Objective: This study examined the effects of the new law on life-sustaining treatment (LST) in emergency patients with advanced malignancy. Methods: This was a retrospective before-after study performed at a single hospital. The enrollment criteria were as follows: patients who visited the emergency department during the study period, age ≥18 years, Korean Triage and Acuity Scale 1-2 to enroll severely ill patients requiring LST, solid malignancy with metastasis, and admitted to the study hospital. The after group was defined as those enrolled in May 2018, and the before group was defined as those enrolled in May 2017. The primary outcomes were defined as LST, including intensive care unit (ICU) admission, renal replacement therapy, mechanical ventilation, and cardiopulmonary resuscitation. Secondary outcomes were defined as each component of the primary outcomes, hospital length of stay, cost, and mortality. Results: Ninety-seven patients were enrolled (before group [n=46], after group [n=51]). LST was provided more frequently in the after group (19.6% vs. 47.1%, P=0.004). The ICU admission rate was higher (19.6% vs. 43.1%, P=0.013), and mechanical ventilation was applied more frequently (6.5% vs. 21.6%, P=0.044) in the after group. Furthermore, the median hospital length of stay (six-day vs. 11-day, P=0.016) was longer, and the median hospital cost was higher (3,777 USD vs. 7,882 USD, P<0.001) in the after group. Hospital mortality did not differ (19.6% vs. 35.3%, P=0.084). Conclusion New end-of-life care law increased the rate of LST in emergency patients with advanced malignancy regardless of the improved survival rate.

Objective: This study examined the effects of the new law on life-sustaining treatment (LST) in emergency patients with advanced malignancy. Methods: This was a retrospective before-after study performed at a single hospital. The enrollment criteria were as follows: patients who visited the emergency department during the study period, age ≥18 years, Korean Triage and Acuity Scale 1-2 to enroll severely ill patients requiring LST, solid malignancy with metastasis, and admitted to the study hospital. The after group was defined as those enrolled in May 2018, and the before group was defined as those enrolled in May 2017. The primary outcomes were defined as LST, including intensive care unit (ICU) admission, renal replacement therapy, mechanical ventilation, and cardiopulmonary resuscitation. Secondary outcomes were defined as each component of the primary outcomes, hospital length of stay, cost, and mortality. Results: Ninety-seven patients were enrolled (before group [n=46], after group [n=51]). LST was provided more frequently in the after group (19.6% vs. 47.1%, P=0.004). The ICU admission rate was higher (19.6% vs. 43.1%, P=0.013), and mechanical ventilation was applied more frequently (6.5% vs. 21.6%, P=0.044) in the after group. Furthermore, the median hospital length of stay (six-day vs. 11-day, P=0.016) was longer, and the median hospital cost was higher (3,777 USD vs. 7,882 USD, P<0.001) in the after group. Hospital mortality did not differ (19.6% vs. 35.3%, P=0.084). Conclusion New end-of-life care law increased the rate of LST in emergency patients with advanced malignancy regardless of the improved survival rate.

No abstract available.
Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Myasthenia Gravis

There was no significant difference in morbidity and mortality between those that received simultaneous operation for coronary artery disease and peripheral vascular disease versus those that received coronary artery bypass graft alone. Simultaneous operation is also cost effective. A 46 year-old patient with resting chest pain and intermittent claudication was diagnosed as unstable angina and Leriche's syndrome. We performed simultaneous revascularization for coronary artery stenosis with internal mammary artery and right gastroepiploic artery and a bifurcated vascular graft interposition between in the aorta, left common iliac and right femoral arteries for Leriche's syndrome. The postoperative coronary angiogram and aortogram revealed a good patency of the arterial conduits and vascular graft. He has been followed for 12 months without any problem.
Angina, Unstable ; Aorta ; Chest Pain ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Stenosis* ; Coronary Vessels* ; Femoral Artery ; Gastroepiploic Artery ; Humans ; Intermittent Claudication ; Leriche Syndrome ; Mammary Arteries ; Middle Aged ; Mortality ; Peripheral Vascular Diseases* ; Transplants

