PURPOSE: The diagnostic criteria of gastric intraepithelial neoplasia (IEN) are controversial across the world. We investigated how many discrepancies occur in the pathologic diagnosis of IEN and early gastric carcinoma in endoscopic submucosal dissection (ESD) specimens, and evaluated the reasons of the discordance. MATERIALS AND METHODS: We retrospectively reviewed 1,202 ESD specimens that were originally diagnosed as gastric IEN and early carcinoma at 12 institutions. RESULTS: The final consensus diagnosis of carcinoma were 756 cases, which were originally 692 carcinomas (91.5%), 43 high-grade dysplasias (5.7%), 20 low-grade dysplasias (2.6%), and 1 others (0.1%), respectively. High- and low-grade dysplasia were finally made in 63 and 342 cases, respectively. The diagnostic concordance with the consensus diagnosis was the highest for carcinoma (91.5%), followed by low-grade dysplasia (86.3%), others (63.4%) and high-grade dysplasia (50.8%). The general kappa value was 0.83, indicating excellent concordance. The kappa values of individual institutions ranged from 0.74 to 1 and correlated with the proportion of carcinoma cases. The cases revised to a final diagnosis of carcinoma exhibited both architectural abnormalities and cytologic atypia. The main differential points between low- and high-grade dysplasias were the glandular distribution and glandular shape. Additional features such as the glandular axis, surface maturation, nuclear stratification and nuclear polarity were also important. CONCLUSION: The overall concordance of the diagnosis of gastric IEN and early carcinoma in ESD specimens was excellent. It correlated with the proportion of carcinoma cases, demonstrating that the diagnostic criteria for carcinoma are more reproducible than those for dysplasia.
Consensus ; Diagnosis ; Retrospective Studies ; Stomach Neoplasms

PURPOSE: Bystander cardiopulmonary resuscitation (CPR) and dissemination of its training are essential to improve the survival outcomes of sudden cardiac death. The purpose of this study was to investigate the tri-temporal trend analysis of the national CPR capacity variables and preparedness in a community. METHODS: This nationwide population-based study used structured questionnaire by a telephone survey for CPR in 2007 (n=1,029), in 2011 (n=1,000), and in 2015 (n=1,000). We used stratified cluster sampling to assess the impact of age, gender, and geographic regions. The contents in the questionnaire consisted of CPR awareness, self-efficacy for bystander CPR, prior training status, and willingness of public CPR training. RESULTS: The proportion of CPR awareness and its recent training experience (<2 years) increased from 89.0% and 14.6%, respectively, in 2007 to 88.5% and 18.7% in 2011, and finally to 94.8% and 30.6% in 2015 (both p for trend<0.001). More than 95% of respondents had agreed to mandatory CPR training acquiring a driver's license or CPR education in school. The awareness of Good Samaritan Law was increased from 20.5% in 2011 to 28.7% in 2015; however, the overall values were lower than the other CPR-related awareness and preparedness. CONCLUSION: In Korea, the trends of national CPR capacity index have been increasing during the past decade. However, the public awareness of the Good Samaritan Law was still low. We suggest that promoting the Good Samaritan Law should be the next step in preparing public CPR training in the future.
Cardiopulmonary Resuscitation* ; Death, Sudden, Cardiac ; Education ; Health Services Needs and Demand ; Humans ; Jurisprudence ; Korea ; Licensure ; Surveys and Questionnaires ; Telephone

PURPOSE: The Surviving Sepsis Campaign recommend initiating broad spectrum antibiotics within the first hour of recognition of septic shock. An unknown proportion of the effectiveness of earlier antibiotics administration will remain in septic shock patients treated with an early quantitative resuscitation in emergency department (ED). We were to compare the 28-day mortality between earlier antibiotic administration (< or =1 hour) and early antibiotic administration (1 hour to 6 hour) in septic shock patients in ED. METHODS: A total of 536 consecutive septic shock patients were prospectively collected from January 2010 to June 2012. We identified 357 patients who were developed shock at initial assessment, and measured the time of initial antibiotics administration. The primary outcome was 28-day mortality. RESULTS: Mean age was 62.8+/-13.7 years old and 222 patients were male (62.2%). The median time from shock recognition-to-antibiotics administration was 94.0 min (IQR 47.0-150.0) and 28-day mortality rate was 20.2%. When the relationship of 28-day mortality between earlier antibiotic administration (< or =1 hour) and early antibiotic administration (1 hour to 6 hour) was compared, no significant difference was shown (19.5% vs. 20.5%, p=0.82). CONCLUSION: Earlier antibiotics administration may have no additional outcome value in septic shock patients treated with an early quantitative resuscitation in ED.
Anti-Bacterial Agents ; Emergency Service, Hospital* ; Humans ; Male ; Mortality* ; Prospective Studies ; Resuscitation ; Sepsis ; Shock ; Shock, Septic* ; Treatment Outcome

