Esophageal achalasia is a primary motility disorder characterized by insufficient lower esophageal sphincter relaxation and loss of esophageal peristalsis. Achalasia is a chronic disease that causes progressive irreversible loss of esophageal motor function. The recent development of high-resolution manometry has facilitated the diagnosis of achalasia, and determining the achalasia subtypes based on high-resolution manometry can be important when deciding on treatment methods. Peroral endoscopic myotomy is less invasive than surgery with comparable efficacy. The present guidelines (the “2019 Seoul Consensus on Esophageal Achalasia Guidelines”) were developed based on evidence-based medicine; the Asian Neurogastroenterology and Motility Association and Korean Society of Neurogastroenterology and Motility served as the operating and development committees, respectively. The development of the guidelines began in June 2018, and a draft consensus based on the Delphi process was achieved in April 2019. The guidelines consist of 18 recommendations: 2 pertaining to the definition and epidemiology of achalasia, 6 pertaining to diagnoses, and 10 pertaining to treatments. The endoscopic treatment section is based on the latest evidence from meta-analyses. Clinicians (including gastroenterologists, upper gastrointestinal tract surgeons, general physicians, nurses, and other hospital workers) and patients could use these guidelines to make an informed decision on the management of achalasia.

BACKGROUND: Hand eczema is one of the most common skin disorders and negatively affects quality of life. However, a large-scale multicenter study investigating the clinical features of patients with hand eczema has not yet been conducted in Korea. OBJECTIVE: To identify the prevalence of various hand diseases, which is defined as all cutaneous disease occurring in hands, and to investigate the clinical features of patients with hand eczema and the awareness about hand eczema in the general population and to compare the prevalence of hand eczema between health care providers and non-health care providers. METHODS: To estimate the prevalence of hand diseases, we analyzed the medical records of patients from 24 medical centers. Patients were assessed by online and offline questionnaires. A 1,000 from general population and 913 hand eczema patients answered the questionnaire, for a total of 1,913 subjects. RESULTS: The most common hand disease was irritant contact dermatitis. In an online survey, the lifetime prevalence of hand eczema was 31.2%. Hand eczema was more likely to occur in females (66.0%) and younger (20~39 years, 53.9%). Health care providers and housewives were the occupations most frequently associated with hand eczema. Winter (33.6%) was the most common season which people experienced aggravation. The 63.0% and 67.0% answered that hand eczema hinders their personal relationship and negatively affects daily living activities, respectively. CONCLUSION: Hand eczema is a very common disease and hinders the quality of life. The appropriate identification of hand eczema is necessary to implement effective and efficient treatment.
Activities of Daily Living ; Dermatitis, Contact ; Eczema* ; Female ; Hand* ; Health Personnel ; Humans ; Korea* ; Medical Records ; Occupations ; Prevalence ; Quality of Life ; Seasons ; Skin ; Surveys and Questionnaires

BACKGROUND: Scabies is an old and common contagious skin disease. The incidence of scabies has decreased through the economic growth of Korea. However, recent outbreaks in medical facilities have created a suspicion that the infection of scabies is an emerging public health problem. OBJECTIVE: We evaluated the epidemiological and clinical aspects of patients diagnosed with scabies in Korea. This prospective study follows the retrospective study already performed by the same authors in 2011. METHODS: A multicenter, prospective study of scabies was performed at 25 hospitals in Korea. We included 914 patients who were diagnosed with scabies. Microscopic examination revealed scabies mites or eggs, or clinical improvement after treatment. Patients were asked to provide information on scabies, especially regarding the contact source, and the physicians examined them. RESULTS: Of the participants, 432 patients were men and 482 were women. Patients aged younger than 10 years and 60~69 years were the most common groups. Scabies more commonly affected patients during the fall and winter. Of the patients, 68.0% were thought to be infected at their homes, followed by nursing homes or hospitals (25.7%), and 31.6% through contact with other patients or, occasionally, staff members, including caregivers. CONCLUSION: We confirmed that scabies is an emerging threat in institutions, especially medical facilities. In addition, we suggest that public and in-hospital education is essential to minimize the problems associated with scabies.
Caregivers ; Disease Outbreaks ; Economic Development ; Education ; Eggs ; Epidemiologic Studies* ; Epidemiology ; Female ; Humans ; Incidence ; Korea ; Male ; Mites ; Nursing Homes ; Ovum ; Prospective Studies* ; Public Health ; Scabies* ; Skin Diseases

