PURPOSE: The purpose of this study was to investigate the effects of Death Education Program which had been provided to family caregivers of disabled individuals. A single group pretest-posttest design was employed for this study, which was conducted at a community rehabilitation center located in Ulsan, South Korea. METHODS: Death Education Program was conducted for 16 family caregivers of disabled individuals who agreed to participate in this study. A 2.5-hour session was conducted once a week for 10 weeks. To investigate the effects of the education program, structured questionnaires, which assessed the patients and their family member's conceptions on the meaning of life, and their resilience, burden, and attitude towards death, were administered before and after the program. RESULTS: The subjects' conception of the meaning of life and resilience did not significantly change. The median scores for the burden of family caregivers declined, while those for the subjects' attitude towards death increased, after attending the education program. CONCLUSION: The findings showed that Death Education Program has an affirmative effect on the burden of family caregivers of disabled individuals and their attitude towards death.
Attitude to Death ; Caregivers ; Disabled Persons ; Fertilization ; Humans ; Rehabilitation Centers ; Resilience, Psychological ; Surveys and Questionnaires

Genetic polymorphisms associated with aggressive periodontitis have previously been reported. Interleukin-10 is an immunoregulatory cyto ine that plays a role in the patho genesis of periodontitis. Individual capacity for IL-10 production appears to be under genetic influence. The aim of present investigation was to explore possible genetic association of IL-10 gene promoter polymorphisms with generalized aggressive periodontitis. The study population consisted of 37 generalized aggressive periodontitis patients from the Department of Periodontology, Chonnam National University Hospital and 27 control subjects, all the subjects were non-smokers. Genomic DNA was obtained from buccal swab. The IL-10 promoter -597, -824, -1082 positions were genotyped by amplifying the polymorphic regions using polymerase chain reaction (PCR), followed by restriction enzyme digestion and gel electrophoresis. IL-10-597 C (allele 1) to A (allele 2) and IL-10-824 C (allele 1) to T (allele 2) and IL-10-1082 G (allele 1) to A (allele 2) polymorphisms were examined. The results were as follows. 1. In patients, the distribution of genotypes C/C, C/A and A/A at Il-10-597 was determined to be 13.5%, 37.8% and 48.7%, respectively and the distribution of genotypes at IL-10-824 was the same as that of IL-10-597. The distribution of genotypes G/G, G/A and A/A at IL-10-1082 was found to be 2.7%, 16.2% and 81.4%, respectively. No statistical difference in genotype distribution was found between the patient and control groups. 2. Allele 2 carriage rate at the three position of the IL-10 promoter region was higher in the control group than the patient group. 3. Allele 2 frequencies at IL-10-597 and -824 positions were higher in female group than male group and its difference was statistically significant(p<0.05). No significant difference in genotype distribution between the control and patient groups. Allele frequency between control and patient groups was not significantly different although allele 2 frequency at the three positions in the IL-10 promoter region appeared to be higher in control group. In conclusion, no clear association between IL-10 gene promoter polymorphisms and generalized aggressive periodontitis in Korean was observed.
Aggressive Periodontitis* ; Alleles ; Digestion ; DNA ; Electrophoresis ; Female ; Gene Frequency ; Genotype ; Humans ; Interleukin-10* ; Jeollanam-do ; Male ; Periodontitis ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Promoter Regions, Genetic

BACKGROUND: Endotracheal intubation is a common procedure in anesthesia, which can usually be accomplished easily. However, if the attempt is unexpectedly difficult the patient may be seriously at risk. If we can anticipate difficult intubation by assessing the airways in advance, anesthesiologists can plan the safest and most effective way of managing tracheal intubation. The purpose of this study is to evaluate a correlation between airway assessment factors and laryngoscopic grades for predicting difficult intubation. METHODS: The data were collected from a total of 427(male 189) patients older than 16 years of age undergoing non-emergency surgery. Seven airway assessment factors, measured at three levels of severity, were evaluated. Airway assessment factors include inter incisor gap, Samsoon and Young classification, thyromental distance, head and neck movement, body weight, history of difficult intubation and buck teeth. RESULTS: There was a significant correlation between total airway score and laryngoscopic grade. The incidence of difficult intubations was 9 out of 427 patients. Samsoon and Young classification, thyromental distance, head and neck movement, history of difficult intubation were significantly independent airway factors for predicting difficult intubations. Increase of total airway score represents the risk of difficult intubations. CONCLUSION: We suggest that total airway score could be used as a valuable predictor for assessing difficult intubations.
Anesthesia ; Body Weight ; Classification ; Head ; Humans ; Incidence ; Incisor ; Intubation* ; Intubation, Intratracheal ; Neck ; Tooth

