Ethical problems in an emergency department (ED) are much more common than is usually recognized. But these difficult ethical dilemmas have not been dealt with by general medical ethicists. Most medical ethics guidelines tend to concentrate on chronic or at least relatively stable situations rather than on the acute, episodic cases that are typical in the ED. most ethical problems such as abortion, euthanasia, and professionalism can be solved after reflection and deliberation, and after a process of communication that reveals the values and interests of the patient or the patient's family. In contrast, when health care professionals in the ED recognize ethical problems, they often don't have enough time for an ethical consultation such as a Hospital Ethics Committee. Ethical principles such as autonomy, beneficence, nonmaleficence, and justice need to be applied to the unique setting of emergency medicine. Hence, it is necessary to develop ethics guidelines in emergency medicine and ethics education for health care professionals in emergency departments. At first, we collected cases involving ethical problems and reviewed the ethical and legal aspects of those cases. In this article, we summarize the ethical issues in emergency medicine, deal with actions in emergency medical services, and also consider the relationships between ethical issues and act on emergency medical services. We want to present the important factors that should be considered in ethical decision making within an emergency medicine department including patient decision making capacity, legal custody, and ethical principles.
Beneficence ; Decision Making ; Delivery of Health Care ; Emergencies ; Emergency Medical Services ; Emergency Medicine ; Ethicists ; Ethics Committees, Clinical ; Ethics, Medical ; Euthanasia ; Humans ; Jurisprudence ; Social Justice

No abstract available.
Abdomen ; Syringoma

No abstract available.
Abdomen ; Syringoma

PURPOSE: To evaluate the risk of vertebral compression fracture (VCF) after conventional radiotherapy (RT) for colorectal cancer (CRC) with spine metastasis and to identify risk factors for VCF in metastatic and non-metastatic irradiated spines. MATERIALS AND METHODS: We retrospectively reviewed 68 spinal segments in 16 patients who received conventional RT between 2009 and 2012. Fracture was defined as a newly developed VCF or progression of an existing fracture. The target volume included all metastatic spinal segments and one additional non-metastatic vertebra adjacent to the tumor-involved spines. RESULTS: The median follow-up was 7.8 months. Among all 68 spinal segments, there were six fracture events (8.8%) including three new VCFs and three fracture progressions. Observed VCF rates in vertebral segments with prior irradiation or pre-existing compression fracture were 30.0% and 75.0% respectively, compared with 5.2% and 4.7% for segments without prior irradiation or pre-existing compression fracture, respectively (both p < 0.05). The 1-year fracture-free probability was 87.8% (95% CI, 78.2-97.4). On multivariate analysis, prior irradiation (HR, 7.30; 95% CI, 1.31-40.86) and pre-existing compression fracture (HR, 18.45; 95% CI, 3.42-99.52) were independent risk factors for VCF. CONCLUSION: The incidence of VCF following conventional RT to the spine is not particularly high, regardless of metastatic tumor involvement. Spines that received irradiation and/or have pre-existing compression fracture before RT have an increased risk of VCF and require close observation.
Colorectal Neoplasms* ; Follow-Up Studies ; Fractures, Compression* ; Humans ; Incidence ; Multivariate Analysis ; Neoplasm Metastasis ; Radiotherapy ; Retrospective Studies ; Risk Factors ; Spinal Fractures ; Spinal Neoplasms ; Spine*

Pulmonary tuberculosis is still endemic in Korea, but esophageal tuberculosis, especially primary esophageal tuberculosis, is very rarely seen. A 76-year-old male is presented dysphagia. The clinical presentation, barium swallow study, and chest CT were suggestive of carcinoma of the esophagus. Findings that can suggest the diagnosis are enlarged lymph nodes, ulceration, and luminal narrowing. The major differential diagnosis was primary esophageal tuberculosis. This was not excluded on biopsy obtained at endoscopy. Operation was done for severe dysphagia and exclusion of malignancy. The patient was finally diagnosed as primary esophageal tuberculosis.
Aged ; Barium ; Biopsy ; Deglutition Disorders ; Diagnosis ; Diagnosis, Differential ; Endoscopy ; Esophagus ; Humans ; Korea ; Lymph Nodes ; Male ; Phenobarbital ; Tomography, X-Ray Computed ; Tuberculosis* ; Tuberculosis, Pulmonary ; Ulcer

