In foreign country, lots of studies were reported about the relationship between heart rate variability (HRV) and cardiac mortality. Lower HRV has been identified as a independent risk factor for sudden death. By the time, the study of HRV is confined to physically diseased state such as myocardial infarction or diabetic neuropathy. However recently the tendency of HRV has been toward to make clear the relationship of HRV and psychological problem. It is well known that depressed person is affected frequently by cardiovascular disease compared with normal people. However the mechanism that depression increases cardiovascular disease is not definitely found even though the autonomic dysfunction measured in HRV is suggested a factor for this mechanism. Depressed person has decreased HRV, decreased low frequency which reflects sympathetic activity, decreased high frequency which reflects parasympathetic activity. It means they have lower autonomic activity, so they have high cardiac mortality. Few physician knows about the utility of heart rate variability and in my thought, especially short time analysis and frequency domain method is first introduced in Korea. So we introduce this case for as many as physician know the utility of HRV.
Cardiovascular Diseases ; Death, Sudden ; Depression ; Depressive Disorder, Major* ; Diabetic Neuropathies ; Heart Rate* ; Heart* ; Humans ; Korea ; Mortality ; Myocardial Infarction ; Risk Factors

BACKGROUND: Evaluation of clinical performance is an essential area of Medical Licensure Examination. Yet, clinical skills has been neither uniformly well taught nor adequately assessed. This study was done as a part of preliminary study to introduce clinical performance assessment to Korean Medical Licensure Examination. The goals of this study were to identify the potential logistic problems and to examine the feasibility of OSCE to Medical Licensure Examination. METHODS: 48 minutes long OSCE, which consist of eight 5-minute stations, was developed. The same examination was administered to students over a four-week period. RESULTS: Total 26 volunteer fourth-year medical students were tested. 11 students were examined at the first administration and the rest of them were evaluated four-week later. Cronbach alpha of the total stations was 0.52. Any big administration problems were not revealed. There was no significant total score difference between early examinee and later ones. Students evaluated the OSCE contents and process positively. CONCLUSION: To acquire more reliable and valid examination, we need to develop more objective checklist and evaluator and SP training.
Checklist ; Clinical Competence ; Humans ; Licensure, Medical* ; Students, Medical ; Volunteers

PURPOSE: The effective suppression of Kupffer cell function is believed to contribute to the prevention of preservation/ reperfusion injury. In this study, the effect of Gadolinium, a synthetic Kupffer cell suppressor, on the reperfusion injury was examined using a canine partial liver transplant model. METHODS: About 70% of the liver was harvested and reimplanted in a mongrel recipient dog weighing 20~25 kg. Gadolinium Chloride (10 mg/kg) was infused via the cephalic vein 24 hour before harvesting the partial liver (Gadolinium group, n=5). Serum Aspartate Aminotransferase (AST) Alkaline phosphatase (ALP), Lactate dehydrogenase (LDH), and morphological grading of the graft were compared with the control group (n=5). Statistical analysis was done with an independent T-test. RESULTS: The total ischemic time was 4 hours and 27 minutes on average. One hour after reperfusion, there were no significant differences in the AST, ALP and LDH level, and the pathologic scores. At 48 hours after reperfusion, the AST (P=0.03) and LDH (P=0.05) levels were significantly lower in Gadolinium group. CONCLUSION: Kupffer cell blockage using the Gadolinium chloride might be an effective way of reducing ischemia reperfusion injury. However, this effect was not evident in the early stages of reperfusion.
Alkaline Phosphatase ; Animals ; Aspartate Aminotransferases ; Dogs ; Gadolinium* ; L-Lactate Dehydrogenase ; Liver* ; Reperfusion ; Reperfusion Injury* ; Transplants ; Veins

The term ""collagenous colitis"" was coined by Lindstrom in 1976 to describe the patient with chronic watery diarrhea who had normal rectal mucosa by proctoscopy but who had a thick subepithelial collagenous deposit on biopsy, and now collagenous colitis is recognized as one of the more common causes of chronic diarrhea of obscure origin. But in this country only a few case has been reported. We have seen a 68-year-old man with chronic watery diarrhea with abdominal pain. Physical examination, laboratory and radiologic studies were no abnormal finding. Colonoscopy disclosed grossly normal mucosa through the entire colon but by histologic examination there are chronic inflammation in the lamina propria and thickened subepithelial collagen layer. Symptoms and pathologic findings of patient improved after treatment with sulfasalazine and prednisolone.
Abdominal Pain ; Aged ; Biopsy ; Colitis, Collagenous* ; Collagen* ; Colon ; Colonoscopy ; Diarrhea ; Esophagus* ; Humans ; Inflammation ; Intestines* ; Mucous Membrane ; Numismatics ; Physical Examination ; Prednisolone ; Proctoscopy ; Stomach* ; Sulfasalazine

