Purpose: Gastric cancer (GC) is among the most prevalent and fatal cancers worldwide.National cancer screening programs in countries with high incidences of this disease provide medical aid beneficiaries with free-of-charge screening involving upper endoscopy to detect early-stage GC. However, the coronavirus disease 2019 (COVID-19) pandemic has caused major disruptions to routine healthcare access. Thus, this study aimed to assess the impact of COVID-19 on the diagnosis, overall incidence, and stage distribution of GC. Materials and Methods: We identified patients in our hospital cancer registry who were diagnosed with GC between January 2018 and December 2021 and compared the cancer stage at diagnosis before and during the COVID-19 pandemic. Subgroup analyses were conducted according to age and sex. The years 2018 and 2019 were defined as the “before COVID” period, and the years 2020 and 2021 as the “during COVID” period. Results: Overall, 10,875 patients were evaluated; 6,535 and 4,340 patients were diagnosed before and during the COVID-19 period, respectively. The number of diagnoses was lower during the COVID-19 pandemic (189 patients/month vs. 264 patients/month) than before it.Notably, the proportion of patients with stages 3 or 4 GC in 2021 was higher among men and patients aged ≥40 years. Conclusions During the COVID-19 pandemic, the overall number of GC diagnoses decreased significantly in a single institute. Moreover, GCs were in more advanced stages at the time of diagnosis. Further studies are required to elucidate the relationship between the COVID-19 pandemic and the delay in the detection of GC worldwide.

Recent advances in endoscopic imaging of the esophagus have revolutionized the diagnostic capability for detecting premalignant changes and early esophageal malignancy. In this article, we review the practical application of narrow-band imaging focusing on diseases of the esophagus, including Barrett’s esophagus, adenocarcinoma, and squamous cell carcinoma.

Recent advances in endoscopic imaging of the esophagus have revolutionized the diagnostic capability for detecting premalignant changes and early esophageal malignancy. In this article, we review the practical application of narrow-band imaging focusing on diseases of the esophagus, including Barrett’s esophagus, adenocarcinoma, and squamous cell carcinoma.

PURPOSE: Iron deficiency anemia (IDA) is one of the most common nutritional deficiencies in children on a weaning diet. We investigated weaning practices in infants and children, as well as their mothers' knowledge about weaning. METHODS: We investigated 129 children with IDA and 166 without IDA (aged 6-36 months) who had visited 10 university hospitals between March 2006 and July 2007. We investigated the hematologic values of both groups. A questionnaire on weaning was answered by the mothers of these children. RESULTS: The hematologic values in the IDA group showed a significant difference from those in the comparison group (P<0.05). Children who were solely breastfed until 6 months of age were 85%, 34% (P<0.05), and weaning was started by 6.3, 6.4 months, respectively (P>0.05). Rice gruel, boiled rice, and fruit juice accounted for approximately 8 0% of the starting foods in both groups (P>0.05). Only 40% of the children in the IDA group had a balanced diet within a month, versus 38% in the comparison group. In response to questions about the necessity of iron-fortified foods for breast-fed infants, less than 50% of mothers in both groups answered correctly. In the IDA group, 42% showed serum ferritin less than 10 ng/ mL, while 92% showed serum MCV less than 72 fL. CONCLUSION: In conclusion, collection of information on history should be thorough for feeding and selective examinations for IDA in high-risk groups. Considering the adaptation period, we suggest beginning children on a weaning diet at 45 months. In addition, we need to educate mothers on weaning practice, especially on the necessity of iron-fortified foods for breast-fed infants.
Anemia, Iron-Deficiency ; Child ; Diet ; Ferritins ; Fruit ; Hospitals, University ; Humans ; Infant ; Iron ; Malnutrition ; Mothers ; Surveys and Questionnaires ; Weaning