PURPOSE: While acute urinary retention(AUR) secondary to bladder outlet obstruction in the male occurs commonly and rarely causes difficulty with diagnosis and treatment but AUR in female is an uncommon findings. This study was performed to evaluate AUR in possible causes by urodynamic study and analyzed the results of treatment. MATERIAL AND METHODS: We have retrospectively tried to evaluate the possible causes of AUR in 41 female patients. Urine analysis, urine culture, urodynamic study and selectively cystoscopy were performed in 41patients. We analysed the urodynamic feature respectively and classified into areflexia type, hyperreflexia type, detrusor hyperreflexia with impaired contractility(DHIC) type and normal finding. RESULTS: The mean age of patients was 57.9 years. Major causes of AUR were CNS lesion(13 cases, 31.7%), diabetes mellitus(6 cases, 15.3%) and spinal lesion(4 cases, 10.2%). Urethral catheterization was employed as initial treatment in 32 cases(78.0%). Catheter was removed after mean 5.2 days and selective urodynamic study was done in 36 cases. Urodynamically, there were hyperreflexia type 16 cases(44.4%), areflexic type 9 cases(25%), DHIC type 6 case(16.7%), normal finding 5 cases(13.9%). The treatments of areflexic type included intermittent catheterization(IC) in 4 cases (44.4%), urethral catheterization in 3 cases (33.3%), medical therapy in 2 cases(22.2%). The treatments of hyperreflexia type included IC in 4 cases(25%), urethral catheterization in 1 case(6.3%) and medical therapy in 11 cases(68.8%). The treatments of DHIC type included IC in 2 cases(5.5%), urethral catheterization in 1 case(2.8%), medical therapy in 2 cases(5.5%) and ileal conduit in 1 case(2.8%). CONCLUSIONS: Causes of female AUR were commonly considered the functional urinary retention and rarely organic urinary retention, but there were various causes. Our study indicated the need to consider the gender and urodynamic finding on the evaluation and treatment of AUR.
Catheters ; Cystoscopy ; Diagnosis ; Female ; Humans ; Male ; Reflex, Abnormal ; Retrospective Studies ; Urinary Bladder Neck Obstruction ; Urinary Catheterization ; Urinary Catheters ; Urinary Diversion ; Urinary Retention* ; Urodynamics

BACKGROUND: An increasing number of elderly are referred for open heart surgeries(OHS). These patients are assumed to have significantly increased morbidity and mortality because of compromised functional reserves in their vital organs. We reviewed the results of OHS patients who were 70 years old or older. MATERIAL AND METHOD: Thirty six consecutive septuagenarians underwent OHS from 1995 to 1997. Operations were coronary artery bypass grafting(CABG) in 26 including 3 left main surgical angioplasty, valve replacement in 7, MVR+CABG in 2, and ASD closure+TAP in 1. Statistical tests were carried out to compare survivor group with nonsurvivor group in respect to risk factors including NYHA functional class, LVEF, emergent operation, IABP support, CPB/ACC time, ventilator time cardiac index, ICU stay and hospital stay for operative mortality. RESULT: Operative mortality rate and postoperative complication were 16%(6/36) and 50%(18/36). One-year and 3-year actuarial survival rates were 76%. Nine patients(25%) had major complications including third-degree A-V block(2), respiratory failure(1), stroke(3), renal failure requiring dialysis(3) and postoperative hemorrhage(2). The causes of death were pneumonia(1), bleeding(1), acute renal failure(1), low cardiac output(1), third-degree A-V block(1), and ventricular tachycardia(1). The univariate analysis of mortality shows that NYHA class IV, LVEF<40%, lesser values for C.I, and longer time for ventilatory support were associated with the risk factors(p value=0.03, 0.001, 0.007, and 0.014). The emergent operation, CPB/ACC time, IABP support, ICU stay and hospital stay were not significant. CONCLUSION: We conclude that cardiac operation can be performed in septuagenarians with acceptable outcomes when done in patients with normal to moderately depressed left ventricular function and adequate functional reserves in their vital organs.
Age Factors ; Aged ; Angioplasty ; Cause of Death ; Coronary Artery Bypass ; Heart* ; Humans ; Length of Stay ; Mortality ; Postoperative Complications ; Renal Insufficiency ; Risk Factors ; Survival Rate ; Survivors ; Ventilators, Mechanical ; Ventricular Function, Left

Primary leiomyosarcoma is an extremely rare tumor. We exprienced a case of 46-year-old man with a mass located in the left upper lobe bronchus which was discovered on a chest CT. Cytology of the sputum and bronchoscopic biopses did not reveal any malignant cells. The patient underwent a left sleeve upper lobectomy. The tumor was growing from the left upper lobe bronchus and had partially destroyed the lung parenchyme. The pathologic feature of the tumor was composed of fascicular arrayed cellular spindle cells with blunt-ended nuclei revealed mild to moderate pleomorphism and frequent mitoses (15/10HPF). The immunohistochemical staining was revealed positive reaction for antibody to smooth muscle actin and desmin. We conclude that the tumor is leiomyosarcoma of the lung and then report with a review of the literatures.
Actins ; Bronchi ; Desmin ; Humans ; Leiomyosarcoma* ; Lung* ; Middle Aged ; Mitosis ; Muscle, Smooth ; Sputum ; Subclavian Artery ; Thoracic Outlet Syndrome ; Tomography, X-Ray Computed

