Background: Current international guidelines recommend against deep sedation as it is associated with worse outcomes in the intensive care unit (ICU). However, in Korea the prevalence of deep sedation and its impact on patients in the ICU are not well known. Methods: From April 2020 to July 2021, a multicenter, prospective, longitudinal, noninterventional cohort study was performed in 20 Korean ICUs. Sedation depth extent was divided into light and deep using a mean Richmond Agitation–Sedation Scale value within the first 48 hours. Propensity score matching was used to balance covariables; the outcomes were compared between the two groups. Results: Overall, 631 patients (418 [66.2%] and 213 [33.8%] in the deep and light sedation groups, respectively) were included. Mortality rates were 14.1% and 8.4% in the deep and light sedation groups (P = 0.039), respectively. Kaplan-Meier estimates showed that time to extubation (P < 0.001), ICU length of stay (P = 0.005), and death P = 0.041) differed between the groups. After adjusting for confounders, early deep sedation was only associated with delayed time to extubation (hazard ratio [HR], 0.66; 95% confidence inter val [CI], 0.55– 0.80; P < 0.001). In the matched cohort, deep sedation remained significantly associated with delayed time to extubation (HR, 0.68; 95% 0.56–0.83; P < 0.001) but was not associated with ICU length of stay (HR, 0.94; 95% CI, 0.79–1.13; P = 0.500) and in-hospital mortality (HR, 1.19; 95% CI, 0.65–2.17; P = 0.582). Conclusion In many Korean ICUs, early deep sedation was highly prevalent in mechanically ventilated patients and was associated with delayed extubation, but not prolonged ICU stay or in-hospital death.

Background/Aims: Although a management fee for hospitalist service was established in Korea, the number of hospitalists required for the system to run remains outmatched. Methods: In January 2020 and February 2022, before and after the establishment of the hospitalist fee system respectively, cross-sectional online surveys were conducted among internal medicine board-certified hospitalists. Results: There were 59 and 64 respondents in the 2020 and 2022 surveys, respectively. The percentage of respondents who cited financial benefits as a motive for becoming a hospitalist was higher in the 2022 survey than in the 2020 survey (34.4% vs. 10.2%; p = 0.001). The annual salary of respondents was also higher in the 2022 survey than in the 2020 survey (mean, 182.9 vs. 163.0 million in South Korean Won; p = 0.006). A total of 81.3% of the respondents were willing to continue a hospitalist career in the 2022 survey. In multivariate regression analysis, the possibility of being appointed as a professor was found to be an independent predictive factor of continuing a hospitalist career (odds ratio, 4.00; 95% confidence interval, 1.09–14.75; p = 0.037). Conclusions Since the establishment of the hospitalist fee system, monetary compensation has improved for hospitalists. The possibility of being appointed as a professor could predict long-term work as hospitalists.

Lung cancer is the leading cause of cancer death in many countries, including Korea. The majority of patients are inoperable at the time of diagnosis because symptoms are typically manifested at an advanced stage. A recent large clinical trial demonstrated significant reduction in lung cancer mortality by using low dose computed tomography (LDCT) screening. A Korean multisociety collaborative committee systematically reviewed the evidences regarding the benefits and harms of lung cancer screening, and developed an evidence-based clinical guideline. There is high-level evidence that annual screening with LDCT can reduce lung cancer mortality and all-cause mortality of high-risk individuals. The benefits of LDCT screening are modestly higher than the harms. Annual LDCT screening should be recommended to current smokers and ex-smokers (if less than 15 years have elapsed after smoking cessation) who are aged 55 to 74 years with 30 pack-years or more of smoking-history. LDCT can discover non-calcified lung nodules in 20 to 53% of the screened population, depending on the nodule positivity criteria. Individuals may undergo regular LDCT follow-up or invasive diagnostic procedures that lead to complications. Radiation-associated malignancies associated with repetitive LDCT, as well as overdiagnosis, should be considered the harms of screening. LDCT should be performed in qualified hospitals and interpreted by expert radiologists. Education and actions to stop smoking must be offered to current smokers. Chest radiograph, sputum cytology at regular intervals, and serum tumor markers should not be used as screening methods. These guidelines may be amended based on several large ongoing clinical trial results.
Biomarkers, Tumor ; Diagnosis ; Early Detection of Cancer ; Education ; Follow-Up Studies ; Humans ; Korea ; Lung ; Lung Neoplasms* ; Mass Screening* ; Mortality ; Radiography, Thoracic ; Smoke ; Smoking ; Sputum