OBJECTIVES: The melanoma antigen gene (MAGE) and synovial sarcoma on X chromosome (SSX) gene families are silent in most normal adult tissues, but are expressed in a variety of malignant lesions. Therefore, detection of MAGE and SSX transcription may be useful for the diagnosis of head and neck cancers. The aim of this study is to detect MAGE and SSX gene transcripts of head and neck cancers using the MAGE 1-6 assay and the SSX 1-9 assay. METHODS: The transcripts of MAGE 1-6 and SSX 1-9 genes were detected by the MAGE 1-6 assay and the SSX 1-9 assay respectively, in cancer cell lines, cancer tissue, and induced sputum specimens from head and neck cancer patients. RESULTS: The transcripts of MAGE 1-6 and SSX 1-9 genes were detected in 82.8% and 75.9% of head and neck cancer tissues (N=29) respectively, and 96.6% of cancer tissues expressed at least one of MAGE 1-6 or SSX 1-9 genes. In the induced sputum of head and neck cancer patients (N=18), the transcripts of MAGE 1-6 and SSX 1-9 genes were detected in 72.2% and 77.8%, respectively, and 94.4% of the sputum specimens were positive for either the MAGE 1-6 or the SSX 1-9 assay. CONCLUSION: These results suggest that the combination of MAGE 1-6 and SSX 1-9 assays may be useful in the diagnosis of head and neck cancer.
Adult ; Cell Line ; Gene Expression ; Head ; Head and Neck Neoplasms ; Humans ; Melanoma ; Neck ; Polymerase Chain Reaction ; Sarcoma, Synovial ; Sputum ; X Chromosome

PURPOSE: To decide diagnostic titer in a single determination of antibody by indirect particle agglutination test and to characterize the occurrence of Mycoplasma pneumoniae during a 9 year-period in Seoul. METHODS: M. pneumoniae pneumonia diagnosed serologically at the Seoul National University Children's Hospital from 1986 to 1995 were reviewed, retrospectively. Antimycoplasma antibody was measured by indirect particle agglutination test. Diagnosis was based on 4 fold-rise or single high titer. Single diagnostic titer was set up by the value greater than the 90th percentile of the titer at one year of the children who initially had 4 fold-rise or > or =160. RESULTS: The geometric mean titer and the 90th percentile at 1 year of the 15 children who initially had antibody titer > or =160 or 4 fold-rise were 122 and 639, respectively, and single diagnostic titer was established as > or =640. A total of 126 childern were included by our diagnostic criteria. Male and female ratio was 1.17:1 and the mean age was 6 years 4 months. Pneumonia by M. pneumonuae occurred every years during the study period showing increased cases every 3 years. In the epidemic years, the cases occurred in late spring, summer and early fall. CONCLUSIONS: It is concluded that the occurrence of Mycoplasma pneumoniae pneumonia in Seoul from 1986 to 1995 was characterized by epidemics every 3 years as well as its endemicity.
Agglutination Tests ; Child ; Diagnosis ; Epidemiology ; Female ; Humans ; Korea* ; Male ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pneumonia* ; Pneumonia, Mycoplasma* ; Retrospective Studies ; Seoul*

OBJECTIVES: We examined the association between the adherence to dietary guidelines for breast cancer survivors and health-related quality of life in a cross-sectional study of Korean breast cancer survivors. METHODS: A total of 157 women aged 21 to 79 years who had been diagnosed with stage I to III breast cancers according to the American Joint Committee on Cancer (AJCC) and had breast cancer surgery at least 6 months before the baseline were included. We used a Korean version of the Core 30 (C30) and Breast cancer 23 (BR23) module of the European Organization for Research and Treatment Cancer Quality of Life Questionnaire (EORTC-QLQ), both of which have been validated for Koreans. Participants were asked about their adherence to dietary guidelines for breast cancer survivors, suggested by the Korean breast cancer society, using a 5-point Likert scale. We summed dietary guideline adherence scores for each participant and calculated the least squares means of health-related quality of life according to dietary guideline adherence scores using the generalized linear model. RESULTS: Breast cancer survivors who had higher adherence to dietary guidelines for breast cancer survivors had lower constipation scores than those with lower adherence (p for trend=0.01). When we stratified by the stage at diagnosis, this association was limited to those who had been diagnosed with stage II or III breast cancers. Also, sexual functioning scores increased significantly with increasing adherence scores of dietary guidelines among those with stage II or III breast cancers (p for trend < 0.001). However, among those who had been diagnosed with stage I, higher scores of dietary guidelines were associated with higher scores of pain (p for trend=0.03) and breast symptoms (p for trend=0.05). CONCLUSIONS: Our study suggested that the health-related quality of life levels of breast cancer survivors are associated with the adherence to dietary guidelines and may differ by the stage of the breast cancer.
Breast ; Breast Neoplasms* ; Constipation ; Cross-Sectional Studies ; Diagnosis ; Female ; Humans ; Joints ; Least-Squares Analysis ; Linear Models ; Nutrition Policy* ; Quality of Life* ; Surveys and Questionnaires ; Survivors*