Methotrexate (MTX) is the most widely used slow-acting anti-rheumatic agent in the treatment of rheumatoid arthritis. But, long-term administration of MTX can be complicated with liver fibrosis and even cirrhosis. We report the case in elderly woman with healthy Hepatitis B viral carrier patient who developed liver cirrhosis without viral replication after low-dose MTX therapy for rheumatoid arthritis.
Aged* ; Arthritis, Rheumatoid* ; Female ; Fibrosis ; Hepatitis B* ; Humans ; Liver Cirrhosis* ; Methotrexate*

BACKGROUND: As surgical techniques and postoperative care are improving, a pneumonectomy is a relatively popular surgical method in disease which is not treated completely with other types of pulmonary resection. However, a postpneumonectomy complication is a serious life-threatening problem if it occurrs. The purpose of this study is to evaluate determinants for postoperative mortality after pneumonectomy. METHODS: Patients were divided for study as follows: the Dead group versus the Alive group. To determine whether age, operation site, operation time, intraoperative fiuid intake, urine output, blood loss, complications, preoperative and intraoperative arterial blood gas analyses, and preoperative pulmonary function tests influence the determinants for postoperative mortality after pneumonectomy, a rettospecive analysis was performed on 71 patients who had undergone pneumonectomy from 1990to 1994 in Kosin Medical COLLEGE hOSPITAL. RESULTS: Operation time and blood loss were longer and greater respectively in the Dead group. The intraoperative PaO2 was lower and incidence of complications was more frequent in the Dead group.Otherwise there were no significant differences between two groups. CONCLUSION: We concluded that operation time, blood loss, incidence of complications and intra-operative PaO2 were closely related with postoperative mortality.
Blood Gas Analysis ; Humans ; Incidence ; Mortality* ; Pneumonectomy* ; Postoperative Care ; Respiratory Function Tests

PURPOSE: We wanted to compare the surgical outcomes of laparoscopic partial nephrectomy(LPN) performed with and without simultaneous artery-vein clamping. MATERIALS AND METHODS: Between April 2005 and December 2006, elective LPN was performed for 56 patients with renal tumors with using hilar clamping by a Satinsky clamp in 42(75%) patients, and with using artery-only or no clamping in the rest of the patients. The Satinsky and non-Satinsky groups were compared for their perioperative characteristics, the pathologic findings and the complication rate. The postoperative renal function was evaluated with measuring the serum creatinine and also by 99technetium labeled diethylenetetraminepentaacetic acid(DTPA) renal scanning. RESULTS: Renal cell carcinoma was diagnosed in 43(76.8%) patients and all had negative margins. There were no significant differences between the two groups for tumor size(2.1 vs. 2.0cm, respectively), the operative time(210.9 vs. 199.3 min, respectively) and the hospital stay(5.9 vs. 5.6 days, respectively). The mean warm ischemia time was longer when the Satinsky clamp was applied(38.5 vs. 21.9 min, respectively, p=0.03). The postoperative serum creatinine level and glomerular filtration rate(GFR) were 1.13mg/dl and 41.4ml/min/m2, respectively, in the Satinsky group and 1.17mg/dl and 33.5ml/min/m2, respectively, in the non-Satinsky group, without significant differences. The postoperative transfusion rate was lower in the Satinsky group(9.5 vs. 28.5%, respectively, p=0.28), although more pelvocalyceal system repair was done in the Satinsky group (47.6 vs. 7.7%, respectively, p=0.006). CONCLUSIONS: Simultaneous clamping of the renal artery and vein during LPN enables efficient removal of tumors that are deep in the renal sinus with a safe margin, it facilitates closure of the pelvocalyceal system and it reduces the need for transfusion without impairing renal function.
Carcinoma, Renal Cell ; Constriction* ; Creatinine ; Filtration ; Humans ; Kidney Neoplasms ; Laparoscopy ; Nephrectomy* ; Renal Artery ; Veins ; Warm Ischemia

