Capsule endoscope is self-contained videoendoscopy device that transmit images of the gastrointestinal tract to an external receiver. Capsule endoscopy has become a very important tool for diagnosing of small bowel disorders. Upcoming capsule endoscopy techniques for the investigation of esophageal, stomach, and colon may render it promising technique for these organs as well. This document is intended to provide the principles by which credentialing organizations may create practical guidelines for granting privileges to perform capsule endoscopy. KSGE recommends that the use of capsule endoscopy be limited to practitioners already competent and privileged to perform standard upper and lower endoscopy and who have extensive experience viewing gastrointestinal mucosa. KSGE recommends additional specific training in capsule endoscopy as well as review of the 20 procedures to verify competence. KSGE also admitted formal fellowship training having a familiarity with the hardware and software systems and interpretation of the at least 10 cases under the supervision of professor in capsule endoscopy during GI fellowship.
Capsule Endoscopes ; Capsule Endoscopy ; Colon ; Credentialing ; Endoscopy ; Endoscopy, Gastrointestinal ; Fellowships and Scholarships ; Financing, Organized ; Gastrointestinal Tract ; Mental Competency ; Mucous Membrane ; Organization and Administration ; Recognition (Psychology) ; Stomach

Excessive wear causes many complications when untreated, so that accurate diagnosis, analysis and predictive treatment plan should be made, and through evaluation of vertical dimension and stepwise treatment, a stable inter-arch relationship can be set. For the long-term success of implant treatment, ideal position and angle of implant is important, and its importance increases especially in multiple implant cases. Therefore, thorough diagnosis and planning, accurate surgery and prosthodontic procedures are significant. In this case, a 68-year-old male patient with a loss of vertical dimension due to multiple tooth loss and overall tooth wear was planned with systematic analyses from the pre-treatment stage to rehabilitate vertical dimension. Full-mouth fixed rehabilitation with computer tomography guided implant surgery was performed to the newly set vertical dimension and attained satisfactory outcomes both functionally and esthetically.
Aged ; Dentition* ; Diagnosis ; Humans ; Male ; Rehabilitation* ; Tooth Loss ; Tooth Wear ; Tooth* ; Vertical Dimension*

Protein C (PROC) deficiency is caused by mutations in the PROC gene on chromosome 2q14.3. Patients with PROC deficiency typically present distinguished purpura, intracerebral and intravascular coagulopathy, and ophthalmologic complications. Here, we report a rare severe form of PROC deficiency resulting from a compound heterozygosity in PROC. The patient was a 5-day-old female neonate born at 39 weeks of gestation with a birth weight of 2,960 g. She was transferred to our hospital with running a fever at 38.5℃ and with dark red patches on her feet. At admission, a complete blood count showed no specific findings, but levels of PROC and protein S were abnormally low (1% and 68%, respectively). Magnetic resonance imaging revealed intracerebral hemorrhaging and parenchymal damage with dysplasia of the brain. Ophthalmologic examination revealed vitreous hemorrhaging with retinal detachment. Genetic testing revealed a missense mutation (Arg211Trp) and a frameshift mutation (Gly239Serfs*8) in PROC, inherited from the father and mother, respectively. The patient recovered from purpura after undergoing ventriculoperitoneal shunting and treatment with fresh frozen plasma, warfarin sodium, and PROC concentrate. This is the first report of severe neonatal PROC deficiency with purpura fulminans, vitreous hemorrhage, and intracerebral hemorrhage confirmed via PROC genetic testing, which identified a rare compound heterozygosity of PROC.
Birth Weight ; Blood Cell Count ; Brain ; Cerebral Hemorrhage ; Diagnosis* ; Fathers ; Female ; Fever ; Foot ; Frameshift Mutation ; Genetic Testing ; Humans ; Infant, Newborn ; Magnetic Resonance Imaging ; Mothers ; Mutation, Missense ; Plasma ; Pregnancy ; Protein C Deficiency* ; Protein C* ; Protein S ; Purpura ; Purpura Fulminans ; Retinal Detachment ; Running ; Ventriculoperitoneal Shunt ; Vitreous Hemorrhage ; Warfarin

OBJECTIVE: The aim of this study is to porve the hypothesis that the etiological neuropathological defects of the Tourette's Disorder (TD) lie in a network linking the basal ganglia and the cerebrum, not at a particular single brain region. In this study, the volumes of 10 cerebral and cerebellar regions and their symmetries were measured in normal boys and TD boys by brain magnetic resonance imaging. METHODS: Brain magnetic resonance images were obtained prospectively, controlled for confounding variables(handedness, drug-effect, effect of comorbid psychiatric disorders), in 19 boys with TD and 17 age-matched normal control boys. The frontal, parietal, temporal, and the occipital lobes and the cerebellum were defined using the semi-automated Talairach atlas-based parcellation method. RESULTS: Although the smaller brain volume was taken into account, boys with TD had larger frontal lobes and reduced normal asymmetry (right>left). There were no significant differences in the regions of interest of the parietal, temporal, or the occipital lobes or the cerebellum. CONCLUSION: These findings suggest that boys with TD may have neuropathological involvement in the frontal lobe. And this findings also support the hypothesis of abnormality in Cortical-Striatal-Thalamo-Cortical (CSTC) circuitry as an etiological factors of the Tourette's Disorder.
Basal Ganglia ; Brain ; Cerebellum* ; Cerebrum* ; Frontal Lobe ; Magnetic Resonance Imaging ; Occipital Lobe ; Prospective Studies ; Rabeprazole ; Tourette Syndrome*