Purpose: To report a case of autosomal dominant drusen confirmed by molecular genetic testing and the clinical features and findings of a multimodal diagnostic imaging study.Case summary: A 32-year-old male presented with decreased visual acuity in his right eye from 1 year prior to his first visit. On the first visit, his visual acuities were 0.3 in the right eye and 1.2 in the left eye. A fundus examination showed numerous drusen of various sizes widely distributed on the posterior pole of both eyes, as well as subretinal fibrotic change with pigmentation in the right eye. Optical coherence tomography showed extensive hyperreflective deposits beneath the retinal pigment epithelium in both eyes and small amounts of cystic intraretinal fluid in the right eye. Fluorescein angiography and fundus autofluorescence showed the drusen as multiple hyperfluorescent spots, while indocyanine green angiography indicated hypofluorescence corresponding to the drusen. Genetic sequence analysis revealed a pathogenic variant of the EFEMP1 gene, heterozygous c.1033C>T (p.Arg345Trp), which accords with the diagnosis of autosomal dominant drusen. Intravitreal bevacizumab injection was given in the right eye; however, there was no improvement in the amount of intraretinal fluid nor visual acuity. Conclusions Autosomal dominant drusen is a very rare disease. It is necessary to distinguish it from age-related macular degeneration, as the affected age and clinical features of drusen are different, including the response to anti-vascular endothelial growth factor treatment.

A type III choledochal cyst, known as a choledochocele, is rare. It is defined as cystic dilatation of the distal common bile duct, protruding into the duodenal lumen. Surgical treatment of a choledochocele remains controversial because it has a low incidence for malignancy compared with other choledochal cysts. While there have been few reported cases of choledochocele with malignancy, here we report our experience of a choledochocele with high-grade dysplasia and provide a literature review of the field.
Choledochal Cyst* ; Common Bile Duct ; Dilatation ; Incidence

Objective: The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus-2, is a global concern. This study aimed to examine the clinical characteristics, demographics and outcomes of COVID-19 patients in the emergency department (ED) and explore clinical predictors of in-hospital mortality. Methods: This single-center, retrospective, observational study used 1,003 adult patients with laboratory-confirmed COVID-19 who went to the ED and were admitted to the hospital between February 28 and September 30, 2020. Results: The median age of the included patients was 55 (37-68) years, and 533 were women (53.1%). Severe COVID-19 was noted in 173 patients (17.2%); seven patients (0.7%) received mechanical ventilation. The mortality rate was 2.1%. Multivariable Cox regression analysis found the risk factors associated with in-hospital death of patients (age >70 years [hazard ratio (HR), 27.411; P<0.001], albumin level <3.5 g/dL [HR, 12.273; P<0.001], CURB-65 [confusion, urea nitrogen, respiratory rate, blood pressure, 65 years of age and older] score ≥3 [HR, 10.137; P=0.002] and platelet count <100×109/L [HR, 3.281; P=0.024]) on admission. Conclusion Age>70 years, hypoalbuminemia, CURB-65≥3 and thrombocytopenia on admission were independent risk factors for mortality in patients hospitalized with COVID-19. Early detection of these predictors and application of CURB-65 score in the ED may provide guidance for appropriate risk stratification at triage and disposition of patients at increased risk of poor prognosis.