BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) has been an established treatment for indicated early gastric cancer (EGC) without deterioration of quality of life (QOL) compared with surgical resection. The aim of this study was to evaluate long-term QOL in patients undergoing ESD for EGC. METHODS: Patients scheduled to undergo curative ESD for EGC were prospectively enrolled from 12 institutions between May 2010 and December 2011. Assessments of QOL with Korean versions of the European Organization for Research and Treatment of Cancer (EORTC) QOL questionnaire-core (QLQ-C30) and a gastric cancer-specific questionnaire (STO22) were performed at baseline and at 7 days, 3 months, and 6 months after ESD. RESULTS: A total of 666 subjects were assessed for QLQ-C30 and QLQ-STO22. The mean QLQ-C30 score was 69.5 at baseline, 68.8 at 7 days, 73.1 at 3 months, and 73.2 at 6 months. The global health status on the EORTC QLQ-C30 was significantly improved after 3 and 6 months (p=0.0003 and p<0.0001, respectively). The QLQ-C30 and STO22 scores were not significantly different, or they only slightly deteriorated between before and immediately after ESD, but they were significantly improved after 3 and 6 months (p<0.05). CONCLUSIONS: QOL did not deteriorate immediately after ESD, and it improved more significantly at up to 6 months in patients who underwent curative ESD for EGC without significant complications.
Cohort Studies* ; Global Health ; Humans ; Prospective Studies* ; Quality of Life* ; Stomach Neoplasms*

Phytochemical constituents were isolated from the fruits of Acanthopanax chiisanensis by repeated column chromatography. Their structures were identified as beta-sitosterol (1), daucosterol (2), sesamin (3), chiisanogenin (4), and 22alpha-hydroxy chiisanogenin (5) by spectroscopic analysis (MS, 1H-, and 13C-NMR). Compounds 1 - 5 were isolated for the first time from the fruits of A. chiisanensis.
Eleutherococcus* ; Araliaceae ; Chromatography ; Fruit* ; Terpenes*

Myotonic dystrophy is an autosomal-dominant inherited neuromuscular disorder that's characterized by slowly progressive muscular dystrophy, muscle weakness and myotonia. The clinical features may vary from just cataracts to involvement of multiple organ systems such as various muscles, the heart, lung and intestine. Its most common complication is postoperative respiratory failure. We encountered a patient who developed sudden unexpected peripartum cardiomyopathy (PPCM) and respiratory failure due to presumed myotonic dystrophy after cesarean section. We report here on our clinical experience with this malady and we include a brief review of the medical literature on myotonic dystrophy.
Cardiomyopathies ; Cataract ; Cesarean Section ; Female ; Heart ; Humans ; Intestines ; Lung ; Muscle Weakness ; Muscles ; Muscular Dystrophies ; Myotonia ; Myotonic Dystrophy ; Peripartum Period ; Pregnancy ; Respiratory Insufficiency

The retrograde approach through a collateral artery is now thought to improve the success rate of percutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO), and different kinds of strategies for this technique have been developed. However, the basic principles of PCI for CTO, such as firm back-up support with a guiding catheter and fine control of the guide wire, should be adhered to more strictly to succeed with this complex procedure. We present a case in which a CTO of the proximal left anterior descending artery was successfully opened by the retrograde approach through a collateral from the left circumflex artery, during which two guiding catheters were simultaneously used in the same coronary artery for the purpose of strong back up support for the retrograde device and fine control for the antegrade device.
Angioplasty, Balloon, Coronary ; Arteries ; Catheters ; Coronary Occlusion ; Coronary Vessels ; Percutaneous Coronary Intervention

BACKGROUND: The authors performed this study to investigate the hemodynamic effect of nicardipine using an esophageal Doppler monitor (EDM) during gynecologic laparoscopic surgery. METHODS: Forty patients scheduled to undergo gynecologic laparoscopic surgery, were divided into two groups; the control group (Group C) and the nicardipine group (Group N). Pneumoperitoneum was initiated using CO2 gas and the intraperitoneal pressure was kept under 12 mmHg. Hemodynamic parameters at critical points were measured using EDM, i.e., before skin incision (T1), 5, 10 and 15 min after the initiation of pneumoperitoneum (T2, T3 and T4), and 5 min after deflation (T5). RESULTS: Mean arterial pressure (MAP) was significantly lower in Group N patients than in Group C patients at 5 and 10 min after the initiation of pneumoperitoneum (T2 and T3) (P < 0.05). No significant heart rate (HR) differences were observed between the two study groups. Cardiac output (CO), peak velocity (PV) and corrected flow time (FTC) were significantly higher in Group N at 10 min after the initiation of pneumoperitoneum (T3) (all P < 0.05). CONCLUSIONS: The nicardipine continuous infusion at 0.5?2.0microg/ kg/min is effective at attenuating hemodynamic changes after pneumoperitoneum during gynecologic laparoscopic surgery.
Arterial Pressure ; Cardiac Output ; Heart Rate ; Hemodynamics ; Humans ; Laparoscopy ; Nicardipine ; Organothiophosphorus Compounds ; Pneumoperitoneum ; Skin

The primary success rate of intraluminal angioplasty for long superficial femoral artery (SFA) occlusions is low due to the long occlusion length and the hard component of the occlusion. To overcome this problem, subintimal angioplasty has been previously proposed and this technique is now considered as an effective method for the treatment of SFA occlusions. Subsequently, various devices and strategies have been developed to increase the success rate of subintimal angioplasty for SFA occlusions. Here, we present a case in which a long chronic total occlusion of SFA was successfully recanalized by the retrograde subintimal angioplasty through the popliteal artery after the failed antegrade subintimal approach.
Angioplasty ; Femoral Artery ; Popliteal Artery

