BACKGROUND: The goal of this study was to analyze the process and characteristics of withholding or withdrawal of life support (WLS) in Korean intensive care units (ICUs). METHODS: This was a single-centered retrospective analysis of patients who died in the ICUs of a tertiary hospital in Korea from January to December 2012. WLS informed consents and clinical data were analyzed. RESULTS: Of 285 deaths during the study period, informed consents for WLS were obtained from 228 patients (80.0%). All WLS decisions were made by family members after the patient's loss of decision-making capacity. Decisions were made most frequently by the patient's son (50.6%). Patients in the WLS group were older than those in the non-WLS group, and older age was associated with the WLS decision. Thirty-seven patients (16.2%) died within one hour of WLS approval, and 182 patients (79.8%) died on the day of WLS approval. The most frequently withheld life support modality was chest compression (100%), followed by defibrillation (95.9%) and pacemaker insertion (63.3%). CONCLUSIONS: Aggressive and invasive life support measures were those most frequently withheld or withdrawn by decision-makers in Korean ICUs. The most common proxy was the son, rather than the spouse.
Humans ; Informed Consent* ; Intensive Care Units* ; Korea ; Life Support Care ; Proxy ; Retrospective Studies ; Spouses ; Tertiary Care Centers ; Thorax ; Withholding Treatment

Annexin-1 (ANX1) is a 37 kDa protein that is induced and secreted by glucocorticosteroid hormone. The secreted ANX1 has been believed to exert its function by binding to its putative rnembrane receptor. In this report we demonstrate that ANXl receptor (ANX1R) signal blocks the interleukin-1B (IL-1B) receptor signal pathway in human peripheral blood mononuclear cells (PBMCs). When PBMCs were treated with both IL-1B (100 ng/ml) and PMA (10 ng/ml) in the absence or presence of dexamethasone for 5 days, dexamethasone (100 nM) suppressed lymphocyte proliferation to 24% of the control. However addition of anti-ANX1 polyclonal antibody of 1:200 and 1:1,000 dilution to this system induced recovery of proliferation to 80% and 40%, respectively, when compared to the control. In the mixed lymphocyte reaction, dexamethasone suppressed lymphocyte proliferation to 9% of that of control when stimulated with IL-1B (100 ng/ml) and phorbol myristate acetate (10 ng/ml). Addition of anti-ANX1 polyclonal antibody (1:1,000) to this system also recovered the proliferation to 20% of that of the control system. In the ANX1 receptor induction experiment using flow cytometry, ANX1 receptor expression on lymphocytes, CD4+ T cells, CD8+ T cells and monocytes increased depending on the externally added IL-1B ranging from 10 to 1,000 ng/ml. From these results, it is evident that dexamethasone induces ANX1 secretion into the culture medium and anti-ANX1 polyclonal antibody abolishes the effects of dexamethasone. Furthermore these results imply that extracellular ANX1 exerts its effects by binding to the receptor on the cell membrane and the activated signal(s) of ANX1R block IL-1B receptor signal in the lymphocytes.
Cell Membrane ; Dexamethasone ; Flow Cytometry ; Humans ; Interleukin-1* ; Lymphocyte Culture Test, Mixed ; Lymphocytes* ; Monocytes ; Signal Transduction ; T-Lymphocytes ; Tetradecanoylphorbol Acetate*

PURPOSE: The purpose of this study was to identify predictors of obesity, serum lipids and CRP in Korean adults. The predictors of obesity and serum lipids were the subject's general characteristics, life style, eating habit and nutrients. The predictors of CRP were the subject's general characteristics, life style, eating habit, nutrients, obesity and serum lipids. METHOD: 115 subjects who had visited the health examination center at a hospital participated in the study. The data analysed with descriptive analysis, ANOVA, Chi-square test, Pearson correlation coefficient and multiple regression. RESULT: Sex, married, eating out (4< or =/w), eating out (2-3/w) and age (61< or =) were anticipated variable on BMI(R2=0.488). Sex and overeating (2-3/w) were anticipated variable on body fat(R2=0.218). Drink (4-6/w), age (51-60), sex, vegetable fat and Systolic BP were anticipated variable on total cholesterol (R2=0.217). Age (51-60), vegetable fat and unmarried were anticipated variable on LDL (R2=0.180).Sex was anticipated variable on HDL and Triglyceride (R2=0.054, 0.192). Breakfast (1-3/w) and meal (2/d) were anticipated variable on CRP (R2=0.1268). CONCLUSION: It is thought that decreasing eating out and overeating might be important to prevent obesity. It is thought that decreasing drinking and fat eating might be important to improve serum lipids. It is thought that eating breakfast might be important to decrease CRP.
Adult ; Breakfast ; C-Reactive Protein ; Cholesterol ; Drinking ; Eating ; Humans ; Hyperphagia ; Life Style ; Meals ; Obesity ; Single Person ; Vegetables

