BACKGROUND/AIMS: In Korea, the nationwide gastric cancer screening program recommends biennial screening for individuals aged 40 years or older by way of either an upper gastrointestinal series or endoscopy. The national endoscopic quality assessment (QA) program began recommending endoscopy in medical institutions in 2009. We aimed to assess the effect, burden, and cost of the QA program from the viewpoint of medical institutions. METHODS: We surveyed the staff of institutional endoscopic units via e-mail. RESULTS: Staff members from 67 institutions replied. Most doctors were endoscopic specialists. They responded as to whether the QA program raised awareness for endoscopic quality (93%) or improved endoscopic practice (40%). The percentages of responders who reported improvements in the diagnosis of gastric cancer, the qualifications of endoscopists, the quality of facilities and equipment, endoscopic procedure, and endoscopic reprocessing were 69%, 60%, 66%, 82%, and 75%, respectively. Regarding reprocessing, many staff members reported that they had bought new automated endoscopic preprocessors (3%), used more disinfectants (34%), washed endoscopes longer (28%), reduced the number of endoscopies performed to adhere to reprocessing guidelines (9%), and created their own quality education programs (59%). Many responders said they felt that QA was associated with some degree of burden (48%), especially financial burden caused by purchasing new equipment. Reasonable quality standards (45%) and incentives (38%) were considered important to the success of the QA program. CONCLUSIONS: Endoscopic quality has improved after 5 years of the mandatory endoscopic QA program.
Diagnosis ; Disinfectants ; Education ; Electronic Mail ; Endoscopes ; Endoscopy ; Korea* ; Mass Screening ; Motivation ; Specialization ; Stomach Neoplasms

OBJECTIVE: To evaluate pulmonary functions of patients with amyotrophic lateral sclerosis (ALS), Duchenne muscular dystrophy (DMD), and myotonic muscular dystrophy (MMD) at the onset of ventilatory insufficiency. METHODS: This retrospective study included ALS, DMD, and MMD patients with regular outpatient clinic follow-up in the Department of Rehabilitation Medicine at Gangnam Severance Hospital before the application of non-invasive positive pressure ventilation (NIPPV). The patients were enrolled from August 2001 to March 2014. If patients experienced ventilatory insufficiency, they were treated with NIPPV, and their pulmonary functions were subsequently measured. RESULTS: Ninety-four DMD patients, 41 ALS patients, and 21 MMD patients were included in the study. The mean SpO2 was lower in the MMD group than in the other two groups. The mean forced vital capacity (FVC) in the supine position was approximately low to mid 20% on average in DMD and ALS patients, whereas it was 10% higher in MMD patients. ALS patients showed a significantly lower FVC in the supine position than in the sitting position. Maximal insufflation capacity, unassisted peak cough flow, maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP) were significantly higher in MMD group than in the other groups. MEP was significantly the lowest in DMD patients, followed by in ALS, and MMD patients, in order. CONCLUSION: Disease-specific values of pulmonary function, including FVC, MEP, and MIP, can be accurately used to assess the onset of ventilatory insufficiency in patients with ALS, DMD, and MMD.
Ambulatory Care Facilities ; Amyotrophic Lateral Sclerosis* ; Cough ; Follow-Up Studies ; Humans ; Insufflation ; Muscular Dystrophies* ; Muscular Dystrophy, Duchenne* ; Myotonic Dystrophy ; Neuromuscular Diseases ; Positive-Pressure Respiration ; Rehabilitation ; Respiratory Insufficiency ; Retrospective Studies ; Supine Position ; Vital Capacity