PURPOSE: Despite numerous trials no various immunochemotherapeutic agents, advanced renal cell carcinomas (RCC) remain highly resistant to treatment. We report the results of immunochemotherapy to evaluate its efficacy, and to investigate factors modulating responses to treatment. MATERIALS AND METHODS: In this retrospective analysis, 54 patients with advanced RCC, having received either interferon-alpha (IFN-alpha) monotherapy, or a combination of interleukin-2 (IL-2), 5-fluorouracil (5-FU) and vinblastine, with IFN-alpha between January 1999 and March 2001, were reviewed. The patients were divided into 2 groups, either single or combined, therapy groups, which were further subdivided into locally advanced and metastatic disease groups. The nephrectomy and performance stati, cancer stage at the beginning of the immunotherapy, metastasized organs and interval to metastasis, were considered, and the responses to treatment and survival were evaluated accordingly in each subgroup. RESULTS: Of the 54 patients, 39 received monotherapy, 34 of which had a metastatic disease. Partial remission was observed in 1 patient (2.9%) with a duration of response of 52 weeks, a median survival of 47 weeks (4-323 wks) and a 1 year survival rate of 41.2%. Of the 15 patients in the combined therapy group, 12 with a metastatic disease, complete remission was noted in 1 patient (8.3%), with a continuous response at 57 weeks, a median survival of 34 weeks (4-204 wks) and a 1 year survival rate 41.7%. Of the prognostic factors, the nephrectomy status proved to be the only significant factor improving survival. CONCLUSIONS: Advanced RCC exhibited a very limited response, and nephrectomy status was revealed to be the only significant factor affecting survival. The efficacy of immunotherapy on locally advanced RCC needs further controlled evaluative studies.
Carcinoma, Renal Cell* ; Fluorouracil ; Humans ; Immunotherapy ; Interferon-alpha ; Interleukin-2 ; Neoplasm Metastasis ; Nephrectomy ; Retrospective Studies ; Survival Rate ; Vinblastine

POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal M protein, and skin lesion) is a rare multisystemic disease of unknown cause with varying clinical manifestations. Amyloidosis-associated POEMS Syndrome is also rare condition. We experienced a 63-year-old female who had been suffered from edema and tingling sensation of low extremities. She also had a marked demyelination, axonal degeneration and regeneration of the nerve, hypoaldosteronism, hyperprolactinemia, decreased sexual hormone, monoclonal gammopathy (IgG lambda type), skin change and ascites. The renal biopsy revealed homogenous mesangial widening with a few cell nuclei at the glomerular capillary, and it showed positive apple-green birefringence in Congo-red stain. It's the first report that shows the deposition of amyloid in patients with POEMS syndrome in Korea. Edema and M-spike were improved by use of prednisolone, melphalan, fludrocortisone and colchicine.
Amyloid ; Amyloidosis* ; Ascites ; Axons ; Biopsy ; Birefringence ; Capillaries ; Cell Nucleus ; Colchicine ; Demyelinating Diseases ; Edema ; Extremities ; Female ; Fludrocortisone ; Humans ; Hyperprolactinemia ; Hypoaldosteronism ; Korea ; Melphalan ; Middle Aged ; Paraproteinemias ; POEMS Syndrome* ; Prednisolone ; Regeneration ; Sensation ; Skin

INTRODUCTION: Tooth requiring extraction before radiotherapy in head and neck cancer patients should be performed as long as possible before the initiation of radiation therapy. Conventionally, a minimum 2-week waiting primary healing period is recommended. Although the above 2-week period is ideal, it is not uncommon for the radiotherapist and cancer patient to feel an urgent need to proceed with radiotherapy despite the need for dental care. Therefore, alternative approaches for early radiotherapy, including conservative endodontic treatment and a 1-week waiting primary healing period after dental extraction at the time of radiotherapy were considered and applied based on a literature review MATERIALS AND METHODS: The clinical study involved 120 head and neck cancer patients who were treated at Wonju Christian Hospital, Wonju College of Medicine, Yonsei University, from January 1995 to December 2004. RESULTS: In the clinical study, there were no specific complications, such as, post-extraction wound infections, radiation osteitis and osteoradionecrosis over the recent 10 years despite the early radiotherapy. CONCLUSION: Based on the clinical study, a minimum 1-week waiting primary healing period for oral care before radiotherapy is suitable for early radiotherapy in head and neck cancer patients.
Dental Care ; Head ; Head and Neck Neoplasms ; Humans ; Osteitis ; Osteoradionecrosis ; Tooth ; Tooth Extraction ; Wound Infection