breast ; Carcinoma, Intraductal, Noninfiltrating ; Follow-Up Studies ; Frozen Sections ; Ink ; Korea ; Mastectomy, Segmental* ; Surgeons* ; Surveys and Questionnaires

PURPOSE: This study aimed to study the antibody response of Japanese encephalitis vaccination in children using different kinds of vaccines (inactivated vaccine, live attenuated vaccine or interchanged) and evaluate the effectiveness of the vaccines to provide the basis of efficient immunization schedule of Japanese encephalitis. METHODS: Measurement of the neutralization antibody (NTAb) titers following Japanese encephalitis vaccination using different vaccines for 170 children, 2-6 year of age, who visited six university hospitals and are confirmed by immunization records. RESULTS: Among 170 children who were given primary immunization on Japanese encephalitis, 103 children were given inactivated vaccine, 64 children were given live attenuated vaccine and 3 children were given interchangeably. NTAb titers were more than 1:10 in all children of three groups. The geographic mean antibody titer was 322 in inactivated vaccine group and 266 in live attenuated vaccine group. However, there was no significant difference between two groups. In both groups, the NTAb titer showed the peak at 1-4 months after the third immunization and declined. The NTAb titers of three children who were given two kinds of vaccines alternately were 1:135, 1:632, and 1:2511, respectively. CONCLUSION: According to the results of this study in children younger than 6 years old, there is no significant difference in effectiveness between inactivated and live attenuated vaccines. However, further studies for the changes of antibody titers for a longer period of time on larger population are required.
Antibodies, Neutralizing ; Antibody Formation ; Asian Continental Ancestry Group* ; Child ; Cohort Studies* ; Encephalitis, Japanese* ; Hospitals, University ; Humans ; Immunization ; Immunization Schedule ; Prospective Studies* ; Vaccination ; Vaccines ; Vaccines, Attenuated

Congenital insensitivity to pain with anhidrosis (CIPA) is a rare, autosomal-recessive disorder characterized by the clinical triad of indifference of pain, anhidrosis and heat intolerance.Because of their lack of autonomic response to noxious stimuli, the determination of adequate depth of anesthesia in the CIPA patient undergoing surgery is a major challenge.We experienced a patient with CIPA who had minor procedures three times under the general anesthesia, in which bispectral index (BIS) was maintained at 40-50 by adjusting sevoflurane concentrations with 50% nitrous oxide.The low end-tidal sevoflurane concentrations (<1.2 vol%) were required to keep the target BIS while vital signs remained stable throughout the surgery in each operation.BIS monitor may be a valuable tool to guide the depth of anesthesia in patients with CIPA.
Anesthesia ; Anesthesia, General ; Hereditary Sensory and Autonomic Neuropathies ; Hot Temperature ; Humans ; Hypohidrosis ; Indoles ; Methyl Ethers ; Organothiophosphorus Compounds ; Propionates ; Vital Signs

We report here on an unusual case of mucinous cystic tumor that was associated with endometriosis in the cecum. A 45-year-old woman was admitted to the hospital due to her 5 day history of right lower quadrant abdominal pain with a mild fever. A laparotomy was performed under the clinical impression of the tubo-ovarian abscess. A relatively well defined a multi-locular cystic mass (8.0x8.0x7.0 cm) filled with white-to-yellow thick mucoid material was found in the wall of the cecum. The right ovary and fallopian tube showed marked fibrous adhesion to the external surface of the cecal mass. A right hemicolectomy and salpingo-oophorectomy were performed. Histologically, the tumor was similar to those of ovarian borderline mucinous tumor, the intestinal type, and the mucinous epithelium of the tumor was merged with the endometriotic epithelium and stroma. On immunostaining, the CK20 positive mucinous epithelium was well demarcated from the CK7 endometriotic epithelium. This is the first case of low-grade mucinous cystic tumor intimately associated with intestinal endometriosis in the cecum.
Abdominal Pain ; Abscess ; Cecum* ; Endometriosis ; Epithelium ; Fallopian Tubes ; Female ; Fever ; Humans ; Laparotomy ; Middle Aged ; Mucins* ; Ovary

