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Background/aim Currently, there are no standard guidelines for the waiting time from the diagnosis of gastric neoplasms to endoscopic submucosal dissection (ESD). Patients and methods A total of 1,605 patients who had undergone ESD for early gastric cancer (EGC) or high-grade dysplasia (HGD) were enrolled. Waiting time for ESD was defined as the time from the first diagnosis to ESD. Multivariable logistic regression analysis was conducted. Results The curative resection rate was 86.8% and the mean waiting time was 36.8 days. In the multivariable model, longer waiting time did not significantly affect non-curative resection, whereas age >70 years, submucosal fibrosis, and initial cancer diagnosis were significantly associated with non-curative resection. Waiting time was still not identified as a risk factor for non-curative resection in EGC and HGD groups. Conclusion A longer waiting time from diagnosis to ESD was not associated with non-curative resection.

Background/Aims Adequate bowel preparation is important for successful colonoscopy. We aimed to evaluate the clinical feasibility and effectiveness of abdominal vibration stimulation in bowel preparation before therapeutic colonoscopy. Methods A single center, prospective, randomized, investigator-blinded study was performed between January 2016 and December 2016. Patients for therapeutic colonoscopy were prospectively enrolled and assigned to either the vibrator group or walking group. Patients who refused to participate in this study as part of the experimental group consented to register in the control group instead. During the preparation period, patients assigned to the walking group walked ≥3,000 steps, whereas those assigned to the vibrator group received abdominal vibrator stimulation and restricted walking. All patients received the same colon cleansing regimen: 4-L split-dose polyethylene glycol (PEG) solution. Results Three hundred patients who received PEG solution for therapeutic colonoscopy were finally enrolled in this study (n=100 per group). Bowel cleansing with abdominal vibration stimulation showed almost similar results to that with walking exercise (Boston Bowel Preparation Scale score for the entire colon: vibrator vs walking vs control, 7.38±1.55 vs 7.39±1.55 vs 6.17±1.15, p

Background We conducted this radiographic study in the elderly population with proximal humeral fracture aiming to evaluate 1) the serial changes of neck-shaft angle after locking plate fixation and 2) find relationship between change in neck shaft angle and various factors such as age, fracture pattern, severity of osteoporosis, medial support and initial reduction angle. Methods Twenty-five patients who underwent surgical treatment for proximal humeral fracture with locking plate between September 2008 and August 2010 are included. True anteroposterior and axillary lateral radiographs were made postoperatively and at each follow-up visit. Measurement of neck shaft angle was done at immediate postoperative, 3 months postoperative and a final follow-up (average, 11 months; range, 8 to 17 months). Severity of osteoporosis was assessed using cortical thickness suggested by Tingart et al. Results The mean neck shaft angles were 133.6° (range, 100° to 116°) at immediate postoperative, 129.8° (range, 99° to 150°) at 3 months postoperative and 128.4° (range, 97° to 145°) at final follow-up. The mean loss in the neck-shaft angle in the first 3 months was 3.8° as compared to 1.3° in the period between 3 months and final follow-up. This was statistically significant (p = 0.002), indicating that most of the fall in neck shaft angle occurs in the first three months after surgery. Relationship between neck shaft angle change and age (p = 0.29), fracture pattern (p = 0.41), cortical thickness (p = 0.21), medial support (p = 0.63) and initial reduction accuracy (p = 0.65) are not statistically significant. Conclusions The proximal humerus locking plate maintains reliable radiographic results even in the elderly population with proximal humerus fracture.

The long-term clinical benefits of vascular access blood flow (VABF) measurements in hemodialysis (HD) patients have been controversial. We evaluated whether early VABF may predict long-term vascular access (VA) patency in incident HD patients. We enrolled 57 patients, of whom 27 were starting HD with arteriovenous fistulas (AVFs) and 30 with arteriovenous grafts (AVGs). The patients' VABF was measured monthly with the ultrasound dilution technique over the course of the first six months after the VA operation. During the 20.4-month observational period, a total of 40 VA events in 23 patients were documented. The new VA events included 13 cases of stenosis and 10 thrombotic events. The lowest quartile of average early VABF was related to the new VA events. After adjusting for covariates such as gender, age, hypertension, diabetes, VA type, hemoglobin levels, body mass index, parathyroid hormone, and calcium-phosphorus product levels, the hazard ratio of VABF (defined as