BACKGROUND: It is often difficult to make a diagnosis of cardiac ischemia in patients attending emergency department (ED) with symptoms of acute coronary syndromes (ACS) because existing cardiac markers are not sensitive for reversible myocardial ischemia. Ischemia modified albumin (IMA) has recently been shown to be an early and sensitive marker of myocardial ischemia. We investigated the usefulness of ischemia modified albumin (IMA) as an early triage marker for ACS and tried to establish a newly standardized albumin-adjusted IMA index which has been expected to be more sensitive and accurate than conventional IMA value. METHODS: We enrolled 209 consecutive patients (men 95, women 114) who presented to the ED with symptoms suggestive of ACS from June to July, 2005. All patients were classified to ACS group (n=42) and others (n=167) based on diagnosis of cardiologists. The ideal cutoff value of IMA was calculated by the receiver operating characteristic (ROC) curve analysis and diagnostic utilities of combination tests (myoglobin, CK-MB, troponin T and EKG) were compared with those of IMA. The albumin-adjusted IMA index was calculated and applicated from the results of correlation assay between serum albumin concentration and IMA value. RESULTS: Mean IMA level (U/mL) of ACS group was significantly higher than that of non-ACS group (P<0.05) and sensitivity and specificity was 92.9% and 35.9% at a cutoff value of 85.1 U/mL, respectably. In combination with conventional cardiac markers, the sensitivity increased to 96.3%. IMA value had a negative lnear relationship with serum albumin concentration (YIMA= -23.1Xalbumin+200, R=0.99) and albumin-adjusted IMA index was calculated as [IMA index = serum albumin conc. (g/dL) x 23 + IMA (U/mL) -100]. The sensitivity and specificity was 97.6% and 34.1% at a cutoff value of 83.3 IMA index, respectively. CONCLUSIONS: IMA is a useful sensitive marker for the identification of ACS in patients with normal cardiac markers and EKG finding and follow-up combination testing may be required to rule out other diseases. The calculated albumin-adjusted IMA index is recommended to make a diagnosis of ACS more sensitively.
Acute Coronary Syndrome* ; Diagnosis ; Electrocardiography ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Humans ; Ischemia* ; Mass Screening* ; Myocardial Ischemia ; ROC Curve ; Sensitivity and Specificity ; Serum Albumin ; Triage ; Troponin T

Ghrelin is a recently identified member of growth hormone secretagogue, which is synthesized as peptide of 28 amino acids in stomach, pituitary and intestines. Ghrelin controls food intake, and induces gastric acid secretion. It has been reported that synthesis and secretion of ghrelin changes according to age of animals. In this study, in situ hybridization technique with digoxigenin-labeled oligonucleotide probe is applied to elucidate the developmental change of ghrelin mRNA expression pattern in rat stomach. Ghrelin mRNA positive cells first appeared in stomach of 9 day rats, mainly in base of gastric glands. It showed the highest density and spread to neck area of the gastric gland in 6 week rats. Number of positive cells decreased significantly in 18 months. Most of ghrelin mRNA positive cells were found as closed-type endocrine cells in fundus area. These results suggest that ghrelin expression may be involved in development and ageing process.
Amino Acids ; Animals ; Eating ; Endocrine Cells ; Gastric Acid ; Gastric Mucosa ; Ghrelin* ; Growth Hormone ; In Situ Hybridization* ; Intestines ; Neck ; Rats* ; RNA, Messenger* ; Stomach*

BACKGROUND: Although medical students' clinical competence should be assessed systematically and objectively, written exams or faculty's subjective methods were used in the past. We assessed the clinical competence of the family medicine clerkship students using the OSCE and evaluated the reliability and the validity of the OSCE. The purpose of this study was to find the logistic problems and the feasibility of the OSCE to an entire clerkship evaluation. METHODS: Twenty six volunteers took part in the OSCE. Ten, 5-minute long stations, were divided into 4 areas: 3 for history taking, 3 for physical exam, 3 for technical skill, and 1 for interview skill areas. RESULTS: Eleven students were examined on first session and 15 students on second session 4 weeks later. The mean OSCE score was 65.5 5.63. The reliability of the total stations was 0.615. The total OSCE score was not different by the sessions, but there was a significant difference in the two stations where the examiners had been changed. There were statistically significant correlations between the total OSCE score and the two previous written exams (r=0.56, 0.54, P<0.01). There was no significant logistic problem and the examinees showed positive responses to the OSCE. CONCLUSION: The OSCE was a useful tool for assessing the clinical competence of family medicine clerkship students. The reliability of the OSCE was moderate and in order to extend the OSCE to an entire clerkship evaluation, we need further study to acquire a higher reliability and validity.
Clinical Competence* ; Humans ; Reproducibility of Results ; Volunteers

OBJECTIVE: To know when we can identify fetal Y chromosome SRY gene by using fetal DNA in maternal plasma. METHODS: DNA from maternal plasma of 62 pregnant women (48: inpatients, 14: outpatients) underwent a sensitive Y-PCR assay to identify SRY gene of Y chromosome. RESULTS: Of the patients, fetus-derived Y sequences were detected in 37 (88.1%) of the 42 maternal plasma samples from women bearing male fetuses. One of the 20 women bearing female fetuses had positive result from plasma DNA. Seventh gestational week was the earliest gestation of gender identification. CONCLUSION: We could identify fetal gender using fetal DNA in maternal plasma (sensitivity 88.1%). The earlist to detect was 7th gestational week.
DNA* ; Female ; Fetus ; Genes, sry ; Humans ; Inpatients ; Male* ; Plasma* ; Pregnancy ; Pregnant Women ; Y Chromosome