BACKGROUND: The aims of this national survey were to determine the views of Korean people regarding the specialty of anesthesiology and the role of anesthesiologists and to consider the ways in which individual anesthesiologists and the Korean Society of Anesthesiologists inform the public. METHODS: This off-line national survey was conducted by a professional research organization to obtain exact and reliable data. The questionnaire included structured questions to identify perceptions of the specialty of anesthesiology and the role of anesthesiologists inside and outside the operating room, people's desire for explanation of anesthesia by anesthesiologists, and their opinion about the best way to raise awareness about anesthesia and anesthesiologists. RESULTS: Of the respondents, 25.2% did not know that anesthesiologists are in charge of anesthesia during surgery. Furthermore, even respondents who knew that had very little knowledge of anesthesiologists' actual roles inside and outside the operating room. Respondents wanted their anesthesiologist to inform them about their anesthesia. CONCLUSIONS: The public's awareness regarding the role of anesthesiologists seems to be inadequate. To improve this awareness, in hospitals, each anesthesiologist should provide patients with more exact and detailed information. Simultaneously, the National Society of Anesthesiology should provide systematic information reflecting the public's thoughts.
Anesthesia ; Anesthesiology* ; Surveys and Questionnaires ; Humans ; Operating Rooms ; Physician's Role ; Public Opinion

PURPOSE: To compare the results of two different surgical methods (translation vs rod derotation) in a correction of double thoracic adolescent idiopathic scoliosis (AIS) using pedicle screw instrumentation. MATERIALS AND METHODS: Forty-seven patients with double thoracic AIS treated by pedicle screw instrumentation were reviewed retrospectively after a minimum follow-up of 2 years. The patients were divided into two groups; TR group (translation method, n=14) and RD group (rod derotation, n=33). There were no significant differences in the preoperative curve characteristics between the two groups. RESULTS: In the TR group, the preoperative upper thoracic curve of 37+/-4 degrees improved to 24+/-4 degrees (35% correction), and the lower thoracic curve of 52+/-9 degrees improved to 18+/-5 degrees (65% correction). In the RD group, the preoperative upper thoracic curve of 40+/-7 degrees improved to 19+/-7 degrees (51% correction), and the lower thoracic curve of 56+/-12 degrees was improved to 16+/-6 degrees (72% correction). The correction of the upper and lower thoracic curves was significantly better in the RD group (p<0.05). Thoracic sagittal kyphosis was corrected from 21 degrees to 24 degrees in the TR group and from 18 degrees to 26 degrees in the RD group. There was no significant difference in the spinal balance, shoulder height difference, T1 tilt and fusion extent. The operating time and the amount of blood loss was 231 minutes and 2050ml in the TR group and 263 minutes and 3217ml in the RD group, respectively (p<0.05). CONCLUSION: In correcting double thoracic AIS using pedicle screw instrumentation, the rod derotation method showed better correction for the upper and lower thoracic curves. The translation method showed the advantages of easier application, a shorter operation time and less blood loss.
Adolescent* ; Follow-Up Studies ; Humans ; Kyphosis ; Retrospective Studies ; Scoliosis* ; Shoulder