PURPOSE: The purpose of this study was to determine the direction for treatment and to evaluate factors influencing improvement by comparison of neurologic and functional outcomes of surgical treatment and conservative treatment for traumatic central cord syndrome. MATERIALS AND METHODS: A total of 28 patients, who were available for follow-up for at least more than one year from January 2005 to December 2008, who were diagnosed as traumatic central cord syndrome were analyzed retrospectively. Fifteen patients underwent surgical treatment (group 1), and 13 patients received conservative treatment (group 2). Maximum canal compromise (MCC), and maximum spinal cord compression (MSCC) were used for radiologic assessment, and American Spinal Injury Association (ASIA) motor score, Japanese Orthopaedic Association (JOA) score, and neck disability index (NDI) were used for assessment of functional outcomes. RESULTS: The mean MCC was 47.2%, mean MSCC was 20.0%, and mean ASIA motor scale was 92.0 (group 1: 92.9, group 2: 90.9) at the final follow-up. The mean JOA score was 12.8 (group 1: 14.0, group 2: 11.4) and mean NDI was 25.0 (group 1: 25.7, group 2: 24.3) at the final follow-up. CONCLUSION: It is concluded that if a patient with traumatic central cord syndrome is young, with a high energy injury combined with fractures, and has severe spinal compression and mild initial neurologic defect, early surgical treatment would be needed as soon as possible.
Asia ; Asian Continental Ancestry Group ; Central Cord Syndrome* ; Follow-Up Studies ; Humans ; Neck ; Retrospective Studies ; Spinal Cord Compression ; Spinal Cord Injuries ; Spinal Injuries ; Treatment Outcome

Despite remarkable progress in understanding and treating gastrointestinal stromal tumors (GISTs) during the past two decades, the pathological characteristics of GISTs have not been made clear yet. Furthermore, concrete diagnostic criteria of malignant GISTs are still uncertain. We collected pathology reports of 1,227 GISTs from 38 hospitals in Korea between 2003 and 2004 and evaluated the efficacy of the NIH and AFIP classification schemes as well as the prognostic factors among pathologic findings. The incidence of GISTs in Korea is about 1.6 to 2.2 patients per 100,000. Extra-gastrointestinal GISTs (10.1%) are more common in Korea than in Western countries. In univariate analysis, gender, age, tumor location, size, mitosis, tumor necrosis, vascular and mucosal invasions, histologic type, CD34 and s-100 protein expression, and classifications by the NIH and AFIP criteria were found to be significantly correlated with patient's survival. However, the primary tumor location, stage and classification of the AFIP criteria were prognostically significant in predicting patient's survival in multivariate analysis. The GIST classification based on original tumor location, size, and mitosis is more efficient than the NIH criteria in predicting patient's survival, but the mechanism still needs to be clarified through future studies.