In this study, we propose a tongue diagnosis method which detects the tongue from face image and divides the tongue area into six areas, and finally generates tongue coating ratio of each area. To detect the tongue area from face image, we use ASM as one of the active shape models. Detected tongue area is divided into six areas widely used in the Korean traditional medicine and the distribution of tongue coating of the six areas is examined by SVM(Support Vector Machine). For SVM, we use a 3-dimensional vector calculated by PCA(Principal Component Analysis) from a 12-dimentional vector consisting of RGB, HIS, Lab, and Luv. As a result, we detected the tongue area stably using ASM and found that PCA and SVM helped raise the ratio of tongue coating detection., {"references":["C.-C. Chiu, \"A novel approach based on computerized image analysis for traditional Chinese medical diagnosis of the tongue,\" Computer Methods\nand Programs in Biomedicine, vol. 61, pp. 77-89, 2000.","Stephen Milborrow, Fred Nicolls, \"Locating Facial Features with an\nExtended Active Shape Model,\" Lecture notes in computer science,2008","Su-Joong Kim, Jae-Keun Hong, \"A Simplification of Polynomial Representations for the Moments of the Mahalanobis Distances,\"\nJournal of the Korean Institute of Electronics Engine- ers, vol.21 no.3, pp. 1~5, May, 1984","V.Vapnik, The Nature of Statistical Learning Theory, Springer-verlag,\nNew York, 1995.","CJC. Burges, \" A Tutorial on Support Vector Machines for Pattern\nRecognition,\" In Data Mining and Knowledge Discovery, Vol.2 No. 2, pp. 121-167, 1998.","H.Z. Zhang; K.Q. Wang; D. Zhang; B. Pang; B. Huang, \"Computer Aided\nTongue Diagnosis System,\" Engineering in Medicine and Biology\nSociety, 2005. IEEE-EMBS 2005. 27th Annual International Conference\nof the Digital Object Identifier pp. 6754 - 6757, Setember, 2005","Keun-Ho Kim, Jun-Hyeong Do, Hyun-Hee Ry- u, Kim, Jong-Yeol,\n\"Systematic Approach to The Extraction of Effective Region for Tongue\nDiagnosis,\" Journal of the Institute of Electro- nics Engineers of Korea.\nSC, System and control, v.45 no.6, pp. 123-131, Nov. 2008","Hao Zhu, Wangmeng Zuo, Hongzhi Zhang, Jianfeng Li, David Zhang,\n\"Exploratory Tongue Color Analysis with Manifold Learning,\"\nBiomedical Engineering and Informatics, pp. 244-248, October, 2010"]}

이전의 연구에서 정신병증과 고프로락틴혈증이 동시에진단되어 bromocriptine으로 고프로락틴혈증을 조절한 증례가 보고된 바 있으나, 정신병증과 프로락틴 분비 뇌하수체거대선종이 동반된 환자에서 두 질환을 약물적인 치료만으로 안정적으로 치료한 증례는 많지 않다. 본 증례에서는 정신분열증으로 항정신병 약제로 장기간 치료를 받던 환자에게 발생한 프로락틴 분비 뇌하수체 거대선종을 진단하여 상반된 치료 기전을 가진 도파민 길항제와 작용제를 동시에처방하여 치료했다. 그 결과 혈청 프로락틴 수치 및 뇌하수체 선종의 크기는 감소하고 정신분열증이 악화되지 않는 등성공적으로 치료되어 문헌고찰과 함께 보고하는 바이다.

Purpose: The purpose of this study was to present a systematic treatment method for nontuberculous mycobacteria (NTM) infection of the hand and wrist to gain better clinical outcomes. Methods: 10 patients of deep NTM infection of the hand and wrist were reviewed. Extensive debridement was performed in all cases. When biopsy result suggested mycobacterial infection such as granulomatous inflammation, empirical tuberculosis medication was started. After culture confirmed NTM growth, the species was identified and in vitro sensitivity test was performed. Then medication was switched according to the results. Functional outcomes of the hand and wrist were measured by total active motion of the fingers and by range of motion of the wrist respectively. Results: Diagnosis was tenosynovitis in seven patients, infective arthritis and osteomyelitis combined with tenosynovitis of the wrist in three patients. Two patients had recurred skin ulcer during follow-up period and undergone second debridement. After second operation, no patient had a persistent discharging sinus and all patient were completely healed during follow-up period. Functional outcome of the eight patients who had NTM infection of their hand was excellent in two, good in four, fair in one, poor in one. Mean range of motion of the two patients who had osteomyelitis of their wrist was dorsiflexion 20°, volar flexion 15°, radial deviation 0°, ulnar deviation 15°. Conclusion: Our standardized treatment protocol can be helpful for treatment of deep NTM infection of the hand and wrist.