BACKGROUND: The advances in surgical technology, anesthesia and perioperative care have made it possible to perform laparoscopic cholecystectomy on an outpatient basis. This study was conducted to assess the analgesic effect and the adverse events of different dosing methods when using transdermal fentanyl patches (TDFPs) after laparoscopic cholecystectomy. METHODS: Sixty patients who were to undergo laparoscopic cholecystectomy under general anesthesia were divided into two groups. Group 1: 2 TDFPs that released 12microgram/h were applied after the induction of anesthesia and these 2 patches were removed after 24 hours. Group 2: 2 TDFPs that released 12microgram/h were applied after the induction of anesthesia and one patch was removed after 7 hours and the other patch was removed after 24 hours. The intensity of the postoperative pain was assessed by using a visual analogue scale (VAS) and assessing the adverse events, including dizziness, pruritus and nausea/vomiting, were recorded for 48 hours postoperatively. RESULTS: The VAS score of postoperative pain was not significantly different between the two groups at all times. The incidence of dizziness in groups I and II was 10 and 3, respectively, and the incidence of nausea/vomiting in group I and II was 4 and 0, respectively. The incidences of dizziness and nausea/vomiting in group II were significantly lower than those of group I (P < 0.05). CONCLUSIONS: A dosing method that removes half of the TDFPs (24microgram/h) after 7 hours of application caused a lower incidence of dizziness and nausea/vomiting without any significant difference of postoperative analgesic efficacy, as compared to leaving on both the TDFPs (24microgram/h) for 24 hours after laparoscopic cholecystectomy.
Anesthesia ; Anesthesia, General ; Cholecystectomy, Laparoscopic ; Dizziness ; Fentanyl ; Humans ; Incidence ; Outpatients ; Pain, Postoperative ; Perioperative Care ; Pruritus

BACKGROUND: The aim of this study was to measure the effect of smoking on bronchial mucus transport velocity with bronchoscope under total intravenous anesthesia. METHODS: Twenty six ASA physical status I male patients (13 smokers and 13 nonsmokers) were enrolled into this study. They scheduled to undergo elective orthopedic surgery and were operated under total intravenous anesthesia using propofol and remifentanil. Single drop (approximately 0.02 cc) of methylene blue was applied to the posterior mucosal surface of right main bronchus 5 cm away from carina by the bronchoscope with epidural catheter 30 minutes after tracheal intubation. Two, four minutes after methylene blue application, the transport of methylene blue was observed. Six minutes after methylene blue application, the distance of methylene blue movement was measured. RESULTS: Mean bronchial mucus transport distance and velocity of methylene blue in smoker group vs nonsmoker group was 9.1 +/- 5.5 mm and 1.5 +/- 1.0 mm/min vs 24.3 +/- 15.2 mm and 4.1 +/- 2.5 mm/min respectively. Mean bronchial mucus transport distance of methylene blue in the smoker group was shorter than that in the nonsmoker group (P value < 0.05). Mean bronchial mucus transport velocity of methylene blue in the smoker group was slower than that in the nonsmoker group (P < 0.05). CONCLUSIONS: Smoking may delay transport of bronchial secretion in terms of bronchial mucus transport velocity under total intravenous anesthesia.
Anesthesia, Intravenous ; Bronchi ; Bronchoscopes ; Catheters ; Humans ; Intubation ; Male ; Methylene Blue ; Mucus ; Orthopedics ; Piperidines ; Propofol ; Smoke ; Smoking

BACKGROUND: Cough reflex in response to extubation of the endotracheal tube is common; however, the effect of remifentanil on cough reflex is uncertain. Therefore, we evaluated the effect of lidocaine and remifentanil on cough reflex following extubation. METHODS: Forty adult patients scheduled to undergo elective surgery in two hours were enrolled in this study. All patients received a standard anesthetic protocol. Following surgery, the patients were randomly divided into two groups, Group L (n = 20), which received 1.5 mg/kg of 2% lidocaine intravenously, and Group R (n = 20), which received 0.5 microgram/kg remifentanil intravenously. Treatment was administered immediately after the patients opened their eyes, after which extubation was performed. We then evaluated breath holding and recorded the number of coughs at 5 minutes, 15 minutes and 30 minutes after extubation. In addition, we checked for sore throat 30 minutes after extubation. RESULTS: The number of coughs was significantly lower in Group R than in Group L at 5 minutes after extubation. However, there was no significant difference in the number of coughs in Group R and Group L at any other times evaluated. CONCLUSIONS: There are no significant differences in suppression of the cough reflex in response to treatment with lidocaine and remifentanil.
Adult ; Breath Holding ; Cough ; Eye ; Humans ; Lidocaine ; Pharyngitis ; Piperidines ; Reflex