BACKGROUND: Scabies is one of the common skin diseases observed in developing countries. The incidence of scabies has decreased dramatically since the late 1980s in Korea. However, recent outbreaks in nursing homes or hospitals have been raising public health concerns. OBJECTIVE: We intended to evaluate the epidemiological and clinical aspects of patients diagnosed with scabies in Korea. In particular, we tried to investigate the changing trend of contact sources in our society. METHODS: A multi-center cross sectional study was performed at 25 hospitals in Korea. We included 1,539 patients who were diagnosed with scabies. These patients showed scabies mites or eggs under microscopic examination, or clinical improvement after treatment. Their medical records with information of contact sources were reviewed. RESULTS: Six hundred and ninety-three patients were males and 826 were females. Patients' age from 70 to 79 was the most common followed by patients below 10 years of age. More patients were found in the fall and winter months. 66.7% of patients were thought to be infected at their homes which were situated next to nursing homes or hospitals (23.1%). Place of infection could not be verified in 39.3% of patients. 25.8% of patients were suggested to be infected through contact with medical staff or patients from hospitals or nursing homes. CONCLUSION: We confirmed that the contact sources of scabies are changing in our society; nursing homes and hospitals are emerging sources of infection. The majority of patients are old or very young who are vulnerable to many diseases. Therefore, dermatologists should pay attention to new contact sources and appropriate care of patients.
Developing Countries ; Disease Outbreaks ; Eggs ; Female ; Humans ; Hypogonadism ; Incidence ; Korea ; Male ; Medical Records ; Medical Staff ; Mites ; Mitochondrial Diseases ; Nursing Homes ; Ophthalmoplegia ; Ovum ; Public Health ; Retrospective Studies ; Scabies ; Skin Diseases

BACKGROUND/AIMS: Antispasmodic agents have been used in the management of irritable bowel syndrome. However, systematic reviews have come to different conclusions about the efficacy in irritable bowel syndrome. Fenoverine acts as a synchronizer of smooth muscle in modulating the intracellular influx of calcium. We compared fenoverine with trimebutine for the treatment of patients with IBS. METHODS: A multicenter, randomized, double-blind, non-inferiority clinical study was conducted to compared fenoverine with trimebutine. Subjects were randomized to receive either fenoverine (100 mg three times a day) or trimebutine (150 mg three times a day) for 8 weeks. A total of 197 patients were analyzed by the intention-to-treat approach. The primary endpoint was the proportion of patients who had 30% reduction in abdominal pain or discomfort measured by bowel symptom scale (BSS) score at week 8 compared to the baseline. The secondary endpoints were changes of abdominal bloating, diarrhea, constipation, overall and total scores of BSS, and overall satisfaction. RESULTS: At week 8, fenoverine was shown to be non-inferior to trimebutine (treatment difference, 1.76%; 90% CI, -10.30-13.82; p=0.81); 69.23% (54 of 78 patients) of patients taking fenoverine and 67.47% (56 of 83 patients) of patients taking trimebutine showed 30% reduction in abdominal pain or discomfort compared to the baseline. There results of the secondary endpoints were also comparable between the fenoverine group and the trimebutine group. CONCLUSIONS: Fenoverine is non-inferior to trimebutine for treating IBS in terms of both efficacy and tolerability.
Abdominal Pain/etiology ; Adult ; Constipation/etiology ; Diarrhea/etiology ; Double-Blind Method ; Drug Administration Schedule ; Female ; Humans ; Irritable Bowel Syndrome/complications/*drug therapy ; Male ; Middle Aged ; Parasympatholytics/*therapeutic use ; Phenothiazines/*therapeutic use ; Severity of Illness Index ; Treatment Outcome ; Trimebutine/*therapeutic use

