BACKGROUND: Both atrophic gastritis and intestinal metaplasia may progress to gastric dysplasia. This study aimed to analyze the factors influencing progression of atrophic gastritis and intestinal metaplasia to dysplasia. METHODS: People diagnosed with atrophic gastritis and intestinal metaplasia for the first time received a follow-up endoscopy and were investigated for the cumulative incidence rate of gastric dysplasia by age, gender, smoking habit, alcohol intake, rice consumption and family history of stomach cancer. RESULTS: The cumulative incidence rate increased with age, consuming > or =3 bowls of rice per day and family history of stomach cancer. Multivariate analysis showed that the cumulative incidence rate of gastric dysplasia increased in subjects >61 years (RR=2.54, P=0.014), in those consuming > or =3 bowls of rice per day (RR=1.46, P=0.021) and in those with a family history of stomach cancer (RR=1.31, P=0.037). CONCLUSIONS: More active management, such as intensive endoscopic follow-up examinations, lifestyle change and education regarding gastric dysplasia, are required in those older than 61 years, having a higher intake of grain or with a family history of stomach cancer.
Edible Grain ; Endoscopy ; Follow-Up Studies ; Gastritis, Atrophic ; Humans ; Incidence ; Life Style ; Metaplasia ; Multivariate Analysis ; Risk Factors ; Smoke ; Smoking ; Stomach ; Stomach Neoplasms

BACKGROUND: Vasoconstrictors have been used as an adjunct to local anesthetics to prolong the duration of spinal anesthesia. Recently, clonidine, an 2-receptor agonist has been shown to prolong the duration of spinal anesthesia following intrathecal administration. Bupivacaine has been used for spinal anesthesia and compared with tetracaine in recent studies. We have undertaken this study to further evaluate the effect of clonidine in hyperbaric 0.5% bupivacaine spinal anesthesia. METHODS: Thirty patients who were scheduled for lower limb or urologic operation were divided into 2 groups: Group A (hyperbaric bupivacaine 13 mg, 2.6 ml + N/S 1 ml), Group B (hyperbaric bupivacaine 13 mg, 2.6 ml + clonidine 150 g, 1 ml). We used standardized techniques and injected above drugs to group A and B intrathecally for spinal anesthesia. We investigated the onset and the duration of spinal anesthesia along with hemodynamic changes (blood pressure and heart rate) in patients. RESULTS: There were no significant differences in the onset of spinal anesthesia and hemodynamic changes between two groups. The time taken to recover from the nerve block was more prolonged in the group B (touch 225, pain 262, foot dorsiflexion 271, knee flexion 290 minutes) than group A (touch 154, pain 188, foot dorsiflexion 198, knee flexion 216 minutes). There were no significant differences in sedation, and in experiencing dry mouth and other side effects between two groups. CONCLUSION: Intrathecal clonidine 150 g has been proved to prolong the duration of hyperbaric 0.5% bupivacaine spinal anesthesia without neurotoxicity or dangerous hemodynamic depression. Therefore, clonidine can be used as an effective adjunct in hyperbaric bupivacaine spinal anesthesia.
Anesthesia, Spinal* ; Anesthetics, Local ; Bupivacaine* ; Clonidine* ; Depression ; Foot ; Heart ; Hemodynamics ; Humans ; Knee ; Lower Extremity ; Mouth ; Nerve Block ; Tetracaine ; Vasoconstrictor Agents

BACKGROUND: To investigate how many rookie pitchers suffered from injuries while playing in the amateur league without guidelines for prevention of excessive pitching, we analyzed their amateur pitching patterns based on the pitch count, use of breaking balls, and pitches during winter camp. METHODS: Forty-one rookie pitchers who graduated from high school or university in 2013 and joined professional baseball teams. Participants were interviewed by a trainer using our questionnaire. Injury inclusion criteria were 1) history of shoulder surgery, 2) history of elbow surgery, 3) shoulder pain requiring treatment, and 4) elbow pain requiring treatment. RESULTS: Mean number of pitches per game and warm-up pitches for practice was 84.5 pitches (range, 15 to 130 pitches) and 16.4 pitches (range, 2 to 210 pitches), respectively. Mean number of pitches during the last year was 906.9 (range, 80 to 2,000). Mean number of maximal pitches was 127 pitches (range, 50 to 210 pitches). Fourteen pitchers had pitched over 150 pitches. Twenty-seven pitchers (65.9%) had pitched in spite of enduring pain. During winter training (mean 1.8 months), mean number of pitches per day was 162.5 pitches, and 20 pitchers (48.8%) had practiced pitching excessively despite the cold weather. Twenty-six rookies (63.4%) had shoulder pain or history of shoulder surgery, and 31 pitchers (75.6%) had elbow pain or history of elbow surgery. Only four participants (9.8%) did not have pain and history of surgery. CONCLUSIONS: For young baseball pitchers, guidelines for prevention of excessive pitching and for regulating the winter training program may be needed.
Baseball* ; Education ; Elbow* ; Humans ; Shoulder Pain ; Shoulder* ; Weather

