Background/Aims: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly-used medications, and ailments such as arthritis or heart disease, require long-term use of these drugs, which can induce gastroenteropathy with bleeding and ulcers. This study investigated the associations between efficacy, safety, and gastrointestinal symptoms linked to rebamipide and proton pump inhibitor administration in patients requiring long-term NSAID use. Methods: This study was a multi-center, randomized, open-labeled, pilot design. Results: Thirty-three patients were included. Of these, 15 were included in the study group and 18 were in the control group. NSAID-induced gastric ulcers, which were the primary outcome of this study, did not occur in either the study or control group. Changes in the number of small bowel erosions and ulcers were –0.6 ± 3.06 in the study group and 1.33 ± 4.71 in the control group. The number of subjects with mucosal breaks (defined as multiple erosions and/or ulcers) was three (20%) in the study group and six (40%) in the control group (p = 0.427). No serious adverse events occurred in either group. However, dyspepsia and skin rashes occurred in six patients (31.58%) in the study group and 13 (65%) in the control group (p = 0.036). Conclusions Although statistically significant differences were not generated, possibly as a result of the small sample size, mucosal breaks observed via capsule endoscopy revealed that rebamipide was likely to be more effective than lansoprazole in preventing small intestine damage caused by NSAIDs. Furthermore, fewer side-effects emerged with rebamipide.

OBJECTIVES: Obstructive sleep apnea (OSA) is a sleep-related breathing disorder that is characterized by repetitive collapse or partial collapse of the upper airway during sleep in spite of ongoing effort to breathe. It is believed that OSA is usually worsened in REM sleep, because muscle tone is suppressed during REM sleep. However, many cases showed a higher apnea-hypopnea index (AHI) during NREM sleep than during REM sleep. We aimed here to determine the characteristics of REM sleep-dependent OSA (REM-OSA) and NREM sleep-dependent OSA (NREM-OSA). METHODS: Five hundred sixty polysomnographically confirmed adult OSA subjects were studied retrospectively. All patients were classified into 3 groups based on the ratio between REM-AHI and NREM-AHI. REM-OSA was defined as REM-AHI/NREM-AHI > 2, NREM-OSA as NREM-AHI/REM-AHI > 2, and the rest as sleep stage-independent OSA (IND-OSA). In addition to polysomnography, questionnaires related to subjective sleep quality, daytime sleepiness, and emotion were completed. Chi-square test, ANOVA, and ANCOVA were performed. RESULTS: There was no age difference among subgroups. The REM-OSA group was comprised of large proportions of mild OSA and female OSA patients. These patients experienced poor sleep and more negative emotions than other two groups. The AHI and oxygen desaturation index (ODI) were lowest in REM-OSA. Sleep efficiency and N3 percentage of REM-OSA were higher than in NREM-OSA. The percentage of patients who slept in a supine position was higher in REM-OSA than other subgroups. IND-OSA showed higher BMI and larger neck circumference and abdominal circumference than REM-OSA. The patients with IND-OSA experienced more sleepiness than the other groups. AHI and ODI were highest in IND-OSA. NREM-OSA presented the shortest total sleep time and the lowest sleep efficiency. NREM-OSA showed shorter sleep latency and REM latency and higher percentage of N1 than those of REM-OSA and the highest proportion of those who slept in a lateral position than other subgroups. NREM-OSA revealed the highest composite score on the Horne and Östberg questionnaire. With increased AHI severity, the numbers of apnea and hypopnea events during REM sleep decreased, and the numbers of apnea and hypopnea events during NREM sleep increased. The results of ANCOVA after controlling age, sex, BMI, NC, AC, and AHI showed the lowest sleep efficiency, the highest AHI in the supine position, and the highest percentage of waking after sleep onset in NREM-OSA. CONCLUSION: REM-OSA was associated with the mild form of OSA, female sex, and negative emotions. IND-OSA was associated with the severe form of OSA. NREM-OSA was most closely related to position and showed the lowest sleep efficiency. Sleep stage-dependent characteristics could provide better understanding of OSA.
Adult ; Animals ; Apnea ; Female ; Horns ; Humans ; Neck ; Oxygen ; Polysomnography ; Respiration ; Retrospective Studies ; Sleep Apnea, Obstructive* ; Sleep, REM ; Supine Position

This article was published with a misspelled the date of acceptance. The date of acceptance should be corrected as “March 7, 2013”.
Breast Neoplasms* ; Breast* ; Humans ; Recurrence*