BACKGROUND/AIMS: The purpose of this study was to investigate the efficacy and safety of irinotecan based FOLFIRI chemotherapy as a second-line treatment after failure of FOLFOX-4 chemotherapy in patients with advanced gastric cancer. METHODS: Fifty-two patients who were pathologically diagnosed with unresectable gastric cancer and received FOLFIRI chemotherapy after failure of FOLFOX-4 chemotherapy between September 2005 and February 2012 were enrolled in this study. Data were collected by retrospectively reviewing the medical records. The response to chemotherapy was assessed every 3 cycles by World Health Organization criteria and long term survival was analyzed. The toxicities were evaluated for every course of chemotherapy according to National Cancer Institution (NCI) toxicity criteria version 3.0. RESULTS: Median age of the patients was 57 years. Median overall survival (OS) and time to progression (TTP) were 7.8 and 5 months, respectively. The number of patients showing complete remission, partial remission, stable disease, and progressive disease were 0 (0.0%), 9 (17.3%), 30 (57.7%), and 13 (25.0%), respectively. The overall response rate was 17.3%. During a total of 345 cycles, anemia worse than NCI toxicity grade 3 occurred in 2.9%, leukopenia in 20.3%, neutropenia in 12.2%, and thrombocytopenia in 1.5%. Patients with less organ involvement by metastasis, less than 34 U/mL of CA 19-9 and good responsiveness to third cycle of second line chemotherapy were associated with longer OS and TTP. CONCLUSIONS: FOLFIRI chemotherapy has a modest efficacy with acceptable toxicities in patients with advanced gastric cancer as a second-line treatment. Further well-controlled studies are needed to elucidate the efficacy of FOLFIRI chemotherapy as second-line treatment in patients with advanced stomach cancer.
Adult ; Aged ; Anemia/etiology ; Antineoplastic Combined Chemotherapy Protocols/adverse effects/*therapeutic use ; Camptothecin/adverse effects/*analogs & derivatives/therapeutic use ; Disease Progression ; Female ; Fluorouracil/adverse effects/therapeutic use ; Humans ; Kaplan-Meier Estimate ; Leucovorin/adverse effects/therapeutic use ; Male ; Middle Aged ; Neoplasm Staging ; Organoplatinum Compounds/adverse effects/therapeutic use ; Retrospective Studies ; Stomach Neoplasms/*drug therapy/mortality/pathology ; Treatment Outcome

BACKGROUND/AIMS: Minor disorders of peristalsis are esophageal motility disorders categorized by the Chicago Classification (CC), version 3.0, which was announced in 2014. This study evaluated the efficacy of anti-reflux therapy in patients with minor peristaltic disorders. METHODS: Patients with minor peristaltic disorders in accordance with CC v3.0 were included. We reviewed the medical records of patients with esophageal high-resolution manometry findings, and investigated the demographic and clinical information as well as the medical therapy. Thereafter, the response to treatment was assessed after at least 4 weeks of treatment. RESULTS: A total of 24 patients were identified as having minor disorders of peristalsis from January 2010 to December 2015. The mean follow-up period was 497 days, and there were 17 patients (70.8%) patients with ineffective esophageal motility. In terms of anti-reflux therapy, proton pump inhibitors (PPIs) with prokinetic agents and PPIs alone were prescribed in 19 patients (79.2%) and 5 patients (20.8%), respectively. When the rate of response to the treatment was assessed, the responders rate (complete+satisfactory [≥50%] responses) was 54.2% and the non-responders rate (partial [<50%]+refractory responses) was 45.8%. Patients in the responder group were younger than those in the non-responder group (p=0.020). Among them, 13 patients underwent 24-hour multichannel intraluminal impedance-pH, and 10 patients (76.9%) were pathologic gastroesophageal reflux. CONCLUSIONS: The majority of esophageal minor peristaltic disorders were accompanied by gastroesophageal reflux, and therefore, they might respond to acid inhibitor. Further well-designed, prospective studies are necessary to confirm the effect of anti-reflux therapy in these patients.
Classification ; Esophageal Motility Disorders ; Follow-Up Studies ; Gastroesophageal Reflux ; Humans ; Manometry* ; Medical Records ; Peristalsis* ; Prospective Studies ; Proton Pump Inhibitors ; Proton Therapy ; Treatment Outcome

Tuberculosis can occur anywhere in the gastrointestinal tract. However, anorectal tuberculosis has rarely been reported. A 46-years-old male presented with abdominal pain and perianal discharge of 30 years' duration. The patient had received operations for anal fistula and inflammation three times. Although he had been taking mesalazine for the past three years after being diagnosed with Crohn's disease, his symptoms persisted. Colonoscopy performed at our hospital revealed cicatricial change of ileocecal valve and diffuse ulcer scar with mild luminal narrowing of the ascending, transverse, and descending colon without active lesions. Multiple large irregular active ulcers were observed in the distal sigmoid and proximal rectum. An anal fistula opening with much yellowish discharge and background ulcer scar was observed in the anal canal. However, cobble-stone appearance and pseudopolyposis were not present. Therefore, we clinically diagnosed him as having intestinal tuberculosis with anal fistula and prescribed antituberculosis medications. Follow-up colonoscopy performed 3 months later showed much improved multiple large irregular ulcers in the distal sigmoid colon and proximal rectum along with completely resolved anal fistula without evidence of pus discharge.
Anal Canal ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Antitubercular Agents/therapeutic use ; Colon/pathology ; Colonoscopy ; Crohn Disease/diagnosis/drug therapy ; Diagnosis, Differential ; Fistula/*diagnosis/pathology ; Humans ; Ileocecal Valve/physiopathology ; Male ; Mesalamine/therapeutic use ; Middle Aged ; Protein C/analysis ; Tuberculosis, Gastrointestinal/*diagnosis/drug therapy