OBJECTIVES: To investigate the association between abnormal inhibin-A level in Quad test during the 15 and 18 weeks of gestation and adverse pregnancy outcomes. METHODS: From January 2005 to March 2007, women who delivered their babies at our institute after Quad test in second trimester of gestation (N=140) were enrolled. We measured inhibin-A levels (MoM) and other serum markers of the Quad test. And we analyzed the incidence of adverse pregnancy outcomes such as preterm birth, fetal growth restriction, pregnancy induced hypertension, fetal loss, and intrauterine fetal death. RESULTS: When the pregnancy outcomes are hypertensive disorders and fetal losses, the inhibin-A levels are is more elevated with statistically significance. Inhibin-A and hCG levels are elevated with significantly at hypertensive disorders and fetal losses. But inhibin-A levels are more significantly associated with abnormal pregnancy outcomes than hCG. CONCLUSIONS: Measurement of inhibin-A levels may be the most useful among other serum markers of the Quad test in predicting adverse obstetric outcomes.
Adenine ; Biomarkers ; Carbamates ; Deoxycytidine ; Drug Combinations ; Female ; Fetal Death ; Fetal Development ; Humans ; Hypertension, Pregnancy-Induced ; Incidence ; Inhibins ; Organophosphonates ; Pre-Eclampsia ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, Second ; Premature Birth ; Quinolones ; Thiazoles ; Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination

OBJECTIVE: This study was designed to describe how to develop the 'ASAN-Drug Allergy Alert System' and evaluate the usefulness of this system. METHODS: The drug allergy alert system was developed by a task force that was consisted of emergency physicians, pharmacists, and programmers for ten months. Since this system had been implemented, we compared frequencies with a previous paper based system. RESULTS: This system was implemented with three stages: an input stage, a censorship stage, and an alertness stage. The input of data was done by physicians and nurses as a multidisciplinary team. The censorship of data was charged of an allergist who confirmed whether a suspicious drug had caused life threatening symptoms or not. If the causative drug was confirmed by an allergist, an alert sign changed 'Code Yellow' to 'Code Red' automatically. After that censorship, an alert sign was noticed to clinicians as a yellow or red colored pop-up window. After an alert system, frequencies per month of report were increased from 44.6 to 594. Also, the report ratio of life threatening symptoms was increased from 5.4% to 12.5% (p<0.001). CONCLUSION: We assumed that the Asan-Drug Allergy Alert System could reduce medication errors effectively.
Advisory Committees ; Chungcheongnam-do* ; Drug Hypersensitivity* ; Emergencies ; Humans ; Hypersensitivity ; Medication Errors ; Pharmacists

Ovarian hyperstimulation syndrome (OHSS) is the most serious complication of sterility treatment, such as pharmacological ovulation induction therapy. OHSS is clinically characterized by ovarian enlargement, abdominal distension, electrolyte imbalance, ascites, hypovolemia and hemoconcentration. But, the exact pathophysiology of OHSS is not fully understood. We believe that an increased capillary permeability leading to enhanced fluid extravasation seems to play a major pathogenic role, and also an imbalance in the rennin-angiotensin system is involved. Thromboembolic disease is usually considered to be a rare complication of OHSS. The common factors known to contribute to the risk of thrombosis are hemoconcentration, leukocytosis, thrombocytosis, and alteration in coagulation and fibrinolysis. But the majority of reported cases are venous in origin (75%), the remaining 25% are arterial thromboses. Especially in arterial thromboses, stroke is a rare event and potentially fatal complication. We report that a case of stroke combined with OHSS was received intravenous thrombolytics and recommend that emergency physicians keep in mind that one of possible causes of stroke in young woman who had been ovarian induction therapy is OHSS, and the timely intervention in OHSS with stroke is critical.
Ascites ; Capillary Permeability ; Emergencies ; Female ; Fibrinolysis ; Humans ; Hypovolemia ; Infertility ; Leukocytosis ; Ovarian Hyperstimulation Syndrome* ; Ovulation Induction ; Paresis* ; Stroke ; Thrombocytosis ; Thromboembolism ; Thrombosis