Behavioral and psychological symptoms of dementia are major components of Alzheimer’s disease. In this study, we aimed at investigating the prevalence and severity of behavioral and psychological symptoms of dementia in very mild to mild Alzheimer’s disease. Forty-four patients with Alzheimer’s disease who visited the neurology outpatient clinic of Seoul Medical Center were included. A trained neurologist or a supervised test technician administered the neuropsychological test, the Seoul Neuropsychological Screening Battery including Mini Mental State Examination and Clinical Dementia Rating. The instrument used for assessing behavioral and psychological symptoms of dementia was Neuropsychiatric Inventory-Questionnaire. In order of prevalence, apathy, depression, irritability, anxiety, and agitation were the most common symptoms occurring in very mild-to-mild Alzheimer’s disease group. The prevalence and severity of behavioral and psychological symptoms of dementia were found to be in positive correlation with the Clinical Dementia Rating scores. Behavioral and psychological symptoms of dementia are found even in the very early stage of Alzheimer’s disease, apathy and depression being the most common symptoms. Physicians should be aware of this when managing dementia patients.

PURPOSE: The benefits of thrombolytic treatment are time-dependent. We developed a smartphone application that aids stroke patient self-screening and hospital selection, and may also decrease hospital arrival time. MATERIALS AND METHODS: The application was developed for iPhone and Android smartphones. Map data for the application were adopted from the open map. For hospital registration, a web page (http://stroke119.org) was developed using PHP and MySQL. RESULTS: The Stroke 119 application includes a stroke screening tool and real-time information on nearby hospitals that provide thrombolytic treatment. It also provides information on stroke symptoms, thrombolytic treatment, and prescribed actions when stroke is suspected. The stroke screening tool was adopted from the Cincinnati Prehospital Stroke Scale and is displayed in a cartoon format. If the user taps a cartoon image that represents abnormal findings, a pop-up window shows that the user may be having a stroke, informs the user what to do, and directs the user to call emergency services. Information on nearby hospitals is provided in map and list views, incorporating proximity to the user's location using a Global Positioning System (a built-in function of smartphones). Users can search for a hospital according to specialty and treatment levels. We also developed a web page for hospitals to register in the system. Neurology training hospitals and hospitals that provide acute stroke care in Korea were invited to register. Seventy-seven hospitals had completed registration. CONCLUSION: This application may be useful for reducing hospital arrival times for thrombolytic candidates.
*Cellular Phone ; Geographic Information Systems ; Hospitals ; Humans ; Republic of Korea ; Stroke/*diagnosis

No abstract available.
Adult* ; Humans ; Neck*

The diagnosis of gastrointestinal stromal tumor (GIST) has become relatively common in recent years, but little is known about its association with other malignancies. We present a rare case of successfully treated metachronous GIST and colon cancer with concurrent FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) chemotherapy and imatinib. A 63-year-old man presented with abdominal pain that had started 2 weeks ago, and endoscopic ultrasonography showed masses that were compatible with GIST on the duodenum. He underwent Whipple surgery. One year after the GIST diagnosis, two liver masses were found on abdominal computed tomography images taken for surveillance. A liver biopsy showed metastatic adenocarcinoma, not GIST. Colonoscopy was then performed to identify the primary site of the metastatic adenocarcinoma in the liver, and sigmoid colon cancer was found. He received 12 cycles of adjuvant FOLFOX concurrently with adjuvant imatinib. There were no serious adverse events of grade 3 or higher from either imatinib or chemotherapy. He has completed adjuvant imatinib and FOLFOX chemotherapy and there is no evidence of disease recurrence. When a synchronous or metachronous tumor is found in a GIST patient, the clinician should keep in mind the possibility of another primary tumor of different histopathology, as well as GIST recurrence.

