BACKGROUND: The i-gel™ (i-gel) and Laryngeal Mask Airway Supreme™ (LMA Supreme) have been safely used in children. We compared the airway performance of the i-gel and LMA Supreme in infants undergoing general anesthesia. METHODS: Sixty infants with American Society of Anesthesiologists physical status I or II were randomly assigned to place either the i-gel or the LMA Supreme. The size 1 or 1.5 of each airway was selected by the weight of infants. The primary outcome variable was oropharyngeal leak pressure (OLP). We also assessed insertion success rate, insertion time, fiberoptic view of the larynx, airway quality, airway manipulations, and perioperative complications. RESULTS: Demographic data did not differ between the two groups. Insertion success rate was similar in both groups. OLP for the i-gel (26.0 ± 3.8 cmH2O) was higher than for the LMA Supreme (23.7 ± 3.2 cmH2O) (P = 0.016). Insertion time for the i-gel (16.4 ± 2.8 s) was shorter than for the LMA Supreme (18.5 ± 2.7 s) (P = 0.002). There were no differences in fiberoptic view of the larynx, airway quality, airway manipulations, and complications between the two groups. CONCLUSIONS: This study demonstrated that the i-gel and LMA Supreme provided a similar performance of airway in infants. Compared with the LMA Supreme, the i-gel provided shorter insertion time and higher OLP in infants.
Anesthesia, General ; Child ; Humans ; Infant ; Laryngeal Masks ; Larynx

BACKGROUND: The i-gel™ (i-gel) and Laryngeal Mask Airway Supreme™ (LMA Supreme) have been safely used in children. We compared the airway performance of the i-gel and LMA Supreme in infants undergoing general anesthesia. METHODS: Sixty infants with American Society of Anesthesiologists physical status I or II were randomly assigned to place either the i-gel or the LMA Supreme. The size 1 or 1.5 of each airway was selected by the weight of infants. The primary outcome variable was oropharyngeal leak pressure (OLP). We also assessed insertion success rate, insertion time, fiberoptic view of the larynx, airway quality, airway manipulations, and perioperative complications. RESULTS: Demographic data did not differ between the two groups. Insertion success rate was similar in both groups. OLP for the i-gel (26.0 ± 3.8 cmH2O) was higher than for the LMA Supreme (23.7 ± 3.2 cmH2O) (P = 0.016). Insertion time for the i-gel (16.4 ± 2.8 s) was shorter than for the LMA Supreme (18.5 ± 2.7 s) (P = 0.002). There were no differences in fiberoptic view of the larynx, airway quality, airway manipulations, and complications between the two groups. CONCLUSIONS This study demonstrated that the i-gel and LMA Supreme provided a similar performance of airway in infants. Compared with the LMA Supreme, the i-gel provided shorter insertion time and higher OLP in infants.

Through a systematic review and meta-analysis of epidemiological studies on dementia, we assessed the prevalence of dementia and its subtypes-Alzheimer' disease (AD) and vascular dementia (VaD)-in Korea. We searched for epidemiological studies on dementia published in 1990-2013 using PubMed, Scopus, EMBASE, KoreaMed, KISS, and RiCH. Dementia prevalence in elderly patients (aged> or =65 yr) was 9.2% (95% confidence interval [CI], 8.2%-10.4%) from 11 studies, which was higher than those from Western and other Asian countries. AD was the most prevalent dementia type, with a prevalence of 5.7% (95% CI, 5.0%-6.4%) from 10 studies compared with 2.1% (95% CI, 1.6%-2.7%) for VaD from 9 studies. The age-specific prevalence of dementia approximately doubled with each 5.8-yr increase of age. Although a significant increasing trend of dementia prevalence was not observed, it increased slightly from 7.3% to 8.7% after 2005; AD prevalence increased after 1995 and VaD prevalence decreased after the early 2000s. The AD/VaD ratio increased from 1.96 in the early 1990s to 4.13 in the 2010s, similar to the worldwide ratio. Owing to this high prevalence in the aging population, dementia will impose significant economic burdens to Korean society.
Age Factors ; Alzheimer Disease/epidemiology ; Asian Continental Ancestry Group ; Databases, Factual ; Dementia/*epidemiology ; Dementia, Vascular/epidemiology ; Humans ; Prevalence ; Quality Assurance, Health Care ; Republic of Korea

Townes-Brocks syndrome is an uncommon autosomal dominant condition first described by Townes and Brocks in 1972. We experienced a newborn female who presented with clinical findings of Townes-Brocks syndrome in an otherwise unaffected family. The patient showed the full spectrum of anomalies including anterior placed anus, triphalangeal thumb, preaxial polydactyly, pre-auricular tags, microtia without opening, sensorineural hearing loss and unilateral renal agenesis.
Anal Canal ; Female ; Hearing Loss, Sensorineural ; Humans ; Infant, Newborn ; Polydactyly ; Thumb