Purpose: : This retrospective study aims to provide basic data for intervention to improve clinical outcomes and identify the characteristics of the rebound hyperthermia (RHG) and non-rebound hyperthermia (NRHG) groups by checking body temperature in patients with post-cardiac arrest syndrome.Method : The study involved 118 patients who completed target temperature management (TTM) in an acute-care unit. Data were analyzed for frequency, percentages, mean, standard deviation, median, and quartiles, and compared using the chi-squared test and Mann–Whitney U-test. Results: : Rebound hyperthermia (RH) was observed in 74 (62.7%) patients, predominantly male (69.5%), with an average age of 64.54 ± 15.98, and a body mass index of 23.22 ± 4.75kg/m2 (overweight). Hypertension (50%) was the most common co-morbidity, followed by diabetes and heart disease (33.1%). Neuron-specific enolase levels were higher in the NRHG 24, 48, and 72 hours after recovery of spontaneous circulation (p = .037, p＜ .001, p= .008). The APHCHE Ⅳ was also higher in the NRHG (p＜ .001). RH occurred 25.49 (7.28–52.96) hours after TTM completion, lasting for 2 (1–3) hours. Temperature reduction strategies included notifying doctors, administering antipyretics, and nursing intervention, with the latter being the most common at 94.6%. Half of the subjects in the RHG and 77.3% in the NRHG fell into cerebral performance categories 3, 4, and 5 (p= .003). Conclusion : RH is more likely a body mechanism related to CPR and TTM than a result of pathogenic infection. Therefore, we require an active intervention for hyperthermia, and a patient-specific nursing intervention protocol.

A 44-year-old man was cutting an outer plate of a ship, at a depth of 25 m below sea level. Following a sudden explosion, he was discovered unconscious and was carried to the surface by other divers. There was no evidence of vital signs upon arrival at the hospital. Postmortem computed tomography, which was performed prior to autopsy, revealed massive pneumocephalus in the brain, pneumohemothorax, diffuse lung contusions with multiple traumatic lung cysts, air-fluid level in the cardiac chamber of the chest, and pneumoperitoneum in the abdomen. Postmortem external examination showed a circular abrasion on the jaw, diffuse subcutaneous emphysema, and contusion in the right upper arm. An internal examination revealed intravascular air bubbles in all four chambers of the heart, and diffuse pulmonary trauma including contusion, laceration, and multiple traumatic cysts. Blast injury to the chest, and air embolism due to the underwater explosion were established as the underlying cause of death.
Abdomen ; Adult ; Arm ; Autopsy ; Blast Injuries ; Brain ; Cause of Death ; Contusions ; Diving ; Embolism, Air ; Explosions* ; Heart ; Humans ; Jaw ; Lacerations ; Lung ; Pneumocephalus ; Pneumoperitoneum ; Ships ; Subcutaneous Emphysema ; Thorax ; Vital Signs

PURPOSE: To evaluate the long-term outcomes of fascial sling operation conducted at multicenters in Korea. MATERIALS AND METHODS: 564 patients, who underwent fascial sling operation for stress urinary incontinence, between December 1996 and May 2001, at 10 institutions in Korea, were included in this study. They were all followed up for a period of at least 2 years. History taking, a physical examination, and urodynamic studies, including Valsalva leak point pressure (VLPP), were conducted before the operation. Postoperative symptoms and satisfaction were assessed using a questionnaire. The 269 (47.7%), 266 (47.2%) and 29 (5.1%) patients underwent operations with autologous rectus fascia, cadaveric allograft fascia and autologous fascia lata, respectively. RESULTS: The mean follow up period was 43.6 months, ranging from 24 to 77 months. Stress urinary incontinence was cured in 485 (86.0%) patients and improved in 31 (5.5%). In autologous fascia group, 252 (84.6%) patients were cured and 18 (6.0%) improved; whereas, in allograft fascia group 233 (87.6%) patients were cured and 13 (4.9%) improved. 253 (84.9%) patients with autologous fascia and 228 (85.7%) patients with allograft fascia were satisfied, making a total of 481 patients (85.3%) that were satisfied with the operation. According to the fascia length and preoperative VLPP value, there were no differences in the success and patient satisfaction rates. There were 197 (34.9%) patients with preoperative urge urinary incontinence, and 92 (46.7%) of these were either cured or improved postoperatively. However, de novo urge urinary incontinence was noted in 8 patients (1.4%). CONCLUSIONS: Our results suggest that the long-term outcome of fascial sling operation for the treatment of stress urinary incontinence was satisfactory.
Allografts ; Cadaver ; Fascia ; Fascia Lata ; Female* ; Follow-Up Studies ; Humans ; Korea* ; Patient Satisfaction ; Physical Examination ; Surveys and Questionnaires ; Urinary Incontinence* ; Urodynamics

No abstract available.
Anemia, Dyserythropoietic, Congenital*

A renal angiomyolipoma (AML) is an unusual benign tumor that is composed of adipose tissue, smooth muscle, and abnormal blood vessels. AMLs can occur sporadically or can be associated with tuberous sclerosis. A ruptured renal AML may manifest as lift-threatening hypovolemic shock or sudden death. Herein, the authors present an autopsy case of traumatic rupture of a renal AML in a patient with tuberous sclerosis.
Adipose Tissue ; Angiomyolipoma* ; Autopsy ; Blood Vessels ; Death, Sudden ; Humans ; Muscle, Smooth ; Rupture* ; Shock ; Tuberous Sclerosis*