Background: Cognitive dysfunction after open heart surgery under the cardiopulmonary bypass is one of major problems in modern cardiac surgery. We designed this study to evaluate the incidence of postoperative neuropsychological changes after routine cardiac surgery with the cardiopulmonary bypass. Methods: We assessed the patients with four cognitive function tests on the day before, 4-5 days after and 9-10 days after cardiac surgery. The test batteries which used in this study were Trail-Making Test part A, Digit Substitution test, Digit Span Test, Grooved Pegboard test. Results: The incidence of cognitive dysfunction was 12.8-25% at postoperative 4-5 days, 2.3-11.5% at postoperative 9-10 days. About 80% of patients who showed cognitive dysfunction at postoperative 4-5 days had gained normal cognitive function score at postoperative 9-10 days. Conclusions: The incidence of cognitive dysfunction after heart surgery is not low, and we must try to find how to reduce these complications.

Background: Lidocaine has been used for attenuating cardiovascular responses to endotracheal intubation and thought to have the sedative effect. The sedative effect of lidocaine has not been known well. The BIS (bispectral index) has been used an indicator of the sedative state and has been considered to be related to anesthetic agents and noxious stimulus. The purpose of this study is to evaluate sedative and cardiovascular effects of lidocaine during TCI (target controlled infusion) of propofol by monitoring BIS and hemodynamics. Methods: Fifty ASA patient status 1 and 2, aged from 20 to 65 years patients (n = 50, 2 groups) undergoing elective surgeries with general anesthesia. These patients were randomly allocated to group C or L. Patients in Group L received 1.5 mg/kg injection and 40/kg/min infusion of lidocaine. Patients in Group C received normal saline. The BIS, blood pressure and heart rate were mesasured before injection of drug, 1, 2 minute after injection of drug, just before intubation, 1, 2, 5 and 10 min after intubation. Results: The BIS of group L more decreased than group C at 1, 2, 5 and 10 min after endotracheal intubation. The blood pressure and heart rate did not show any differences between two groups. Conclusions: Intravenous injection of lidocaine reduced BIS. Lidocaine had sedative effects under propofol target controlled infusion. But Cardiovascular variables of this study failed to show any differences between two groups (P

Background: It is well known that both thiopental sodium and propofol reduce the cerebral metabolic rate. The author investigated whether these drugs have similar effects on neurobiochemical compounds by using 1H-NMR, which enables noninvasive in vivo measurements of brain biochemistry. Methods: Six healthy white New Zealand rabbits (2.5-3.0 kg) were studied. A marginal ear vein was punctured for continuous intravenous infusion. Spontaneous breathing was maintained during the anesthesia. Neurobiochemical compounds such as Nacetylaspartate (NAA), choline-containing compounds (Cho), creatine plus phosphocreatine (Cr), myoinositol (MI), and lactate were examined at 30, 45 and 60 min during intravenous anesthesia induced with thiopental sodium (n = 3) and propofol (n = 3). Results: The signals of NAA, Cho, Cr and MI were unchanged during thiopental anesthesia, but the NAA signal was reduced at 45 and 60 min, and that of Cr was reduced from 30 min until the end of the propofol anesthesia. The Cho signal was increased at 45 and 60 min during propofol anesthesia. Thiopental sodium signal were detected through the study, but propofol was detected only at 30 min. On comparing metabolic ratios in the two groups, the ratio of NAA/Cr was reduced and those of Cho/Cr and MI/Cr were higher in propofol group than in the thiopental sodium group. Conclusions: Our results suggest that thiopental sodium has a cerebral protective function. Howerver, further study is needed upon the cerebral protective function of propofol anesthesia. Propofol is more useful for total intravenous anesthesia than thiopental sodium.