The role of atypical bacteria and the effect of antibiotic treatments in acute bronchitis are still not clear. This study was conducted at 22 hospitals (17 primary care clinics and 5 university hospitals) in Korea. Outpatients (aged > or = 18 yr) who had an acute illness with a new cough and sputum (< or = 30 days) were enrolled in 2013. Multiplex real-time polymerase chain reaction (RT-PCR) was used to detect five atypical bacteria. A total of 435 patients were diagnosed as having acute bronchitis (vs. probable pneumonia, n = 75), and 1.8% (n = 8) were positive for atypical pathogens (Bordetella pertussis, n = 3; B. parapertussis, n = 0; Mycoplasma pneumoniae, n = 1; Chlamydophila pneumoniae, n = 3; Legionella pneumophila, n = 1). Among clinical symptoms and signs, only post-tussive vomiting was more frequent in patients with atypical pathogens than those without (P = 0.024). In all, 72.2% of the enrolled patients received antibiotic treatment at their first visits, and beta-lactams (29.4%) and quinolones (20.5%) were the most commonly prescribed agents. In conclusion, our study demonstrates that the incidence of atypical pathogens is low in patients with acute bronchitis, and the rate of antibiotic prescriptions is high.
Anti-Bacterial Agents/therapeutic use ; Bordetella parapertussis/genetics/*isolation & purification ; Bordetella pertussis/genetics/*isolation & purification ; Bronchitis/drug therapy/*microbiology ; Chlamydophila pneumoniae/genetics/*isolation & purification ; Community-Acquired Infections/microbiology ; Female ; Humans ; Hypertension/complications ; Legionella pneumophila/genetics/*isolation & purification ; Male ; Middle Aged ; Mycoplasma pneumoniae/genetics/*isolation & purification ; Real-Time Polymerase Chain Reaction ; Republic of Korea ; Sputum/microbiology

OBJECTIVE: This study aimed to examine clinical practice patterns in the management of pregnant women admitted with threatened preterm labor (TPL) in Korea. METHODS: Data from women admitted with a diagnosis of TPL were collected from 22 hospitals. TPL was defined as regular uterine contractions with or without other symptoms such as pelvic pressure, backache, increased vaginal discharge, menstrual-like cramps, bleeding/show and cervical changes. Data on general patient information, clinical characteristics at admission, use of tocolytics, antibiotics, and corticosteroids, and pregnancy outcomes were collected using an online data collections system. RESULTS: A total of 947 women with TPL were enrolled. First-line tocolysis was administered to 822 (86.8%) patients. As a first-line tocolysis, beta-agonists were used most frequently (510/822, 62.0%), followed by magnesium sulfate (183/822, 22.3%), calcium channel blockers (91/822, 11.1%), and atosiban (38/822, 4.6%). Of the 822 women with first-line tocolysis, second-line tocolysis were required in 364 (44.3%). Of 364 with second-line, 199 had third-line tocolysis (37.4%). Antibiotics were administered to 29.9% of patients (284/947) with single (215, 22.7%), dual (26, 2.7%), and triple combinations (43, 4.5%). Corticosteroids were administered to 420 (44.4%) patients. Betamethasone was administered to 298 patients (71.0%), and dexamethasone was administered to 122 patients (29.0%). CONCLUSION: Practice patterns in the management of TPL in Korea were quite various. It is needed to develop standardized practice guidelines for TPL management.
Adrenal Cortex Hormones ; Anti-Bacterial Agents ; Back Pain ; Betamethasone ; Calcium Channel Blockers ; Dexamethasone ; Diagnosis ; Female ; Humans ; Korea ; Magnesium Sulfate ; Muscle Cramp ; Obstetric Labor, Premature* ; Physician's Practice Patterns ; Pregnancy ; Pregnancy Outcome ; Pregnant Women ; Premature Birth ; Retrospective Studies* ; Tocolysis ; Tocolytic Agents ; Uterine Contraction ; Vaginal Discharge

Vitamin D (vit-D) is essential for bone health, although many osteoporosis patients have low levels of 25-hydroxy-vit-D [25(OH)D]. This randomized, open-label study compared the effects of once weekly alendronate 70 mg containing 5600 IU vit-D3 (ALN/D5600) to alendronate 70 mg without additional vit-D (ALN) on the percent of patients with vit-D insufficiency [25(OH)D <15 ng/mL, primary endpoint] and serum parathyroid hormone (PTH, secondary endpoint) levels in postmenopausal, osteoporotic Korean women. Neuromuscular function was also measured. A total of 268 subjects were randomized. Overall, 35% of patients had vit-D insufficiency at baseline. After 16-weeks, there were fewer patients with vit-D insufficiency in the ALN/D5600 group (1.47%) than in the ALN group (41.67%) (p<0.001). Patients receiving ALN/D5600 compared with ALN were at a significantly decreased risk of vit-D insufficiency [odds ratio=0.02, 95% confidence interval (CI) 0.00-0.08]. In the ALN/D5600 group, significant increases in serum 25(OH)D were observed at weeks 8 (9.60 ng/mL) and 16 (11.41 ng/mL), where as a significant decrease was recorded in the ALN group at week 16 (-1.61 ng/mL). By multiple regression analysis, major determinants of increases in serum 25(OH)D were ALN/D5600 administration, seasonal variation, and baseline 25(OH)D. The least squares mean percent change from baseline in serum PTH in the ALN/D5600 group (8.17%) was lower than that in the ALN group (29.98%) (p=0.0091). There was no significant difference between treatment groups in neuromuscular function. Overall safety was similar between groups. In conclusion, the administration of 5600 IU vit-D in the ALN/D5600 group improved vit-D status and reduced the magnitude of PTH increase without significant side-effects after 16 weeks in Korean osteoporotic patients.
Adult ; Aged ; Alendronate/adverse effects/*therapeutic use ; Cholecalciferol/adverse effects/deficiency/*therapeutic use ; Female ; Humans ; Middle Aged ; Osteoporosis, Postmenopausal/*drug therapy ; Vitamin D Deficiency/*drug therapy