PURPOSE: Polyethylene glycol(PEG) with electrolytes has been used for intestinal clearance for colonoscopy and operations in children. But its efficacy and safety for disimpaction in children with chronic functional constipation has been studied little. METHODS: This study enrolled 26 patients with chronic functional constipation(11 children had failed to disimpaction by conventional management at OPD) who were admitted to the Eul-Ji Hospital between May 2000 and July 2003. PEG with electrolytes was administered per oral and/or rectal enema. We observed the effects for disimpaction by measuring the frequency and consistency of stools, and by simple abdominal X-ray. We evaluated the safety by measuring serum electrolytes and osmolarity in three hours after PEG with electrolytes administration, and by observation of the clinical status of the patients. The protocol of PEG with electrolytes was a dose of 60-80 mL/kg within three hours per oral and/or of 15-25 mL/kg by rectal enema. RESULTS: In all patients, simple abdominal X-ray films showed improvements of fecal impaction. Consistency and frequency of stool were improved in all patients except one. As for side effects, diarrhea developed in three patients(11.5% of all patients). Headaches developed in one patient(3.8% of all patients) but it improved without treatment. Serum electrolytes was checked in 16 patients after PEG with electrolytes management and mild hypernatremia(146 mmol/L) was checked in one patient. Serum osmolarity was checked in 11 patients after PEG with electrolytes management and was normal in all patients. CONCLUSION: PEG with electrolytes was effective and safe for disimpaction in children with chronic functional constipation, including patients who had failed in disimpaction by conventional management.
Child* ; Colonoscopy ; Constipation* ; Diarrhea ; Electrolytes* ; Enema ; Fecal Impaction ; Headache ; Humans ; Osmolar Concentration ; Polyethylene Glycols ; Polyethylene* ; X-Ray Film

OBJECTIVES: The Child Bipolar Questionnaire 2.0 (CBQ 2.0) is a rapid screener with a Core Index subscale of symptom dimensions frequently reported in childhood-onset bipolar disorder (BD) and scoring algorithms for DSM-IV BD, with and without ADHD, and the proposed Narrow, Broad, and Core phenotypes. This report provides preliminary data on the reliability and validity of the CBQ 2.0- Korean version. METHODS: Core Index subscale to effectively predict diagnostic classification by structured interview was assessed using the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version-Korean Version (K-SADS-PL-K). Test-retest and inter-rater reliabilities of the CBQ 2.0 were assessed. Correlation of Korean Child Behavior Checklist (K-CBCL) with CBQ 2.0-Korean version was performed. RESULTS: The CBQ 2.0 screening algorithms performed with a specificity of 66.7% and a sensitivity of 94.7% in classifying subjects with K-SADS-PL-K diagnosis of BD vs. no BD. The Core Index subscale had "good" agreement with K-SADS-PL-K diagnosis (Kappa=0.676) in identifying BD, ADHD-only, and no diagnosis. CONCLUSION: This preliminary data is from a sample derived from the child and adolescent psychiatric clinics. Further validation is needed with community based samples in which childhood-onset BD is rarer and diagnoses more diverse. The CBQ 2.0-Korean version shows potential for rapid and economically feasible identification of possible childhood-onset BD cases as defined by DSM-IV criteria as well as by alternate disease phenotypes.
Adolescent ; Bipolar Disorder ; Checklist ; Child ; Child Behavior ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Mass Screening ; Mood Disorders ; Phenotype ; Surveys and Questionnaires ; Reproducibility of Results ; Sensitivity and Specificity

Desmoplastic small round cell tumor (DSRCT) is a rare, aggressive neoplasm that preferentially involves the abdominal and pelvic cavities in relatively young males. We present a rare case of DSRCT arising in the ovary of a 16-year-old girl. During surgery, a 15 cm-sized huge mass was noted in the right ovary and wide spreading of the tumor was identified in the left ovary, uterine wall, and omentum and bowel wall. Histological investigation showed nests of small round cells with round nuclei and scanty eosinophilic cytoplasm accompanied with dense desmoplastic stroma. The immunohistochemistry showed that the tumor coexpressed epithelial, mesenchymal, and neuronal markers. The tumor cells ultrastructurally showed poorly developed cell junctions and occasionally showed intracytoplasmic aggregates of intermediate filaments. Molecular analysis of the tumor revealed chromosomal translocation t(11:22)(p13;q12) associated with the EWS-WT1 fusion protein. DSRCT should be included in the differential diagnosis of ovarian neoplasms in young patients.
Adolescent ; Cytoplasm ; Desmoplastic Small Round Cell Tumor ; Diagnosis, Differential ; Eosinophils ; Female ; Humans ; Immunohistochemistry ; Intercellular Junctions ; Intermediate Filaments ; Male ; Neurons ; Omentum ; Ovarian Neoplasms ; Ovary ; Translocation, Genetic

