Considering the recent medicalization of death, the importance of preparing both laypersons and medical students to have meaningful end-of-life conversations, which is among the objectives of death education, will grow. The Act of Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life provided a new source of momentum to death education for both laypersons and medical professionals, as the importance of education on death is widely recognized. However, problems remain regarding how to prepare people for productive conversations at the end-of-life and how to secure the continuity of care. Different focuses and deficiencies are observed in death education programs for each category of learner. In education for laypeople, tangible information on how to actualize one’s existential and personal understanding of death through real-life options is lacking, except for presenting the “protocol” of the Act. Conversely, basic medical education lacks an understanding of or confrontation with death on the existential and personal levels. Death education should aim to build a shared understanding that can facilitate communication between the two groups. The scant overlap between layperson education and basic medical education even after the Act’s enactment is worrisome. Further fundamental changes in death education are required regarding its content. Topics that patients and doctors can share and discuss regarding death and end-of-life care should be discovered and provided as educational content both to laypeople and future medical professionals.

OBJECTIVE: The treatment of intraepithelial neoplasia and microinvasive cervical cancer ranges from local destruvtive methods to total hysterectomy. The conservative treatment has increased as more lesions are being detected in young women. METHODS: This study was designed to compare the 112 microinvasive cervical cancer treatment reliability, efficacy, and safety of cold knife conization (23), electric conizer (31), and largr loop (58). RESULTS: The mean age for cold cone, conizer, and LEEP were 41.1, 41.4, and 42.2 years old. The parity for cold cone, conizer and LEEP were 3.1, 2.1, and 2.7 siblings. Resection margine involved pathologic finding were 47.8%, 54.8%, and 74.1% (P<0.05). After hysterectomy, residual disease for cold cone, conizer and LEEP were 1, 24, and 30 cases CONCLUSION: The results suggest that LEEP is quicker, safer, and lower cost than cold knife conization for the management of cervical intraepithelial neoplasia and micro invasive cancer.
Cervical Intraepithelial Neoplasia ; Conization* ; Female ; Humans ; Hysterectomy ; Parity ; Siblings ; Uterine Cervical Neoplasms

Lynch syndrome is also called Hereditary nonpolyposis colorectal cancer (HNPCC). It is characterized by a risk of colorectal cancer and other cancers of the endometrium, ovary, stomach, small intestine etc. The increased risk is due to inherited mutations that impaired DNA mismatch repair. Two to three percentage of colon cancer is caused by Lynch syndrome. A family history of colon cancer occurs at a young age. We experienced one case of Lynch syndrome who had had stomach cancer, endometrial cancer and colon cancer recently. Hence we report this case with a brief review of literature.
Colonic Neoplasms ; Colorectal Neoplasms ; Colorectal Neoplasms, Hereditary Nonpolyposis ; DNA Mismatch Repair ; Endometrial Neoplasms ; Endometrium ; Female ; Humans ; Intestine, Small ; Ovary ; Stomach ; Stomach Neoplasms

A 74-year-old postmenopausal woman visited our gynecology clinic complaining of a palpable abdominal mass. Physical and radiological evaluation indicated that the mass exhibited features of a left ovarian neoplasm showing heterogeneous enhancement. Surgical resection was performed to confirm this suspicion. During surgery, a mass was observed only in the left ovary with no invasive growth, but adhesions to the surrounding peritoneum were seen. Given the patient's age, large mass size, and accompanying uterine myoma and right ovarian cyst, total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. The final pathologic diagnosis was dedifferentiated liposarcoma. The liposarcoma was suspected to originate from retroperitoneal adipose tissue rather than the ovary. Radiotherapy was planned if a gross lesion indicating recurrence followed 6 months later. This case required a considerable multi-disciplinary approach for diagnosis and treatment because of its ambiguous clinical and radiological findings.
Aged ; Diagnosis ; Female ; Gynecology ; Humans ; Hysterectomy ; Intra-Abdominal Fat ; Leiomyoma ; Liposarcoma* ; Ovarian Cysts ; Ovarian Neoplasms ; Ovary ; Peritoneum ; Radiotherapy ; Recurrence ; Retroperitoneal Neoplasms

Among the possible complications of radiation therapy, acute and chronic side effects on the skin can be induced by percutaneous radiotherapy in the target site. Common skin lesions include radiation dermatitis, which can be treated by topical application of dressing and ointment. Pemphigoid disease, which displays similar clinical features as other skin diseases such as recurrent cancer and herpes zoster, rarely occurs in the site of radiotherapy; therefore, care must be taken during diagnosis for a timely treatment. The present report is a case of pemphigoid disease that had developed in a patient with endometrioid/clear cell carcinoma after radiation therapy, and the time between onset and radiotherapy was more than 6 months.