Gallbladder perforation during laparoscopic cholecystectomy (LC) with spillage of bile and gallstones occurs frequently, but clinical sequelae caused by dropped gallstones are uncommon. We present a case of subhepatic and right-back abscess formation due to spilled gallstones occurring two years after LC, which were successfully removed using a percutaneous method as a minimally invasive technique. The patient firstly visited a primary care physician with right-back mass that was increasing in size and becoming symptomatic, then underwent incision and drainage. He was referred to our hospital and the subhepatic and right-back inflammatory mass containing spilled gallstones was revealed by computed tomography. Under fluoroscopic control, a percutaneous drainage catheter was placed within the abscess and pus was aspirated. The spilled gallstones were successfully retrieved with basket forceps, thereafter. The patient was discharged without significant complications on the 9th day after the percutaneous stone removal.
Abscess ; Bile ; Catheters ; Cholecystectomy, Laparoscopic ; Drainage ; Gallstones ; Humans ; Physicians, Primary Care ; Suppuration ; Surgical Instruments

Atopic dermatitis (AD) is a chronic eczematous skin disease attended by pruritus, erythema, edema, excoriation, and dryness. This study was to evaluate the effects of Korean red ginseng (RG) on AD in NC/Nga mice treated with 1-chloro-2,4,6-trinitrobenzene (picryl chloride; PC). Experimental groups were divided into 4 groups; normal control (NC), PC control, and PC-RG (50 and 100 mg/kg). RG was orally administered every day repeatedly during 6 weeks. The skin lesions in severity score, scratching behavior, serum immunoglobulin E (IgE), interleukin-4 (IL-4) and interferon-gamma (IFN-gamma) levels, and histological appearance were examined. AD-like lesions were developed on the NC/Nga mice by topical PC applications. Oral administration of RG (50 and 100 mg/kg) significantly suppressed the development of AD, as analyzed by a modified SCORAD score. The scratching behavior decreased after RG administration. The levels of serum IgE, IL-4 and IFN-gamma were increased by PC stimulation, but treatment with RG (100 mg/kg) suppressed the increment of the serum IgE, IL-4 and IFN-gamma levels. Histologically, RG inhibited dermatitis lesions such as hypertrophy, hyperkeratosis, and infiltration of inflammatory cells into epidermis and dermis. These results suggest that the administration of RG may be effective in alleviating the AD induced by PC.
Administration, Oral ; Animals ; Dermatitis ; Dermatitis, Atopic ; Dermis ; Edema ; Epidermis ; Erythema ; Hypertrophy ; Immunoglobulin E ; Immunoglobulins ; Interferon-gamma ; Interleukin-4 ; Mice ; Panax ; Picryl Chloride ; Pruritus ; Skin ; Skin Diseases, Eczematous