OBJECTIVE: To investigate the MR imaging and 1H-MR spectroscopic findings of acute fire-related post-traumatic stress disorder (PTSD). MATERIALS AND METHODS: Sixteen patients (M: F=10: 6; mean age, 16 years) with fire-related PTSD underwent MR imaging and 1H-MR spectroscopy, and for control purposes, the procedures were repeated in eight age-matched normal volunteers. In all patients and controls, the regions of interest where data were acquired at MRS were the basal ganglia (BG), frontal periventricular white matter (FWM), and parietal periventricular white matter (PWM). RESULTS: In all patients with PTSD, MR images appeared normal. In contrast, MRS showed that in the BG, NAA/Cr ratios were significantly lower in patients than in volunteers. This decrease did not, however, show close correlation with the severity of the neuropsychiatric symptoms. In patients, neither NAA/Cr ratios in FWM nor PWM, nor Cho/Cr ratios in all three regions, were significantly different from those in the control group. CONCLUSION: Decreased NAA/Cr ratios in the BG, as seen at 1H-MRS, might be an early sign of acute fire-related PTSD.

PURPOSE: Caffeine shows wide interindividual pharmacokinetic (PK) variation, and therapeutic drug monitoring (TDM) may be needed. The PK profile of caffeine in Korean preterm neonates was investigated, and factors influencing the clearance of caffeine were analyzed. METHODS: Fifty-nine preterm neonates receiving caffeine for apnea of prematurity were enrolled in the study (gestational age, 29.5±2.2 weeks and birth weight [BW], 1,318±358 g). Caffeine (20 mg/kg) was intravenously administered to each neonate as a loading dose, followed by a maintenance dose of 5-10 mg/kg/d. A total of 190 serum concentrations were measured for population PK analysis and modeling using nonlinear mixed-effects model (NONMEM®) software. RESULTS: The mean serum concentration of caffeine was 15.4±4.5 mg/L (range 7.8-33.0 mg/L). High serum concentrations (>20 mg/L) were noted in 36 samples (29%). At the first measurement of serum caffeine, the mean postmenstrual age was 33.9±2.3 weeks, mean BW was 1,802±471 g, mean duration of treatment was 7.4±9.4 days, and mean sampling time after the last dose was 21.8±2.1 hours. In the population PK analysis, the clearance was 0.033 L/h and volume of distribution was 0.371 L. Typical clearance was calculated as 0.0293×(BW/70)1.33. Among the subjects receiving 5 mg/kg/d caffeine, the most significant risk factor associated with high serum concentrations (>20 mg/L) was low BW (P=0.024). CONCLUSION: BW was the only covariate that influenced caffeine clearance in preterm neonates. Preterm neonates with low BW should be carefully monitored for apnea and adverse reactions in addition to undergoing TDM.
Apnea* ; Birth Weight ; Caffeine* ; Drug Monitoring ; Humans ; Infant, Newborn ; Infant, Premature* ; Pharmacokinetics* ; Risk Factors

OBJECTIVE: The aim of our study is to evaluate the clinical usefulness of transvaginal sonography (TVS) and saline infusion sonohysterography (SHG) in the evaluation of endometrial abnormality. METHODS: We retrospectively reviewed 370 patients with abnormal uterine bleeding or uterine cavity abnormalities confirmed by TVS. SHG was carried out by experienced gynecologist, on the same setting in an outpatient clinic after the performance of TVS. Two hundred nineteen patients aged between 23 and 69 years (mean age 41+/-8.2) had operative hysteroscopy (88.2%), hysterectomy (9.1%) and dilatation/curettage (2.7%) within 3 months which provided a detailed description of uterine cavity. Surgical-pathologic findings were compared with the results obtained from TVS and SHG. RESULTS: The sensitivity and specificity were 71.7% and 31.4% for TVS, and 98.4% and 67.6% for SHG respectively. The positive and negative predictive values were 84.6% and 17.5% for TVS, and 94.3% and 92.3% for SHG, respectively. Twenty one cases showed a discrepancy between the TVS and SHG, and 16 cases showed a discrepancy between SHG and the pathologic diagnosis. Fifty five cases (25%) in TVS were unconfirmed, but SHG showed 51 pathologic confirmed intracavitary lesion. CONCLUSION: SHG is a sensitive tool and is superior to TVS used alone for evaluation of endometrial abnormalities. SHG definitely enhances the diagnostic potential of TVS in assessment of endometrium and intracavitary pathologies.
Ambulatory Care Facilities ; Diagnosis ; Endometrium ; Female ; Humans ; Hysterectomy ; Hysteroscopy ; Pathology ; Retrospective Studies ; Sensitivity and Specificity ; Uterine Hemorrhage