Background: This study was undertaken to elucidate the effects of general anesthesia by power spectral analysis of heart rate variability in diabetic and non-diabetic patients. Methods: EKG was measured in 35 patients, 17 without diabetes (control group) and 18 with diabetes (DM group). EKG and signal were digitized at 500 Hz for; 3 min in the period before anesthesia, during 1 to 5 min after intubation, 5 to 10 min after intubation and 30 min after skin incision. We also measured systolic and diastolic blood pressure, and heart rate in each period. The signal was analyzed using a fast Fourier transform algorithm to yield the power spectrum of the heart rate variability. Low frequency (LF, 0.04-0.15 Hz), high frequency (HF, 0.15-0.5 Hz) powers and the LF/HF ratio were obtained. Results: The blood pressure was increased transiently by tracheal intubation but decreased gradually while anesthesia progressed. To maintain a minimal pressure range, ephedrine 10mg was injected into 11 patients in the DM group. Heart rate also showed the same trend as blood pressure, and no difference between the two groups. LF and HF power of heart rate variability, which was measured before induction, were significantly decreased in the DM group compared to the control group. As anesthesia was applied, overall frequency power was significantly attenuated in both groups. As the operation proceeded, frequency power gradually recovered only in the control group. Changes of the LF/HF ratio in the control group were 2.58 0.62 at pre-induction and 5.47 1.36, 1.11 0.33, 1.03 0.21 successively and in the DM group were 3.21 0.76 at pre-induction and 4.92 2.55, 0.80 0.18, 0.56 0.16 as the anesthesia progressed. Conclusions: These results suggest that the heart rate variability is significantly attenuated when anesthetics are administered, and that in the DM group heart rate variability is more prominently attenuated than in the control group. This result implies that diabetic patients have an underlying impairment of autonomic nervous system function and that this may lead to a further impairment of autonomic control, which has the potential to allow substantial intraoperative blood pressure liability during periods of surgical stress or blood loss.

Background: Depolarizing muscle relaxant, frequently used for rapid sequence endotracheal intubation in clinical field, has serious complication that occur intermittently, such as, hyperkalemia, increased intraoccular pressure and sudden cardiac arm, especially in infants and adolescents. So the priming principle, i.e., the administration of a subparalyzing dose of a nondepolarizing muscle relaxant (priming dose) prior to the intubating dose, was developed for rapid sequence endotracheal intubation with nondepolarizing muscle relaxant. However, the priming dose sometimes causes complications, such as, swallowing difficulty or pulmonary aspiration, and this can cause patient discomfort or fatal complications. In this study we examined proper atracurium priming dose and evaluated possible complications of priming doses. Methods: One hundred patients, scheduled for elective surgery were randomly allocated into five groups according to the priming dose used (group 1; 0, group 2; 0.03, group 3; 0.06, group 4; 0.09, group 5; 0.12 mg/kg). Patients received a midazolam and fentanyl injection, the base line TOF ratio was measured, and an intubating dose was given. We also examined changes in vital sign for 20 minutes after injection and noted the time when the twitch height became zero (onset time). Results: In group 1, the onset time was 107 22.9 sec, and in groups 4 and 5, the onset times were 85.0 15.6 and 69.9 19.3 sec, respectively. But, in group 5, some patients showed tachycardia and swallowing difficulty. Conclusions: The optimal priming dose of atracurium was determined as 0.09 mg/kg, in most cases, however patients sensitivity to the atracurium should be considered.

Background: Pain remains the chief complaint that brings patients to physician's office, despite recent insights into underlying mechanism and the identification of potential new therapeutic targets. In recent years, however, with the development of molecular biology cell transplantation gives us a new chance for treating intractable chronic pain. The major purpose of the present study was to determine if the chromaffin cells that were encapsulated with 1.3% (w/v) sodium alginate-poly-l-lysine-alginate (APA) had robust analgesic effects in the spinal atlanto-occipital subarachnoid space even without nicotine stimulation. Methods: In order to determine whether microencapsulated bovine adrenal medullary chromaffin cells transplanted in the spinal cord can produce analgesic effects, we microencapsulated adrenal medullary chromaffin cells with APA and implanted them into the subarachnoid space of rats' (n = 10) spinal cord, and investigated the hot sensitivity of rats' hind-paw by a light-beam test. Results: It was found that compared with the control group, hot response latency of the group which received adrenal medullary chromaffin cells increased from the 12th day and the analgesic efficacy was maintained for at least 75 days. Conclusions: Microencapsulated bovine adrenal medullary chromaffin cells transplanted in the rats' spinal cord may provide a permanent and locally available source of neuropeptides for the relief of intractable pain. Furthermore, these kinds of analgesic effect were produced without any stimulation such as nicotine.