BACKGROUND: We evaluated the correlation between the difference of estimated lean body mass (LBM(E)) with actual lean body mass (LBM(A)) and actual blood concentration of propofol, hemodynamic variables and Bispectral index (BIS) during target controlled infusion (TCI) of propofol in Korean female patients who would take total intravenous anesthesia (TIVA) using propofol-remifentanil combination. METHODS: Eighty Korean women participated in this trial. Demographic data were collected and LBM(A) was measured using body mass analyzer. Target concentration of propofol was set at 6microgram/ml during induction and 3microgram/ml during maintenance. Hemodynamic variables and BIS were measured at 60 minutes after anesthetic induction. Peripheral blood sample was collected from a large forearm vein on the contralateral side of infusion for measurement of whole blood concentration of propofol at 60 minutes after anesthetic induction. Delta lean body mass (delta LBM) was obtained by subtracting LBM(A) from LBM(E). Correlation analyses were done between delta LBM and plasma propofol concentration, blood pressure, and BIS, respectively. RESULTS: Blood concentrations of propofol were 1.9-6.9microgram/ml. Mean plasma concentration of propofol was higher than target concentration. delta LBM had a positive correlation with actual plasma propofol concentration. delta LBM was not correlated with hemodynamic variables and BIS. CONCLUSIONS: TCI of propofol resulted in large variation in measured plasma concentration. We thought delta LBM was one of interpatient variation factors of propofol plasma concentration during TCI. We found that TCI of propofol using Schnider model would result in higher blood concentration than target concentration in Korean women.
Anesthesia, Intravenous ; Blood Pressure ; Female ; Forearm ; Hemodynamics ; Humans ; Plasma ; Propofol ; Veins

Electroconvulsive therapy (ECT) is sometimes indicated for the treatment of psychiatric disorders during pregnancy. We describe a patient at 17-26 weeks gestation who took twelve ECT treatments for her bipolar disorder. At third ECT, we changed the induction agent from thiopental sodium to propofol due to her post-ECT delirium. At ninth ECT, there was a brief fetal heart rate deceleration associated with maternal ECT. The patient gradually improved and was discharged in remission after twelve ECT treatments. A healthy boy was born by cesarean section at 38 weeks of gestation. We report this case with a brief review of the relevant literature.
Anesthesia ; Bipolar Disorder ; Cesarean Section ; Deceleration ; Delirium ; Electroconvulsive Therapy ; Female ; Heart Rate, Fetal ; Humans ; Pregnancy ; Propofol ; Thiopental

BACKGROUND: Laryngoscopy and endotracheal intubation may cause tachycardia and hypertension. Magnesium directly inhibits the release of catecholamine from the adrenal medulla, with has a vasodilating effect. Remifentanil indirectly decreases the release of catecholamine by increasing the depth of anesthetic. The effects of magnesium sulfate and remifentanil at attenuating the sympathetic responses were compared during laryngoscopy and endotracheal intubation. METHODS: Eighty ASA class 1 or 2 patients, scheduled for elective surgery under general anesthesia, and requiring endotracheal intubation, were divided into four groups. The patient received either normal saline, 50 mg/kg magnesium sulfate, 1.0microgram/kg remifentanil or 25 mg/kg magnesium sulfate and 0.5microgram/kg remifentanil Groups C, M, R and MR, respectively, according to their assigned group. The specific drugs for each group were administered over a 30 second period prior to the induction of anesthesia with 2 mg/kg propofol and 1.5 mg/kg succinylcholine. The Systolic blood pressure, diastolic blood pressure and heart rate were recorded prior to induction (T1), immediately prior to intubation (T2), immediately after intubation (T3), and 1 and 3 minutes after intubation (T4 and T5, respectively). RESULTS: The percentage changes in the systolic blood pressure of groups M, R and MR were lower immediately after intubation than that of group C. The systolic blood pressures of groups M and MR increased from those at the baseline, but the systolic blood pressure of group R decreased from that at the baseline immediately after intubation. The heart rate of group M increased from that at the baseline, but the heart rate of group R decreased from that at the baseline immediately prior to intubation. CONCLUSIONS: The blood pressure immediately after endotracheal intubation was increased by the administration of magnesium sulfate, but the induced change was less than that of group C. The blood pressure was decreased by the administration of remifentanil immediately after endotracheal intubation. Magnesium sulfate caused tachycardia, but remifentanil caused bradycardia.
Adrenal Medulla ; Anesthesia ; Anesthesia, General ; Blood Pressure ; Bradycardia ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension ; Intubation ; Intubation, Intratracheal* ; Laryngoscopy ; Magnesium Sulfate* ; Magnesium* ; Propofol ; Succinylcholine ; Tachycardia