OBJECTIVE: The objective of this study was to compare clinical and pathologic variables and prognosis of FIGO stage IB 1 adenocarcinoma and squamous cell carcinoma of uterine cervix who were treated primarily by surgery. METHODS: From May 1982 to October 2000, 2,209 patients with invasive cancer of the uterine cervix were diagnosed and treated at Cheil Hospital. A retrospective review was performed of 533 patients with stage IB1 squamous cell carcinoma (group A) and 84 with adenocarcinoma (group B) of cervix who treated primarily by type 3 hysterectomy and pelvic and paraaortic lymphadenectomy. RESULTS: Age, endometrial extension, lymph node metastasis and postoperative adjuvant therapy were not different between two group. There were more the lymphovascular space invasion in group A (136 patients, 25.5%) than group B (9 patients, 10.7%) (p<0.0046). 5 year survival were 95.0% vs 93.8% for group A and group B (p=0.75). Using univariate analysis, pelvic node metastasis, paraaortic metastasis, postoperative adjuvant therapy were significant for survival. Multivariate analysis of 5 year survival revealed independent prognostic factor as postoperative adjuvant therapy. CONCLUSION: Prognosis of FIGO stage IB1 cervical cancer patients who were treated by primarily by type 3 hysterectomy and pelvic and paraaortic lymphadenectomy between adenocarcinoma and squamous cell carcinoma was found to be same.
Adenocarcinoma* ; Carcinoma, Squamous Cell* ; Cervix Uteri ; Female ; Humans ; Hysterectomy ; Lymph Node Excision ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis* ; Retrospective Studies ; Survival Rate ; Uterine Cervical Neoplasms

BACKGROUND/AIMS: Capsule endoscopy (CE) has become an important tool for the diagnosis of small bowel disease. Although CE does not require the skill of endoscope insertion, the images should be interpreted by a person with experience in assessing images of the gastrointestinal mucosa. This investigation aimed to document the number of cases needed by trainees to gain the necessary experience for CE competency. METHODS: Fifteen cases were distributed to 12 trainees with no previous experience of CE during their gastroenterology training as clinical fellows. Twelve trainees and an expert were asked to read CE images from one patient each week for 15 weeks. The diagnosis was reported using five categories (no abnormalities detected, small bowel erosion or ulcer, small bowel tumor, Crohn disease, and active small bowel bleeding with no identifiable source). We then examined, using the kappa coefficient, how the degree of mean agreements between the trainees and the expert changed as the training progressed each week. RESULTS: The agreement rate of CE diagnosis increased as the frequencies of interpretation increased. Most of the mean kappa coefficients were >0.60 and >0.80 after week 9 and 11, respectively. CONCLUSIONS: Experience with approximately 10 cases of CE is appropriate for trainees to attain CE competency.
Capsule Endoscopy* ; Crohn Disease ; Diagnosis ; Endoscopes ; Gastroenterology ; Hemorrhage ; Humans ; Learning Curve* ; Learning* ; Mucous Membrane ; Ulcer

Neuropathological deficits are an etiological factor in Tourette syndrome (TS), and implicate a network linking the basal ganglia and the cerebrum, not a particular single brain region. In this study, the volumes of 20 cerebral and cerebellar regions and their symmetries were measured in normal boys and TS boys by brain magnetic resonance imaging. Brain magnetic resonance images were obtained prospectively in 19 boys with TS and 17 age-matched normal control boys. Cerebral and cerebellar regions were segmented to gray and white fractions using algorithm for semi-automated fuzzy tissue segmentation. The frontal, parietal, temporal, and the occipital lobes and the cerebellum were defined using the semiautomated Talairach atlas-based parcellation method. Boys with TS had smaller total brain volumes than control subjects. In the gray matter, although the smaller brain volume was taken into account, TS boys had a smaller right frontal lobe and a larger left frontal lobe and increased normal asymmetry (left>right). In addition, TS boys had more frontal lobe white matter. There were no significant differences in regions of interest of the parietal, temporal, or the occipital lobes or the cerebellum. These findings suggest that boys with TS may have neuropathological abnormalities in the gray and the white matter of the frontal lobe.
Adolescent ; Analysis of Variance ; Case-Control Studies ; Cerebellum/*pathology ; Child ; Frontal Lobe/*pathology ; Humans ; Intelligence ; Korea ; Magnetic Resonance Imaging ; Male ; Regression Analysis ; Tourette Syndrome/*pathology/physiopathology