OBJECTIVE: The study’s aim was to develop and standardize a Korean version of the University of California San Diego Performance-based Skills Assessment (K-UPSA), which is used to evaluate the daily living function of patients with schizophrenia. METHODS: Study participants were 78 patients with schizophrenia and 27 demographically matched healthy controls. We evaluated the clinical states and cognitive functions to verify K-UPSA’s reliability and validity. For clinical states, the Positive and Negative Syndrome Scale, Clinical Global Impression-Schizophrenia scale, and Social and Occupational Functioning Assessment Scale and Schizophrenia Quality of Life Scale-fourth revision were used. The Schizophrenia Cognition Rating Scale, Short-form of Korean-Wechsler Adult Intelligence Scale, and Wisconsin Card Sorting Test were used to assess cognitive function. RESULTS: The K-UPSA had statistically significant reliability and validity. The K-UPSA has high internal consistency (Cronbach’s alpha, 0.837) and test-retest reliability (intra-class correlation coefficient, 0.381–0.792; p<0.001). The K-UPSA had significant discriminant validity (p<0.001). Significant correlations between the K-UPSA’s scores and most of the scales and tests listed above demonstrated K-UPSA’s concurrent validity (p<0.001). CONCLUSION: The K-UPSA is useful to evaluate the daily living function in Korean patients with schizophrenia.
Adult ; California* ; Cognition ; Humans ; Intelligence ; Quality of Life ; Reproducibility of Results* ; Schizophrenia ; Weights and Measures ; Wisconsin

C1q nephropathy is a rare glomerular disease, defined by characteristic mesangial C1q immune deposition seen in immunofluorescence microscopy with no serological evidence of systemic lupus erythematosus. C1q nephropathy can be diagnosed with a subsequent biopsy, as with IgA nephropathy. There are some cases with an initial diagnosis of hematuria and proteinuria with minimal disease changes, focal segmental glomerulonephritis, and mesangial proliferative glomerulonephritis, but lacking C1q nephropathy, in which C1q deposition on immunofluorescence subsequently develops. We report a case that was diagnosed as diffuse mesangial proliferative glomerulonephritis, but a subsequent biopsy showed C1q nephropathy, with C1q deposition in both immunohistochemistry and electron microscopy (EM). We treated the C1q nephropathy with methylprednisolone and confirmed the disappearance of C1q depositions by both immunohistochemistry and EM in a follow-up biopsy.
Biopsy ; Complement C1q ; Diagnosis ; Fluorescent Antibody Technique ; Follow-Up Studies ; Glomerulonephritis ; Glomerulonephritis, IGA ; Hematuria ; Immunohistochemistry ; Lupus Erythematosus, Systemic ; Methylprednisolone ; Microscopy, Electron ; Microscopy, Fluorescence ; Proteinuria

In order to determine the status of Enterobius vermicularis infection among schoolchildren in suburban areas of Myanmar, 761 primary schoolchildren in 3 different townships around Yangon City were subjected to a survey using cello-tape anal swabs. The subjected schoolchildren were 383 boys and 378 girls who were 5-7 years of age. Only 1 anal swab was obtained from each child. The overall egg positive rate of E. vermicularis was 47.2% (359 positives), and sex difference was not remarkable (48.6% in boys and 45.8% in girls). However, the positive rate was the highest in South Dagon (54.6%) followed by Hlaing Thayar (43.8%) and North Dagon (34.8%). This difference was highly correlated with the living standards of the people in each township. Nucleotide sequence of the 5S rDNA from the eggs on the cello-tape (2 children) revealed 99.7% identity with that of E. vermicularis reported in GenBank. The results indicated that E. vermicularis infection is highly prevalent among primary schoolchildren around Yangon, Myanmar.
Animals ; Child ; Child, Preschool ; Enterobiasis/diagnosis/*epidemiology/*parasitology ; Enterobius/genetics/*isolation & purification ; Female ; Humans ; Male ; Myanmar/epidemiology ; Parasite Egg Count ; Prevalence ; Students/statistics & numerical data

PURPOSE: IBTR! 2.0 is a web-based nomogram that predicts the 10-year ipsilateral breast tumor recurrence (IBTR) rate after breast-conserving therapy. We validated this nomogram in Korean patients. METHODS: The nomogram was tested for 520 Korean patients, who underwent breast-conserving surgery followed by radiation therapy. Predicted and observed 10-year outcomes were compared for the entire cohort and for each group, predefined by nomogram-predicted risks: group 1, <3%; group 2, 3% to 5%; group 3, 5% to 10%; group 4, >10%. RESULTS: In overall patients, the overall 10 year predicted and observed estimates of IBTR were 5.22% and 5.70% (p=0.68). In group 1, (n=124), the predicted and observed estimates were 2.25% and 1.80% (p=0.73), in group 2 (n=177), 3.95% and 3.90% (p=0.97), in group 3 (n=181), 7.14% and 8.80% (p=0.42), and in group 4 (n=38), 11.66% and 14.90% (p=0.73), respectively. CONCLUSION: In a previous validation of this nomogram based on American patients, nomogram-predicted IBTR rates were overestimated in the high-risk subgroup. However, our results based on Korean patients showed that the observed IBTR was higher than the predicted estimates in groups 3 and 4. This difference may arise from ethnic differences, as well as from the methods used to detect IBTR and the healthcare environment. IBTR! 2.0 may be considered as an acceptable nomogram in Korean patients with low- to moderate-risk of in-breast recurrence. Before widespread use of this nomogram, the IBTR! 2.0 needs a larger validation study and continuous modification.
Breast ; Breast Neoplasms ; Cohort Studies ; Delivery of Health Care ; Humans ; Mastectomy, Segmental ; Nomograms ; Recurrence