We report a case of subcutaneous panniculitic T-cell lymphoma (SPTCL) which occurred in a 10-year-old Korean girl. Her disease presented as multiple erythematous subcutaneous nodules on the right cheek, left chest, abdomen, left flank, both calves, and left shin with systemic symptoms. She had a protracted course of multiple erythematous subcutaneous nodules for 2 months often with spiking fever. Histopathologic findings for the subcutaneous nodules revealed lobular panniculitis-like findings composed of atypical small, bland lymphocytes and histiocytes. Characteristically, atypical lymphocytes rimmed individual fat cells in a lace-like pattern and some histiocytes occasionally phagocytosed WBCs. Bone marrow findings revealed increased phagocytic histiocytes with engulfed hematopoietic cell. The immunophenotypic studies showed CD45RO (UCHLl)+, CD20-, CD4-, CD8+ and CD56+ (focal), lysozyme+, CD45 (LCA)+ and EBV-. She received three cycles of high-dose cyclophosphamide, adriamycin, vincristine, prednisolone (CHOP) and methotrexate, intrathecal methotrexate and one cycle of fludarabine, mitoxantrone and dexamethasone (FND) chemotherapy. She died of acute renal failure during multiple chemotherapy.
Abdomen ; Acute Kidney Injury ; Adipocytes ; Bone Marrow ; Cheek ; Child* ; Cyclophosphamide ; Dexamethasone ; Doxorubicin ; Drug Therapy ; Female ; Fever ; Glycogen Storage Disease Type VI ; Histiocytes ; Humans ; Lymphocytes ; Lymphoma, T-Cell* ; Lymphoma, T-Cell, Cutaneous ; Methotrexate ; Mitoxantrone ; Prednisolone ; T-Lymphocytes* ; Thorax ; Vincristine

PURPOSE: To compare the clinical outcomes between high and low fluid-dynamic parameter settings during phacoemulsification. METHODS: In this retrospective study we analyzed 183 consecutive eyes with senile cataracts that underwent cataract surgery between October 2010 and January 2015. The phacoemulsifications were performed with high and low fluidic parameter settings, which were designated by different fluid heights, aspiration flow rates, and vacuum settings. We measured and compared the intraoperative factors including fluid consumption, cumulative dissipated energy (CDE), ultrasound time, intraoperative complications, and pupil size changes during the phacoemulsification. Central corneal thickness (CCT), endothelial cell density (ECD), uncorrected visual acuity (UCVA), and best corrected visual acuity (BCVA) were measured and compared preoperatively and postoperatively. RESULTS: There was no statistically significant difference in the fluid consumption, CDE, or ultrasound time during phacoemulsification between the 2 groups. The frequencies of intraoperative complications were not statistically significant. UCVA, BCVA, and ECD were not statistically significantly different between the 2 groups during the postoperative follow-up. The low parameter group showed the lower increase in CCT on postoperative day 30. CONCLUSIONS: The phacoemulsifications with low fluid-dynamic parameter resulted in less damage to intraocular tissue without any significantly different postoperative findings. The phacoemulsification with low fluid-dynamic parameter setting is more advantageous due to stable and safe aspects.
Cataract ; Endothelial Cells ; Follow-Up Studies ; Intraoperative Complications ; Phacoemulsification* ; Pupil ; Retrospective Studies ; Ultrasonography ; Vacuum ; Visual Acuity

BACKGROUND: More than 90% of acute stroke patients have measurable cardiovascular sequelae, but we have been often overlooked in formal discussions of treatment. If we estimate the incidence of myocardial injury in patient with spontaneous SAH, we may figure the possibility of cardiac dysfunction in such patients. This study was designed to investigate the incidence of myocardial injury in patients with spontaneous SAH using cardiac troponin I(cTnI). METHODS: A prospective single emergency center study was performed to determined preoperative incidence of unrecognized cardiac injury in patients suffering spontaneous SAH. We include the spontaneous SAH patients who underwent serum measurements of the cardic troponin I immediately upon admission last six month period. ECG, CK, CK-MB and myoglobin were also performed at admission. We excluded the spontaneous SAH patients who had past history of myocardial ischemia and ECG abnormality. RESULTS: Fifty-two patients(34 females, 18 males) with spontaneous SAH were studied prospectively. 18 patients(34.6% of the total study population) had cTnI level above 0.5ng/ml. ECG was performed in 52 patients and was abnormal in 15 of the 52 patients(28.8%). CONCLUSION: The measurement of cTnI has provided physicians with a myocardial marker that has a cardiac sensitivity for cardiac injury equal to that of CK-MB yet with greater specificity. So, cardiac troponin I is useful to estimate the incidence of myocardial injury in patients with spontaneous SAH. And we may estimate the possibility of cardiac dysfunction in such patients. This knowledge will hopefully aid in the care and improve the outcome.
Electrocardiography ; Emergencies ; Female ; Humans ; Incidence* ; Myocardial Ischemia ; Myoglobin ; Prospective Studies ; Sensitivity and Specificity ; Stroke ; Troponin I* ; Troponin*