PURPOSE: Intestinal failure (IF) is a complex clinical condition requiring a multi-disciplinary team approach. Our objective was to set up the treatment protocols and education documents for IF patients for development of intestinal rehabilitation programs in our hospital. METHODS: We compared the number of inpatients, length of hospital stay, mode of nutrition and calorie supply at discharge, and the frequency of blood transfusions before and after quality improvement of multidisciplinary activities, in order to evaluate the indirect effects of new protocols and training materials and for development of the intestinal rehabilitation system. RESULTS: We integrated eleven protocols for treatment and monitoring and seven educational materials for patients and caregivers. We compared indirect effects before and after the quality improvement activities. The number of IF patients hospitalized was reduced from 12 to 9. The mean days of hospital stay was decreased from 322 days to 73 days, the average number of monthly blood transfusions was also reduced from 1.8 to 0.3. In addition, the percentage of patients administered enteral nutrition and calories supplied was increased at discharge. CONCLUSION: By integrating IF protocols and education materials for IF patients, we found possible indirect effects of intestinal rehabilitation using a multidisciplinary team approach.
Blood Transfusion ; Caregivers ; Clinical Protocols ; Education ; Enteral Nutrition ; Humans ; Inpatients ; Length of Stay ; Quality Improvement* ; Rehabilitation*

BACKGROUND: Childhood socioeconomic status (SES) is known to affect cardio-metabolic disease risk. However, the relationship between childhood SES and metabolic syndrome (MetS) remains uncertain. Therefore, we investigated the relationship between childhood SES, as measured by maternal education and occupational status and adult-onset MetS in the Korean population. METHODS: We examined the association between childhood SES, as measured by maternal education level and occupational status during an individual's childhood, and MetS in Korean adults aged 20 to 79 years who participated in the 2007-2009 Korean National Health Examination and Nutrition Survey. The components of MetS, including waist circumference, fasting glucose, lipid profiles, and blood pressure, were measured. Adjusted odds ratios (ORs) for MetS were calculated using multiple logistic regression models. RESULTS: Significant differences in the association between maternal education level, occupational status, and MetS were found between males and females. In females, the adjusted MetS OR for the highest maternal education quartile relative to the lowest quartile was 0.46 (0.21-0.99). Similarly, in females, the adjusted OR for individuals whose mothers worked when they were children relative to those whose mothers did not work was 1.23 (1.04-1.44). In males, no significant associations between maternal education, maternal occupational status, and MetS were found. CONCLUSION: We found independent, positive associations between maternal education and occupational status and MetS in Korean females. These findings suggest that public health education targeting MetS prevention should be considered, especially among children with less opportunity for maternal support.
Adult ; Blood Pressure ; Child ; Education* ; Employment ; Fasting ; Female ; Glucose ; Humans ; Logistic Models ; Male ; Mothers ; Nutrition Surveys ; Odds Ratio ; Public Health ; Social Class ; Waist Circumference

BACKGROUND: Insulin resistance, decreased response of peripheral tissue to normal insulin levels, is known to be related to cardiometabolic diseases. Cardiopulmonary fitness is also considered to be related to these comorbidities. Therefore, we investigated the relationship between insulin resistance and cardiopulmonary fitness by performing a 3-minute step test in a Korean non-diabetes mellitus (DM) population. METHODS: A total of 118 non-DM subjects were enrolled during their routine health check-up. Insulin resistance was measured by calculating homeostatic model assessment-insulin resistance (HOMA-IR), and a 3-minute step test was performed to measure cardiopulmonary fitness. RESULTS: Post-60 seconds exercise heart rate after 3-minute test (R60 heart rate) was correlated with age (r = -0.21, P = 0.02), education (r = 0.17, P = 0.04), body mass index (r = 0.23, P = 0.01), waist circumference (r = 0.28, P < 0.01), fasting insulin (r = 0.28, P < 0.01), HOMA-IR (r = 0.25, P < 0.01), low density lipoprotein-cholesterol (r = 0.28, P < 0.01), high sensitivity C-reactive protein levels (r = 0.22, P = 0.02), and baseline heart rate (r = 0.56, P < 0.01). In a step-wise multiple regression analysis, baseline heart rate (beta = 0.79, P < 0.001), HOMA-IR (beta = 0.65, P = 0.02), and systolic blood pressure (beta = 0.15, P = 0.03) were identified as explanatory variables for R60 heart rates. CONCLUSION: Our results suggested that cardiopulmonary fitness was associated with insulin resistance in non-DM patients of a university hospital in Korea. Further studies are needed to elucidate the underlying mechanisms.
Blood Pressure ; Body Mass Index ; C-Reactive Protein ; Comorbidity ; Exercise Test ; Fasting ; Heart ; Heart Rate ; Humans ; Insulin ; Insulin Resistance ; Korea ; Physical Fitness ; Waist Circumference