PURPOSE: Prostatitis is an extremely common syndrome that afflicts 2~10% of men and is now classified into NIH category. Of these, NIH category III(Chronic Prostatitis/Chronic Pelvic Pain Syndrome, CP/CPPS) varies widely in clinical presentation and response to treatment. We evaluated the characteristic symptoms of CP/CPPS based on NIH chronic prostatitis symptom index(NIH-CPSI), International Prostate Symptom Score(IPSS) and International Index of Erectile Function-5(IIEF-5) for the exploration of the future prospects of treatment. MATERIALS AND METHODS: 114 subjects agreed to participate in the study. The data from 99 patients were available for evaluation. The candidates with category IIIa and IIIb chronic pelvic pain syndrome were from 3rd decade to 6th decade for exclusion of effect of BPH. The NIH-CPSI, IPSS, IIEF-5 were used to grade symptoms and the quality of life impact at the start of the study. We investigated the correlation of the each domain of the scales categorized by age, location and multiplicity of the pain, and duration of the disease. Pearson's correlation method and ANOVA test were used for statistical analysis. RESULTS: Mean age of the patients was 41.1+/-8.5(3rd decade; 8 patients, 4th decade; 30, 5th decade 47, 6th decade 14). There were significant correlation between IPSS total score and urinary domain of NIH-CPSI (R=0.82), and irritative domain of IPSS and urinary domain of NIH-CPSI(R=0.76) with pearson's method. Analysis of the scores categorized by age revealed that there were no difference in 2nd, 3rd, 4th decade, but 6th decades had high IPSS total score. Analysis of the scores categorized by location and multiplicity of the pain revealed that the most common site of the pain was perineum(34.3%), and the patients who had 3 or more painful area had higher scores in all domains of CPSI and IPSS except pain domain of NIH-CPSI than the patients who had 1 painful area. Analysis of the scores categorized by duration of the disease revealed that the IPSS scores of the patients suffered during 1 year or more were higher than the patient suffered during 6months or less. There was no significant correlation between IIEF-5 and other scales. CONCLUSION: In our study there was significant correlation between urinary domain of NIH-CPSI and total score of IPSS. So, urinary domain of NIH-CPSI could be helpful index when alpha-blocker is used for the treatment of CP/CPPS. And alpha-blocker could be more effective in patients who are older and have longer duration of the disease and have multiple painful areas.
Humans ; Male ; Pelvic Pain* ; Prostate ; Prostatitis ; Quality of Life ; Weights and Measures

OBJECTIVES: Protein-calorie malnutrition has been shown to be prevalent among patients on chronic dialysis, And assessment of nutritional status of continuous ambulatory peritoneal dialysis(CAPD) patients has assumed greater importance because of the association of protein-calorie malnutrition with increasing morbidity and mortality. So we observed the incidence and clinical effect of protein-calorie malnutrition, and we compared the indices of nutrition with dialysis adequacy utilizing urea kinetic modeling and cretinine clearance in CAPD patients. METHODS: We performed a cross-sectional study in which eight parameters, based on anthropometry, blood chemistry and subjective symptoms, were scored according to the degree of abnormalities in 82CAPD patients. A malnutrition index was derived from these scores. We also performed comparative analysis to identify significant correlations of the indices of urea kinetic modeling and creatinine clearance with the other parameters of nutritional status. RESULTS: The malnutrition index classified 47(57%) patients as normal, 30(37%) intermediately malnourished, and 5(6%) as severely malnourished. Malnutrition index showed a significant correlation with the body mass index(BMI), triceps skinfold thickness(TSF), mid-arm circumference(MAC), mid-arm muscle area (MAMA), duration of CAPD, subjective symptoms, serum albumin, transferrin, cholesterol, and triglyceride. The malnutrition index also showed a significant correlation with residual renal function(RRF), and standardized creatinine clearance(SCCr). The TWR-Kt/V(total Kt/Vurea per week with consideration of residual renal urea clearance) was significantly lower in the severely malnourished group than in the normal group. Serum alkaline phosphatase and BUN levels were higher in the severely malnourished group than in the normal and inter-mediate groups. CONCLUSION: In assessing the nutrition status of CAPD patients, body weight, TSF, MAC, MAMA, subjective symptoms, serum albumin, transferrin, cholesterol, triglyceride, urea nitrogen, and alkaline phosphatase were considered useful parameters. There was a trend of increased BUN and decreased TWR-Kt/V in severely malnourished patients, and the value of SCCr was significantly lower in malnourished patients. However, no meaningful relationships between TW-Kt/V and malnutrition index or between NPCR(normalized protein catabolic rate) and malnutrition index were found m this cross-sectional study. As the number of patients with longer duration of CAPD or negligible RRF has increased in the malnourished patients, regular monitoring of these parameters, especially TWR-Kt/V and SCCr, may be helpful to assess dialysis adequacy to keep good nutritional status of each CAPD patient.
Alkaline Phosphatase ; Anthropometry ; Body Weight ; Chemistry ; Cholesterol ; Creatinine* ; Cross-Sectional Studies ; Dialysis ; Humans ; Incidence ; Malnutrition ; Mortality ; Nitrogen ; Nutritional Status ; Peritoneal Dialysis, Continuous Ambulatory* ; Protein-Energy Malnutrition ; Serum Albumin ; Transferrin ; Triglycerides ; Urea*