BACKGROUND: The TRUE test is a commercially available ready-to-apply patch test widely used in many countries, but no large-scale study is available on the TRUE test in Korea. OBJECTIVE: The purpose of this study was to analyze the type, frequency, and changes in the common contact allergens in Korea using the TRUE test. METHODS: From January 2009 to March 2010, TRUE tests were performed on patients with contact dermatitis at the Departments of Dermatology of 15 hospitals. The epidemiological findings of patients, and the results of the patch tests were analyzed. RESULTS: In total, 795 patch tested cases (246 males, 549 females) were compiled and analyzed. The oldest age distribution was the third decade in both males and females, and housewives and office-workers were the most common jobs, comprising 29.7% and 19.8% of the occupations, respectively. Overall, 65.1% of patients had at least one positive reaction, and the most common allergens were nickel sulfate (34.1%), thimerosal (12.6%), cobalt chloride (11.1%), and p-phenylenediamine (8.4%), in order of frequency. A univariate analysis of multiple variables including age, gender, occupation, and affected sites was conducted and a comparison with a previous multicenter study was also analyzed. CONCLUSION: These results provide the basis for use of the TRUE test in patients with contact dermatitis in Korea.
Age Distribution ; Allergens ; Cobalt ; Dermatitis, Contact ; Dermatology ; Female ; Humans ; Korea ; Male ; Nickel ; Occupations ; Patch Tests ; Phenylenediamines ; Thimerosal

PURPOSE: To assess the efficacy of the use of accelerated hyperfractionated radiotherapy (AHRT) for locally advanced uterine cervix cancers. MATERIALS AND METHODS: Between May 2000 and September 2002, 179 patients were identified with FIGO stage IIB, IIIB, and IVA cancers. Of the 179 patients, 45 patients were treated with AHRT (AHRT group) and 134 patients were treated with conventional radiotherapy (CRT group), respectively. Patients undergoing the AHRT regimen received a dose of 30 Gy in 20 fractions (1.5 Gyx2 fractions/day) to the whole pelvis. Subsequently, with a midline block, we administered a parametrial boost with a dose of 20 Gy using 2 Gy fractions. Patients also received two courses of low-dose-rate brachytherapy, up to a total dose of 85~90 Gy to point A. In the CRT group of patients, the total dose to point A was 85~90 Gy. The overall treatment duration was a median of 37 and 66 days for patients that received AHRT and CRT, respectively. Statistical analysis was calculated by use of the Kaplan-Meier method, the log-rank test, and Chi-squared test. RESULTS: For patients that received cisplatin-based concurrent chemotherapy and radiotherapy, the local control rate at 5 years was 100% and 79.2% for the AHRT and CRT group of patients, respectively (p=0.028). The 5-year survival rate for patients with a stage IIB bulky tumor was 82.6% and 62.1% for the AHRT group and CRT group, respectively (p=0.040). There was no statistically significant difference for severe late toxicity between the two groups (p=0.561). CONCLUSION: In this study, we observed that treatment with AHRT with concurrent chemotherapy allows a significant advantage of local control and survival for locally advanced uterine cervix cancers.
Chemoradiotherapy

PURPOSE: To evaluate upper sacral morphology and anatomy of safe zone related to iliosacral screw fixation in Korean. MATERIALS AND METHODS: 100 patients performed pelvis 3D CT scan were evaluated. We used 16 channel CT and analyzed reconstructed image (shaded-surface display, transparent image and reformat image). RESULT: The angle between superior aspect of S1 body and iliac cortical density is 27.3°, between anterior cortical line of S1,2 body and horizontal plane 24.6°, and between superior aspect of S1 body and horizontal plane is 39.7°. The axis of S1, S2 pedicle is 32.5° and 15.6° toward anteromedial. The area of S1 pedicle according to sagittal plane and sagittal-oblique axis is 310.7 mm2 and 384.8 mm2. Also, S2 pedicle area is increased 163.1 mm2 to 188.4 mm2. The average depth of ala indentation is 5.1 mm and the maximal value is 9.5 mm. Distinct upper sacral dysplasia is 22%, transitional form is 32%. CONCLUSION: We measured Korean upper sacrum with 3D-CT, found out dysplasia come up to 54%. Considering the frequency of dysplasia, the investigation of anatomy and technique is essential to sacroiliac screw insertion.
Humans ; Pelvis ; Sacrum ; Tomography, X-Ray Computed