Gastric surgeries may predispose patients to the formation of gastric phytobezoars. Cola-lysis through nasogastric lavage, endosopic infusion and/or the oral intake of cola are recently introduced techniques for the dissolution of phytobezoars. However, their complications have rarely been reported. Herein, we report a 56-year-old woman, who had previously undergone partial gastrectomy, severe intestinal obstruction due to the migration of a phytobezoar during cola-lysis and was successfully managed with surgical intervention.
Bezoars ; Cola ; Female ; Gastrectomy ; Humans ; Intestinal Obstruction ; Middle Aged ; Therapeutic Irrigation

OBJECTIVE: Patient-controlled-analgesia (PCA) using intravenous (IV) opioids is recognized a safe and effective method for pain control. However, postoperative analgesia with opioids is associated with a high incidence of postoperative nausea and vomiting (PONV) exceeding 30%. The 5-hydroxytryptamine receptor 3 (5-HT3) antagonists alleviate nausea and vomiting. This study aims to compare the effectiveness of ramosetron and ondansetron in preventing PONV following laparoscopic hysterectomy for benign uterine diseases under general anesthesia. METHODS: The medical records of 1483 patients who underwent laparoscopic hysterectomy between January 2005 and May 2009 were reviewed. Of the 1483 patients, 1184 patients who received IVPCA with ramosetron 0.3 mg (n=761) or ondansetron 8 mg (n=423) were analyzed. Fentanyl-based IVPCA was administered for 48 hours after surgery. The overall incidence of postoperative nausea and vomiting, bowel ileus, Levin tube insertion for severe bowel ileus, additional usage of pain killers and discontinuation of the IVPCA infusion with PCA-related severe nausea and vomiting were assessed for 48 hours after surgery. The amount of time until bowel gas passage resumption after surgery was measured. RESULTS: There was a significant difference between the two groups regarding the duration until post-operative bowel gas passage resumption (1.78+/-0.79 days in the ramosetron group, and 2.23+/-0.83 days in the ondansetron group; p=0.005); however, there were no significant differences found in other aspects. CONCLUSION: Ramosetron is superior to ondansetron in terms of faster recovery in bowel mobility, with similar effects in preventing the incidence of PONV.
Analgesia ; Analgesia, Patient-Controlled ; Analgesics, Opioid ; Benzimidazoles ; Humans ; Hysterectomy ; Ileus ; Incidence ; Medical Records ; Nausea ; Ondansetron ; Postoperative Nausea and Vomiting ; Serotonin ; Uterine Diseases ; Vomiting

Dermatomyositis is a systemic connective tissue disease affecting the skeletal muscles and skin. Necrotizing cutaneous vasculitis and subsequent diffuse subcutaneous and muscular calcification in patients with dermatomyositis is uncommon and has not been reported. A 23-year-old female with dermatomyositis developed necrotizing cutaneous vasculitis in the knee, elbow, buttock, toe and fingers associated with large ulcer formation. Her left 5th finger was amputated due to massive soft tissue destruction, and her right 5th finger later auto-amputated. Thereafter, she developed small subcutaneous nodules on both wrists, elbows, upper arms, neck, buttocks and thighs. X-ray, computerized tomography and gracilis muscle biopsy confirmed diffuse subcutaneous, fascia and muscular calcifications.
Arm ; Biopsy ; Buttocks ; Connective Tissue Diseases ; Dermatomyositis ; Elbow ; Fascia ; Female ; Fingers ; Humans ; Knee ; Muscle, Skeletal ; Muscles ; Neck ; Skin ; Thigh ; Toes ; Ulcer ; Vasculitis ; Wrist ; Young Adult

Metastatic gastric cancer is extremely rare and gastric metastasis from ovarian adenocarcinoma has rarely been reported. All of the previously reported metastatic lesions presented as an ulcerative lesions. We report a case of 49-year-old woman in which gastric metastasis from ovarian adenocarcinoma presented as a submucosal tumor without ulceration on endoscopic examination. Gastrointestinal stromal tumor was suspected on endoscopic ultrasound (EUS) examination. It was confirmed histopathologically as metastatic ovarian adenocarcinoma after endoscopic submucosal dissection (ESD) with enucleation. Submucosal tumor of the stomach in patients with ovarian carcinoma should not be overlooked and ESD with enucleation may be a viable option when EUS with fine needle aspiration is not available.
Adenocarcinoma ; Biopsy, Fine-Needle ; Female ; Gastrointestinal Stromal Tumors ; Humans ; Middle Aged ; Neoplasm Metastasis ; Stomach ; Stomach Neoplasms ; Ulcer