BACKGOUND: An end-tidal concentration of 1% sevoflurane with 50% nitrous oxide (N2O) during a Cesarean section resulted in bispectral index (BIS) values > 60, which are considered at risk for awareness. The present study aimed to determine whether the presence or absence of labor pain prior to the Cesarean section would affect the BIS value. METHODS: Sixty women scheduled to undergo Cesarean section under general anesthesia, were allocated to three groups of 20 patients: women undergoing elective surgery without labor pain (group 1, control), or emergency surgery without (group 2) or with (group 3) active labor pain. After endotracheal intubation, anesthesia was maintained with end-tidal 1% sevoflurane and 50% N2O in oxygen throughout the surgery. The BIS value, systolic blood pressure and heart rate were measured before (baseline) and during the induction of anesthesia, intubation, skin incision, uterine incision, delivery and at 1, 3, 5 and 10 min after delivery. Neonatal effects were assessed using Apgar scores at 1 and 5 min after delivery. RESULTS: BIS values were significantly lower in group 3 than in groups 1 and 2 throughout the study, except at baseline and induction (P < 0.05). However, the systolic blood pressure, heart rate and Apgar scores did not differ among the three groups. CONCLUSIONS: These results demonstrate that 1.0% sevoflurane combined with 50% N2O results in BIS values < 60 during Cesarean delivery in women with active labor pain but not in those without active labor pain, consistent with an adequate depth of anesthesia to prevent recall.
Anesthesia ; Anesthesia, General ; Blood Pressure ; Cesarean Section ; Emergencies ; Female ; Heart Rate ; Humans ; Intubation ; Intubation, Intratracheal ; Labor Pain ; Nitrous Oxide ; Oxygen ; Pregnancy ; Skin

PURPOSE: Currently MRI (Magnetic Resonance Imaging) is widely used for the preoperative staging of breast cancer. In this study, we assessed the impact of preoperative breast MRI on the surgical management of breast cancer in women. METHODS: From March 2004 to October 2006, 162 cases were enrolled for preoperative MRI for the staging of breast cancer. The MRI findings and clinicopathological results were investigated and the accuracy of breast MRI was analyzed with respect to the detection of multiplicity, nipple involvement and bilaterality of the breast cancers. RESULTS: For detecting multifocal lesions, the sensitivity and specificity of breast MRI were 100% and 48.5%, respectively, and the results of bresat ultrasound were 100% and 63.4%, respectively. For detecting nipple invasion, the sensitivity and specificity of breast MRI was 80% and 74.6%, and for ultrasound was 33.3% and 86.4%. In 27 cases (16.7%) the type of surgery was changed according to the preoperative MRI findings; however, in only 6 cases were the MRI findings in concordance with the pathological findings of the mastectomy specimen. CONCLUSION: In clinical application of breast MRI for preoperative staging, the decision to undertake surgery for breast cancer based on a MRI findings should be prudent due to its low specificity.
Breast Neoplasms* ; Breast* ; Female ; Humans ; Magnetic Resonance Imaging* ; Mastectomy ; Nipples ; Sensitivity and Specificity ; Ultrasonography

BACKGROUND: It has been known that melatonin is involved in the modulation of nociceptive transmission. However, the effect of melatonin administered spinally has not been examined. Therefore, we examined the effect of melatonin on the formalin-induced or thermal-induced nociception at the spinal level. METHODS: Intrathecal catheter was inserted into the subarachnoid space of male Sprague-Dawley rats. Pain was assessed by formalin test (induced by injection of 50microliter of a 5% formalin solution to the hindpaw) or Hot-Box test (induced by radiant heat application to the hindpaw). The effect of intrathecal melatonin was examined on flinching behavior in the formalin test or withdrawal response in Hot-Box test. RESULTS: Intrathecal melatonin produced a limited, but dose-dependent reduction of the flinching response during phase 1 and 2 in the formalin test. In addition, melatonin delivered at evening also decreased the flinching response in both phases of the formalin test. Melatonin restrictively increased the withdrawal latency in Hot-Box test. CONCLUSIONS: These results suggest that melatonin is active against the formalin- and thermal-induced nocicpetion at the spinal level, but the effect is limited.
Animals ; Catheters ; Formaldehyde* ; Hot Temperature ; Humans ; Male ; Melatonin* ; Nociception ; Pain Measurement ; Rats* ; Rats, Sprague-Dawley ; Spinal Cord ; Subarachnoid Space