BACKGROUND/AIMS: The current standard regimen for the treatment of Helicobacter pylori infection is a combination of a proton pump inhibitor (PPI), amoxicillin, and clarithromycin. The aim of this study was to determine the effectiveness of PPIs taken separately before a meal for the treatment of H. pylori infection. MATERIALS AND METHODS: This retrospective study included 160 patients who were tested positive for rapid urease in Kosin Unversity Gospel Hospital between January 2008 and December 2012. The patients were divided into two groups (n=80 in each group) based on the method of administration of the H. pylori triple therapy. Group A took a PPI before a meal and amoxicillin and clarithromycin after a meal. Group B took all three medications together after a meal. The 13C-urea breath test was performed after 4 weeks to assess the eradication of H. pylori. RESULTS: H. pylori was eradicated in 58/80 (72.5%) patients in group A and 60/80 (75.0%) patients in group B, with no significant difference between the groups (P=0.719). Adverse effects occurred in 4 patients of group A and 7 patients of group B (5.0% and 8.8%, respectively); however, the difference between the groups was not significant (P=0.232). CONCLUSIONS: Administration of all medicines at once after a meal may be the better prescription for treatment, considering patient convenience and improved likelihood of compliance.
Amoxicillin ; Breath Tests ; Clarithromycin ; Compliance ; Helicobacter pylori ; Helicobacter ; Humans ; Meals ; Methods ; Prescriptions ; Proton Pump Inhibitors ; Proton Pumps ; Protons ; Retrospective Studies ; Urease

BACKGROUND/AIM: We aimed to evaluate the efficacy of sending educational video clips via smartphone mobile messenger (SMM) on enhancing bowel preparation before colonoscopy. METHODS: This was a prospective, endoscopist-blinded, randomized controlled study. Patients in the SMM group received two video clips sent via SMM that explained the diet and regimen for bowel preparation, whereas those in the control group did not receive any video clips. We compared the quality of bowel preparation between the two groups, which was assessed by an endoscopist using the Ottawa scale. RESULTS: Between August and November 2014, 140 patients in the SMM group and 141 patients in the control group underwent colonoscopic examination. The total Ottawa score of the SMM group was significantly lower than that of the control group (5.47±1.74 vs. 5.97±1.78, p=0.018). These results were particularly prominent in the younger age group; the total Ottawa score of patents in the SMM group aged <40 years was significantly lower than that of patients in the control group aged <40 years (5.10±1.55 vs. 6.22±2.33, p=0.034). CONCLUSIONS: We demonstrated that sending educational video clips via SMM could result in better bowel preparation, especially in the younger age group.
Colonoscopy ; Diet ; Education ; Humans ; Prospective Studies ; Smartphone

BACKGROUND/AIMS: The numbers of women, young doctors, and foreigners in the medical field have increased continuously. On the other hand, the environment for these minority groups has not improved, particularly in Eastern countries. The authors aimed to increase the awareness of the importance of a Diversity Committee in the Korean Society of Gastroenterology (KSG) by an analysis of a survey.METHODS: From January to February in 2019, a survey was conducted on physicians and a few medical students by googling. The questionnaire consisted of the target doctors of the Diversity Committee, purpose, specific activities, and expected effects of Diversity Committee to the KSG. The participants requested to respond with yes/no or a 5-point scale.RESULTS: A total of 202 participants completed the questionnaire, and 93.5% (189/202) were medical specialists. The proportion of males was 61.9% (125/202), and 39.6% (80/202) and 36.1% (73/202) participants were in their 30s and 40s, respectively. A total of 174 participants (86.1%) agreed with the necessity of a Diversity Committee, and 180 participants (89.1%) answered this committee would help advance the KSG with significant differences between males and females (80.8% vs. 94.8%, p=0.006; 84.8% vs. 96.1%, p=0.011). Similarly, there were significant differences in the responses according to sex in most questions.CONCLUSIONS: Most participants of the survey expected a contribution of the Diversity Committee to the advancement of the KSG. On the other hand, in most of the priorities of the target, purpose, specific activities, and expected effects of the Diversity Committee, there was a difference in the perceptions between males and females. Therefore, continuous efforts are needed to reduce the differences within the KSG.
Emigrants and Immigrants ; Female ; Gastroenterology ; Hand ; Humans ; Male ; Minority Groups ; Specialization ; Students, Medical ; Surveys and Questionnaires