BACKGROUND: Ota's nevus, characterized by the presence of melanocytes in the dermis, has been familiar among dermatologists, but the etiology, the pathophysiology, the clinical and histological classification are not entirely clear. To understand and elucidate them, more clinical studies and researches are necessary. OBJECT: The aim of this study was to document the clinical and histopathological features of Ota's nevus. METHODS: We examined 299 patients with Ota's nevus who visited the dermatology clinic in Korea from February 1993 to August 2003. Among them, 188 patients were biopsied. All the specimens were stained with hematoxylin and eosin. We examined the age & sex distribution, age of onset, seasonal variation, associated skin diseases, aggravating factors and color. We clinically classified Ota's nevus into 4 types according to Tanino's classification and histologically into 5 types based on the pattern of pigmentation. RESULTS: 1. The ratio of male and female was 1: 3. 2. The peak age of onset was at birth (28.4%) and puberty (24.8%). 3. Seasonal variation was observed with distinct aggravation in the summer (60%). 4. The associated diseases were 9 cases of persistent mongolian spot, 6 cases of nevus flameus, 4 cases of blue nevus, 3 cases of vitiligo, 3 cases of nevus of Ito, 2 cases of atopic dermatitis, 2 cases of psoriasis, 2 cases of cafe au late macules and 2 cases of contact dermatitis. 5. The aggravating factors were sunlight (35.8%), emotional stress (21.0%), menstruation (12.6%), cold exposure (9.5%), pregnancy (9.5%), fatigue (9.5%) and chemical agents (2.1%). 6. The color of lesions were blue black (36.8%), brown (34.8%), dark brown (16.1%) and slate (11.0%). 7. All cases were classified according to Tanino's METHODS: type Ia (23.1%), type Ib (20.1%), type II (26.7%), type III (9.4%), type IV (20.7%). 8. The histological subtypes of Ota's nevus were classified as: the superficial type (35.6%); the middermis type (5.9%), the superficial-middermis type (18.6%); the mid-lower dermis type (2.7%); the diffuse type was composed of the superficial dominant type (19.7%), the middermis dominant type (4.8%), the dispersed (true diffuse) type (12.2%) and the deep dominant type (0.5%). 9. In the relation between histological types and the color of the lesion: the superficial type had 31 cases of brown color, 15 cases of blue black color, 11 cases of dark brown color and 9 cases of slate color; the middermis type had 6 cases of blue black color and 2 cases of dark brown color, query number of cases of slate color; the superficial-middermis type had 12 cases of blue black color, 10 cases of dark brown color, 7 cases of brown color and 6 cases of slate color: the mid-lower dermis type had 3 cases of blue black color; for the diffuse type, the superficial dominant type had 13 cases of brown color, query number of cases of blue black color and 7 cases of dark brown color; the mid-dermis dominant type had 4 cases of brown color, query number of cases of dark brown color, the dispersed type had 14 cases of blue black color and 5 cases of brown color; the deep dominant type had 1 case of blue black color. CONCLUSION: The histological reclassification of Ota's nevus may be very useful in making a therapeutic prognosis of the disease.
Adolescent ; Age of Onset ; Classification ; Dermatitis, Atopic ; Dermatitis, Contact ; Dermatology ; Dermis ; Eosine Yellowish-(YS) ; Fatigue ; Female ; Hematoxylin ; Humans ; Korea ; Male ; Melanocytes ; Menstruation ; Mongolian Spot ; Nevus ; Nevus of Ota* ; Nevus, Blue ; Parturition ; Pigmentation ; Pregnancy ; Prognosis ; Psoriasis ; Puberty ; Seasons ; Sex Distribution ; Skin Diseases ; Stress, Psychological ; Sunlight ; Vitiligo

BACKGROUND: Large hospitals should execute the forty-hour workweek from July 2004 as a matter of laws. Some institutes have used this system as the concept of five-day workweek since 2 years ago. To prepare for the forty-hour workweek effectively, all emergency physicians and headquarters of hospitals should make plans from this time. METHOD: We analyzed the emergency patients who visited the ER on two consecutive work-free days and ordinary days of last year. The number of patients, final results, such as admission or home discharge, the clinics participating in emergency care, and other components were analyzed according to two consecutive work-free days and the ordinary days. RESULT: The number of emergency patients who visited ER during the two consecutive work-free days was increased by 39.5~100.8% compared to the ordinary days. Although the number of emergency patients was larger during these days, the admission rate was lowered by 3.8~14.5%. Patients who were cared for by an emergency physician or a pediatric physician were markedly larger during the two consecutive work-free days, and the patients cared by an internal medicine were lower. CONCLUSION: To care for the emergency patients more effectively during the two consecutive work-free days in the forty-hour workweek system, we should increase the number of emergency physicians and pediatric physicians, and space for fast track and pediatric emergency care should be secured.
Academies and Institutes ; Emergencies* ; Emergency Medical Services ; Humans ; Internal Medicine ; Jurisprudence