BACKGROUND: Previous studies reported a poor prognosis in patients with persistent proteinuria later in the posttransplantation course, suggesting that posttransplantation proteinuria is a marker for graft failure. This study was undertaken to elucidate the role of proteinuria after renal transplantation in the pathogenesis and outcome of allograft dysfunction in transplant biopsy-proven recipients. METHODS: We retrospectively analyzed the data from 55 patients who underwent transplant renal biopsy for proteinuria and/or azotemia occurring beyond 1 year after transplantation. Proteinuria was considered as significant when >or=30 mg/dL, and the results of transplant biopsy were categorized according to the Banff 97 classification. Logistic regression was used to estimate odds ratios (OR) for graft loss associated with proteinuria and transplant pathology. RESULTS: The patients were followed for 86.0 +/- 32.8 (mean +/- SD) months after transplantation, and transplant biopsy was performed at 54.1 +/- 31.0 months. Proteinuria at 1 year after transplantation was noted in 29.1% of the patients, and it was not significantly associated with graft loss (OR=1.94, 95% CI 0.59-6.41). In addition, proteinuria at the time of transplant biopsy was not significantly associated with graft loss, and none of each category of transplant pathology was significantly associated with graft loss. Chronic allograft nephropathy was the most frequent transplant pathology, and only glomerulonephritis was significantly associated with proteinuria at the time of transplant biopsy. On the other hand, graft loss was significantly associated with the presence of proteinuria both at 1 year after transplant biopsy and at the final follow-up. CONCLUSION: These results suggest that posttransplantation proteinuria is an important marker of graft dysfunction but may not be predictive of graft loss in biopsy-proven cases. Appropriate management guided by the results of transplant biopsy may improve the outcome.
Allografts* ; Azotemia ; Biopsy ; Classification ; Follow-Up Studies ; Glomerulonephritis ; Hand ; Humans ; Kidney Transplantation ; Kidney* ; Logistic Models ; Odds Ratio ; Pathology ; Prognosis ; Proteinuria* ; Retrospective Studies ; Transplants

BACKGROUND: Cigarette smoking is the single biggest avoidable cause of death and disability in most countries. Effective prevention of cigarette Smoking and help for those wishing to quit can therefore yield enormous health benefits for populations and individuals. Although most of smokers try to stop smoking for themselves, the success rate of quitting smoking is very low. Promoting and supporting smoking cessation should be an important health policy priority for healthcare professionals in all clinical settings. In this study, we tried to evaluate the effect of the educational program for smoking cessation of our hospital, the smoking pattern, and characteristics of adult smokers enrolled in the program. METHODS: We enrolled 640 smokers, who has visited the '5 day stop smoking school' for smoking cessation from Jan 1998 to 2001. we evaluated the characteristics of the smokers based on the self report questionnaire at the beginning of the program and we also checked 100 smokers, enrolled in Inpatient Smoking Cessation Educational program, their smoking behavior and the cessation rate with postal questionnaire after finishing this program from Nov 2002 to Jan 2003. RESULTS: The health was most common motivation for smoking cessation. The stress was the most important motivation of smoking. The overall smoking cessation rate of the smokers enrolled in inpatient smoking cessation school was 60%. The age of starting smoking and the kind of occupation have a significant difference between the success group and failure group of smoking cessation. CONCLUSION: The inpatient smoking cessation program was effective smoking cessation intervention in the adult smokers who enrolled in '5 day stop smoking school'.
Adult ; Cause of Death ; Delivery of Health Care ; Health Policy ; Humans ; Inpatients* ; Insurance Benefits ; Motivation ; Occupations ; Surveys and Questionnaires ; Self Report ; Smoke* ; Smoking Cessation* ; Smoking*