Atopic dermatitis (AD) is a chronic eczematous skin disease attended by pruritus, erythema, edema, excoriation, and dryness. This study was to evaluate the effects of Korean red ginseng (RG) on AD in NC/Nga mice treated with 1-chloro-2,4,6-trinitrobenzene (picryl chloride; PC). Experimental groups were divided into 4 groups; normal control (NC), PC control, and PC-RG (50 and 100 mg/kg). RG was orally administered every day repeatedly during 6 weeks. The skin lesions in severity score, scratching behavior, serum immunoglobulin E (IgE), interleukin-4 (IL-4) and interferon-gamma (IFN-gamma) levels, and histological appearance were examined. AD-like lesions were developed on the NC/Nga mice by topical PC applications. Oral administration of RG (50 and 100 mg/kg) significantly suppressed the development of AD, as analyzed by a modified SCORAD score. The scratching behavior decreased after RG administration. The levels of serum IgE, IL-4 and IFN-gamma were increased by PC stimulation, but treatment with RG (100 mg/kg) suppressed the increment of the serum IgE, IL-4 and IFN-gamma levels. Histologically, RG inhibited dermatitis lesions such as hypertrophy, hyperkeratosis, and infiltration of inflammatory cells into epidermis and dermis. These results suggest that the administration of RG may be effective in alleviating the AD induced by PC.
Administration, Oral ; Animals ; Dermatitis ; Dermatitis, Atopic ; Dermis ; Edema ; Epidermis ; Erythema ; Hypertrophy ; Immunoglobulin E ; Immunoglobulins ; Interferon-gamma ; Interleukin-4 ; Mice ; Panax ; Picryl Chloride ; Pruritus ; Skin ; Skin Diseases, Eczematous

Triple valve surgery is usually complex and carries a reported operative mortality of 13% and 10-yr survival of 61%. We examined surgical results based on our hospital's experience. A total of 160 consecutive patients underwent triple valve surgery from 1990 to 2006. The most common aortic and mitral valve disease was rheumatic disease (82%). The most common tricuspid valve disease was functional regurgitation (80%). Seventy-four percent of the patients were in New York Heart Association (NYHA) class III and IV. Univariate and multivariable analyses were performed to identify predictors of early and late survival. Operative mortality was 6.9% (n=11). Univariate factors associated with mortality included old age, preoperative renal failure, postoperative renal failure, pulmonary complications, and stroke. Of them, postoperative renal failure and stroke were associated with mortality on multivariable analysis. Otherwise, neither tricuspid valve replacement nor reoperation were statistically associated with late mortality. Survival at 5 and 10 yr was 87% and 84%, respectively. Ninety-two percent of the patients were in NYHA class I and II at their most recent follow-up. Ten-year freedom from prosthetic valve endocarditis was 97%; from anticoagulation-related hemorrhage, 82%; from thromboembolism, 89%; and from reoperation, 84%. Postoperative renal failure and stroke were significantly related with operative mortality. Triple valve surgery, regardless of reoperation and tricuspid valve replacement, results in acceptable long-term survival.
Adult ; Aged ; Anticoagulants/adverse effects/therapeutic use ; Aortic Valve/*surgery ; Female ; Heart Valve Diseases/complications/mortality/*surgery ; Heart Valve Prosthesis Implantation/*methods ; Hemorrhage/chemically induced/epidemiology ; Humans ; Intraoperative Complications/mortality ; Kidney Failure/etiology ; Male ; Middle Aged ; Mitral Valve/*surgery ; Postoperative Complications/mortality ; Reoperation ; Risk Factors ; Severity of Illness Index ; Stroke/etiology ; Survival Analysis ; Thromboembolism/epidemiology ; Tricuspid Valve/*surgery

Flexibility and fracture properties determine the performance of NiTi rotary instruments. The purpose of this study was to evaluate how geometrical differences between three NiTi instruments affect the deformation and stress distributions under bending and torsional conditions using finite element analysis. Three NiTi files (ProFile .06 / #30, F3 of ProTaper and ProTaper Universal) were scanned using a Micro-CT. The obtained structural geometries were meshed with linear, eight-noded hexahedral elements. The mechanical behavior (deformation and von Mises equivalent stress) of the three endodontic instruments were analyzed under four bending and rotational conditions using ABAQUS finite element analysis software. The nonlinear mechanical behavior of the NiTi was taken into account. The U-shaped cross sectional geometry of ProFile showed the highest flexibility of the three file models. The ProTaper, which has a convex triangular cross-section, was the most stiff file model. For the same deflection, the ProTaper required more force to reach the same deflection as the other models, and needed more torque than other models for the same amount of rotation. The highest von Mises stress value was found at the groove area in the cross-section of the ProTaper Universal. Under torsion, all files showed highest stresses at their groove area. The ProFile showed highest von Mises stress value under the same torsional moment while the ProTaper Universal showed the highest value under same rotational angle.
Collodion ; Finite Element Analysis ; Pliability ; Torque