Background : Lumbar plexus block was used not only for the proposal of lower limb surgery, but also for that of pain control in the pain clinic. The aim of our study was to evaluate the motor, sensory function and the anatomic parameters after posterior approach of the lumbar plexus block with the help of a nerve stimulator. Methods : 30 patients of low back pain radiating to lower extremities were randomized into two groups. We performed the psoas compartment block guided by C-arm fluoroscope. With the pateints in prone position, a 100 mm insulated needle was introduced at the surface of L5 transverse process. Stimulation of femoral nerve was used to optimize the needle placement at the center of lumbar plexus (Dancing Patella). 1% mepivacaine hydrochloride (0.2 ml/kg) solution in group 1 (n=11) and 0.5% mepivacaine hydrochloride (0.2 ml/kg) solution in group 2 (n=19) were then injected. We measured the minimal current, distance of puncture site from midline, distance from skin to transverse process, distance from skin to the point of maximal twitch, and distance from transverse process to the point of maximal twich. Motor and sensory functions were measured at 5, 15, 30, 45, 60, 90 and 120 min after procedure. Results : Anatomical parameters were as follows; distance of puncture site from midline was 42.6 5.6 mm, distance from skin to transverse process was 52.9 ± 7.0 mm, distance from skin to the point of maximal twitch was 68.8±5.6 mm, and distance from transverse process to the point of maximal twich is 15.9±3.9 mm. Difference in attenuated motor function(hip adduction, knee extension) was observed between two groups (P＜0.05). Hip adduction and knee extension were recovered 60 min after injection in group 1. In group 2, knee extension was attenuated above 2 hours. We observed significant hip flexion attenuation 90 and 120 min (group 1 and group 2, etc) after injection Sensory blockade was recovered 120 min after injection in both groups. Conclusions : It is suggested that above mentioned anatomical parameters would be useful for the safe blockade. We found that recovery of attenuated hip flexion is crucial for the discharge criteria of ambulating outpatient with the low back pain. (Korean J Anesthesiol 1999; 36: 422∼430)

Background : Recent studies revealed that inhalational anesthetics(IA) attenuate NO production. But the hemodynamic changes produced by IA in septic syndrome patient are still sufficient to threaten patient, surgeon and anesthesiologist. So we examined which IA is proper to maintain vascular contractile force and evaluated the effects of NOS inhibitors on contractile force of septic rat aorta under IA. Methods : Aortic ring preparation was obtained from LPS-treated(1.5 mg/kg, i.p. for 18h) rats. The development of sepsis was confirmed by iNOS activity and iNOS expression using RT-PCR. Contractile responses of aorta to phenylephrine admministation in the presence or absence of halothane, enflurane and isoflurane were evaluated. We also evaluated the effects of NOS inhibitors, one is NG-nitro-L-arginine methyl ester(L-NAME) and the other is aminoguanidine. Statistical significances(p

The direct effects of thiobarbiturates on helical strips of aortas from spontaneously hypertensive (SH) rats were compared with those from Wistar-Kyoto (WKY) rats. At 5-6 wk of age, the arterial pressure of SH and WKY rats did not differ, and the effects of thiobarbiturates on aortic strips from SH and WKY rats were similar. By contrast, at the age of 10-12 or 20-21 wk arterial pressure was higher in SH than in WKY rats, and responses to thiobarbiturates differed in aortic strips from SH and WKY rats: contractile responses were greater in WKY than in SH rats, and relaxing effects were greater in SH than in WKY rats. Responses to sodium nitroprusside did not differ in the aortas of SH and WKY rats, but the effects of nifedipine were greater in strips from SH rats than from WKY rats at the age of 10-12 wk. Ca2(+)-induced contractions of strips exposed to Ca2(+)-free media and depolarized by high K+ were inhibited by treatment with thiamylal; the inhibition was greater in SH than in WKY rats. The increase in smooth-muscle relaxation induced by thiobarbiturates in strips from SH rats may be due to increased sensitivity to the Ca2(+)-channel blocking action of thiobarbiturates.

The aim of this investigation was to determine whether epidural analgesia has any effect on the uterine activity. Uterine activity was checked by an intermal tocometer and calculated in uterine activity units (UAU) which were expressed as Montevideo units. Twenty two gravidas who had the term pregnancy in labor without any obstertical complications were selected and epidural analgesia was performed in 17 of these patients. Plain lidocaine was used in 10 of them, lidocaine mixed with epinephrine (200,000:1) was used in another 7 gravidas and 5 gravidas were chosen as a control group. The results were as follows: The uterine actvity of the continuous epidural anesthesia group did not differ from that of the control group. The uterine activity changes were not statistically significant between the plain Iidocaine group and the epinephrine mixed group.