BACKGROUND/AIMS: Microsatellite instability (MSI) is associated with mutations in the DNA mismatch repair system and accounts for 10-15% of all cases of sporadic colorectal cancer (CRC). However, the characteristics and role of MSI as a marker for predicting the prognosis and therapeutic effect on CRC remain unclear. METHODS: Between June 2003 and December 2007, 259 patients (males, 159 [61%]; age, 63 [+/-11] years) who underwent surgery for CRC were retrospectively enrolled. The clinicopathologic characteristics of patients with high-frequency MSI (MSI-H) CRC were reviewed and compared to patients with low-frequency MSI or microsatellite stable CRC. The patient characteristics and MSI-related data were recorded for the following variables: gender, age, clinicopathologic findings, chemotherapy response, recurrence, and survival. RESULTS: MSI-H CRC was diagnosed in 30 patients (12%), low-frequency MSI CRC was diagnosed in 10 patients (4%), and microsatellite stable CRC in was diagnosed in 219 patients (84%). The MSI-H group exhibited the following characteristics: large size, right colon location, positive response to chemotherapy, low recurrence, longer survival, less neural invasion, poor differentiation, diffuse lymphoid reaction, and mucin pool formation. However, in the chemotherapy group (n=180), MSI-H was not a marker of longer survival. Based on Cox-regression analysis, stage IV CRC (OR=6.66; 95% CI, 2.24-53.00), MSI-H (OR=0.17; 95% CI, 0.04-0.73), and a positive response to chemotherapy (OR=0.02; 95% CI, 0.01-0.11) were related to mortality. CONCLUSIONS: MSI-H CRC had less neural invasion and diffuse lymphoid reaction. Further studies regarding the relationship between those pathologic findings and survival are needed.
Colon ; Colorectal Neoplasms ; DNA Mismatch Repair ; Humans ; Microsatellite Instability ; Microsatellite Repeats ; Mucins ; Prognosis ; Recurrence ; Retrospective Studies ; Succinimides

OBJECTIVE: The purpose of this study is to identify the cooperation between histologic diagnosis and sonographic pattern of functional ovarian cyst. And also determine performances of ultrasound, computed tomography, and tumor markers in diagnosis of functional ovarian cyst. METHODS: We retrospectively reviewed the medical records of 129 patients with ovarian cystic tumors undergone an adnexectomy between 2006 and 2008 at Kyung Hee medical center. All patients performed sonographic examinations, and a computed tomography or CA-125 or CA-19-9 were done if needed. RESULTS: Among 129 patients, 35 patients were diagnosed to be functional ovarian cyst. Sensitivity and specificity of ultrasound for functional cyst was 37.1% and 82.9%, respectively. Sensitivity and specificity of computed tomography was 47.6% and 69.3%, respectively. Tumor markers were not useful to detect functional ovarian cyst. If any one of the two appeared functional ovarian cyst, the sensitivity and specificity was 66.6%, 67.7% each. CONCLUSION: Computed tomography can be used as an alternative option replacing ultrasound, but combination of computed tomography and ultrasound does not provide the additional benefit in early diagnosis of functional ovarian cyst.
Early Diagnosis ; Female ; Humans ; Medical Records ; Ovarian Cysts ; Retrospective Studies ; Sensitivity and Specificity ; Biomarkers, Tumor

OBJECTIVE: The impact of maternal stress on pregnancy outcome has been a focus of research and cortisol is known as a biomarker of psychological stress. The aim of this study is to evaluate the relationship between salivary cortisol levels and pregnancy outcomes prospectively. METHODS: The subjects of this study were healthy pregnant women who collected morning samples of saliva (10~12 AM) at 10~13, 20~23 weeks of gestation, and postpartum 2 days between April 2007 to March 2008. Saliva was collected with commercial collector, Salivette(R), and cortisol level was analyzed by enzyme immunoassay. They also underwent ultrasonographic examination of umbilical and uterine artery Doppler between 20~23 weeks of gestation. Statistical analysis was assessed between salivary cortisol levels and pregnancy outcomes, including Doppler findings. RESULTS: A total 39 pregnant women collected salivary cortisol as indicated. They showed increase in cortisol level in 2nd trimester compared to 1st trimester, which decreased after delivery. Salivary cortisol level was not associated with maternal age, parity, occupation, body mass index, blood pressure, delivery mode, fetal sex, and fetal weight. However higher cortisol level was associated with lower resistance index of uterine artery, even there was no statistical significance. CONCLUSION: Our data could not show any association between salivary cortisol levels and pregnancy outcomes. Although this study presents a number of methodological and conceptual challenges, this does not necessarily preclude the use of salivary cortisol measures, but rather point to the importance of careful research design.
Blood Pressure ; Body Mass Index ; Female ; Fetal Weight ; Humans ; Hydrocortisone ; Immunoenzyme Techniques ; Maternal Age ; Occupations ; Parity ; Postpartum Period ; Pregnancy ; Pregnancy Outcome ; Pregnant Women ; Research Design ; Saliva ; Stress, Psychological ; Uterine Artery