PURPOSE: Various surgical methods have been using to treat female stress urinary incontinence. However, significant numbers of those patients suffered from immediate or delayed recurrences. The aims of this study were to analyze the etiology of recurrent stress urinary incontinence and evaluate the efficacy of each operation which was used as methods of treating recurrent stress urinary incontinence. MATERIALS AND METHODS: Data of 16 female patients with recurrent stress urinary incontinence who visited and treated at our urologic department from January 1995 to March 1998 were analyzed. All patients were assessed for their age, types of previous and current anti-incontinence operations, urodynamic findings and final outcomes. RESULTS: Mean age was 48.8 years old. 12 patients were taken anti-incontinence operations only once before recurrence, and 4 patients experienced two times of anti-incontinence operations. Two of 16(12%) patients were diagnosed as anatomic incontinence(AI), 3(19%) patients were diagnosed as intrinsic sphincteric dysfunction(ISD), and 11(69%) patients had both AI and ISD. Two AI patients were finally managed by Raz bladder neck suspension with anterior and posterior colporrhaphy(APR), and Burch colposuspension, respectively. Three ISD patients were treated by sling operation & APR, collagen injection, and Burch colposuspension, repectively. 11 mixed incontinence patients were treated by sling operations & APR(7), Burch colposuspension(3), Stamey`s needle suspension & APR(1). None of 16 patients has developed recurrent urinary incontinence so far. CONCLUSIONS: Basic principle in treating AI is the correction of the urethral hypermobility. However, 81%(13/16) of patients still had urethral hypermobility in spite of previous anti-incontinence surgery, and it seems that those anti-incontinence surgeries were improperly selected or urethral hypermobility reappeared. Patients who showed urinary incontinence in spite of well supported bladder neck suggest the possibility of undetected or secondary ISD. These findings support the importance of selection of proper initial surgical management. In recurrent urinary incontinence, majority of them show undetected or newly appeared ISD component regardless of urethral hypermobility. In those situations, sling operation can be a safe and effective procedure in the management of patients with failed anti-incontinence surgery.
Collagen ; Female ; Humans ; Neck ; Needles ; Recurrence ; Reoperation ; Urinary Bladder ; Urinary Incontinence ; Urodynamics

AIMS: To explore the relationship between shiftwork duration and metabolic risk factors on cardiovascular disease in shiftworkers. METHODS: The study subjects comprised of 226 nurses, from a hospital, and 130 male workers, from a diaper and feminine hygienic material manufacturing firm. The mean ages of the male workers and nurses were 29 and 28.5 years, respectively. The fasting blood sugar, serum cholesterol, blood pressure, height and weight, waist and hip circumferences (only in nurses), and number of step for a shift as indices of physical activity were measured. Using the Korean version of Karasek's job contents questionnaire, the job stress was assessed. Information about the number of years worked, duration of shiftwork, and past medical and behavioral histories, including smoking, were obtained by self-administrated questionnaires. Linear regression analyses were performed, to show the relationships between shiftwork duration and metabolic risk factors, using simple and multivariate models, adjusted for age, smoking, job strain and physical activity. The following criteria were defined: hypertension as a SBP>or160 or a DBP>or=90 mmHg at least once, hypercholesterolemia, as a serum total cholesterol >or=240 mg/dl, obesity as BMI (Body Mass Index) >or=25kg/m2 and central obesity as a WHR (Waist to Hip Ratio) >or=0.85; and the logistic regression analyses, according to years of shiftwork, were performed using simple and adjusted models. RESULTS: The cholesterol and fasting blood sugar showed increasing trends, but without statistical significances, according to the increase in shiftwork duration of the male workers, although, the increases in the blood pressure and BMI were statistically significant. In the nurses, only the WHR showed a significant increase in relation to the shiftwork duration. In the logistic regression analyses, hypercholesterolemia and obesity showed significant increasing risks according to the number of years of shiftwork (OR=3.32 95%CI 1.27-8.72 and OR=3.21 95%CI 1.24-8.32 respectively) in the male workers, but hypertension showed no significance. In the nurses, only an increased central obesity was significant as a risk factor (OR=1.30 95%CI 1.05-1.62). CONCLUSIONS: These results provide evidence of the associations between shiftwork and metabolic risk factors for cardiovascular disease, although healthy shiftworker effects might exist in our cross sectional study design.
Blood Glucose ; Blood Pressure ; Cardiovascular Diseases* ; Cholesterol ; Fasting ; Hip ; Humans ; Hypercholesterolemia ; Hypertension ; Linear Models ; Logistic Models ; Male ; Motor Activity ; Obesity ; Obesity, Abdominal ; Questionnaires ; Risk Factors* ; Smoke ; Smoking