Rhabdomyosarcoma (RMS) of the breast is rare and there is scant information about the clinical behavior and treatment strategies. We report an adolescent female patient with metastatic RMS of the breast from the anus. An 18-year-old female patient was referred to our clinic due to palpable mass in the left breast. At age seven, she was diagnosed with acute lymphoblastic leukemia and treated with chemoradiation therapy. After 10 years of complete remission state, she presented with anal mass which was diagnosed as RMS and she received chemoradiation therapy. After 1 year of complete remission state, she noticed a palpable mass in her left breast. The breast mass was diagnosed as metastatic RMS based on core needle biopsy specimen. The RMS in breast was excised for the decreasing tumor burden despite of another metastatic lesion. Although rarely reported, metastasis of RMS should be considered as a cause of breast mass. Tissue biopsy is recommended when clinically suspected lesion is detected.
Adolescent ; Anal Canal ; Biopsy ; Biopsy, Large-Core Needle ; Breast ; Female ; Humans ; Neoplasm Metastasis ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Rhabdomyosarcoma ; Tumor Burden

PURPOSE: Primary breast lymphoma is a very rare disease, accounting for 0.4-0.5% of all breast malignancies. Due to the rarity, there are only limited reports of this disease in Korean women. In this reason, we report the experience of a single institution in Korea with primary breast lymphoma (PBL). METHODS: We retrospectively reviewed the medical records of 9 patients with PBL and evaluated the clinicopathologic characteristics and treatment outcomes. RESULTS: All nine patients were female and had diffuse large B-cell lymphoma (DLBL). The median age at diagnosis was 47.9 years and the median tumor size was 3.8 cm in diameter. The most common symptom was a painless palpable mass. Five patients were classified as stage IEA and four patients were IIEA according to the Ann Arbor staging system. Four patients underwent excisional biopsy and one patient underwent a lumpectomy with sentinel lymph node biopsy due to uncertain histology of the preoperative core needle biopsy. Nine patients received anthracycline containing combined chemotherapy; among them, five patients were treated with a rituximab containing regimen. Four patients received radiotherapy combined with chemotherapy. A complete response was achieved in eight patients. During the 44 months of the median follow-up period, three cases of relapse occurred, and among them, two patients died due to disease progression. CONCLUSION: Most PBLs are B-cell origin, with DLBL being the most common histologic type. A combined treatment modality has been known to have positive effects on prognosis, and surgery should be limited to a diagnostic purpose.
Accounting ; Antibodies, Monoclonal, Murine-Derived ; B-Lymphocytes ; Biopsy ; Biopsy, Large-Core Needle ; Breast ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Humans ; Korea ; Lymphoma ; Lymphoma, B-Cell ; Mastectomy, Segmental ; Medical Records ; Nitriles ; Prognosis ; Pyrethrins ; Rare Diseases ; Recurrence ; Retrospective Studies ; Rituximab ; Sentinel Lymph Node Biopsy ; Treatment Outcome

BACKGROUND: The loss of resistance technique is the most popular method for identifying the epidural space. Air or liquid is a commonly used medium for this technique. These two media have certain advantages and disadvantages. A liquid filled pressure line connected to an air syringe might have advantages of both air and liquid while preventing the drawbacks of each medium. METHODS: Twenty-five consecutive patients were scheduled to receive an epidural anesthesia for surgery and selected for study. A lidocaine filled pressure line connected to an air syringe allowed for sequential injection of lidocaine and air. The time spent on the procedure, amount of air injected into the epidural space, inadvertent puncture of the dura mater, and rate of anesthetic failure were recorded. RESULTS: The procedure took less than 2 minutes in 22 cases. The average amount of air lost from the syringe during the loss of resistance test was 0.98 +/- 0.23 ml in 22 patients. Volume of the 3-way connected pressure line was 0.95 ml. Therefore, the air volume injected into the epidural space was minimal. In the other 3 cases where previous spinal disease existed, multiple epidural approaches were needed and the procedure took relatively longer with larger injection volumes. There were no complications. CONCLUSIONS: This technique minimized injection of the air into the epidural space during identification but simultaneously, it does not disturb the feel of air compressibility in the syringe.
Anesthesia, Epidural ; Dura Mater ; Epidural Space ; Feasibility Studies ; Humans ; Lidocaine ; Punctures ; Spinal Diseases ; Syringes