Recently, there has been considerable attention focused on the multipotent progenitor cells existing in ependymal and subependymal layer. However, almost all results have been derived from brain or injured CNS researches. So, the studies on the developmental characteristics of intact spinal ependymal layer have been relatively ignored. In the present study, we labeled rat spinal cord with nestin, bromodeoxyuridine (BrdU), and glial fibrillary acidic protein (GFAP) antibodies in order to track the differentiation and proliferative capacity of rat ependymal layer cells according to their developmental stages. At embryonic day 14 (E14), a number of cells in the spinal ependymal layer, especially constituting the alar and basal plates, showed extensive nestin immunoreactivities (ir). They also showed active proliferative capacities, because many nuclei of nestin-ir cells were also BrdU-ir. From postnatal day 0 (P0), nestin-ir cells were almost completely disappeared, and from P7, no nestin-ir cells could be detected. However, BrdU-ir nuclei continued to be identified until P14. These results suggested that the cells in the spinal ependymal layer retain their proliferative capacity until later stage of development. On the other hand, no GFAP-ir cells could be identified in the ependymal layer in our experimental period.
Animals ; Antibodies ; Brain ; Bromodeoxyuridine* ; Glial Fibrillary Acidic Protein ; Hand ; Nestin* ; Rats* ; Spinal Cord ; Stem Cells

Changes in morphology, immunophenotypes and proliferative activity of neuroglia are key features in most forms of CNS pathology. We compared proliferative activity of neuroglial cells in response to two different types of brain injury induced by medial forebrain bundle (MFB) axotomy. In the cannula track where acute necrosis occurs due to mechanical lesion caused by cannula inserted to incise the MFB, many BrdU-immunoreactive (ir) cells appeared around the cannula track already at 1 day post-lesion (1 dpl). Their number significantly increased by 7 dpl and then decreased, but considerable number of BrdU-ir cells was still found at 14 dpl. Some of the BrdU-ir cells were double-labeled with either OX-42 or GFAP. This finding suggests that both microglia and astrocytes are activated and proliferate immediately after the mechanical damage, and the proliferative activity is maintained in a considerable number of these cells by 14 dpl. In general, the main cell type showing BrdU immunoreactivity was amoeboid microglia within the necrotic zone immediately surrounding the cannula track, and was astrocytes in the periphery of the necrotic zone more or less apart from the cannula track. Previously, we reported that MFB axotomy induces apoptosis of dopaminergic (DA) neurons in the substantia nigra (SN). In the SN where axotomized DA neurons undergo apoptosis, only a few BrdU-ir cells were found at 1 dpl. Their number increased gradually from 3 dpl and peaked at 7 dpl, then significantly reduced at 14 dpl. Most of them were double-labeled with OX -42-positive ramified microglia but not with GFAP. This data indicates that microglia but not astrocyte are the cell type that proliferate in response to apoptotic neuronal cell death, and their morphology and proliferative activity are different from those observed in the cannula track. Meanwhile, in the both cannula track and SN, some BrdU-ir cells were thought to be neither GFAP-positive nor OX-42-positive, and thus they were presumed to be infiltrated peripheral immune cells. These results demonstrate that different types of neuronal cell death are accompanied with different neurogilal proliferative activities.
Apoptosis ; Astrocytes ; Axotomy* ; Brain Injuries ; Bromodeoxyuridine ; Catheters ; Cell Death ; Medial Forebrain Bundle* ; Microglia ; Necrosis ; Neuroglia ; Neurons ; Pathology ; Substantia Nigra