We report on a case of malignant pleural effusion as initial metastatic presentation of occult gastric cardia cancer in a young woman. To the best of our knowledge, this is the first report of gastric adenocarcinoma metastasized to pleura as an initial presentation. Location of cardia and signet ring cell histology may contribute to the manifestation. Utilization of positron emission tomography-computed tomography was helpful for proper diagnosis. For patients with such distinct clinical presentations, it would be appropriate to consider gastric cancer as one of the possible primary sites.
Adenocarcinoma ; Carcinoma, Signet Ring Cell ; Cardia* ; Diagnosis* ; Electrons ; Female ; Humans ; Neoplasm Metastasis* ; Pleura ; Pleural Effusion, Malignant ; Positron-Emission Tomography ; Stomach Neoplasms

BACKGROUND: Limited data are available on the current status of cytology practices in Korea. This nationwide study presents Korean cytology statistics from 2015. METHODS: A nationwide survey was conducted in 2016 as a part of the mandatory quality-control program by the Korean Society for Cytopathology. The questionnaire was sent to 208 medical institutions performing cytopathologic examinations in Korea. Individual institutions were asked to submit their annual cytology statistical reports and gynecologic cytology-histology correlation data for 2015. RESULTS: Responses were obtained from 206 medical institutions including 83 university hospitals, 87 general hospitals, and 36 commercial laboratories. A total of 8,284,952 cytologic examinations were performed in 2015, primarily in commercial laboratories (74.9%). The most common cytology specimens were gynecologic samples (81.3%). Conventional smears and liquid-based cytology were performed in 6,190,526 (74.7%) and 2,094,426 (25.3%) cases, respectively. The overall diagnostic concordance rate between cytologic and histologic diagnoses of uterine cervical samples was 70.5%. Discordant cases were classified into three categories: category A (minimal clinical impact, 17.4%), category B (moderate clinical impact, 10.2%), and category C (major clinical impact, 1.9%). The ratio of atypical squamous cells of undetermined significance to squamous intraepithelial lesion was 1.6 in university hospitals, 2.9 in general hospitals, and 4.9 in commercial laboratories. CONCLUSIONS: This survey reveals the current status and trend of cytology practices in Korea. The results of this study can serve as basic data for the establishment of nationwide cytopathology policies and quality improvement guidelines in Korean medical institutions.
Atypical Squamous Cells of the Cervix ; Diagnosis ; Hospitals, General ; Hospitals, University ; Korea* ; Quality Improvement ; Squamous Intraepithelial Lesions of the Cervix

OBJECTIVES: It has been known that the incidence of protein malnutrition is high in patients with chronic renal failure(CRF). Although the effect of uremia on protein metabolism has not been known clearly, some reports suggest that metabolic acidosis, one of the uremic manifestations, increases protein catabolism. In a steady state, acid production is mainly related to dietary protein intake. Also severe acidosis causes anorexia and may decreases protein intake. But the relationship between diet and metabolic acidosis in chronic dialysis patients has not been established. In order to investigate the relation between metabolic acidosis and diet in CRF patients, we analyzed the diet intake and the nutritional status in chronic dialysis patients with or without severe metabolic acidosis. METHODS: We selected 10 patients as an acidosis group (total CO2 < 14.0mEq/L) and 10 patients with acid-base balance as control group (total CO2 > 17.5mEq/L) among patients who have been receiving hemodialysis. RESULTS: The mean ages and male to female ratios were similar in both groups, but in the underlying diseases of acidosis group, non-chronic glomerular nephritis (nonCGN) was more prevalent. Weekly hemodialysis time of the acidosis and the control group were 10.20, 11.45hours per week, respectively. The concentrations of pre-dialysis BUN were 89.74 vs. 71.25mg/dL and nPCR were 1.289 vs. 1.035g/kg/ day in each group.. However, the analysis of dietary protein intake showed no significant difference between both groups. The nutritional status of both groups were similar. CONCLUSION: In CRF patients, metabolic acidosis increases protein catabolism by stimulated amino acid oxidation and protein degradation in muscle. This study therefore suggests that patients with metabolic acidosis need to receive more adequate dialysis to correct the acidosis. And we recommend the indivisualization of protein intakes rather than the indiscriminate protein restriction in CRF patients with metabolic acidosis.
Acid-Base Equilibrium ; Acidosis* ; Anorexia ; Dialysis* ; Diet* ; Dietary Proteins ; Female ; Humans ; Incidence ; Kidney Failure, Chronic ; Male ; Malnutrition ; Metabolism ; Nephritis ; Nutritional Status ; Proteolysis ; Renal Dialysis ; Uremia