No abstract available.
Humans ; Shoulder*

PURPOSE: This study was conducted to study the attitude of Korean lawyers toward withdrawal of life sustaining treatment, and compare and analyze different types of their attitudes. METHODS: Research design of this project was Q methodology approach. The study population was 24 lawyers, aged from 32 to 69 years. Q sample to investigate the attitude of the lawyers toward withdrawal of life sustaining treatment included 34 statements obtained from literatures, TV debate, and depth interviews of 5 lawyers among the lawyers included. After listening to the purpose and method of the study, the 24 lawyers agreed to fill out a survey asking sociodemographic information, and the information was distributed in 9 scale Q-sample. RESULTS: The collected data were processed through QUANL PC program and sorted into 5 types as follows: The first type was 'Choosing to withdraw life sustaining treatment', the second 'Withholding life sustaining treatment' regardless of the cost, the third is neutral type that claims that humans have the right to decide the death and life, and demands the proper legalization to protect such rights, the fourth type agrees to withdrawal of life sustaining treatment, nevertheless, admits that one has a rigt to withhold one's own life treatment, categorized as self contradiction type. The fifth type believed that 'Life and death are providential' with the faith, therefore, such authority to decide life and death belongs to God, but not human beings. CONCLUSION: In conclusion, the lawyer's attitudes toward withdrawal of life sustaining treatment were grouped into five different types as follows: 'Choosing to withdraw life sustaining treatment', 'Withholding life sustaining treatment', 'Demanding legalization', 'Self contradiction type', and 'Life and death are providential'.
Aged ; Human Rights ; Humans ; Lawyers ; Nursing Methodology Research ; Q-Sort ; Research Design ; Withholding Treatment

No abstract available.
Gangwon-do* ; Rehabilitation*

PURPOSE: To comparatively analyze treatment-related adverse events and the treatment dropout rate between immunochemotherapy and target therapy in Korea. MATERIALS AND METHODS: Forty-nine subjects with metastatic renal cell carcinoma (21 target therapy recipients and 28 immunochemotherapy recipients) who underwent either 6-week cycles of sunitinib treatment (50 mg once daily for 4 weeks on and 2 weeks off) or 8-week cycles of immunochemotherapy (combination of interleukin [IL]-2, interferon [IFN]-alpha, and 5-fluorouracil [FU]) were enrolled. Treatment-related toxicity was objectively graded and quantitative analysis was performed with a scoring system. Patient compliance was categorized into three classes (1: administration as scheduled, 2: dose modification required, 3: discontinuation required). RESULTS: Compared with those of the immunochemotherapy group, subjects of the sunitinib-treatment group had higher occurrence rates of mucositis-stomatitis (43% vs. 10%), hand-foot syndrome (38% vs. 0%), diarrhea (33% vs. 14%), and hypertension (33% vs. 14%). According to the toxicity-grade-based scoring system, the total incidence and severity of toxicities were not significantly different between the two groups (p>0.05), whereas high-grade hematologic toxicities were more frequent in the immunochemotherapy group. The dropout rate of the immunochemotherapy group was significantly higher than that of the sunitinib group (administration as scheduled: 52% vs. 21%, p=0.026; discontinuation required: 19% vs. 50%, p=0.037). CONCLUSIONS: The results of this study are indicative of a comparable treatment-related toxicity profile of sunitinib and greater adherence to the treatment protocol in comparison with immunochemotherapy in patients with metastatic renal cell carcinoma (mRCC).
Carcinoma, Renal Cell ; Clinical Protocols ; Diarrhea ; Fluorouracil ; Hand-Foot Syndrome ; Humans ; Hypertension ; Immunotherapy ; Incidence ; Indoles ; Interferons ; Interleukins ; Korea ; Patient Compliance ; Patient Dropouts ; Pyrroles