Among the possible complications of radiation therapy, acute and chronic side effects on the skin can be induced by percutaneous radiotherapy in the target site. Common skin lesions include radiation dermatitis, which can be treated by topical application of dressing and ointment. Pemphigoid disease, which displays similar clinical features as other skin diseases such as recurrent cancer and herpes zoster, rarely occurs in the site of radiotherapy; therefore, care must be taken during diagnosis for a timely treatment. The present report is a case of pemphigoid disease that had developed in a patient with endometrioid/clear cell carcinoma after radiation therapy, and the time between onset and radiotherapy was more than 6 months.

Background and Objectives: Recurrence rates after radiofrequency catheter ablation (RFCA) in atrial fibrillation (AF) patients are not low especially in non-paroxysmal AF. The diameter of left atrium (LA) has been widely used to predict the recurrence after RFCA for decades. However, LA diameter represents structural remodeling of LA and does not reflect electrical remodeling. We aimed to determine the predictive value of electrical remodeling of LA which is represented by the amount of low voltage zone (LVZ). Methods: We performed a retrospective cohort analysis of AF patients who underwent de novo RFCA in a single-center. Results: A total of 3,120 AF patients with de novo RFCA were analyzed. Among these patients, 537 patients underwent an electroanatomic mapping with bipolar voltage measurement of LA.The diameter of LA and flow velocity of LA appendage (LAA) differed significantly according to quartile group of LVZ area and percentage: patients with high LVZ had large LA diameter and low LAA flow velocity (p<0.001). Freedom from late recurrence (LR) was significantly lower in patients with high LVZ area and percentage (p<0.001). The diameter and surface area of LA had area under curve (AUC) of 0.592 and 0.593, respectively (p=0.002 for both). The predictive value of LVZ area (AUC, 0.676) and percentage (AUC, 0.671) were both superior compared with LA diameter (p=0.011 and 0.027 for each comparison). Conclusions In conclusion, LVZ can predict freedom from LR after RFCA in AF patients. Predictive value was higher in parameters reflecting electrical rather than structural remodeling of LA.

PURPOSE: To evaluate the difference between corneal endothelial cell density at the moment of preservation and at keratoplasty in imported donor corneas and to analyze the correlated factors of the difference. METHODS: Eighty-seven imported corneas were evaluated. Corneal endothelial cell density at the moment of preservation was obtained from the medical record and was measured just before the keratoplasty. Correlation of the difference in endothelial cell density with the following factors were analyzed; donor sex, donor age, death-to-preservation time, preservation-to-surgery time, death-to-surgery time, endothelial cell density at the moment of preservation, and preservation period of the corneas. RESULTS: All of the corneas showed a decrease in endothelial cell density. Mean endothelial cell density of imported donor corneas at the moment of preservation and at keratoplasty was 2789 +/- 235 cells/mm2 and 2592 +/- 254 cells/mm2 (p < 0.001), respectively. Mean endothelial cell loss was 197 +/- 148 cells/mm2, which was significantly correlated with preservation-to-surgery time, death-to-surgery time and a preservation period longer than 7 days (p = 0.042, p = 0.045, p = 0.036, respectively). CONCLUSIONS: Reduced death-to-surgery time and keratoplasty before 7 days of preservation are needed for better surgical outcome.
Cornea ; Corneal Transplantation ; Endothelial Cells ; Humans ; Medical Records ; Tissue Donors

Background: In a substantial proportion of patients with syncope, the exact cause is not identified because of the difficulty to document electrocardiograms correlated with the events during a syncope episode. Thus, an implant‑ able loop recorder (ILR) was introduced for diagnosing hidden arrhythmia; however, its clinical use remains limited.Therefore, we conducted a retrospective analysis to assess the diagnostic value of the ILR in patients with unexplained syncope or palpitations. Methods: All patients who had undergone ILR implantation from May 2016 to January 2020, were studied retrospec‑ tively. We analyzed their electrocardiogram stored in the device. Results: Among the 70 patients (mean age ± SD; 50.2 ± 20.3 years, 27 men) with unknown causes of syncope or pal‑ pitation, during two years follow-up, arrhythmia was detected in 26 patients (37.1%). Nineteen (73.1%) patients under‑ went permanent pacemaker implantation due to symptomatic bradycardia or atrioventricular block. All arrhythmias were detected within 6 days to 39 months after loop recorder implantation. Thirteen patients (50%) showed sick sinus syndrome (eight long pauses and five tachycardia-bradycardia syndromes). Eleven patients (42.3%) had paroxysmal atrioventricular block. Two patients who underwent permanent pacemaker implantation showed a positive tilt-table test. Three patients underwent radiofrequency catheter ablation for paroxysmal supraventricular tachycardia and atrial fibrillation. The mean duration for the detection of first sign (arrhythmia or palpitations) was 7.5 months, and the time from the detection of arrhythmia to ablation or device implantation was 3.4 months. Conclusion ILR monitoring detected a substantial number of significant bradycardias in patients with unexplained syncope and palpitations, suggesting that it is an effective diagnostic method that can shorten the time required to identify the cause of arrhythmias.