PURPOSE: The aim of this research was to compare surgical outcomes and complications of obese and non-obese patients who underwent open radical nephrectomy (ORN) and laparoscopic radical nephrectomy (LRN). MATERIALS AND METHODS: The data of 26 ORN patients and 30 LRN patients between January 2006 and December 2008 were analyzed. Patients with a body mass index (BMI) of 25.0 kg/m2 or more were defined as obese, and those with a BMI of <25.0 kg/m2 were defined as non-obese. All patients were divided into two groups according to the criteria above to compare demographic and clinical and pathologic parameters. RESULTS: The mean BMIs of the 15 obese patients in the ORN group and the 13 obese patients in the LRN group were 26.8+/-1.1 and 27.7+/-2.4, respectively. LRN was enormously effective for lowering estimated blood loss (EBL) and postoperative days compared with ORN. Operation times and EBL in ORN were affected by obesity, both of which were increased. In contrast, the data of both LRN groups indicated similar outcomes. The perioperative data of obese patients revealed LRN to have reduced blood loss (143.0+/-62.7 vs. 446.7+/-222.4 ml, p=0.001) and not significantly different postoperative days (7.3+/-2.2 vs. 8.4+/-1.5 days, p=0.065). Operation time, however, did not differ significantly among obese patients between ORN and LRN. The complications due to LRN had no relation with obesity, whereas ORN had an increased complications rate (34.6% vs. 3.8%). CONCLUSIONS: This study shows that LRN is more effective than ORN for both obese and non-obese patients with regard to perioperative outcomes and complication rates.
Body Mass Index ; Carcinoma, Renal Cell ; Humans ; Laparoscopy ; Nephrectomy ; Obesity

PURPOSE: Although its incidence has decreased with the widespread use of less invasive surgical techniques including laparoscopic surgery, postoperative ileus remains a common postoperative complication. In the field of urologic surgery, with the major exception of radical cystectomy, few studies have focused on postoperative ileus as a complication of laparoscopic surgery. The present study aims to offer further clues in the management of postoperative ileus following urological laparoscopic surgery through an assessment of the associated risk factors. METHODS: The medical records of 267 patients who underwent laparoscopic surgery between February 2004 and November 2009 were reviewed. After excluding cases involving radical cystectomy, combined surgery, open conversion, and severe complications, a total of 249 patients were included for this study. The subjects were divided into a non-ileus group and an ileus group. The gender and age distribution, duration of anesthesia, American Society of Anesthesiologists Physical Status Classification Score, body mass index, degree of operative difficulty, presence of complications, surgical procedure and total opiate dosage were compared between the two groups. RESULTS: Of the 249 patients, 10.8% (n = 27) experienced postoperative ileus. Patients with ileus had a longer duration of anesthesia (P = 0.019), and perioperative complications and blood loss were all correlated with ileus (P = 0.000, 0.004, respectively). Multiple linear regression analysis showed that the modified Clavien classification was an independent risk factor for postoperative ileus (odds ratio, 5.372; 95% confidence interval, 2.084 to 13.845; P = 0.001). CONCLUSION: Postoperative ileus after laparoscopic urologic surgery was more frequent in patients who experienced more perioperative complications.
Age Distribution ; Anesthesia ; Body Mass Index ; Cystectomy ; Humans ; Ileus ; Incidence ; Laparoscopy ; Linear Models ; Medical Records ; Postoperative Complications ; Risk Factors ; Urology

There are diverse surgical methods for treating large bladder stones, such as transurethral cystolithotripsy (TUCL), percutaneous suprapubic cystolithotripsy (PCCL), open surgery, and laparoscopic methods. We report here a case of two large bladder stones treated by using a combined surgical method of a laparoscopic approach and direct visual lithotripsy.
Chimera ; Laparoscopy ; Lithotripsy ; Surgical Procedures, Minimally Invasive ; Urinary Bladder ; Urinary Bladder Calculi

PURPOSE: The purpose of this study is to evaluate the displacement of artificial tooth of monolithic complete denture manufactured by milling and 3D printing method in which the denture base and the artificial teeth are simultaneously made. MATERIALS AND METHODS: Twelve upper and lower complete dentures for each were made by milling and 3D printing method. Group Up and Group Lp are a group of upper and lower dentures made by printing, and Group Um and Group Lm are denture groups made by milling. Group Uc and Group Lc are is a group of finally designed upper and lower dentures respectively. Measurements were performed between both central incisors (AB, ab), both canines (CD, cd), both first molars (EF, ef), between an incisor and a first molar (AE, ae), and between incisor and lingual point (AG, ag) for each upper and lower denture. RESULTS: AG and ag value between printed dentures and original ones as well as between milled dentures and original ones showed a statistically significant difference (One-way ANOVA, P<.05) in both lower and upper monolithic dentures. In the lower monolithic ones, ab, cd and ef value revealed a significant difference between Group Lp and Group Lm (One-way ANOVA, P<.05). CONCLUSION: Dentures made using milling or 3D printers revealed statistically significant difference compared with those of original data. However, it showed clinically very accurate reproducibility.
Denture Bases ; Denture, Complete* ; Dentures ; Incisor ; Methods ; Molar ; Printing, Three-Dimensional* ; Tooth, Artificial*

Neuromyotonia, or Isaacs' syndrome, consists of continuous muscle fiber activity caused by hyperexcitability of the peripheral nerves. Rarely, these patients also develop CNS symptoms characterized by confusion, insomnia, hallucinations, and agitation. A rare disease consisting of neuromyotonia, autonomic symptoms, and CNS dysfunction is called Morvan's syndrome. We report a 24-year-old man who presented with insomnia, malaise, anorexia, hyperhidrosis, palpitation and myokymia in both the lower extremities. The pathomechanism of Morvan's syndrome is related to the voltage-gated K+ channel (VGKC) antibodies.
Anorexia ; Antibodies ; Dihydroergotamine ; Hallucinations ; Humans ; Hyperhidrosis ; Isaacs Syndrome ; Lower Extremity ; Myokymia ; Peripheral Nerves ; Rare Diseases ; Sleep Initiation and Maintenance Disorders ; Young Adult

OBJECTIVE: Spontaneous intracerebral hemorrhage (ICH) in young adults is rare. The purpose of this study was to investigate causes, sites and other factors affecting the prognosis of ICH in young adults aged < or = 40 years. METHODS: We reviewed 39 consecutive patients diagnosed with spontaneous ICH between January 2001 and June 2012. Patients with primary subarachnoid hemorrhage, previously diagnosed brain tumor bleeding, or vascular malformation were excluded. We analyzed the differences in prognostic factors such as hemorrhage location and vascular structural etiology. The outcome was measured using the Glasgow outcome scale (GOS), and a good outcome was defined as a score of 4 or more. RESULTS: We retrospectively evaluated 39 patients (mean age, 33 years; SD = 6.4, range 17 to 40 years). The most common structural etiology was arteriovenous malformation. A statistically significantly higher proportion of patients with good outcomes had a lower initial systolic blood pressure (SBP < or = 160 mmHg, p = 0.036), a higher initial Glasgow coma scale (GCS) (9 or more, p = 0.034), lower cholesterol levels (< 200 mg/dl, p = 0.036), and smoking history (at discharge, p = 0.008; 6 months after discharge, p = 0.019). CONCLUSION: In this study, cryptogenic ICH was the leading cause of spontaneous ICH. A GCS score of 9 or more on admission, a lower serum cholesterol level (< 200 mg/dl), and a lower SBP (< 160 mmHg) predicted a good outcome.
Aged ; Arteriovenous Malformations ; Blood Pressure ; Brain Neoplasms ; Cerebral Hemorrhage ; Cholesterol ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Hemorrhage ; Humans ; Prognosis ; Retrospective Studies ; Smoke ; Smoking ; Subarachnoid Hemorrhage ; Vascular Malformations ; Young Adult