OBJECTIVE: This study was performed to evaluate the overall survival and the change in treatment modalities in patients with uterine endometrial cancer in Korea. METHODS: From January 1990 to March 2005, medical records of 740 patients with endometrial cancer in nine hospitals were reviewed. The overall survival was determined supported by the death statistics of Korea National Statistical Office. RESULTS: The mean age of patients was 51.5 years (range: 21-82 years). The mean gravidity and parity were 3.3 and 2.1 (range: 0-18, 0-9), respectively. The most common stage, grade and histological type at diagnosis were FIGO stage I, grade 1 and endometrioid adenocarcinoma (76.5%, 56.4% and 87.2%), respectively. The main treatment modalities was surgery on stage I (59.8%), surgery-adjuvant radiotherapy on stage II (55.1%), surgery-adjuvant radiotherapy or surgery-adjuvant chemoradiation on stage III (38.3%) and surgery-adjuvant chemotherapy on stage IV (55.6%). The preferred treatment modality was surgery only on grade 1 (69.0%) and surgery-adjuvant radiotherapy on grade 2-3 (43.4% and 53.2%). Surgery had been the most common method of therapy before 1998 but its prevalence gradually decreased. As a result, surgery-adjuvant radiotherapy and surgery-adjuvant chemotherapy were most widely performed in 2004-2005 and surgery-adjuvant chemoradiation also increased more than a twofold. The overall 5 years survival rate (5YSR) for all 740 patients was 81.3%. The overall 5YSR of stage I was 89.0%. The overall 5YSR of grade 1, grade 2, grade 3 were 96.0%, 92.0%, 80.0%. Before 1998, the survival rate was 77.0%. Since then it increased to 83-88% and in 2000-2001 it increased to 88.0%, and it was the highest survival rate. CONCLUSION: The survival rate of endometrial cancer has been improving for the past 15 years and the method of treatment is also being changed currently. In order to improve the survival rate of endometrial cancer, a close investigation including genetic and environmental factors of the pathophysiology of endometrial cancer along with the epidemiology of risk factors, should be carried out.
Carcinoma, Endometrioid ; Diagnosis ; Drug Therapy ; Endometrial Neoplasms* ; Epidemiology ; Female ; Gravidity ; Humans ; Korea* ; Medical Records ; Parity ; Prevalence ; Radiotherapy ; Risk Factors ; Survival Rate

We experienced 5 cases of acute rubella encephalitis, a serious complication of rubella. The patients presented with convulsions and a deteriorated mental state, both of which occurred with a vanishing maculopapular rash and a low grade fever. The cerebrospinal fluid analysis showed pleocytosis and increased protein and normal glucose levels. We diagnosed the rubella encephalitis by detection of IgM in the serum. Rubella encephalitis is known to be a serious complication of rubella, and with poor prognosis. The mortality rate may reached as high 20%. Our cases recovered without any sequelae.
Cerebrospinal Fluid ; Encephalitis* ; Exanthema ; Fever ; Glucose ; Humans ; Immunoglobulin M ; Leukocytosis ; Mortality ; Prognosis ; Rubella* ; Seizures

Generally, absolute alcohol embolization has been commonly used for treatment of arteriovenous malformation (AVM) because complete surgical extirpation of AVM can be an extremely hazardous and difficult. Even if absolute alcohol is safe embolic agent, it can result in pain, pulmonary hypertension, pulmonary embolism and post-embolization syndrome such as nausea, vomiting, hemolysis and myoglobinuria. So, general anesthesia is needed for alcohol embolization. In this case, anesthesia was induced with intravenous (IV) propofol 110 mg and succinylcholine 60 mg and maintained with propofol and vecuronium. The pulmonary artery pressure was monitored with a Swan-Ganz catheter. After alcohol injectons, systolic pulmonary artery pressure was increased, ranging 35-40 mmHg. And cola-colored urine was noticed. For treatment of pulmonary hypertension, nitroglycerine was given IV. The IV fluid rate was increased and furocemide was given IV to increase the urine output. After general anesthesia, the patient was awake but appeared to be alcohol-intoxicated. Blood alcohol level was 42 mg/dl. Urinalysis showed large amounts of myoglobin, hemoglobin and albumin. So, anesthesiologists have to keep in mind of such complications when absolute alcohol embolization is done.
Anesthesia ; Anesthesia, General ; Arteriovenous Malformations* ; Catheters ; Ethanol* ; Hemolysis ; Humans ; Hypertension, Pulmonary ; Myoglobin ; Myoglobinuria ; Nausea ; Nitroglycerin ; Propofol ; Pulmonary Artery ; Pulmonary Embolism ; Succinylcholine ; Urinalysis ; Vecuronium Bromide ; Vomiting

PURPOSE: Polymorphonuclear leukocytes (PMNs) are the first line of cellular response for host defense during acute inflammation. The ability of PMNs to produce and release numerous pro-inflammatory cytokines is now estabilished and plays an important role in triggering and maintaining the inflammatory response. We studied the autocrine downregulation of this process by invesgating the potential production by human PMNs of the major anti-inflammatory cytokine, interleukine 10 (IL-10). METHODS: Human PMNs were isolated from the peripheral blood of health volunteers by using the modified boyum method. Human PMNs were incubated at 37 degrees Cwith and without formyl Met-Leu-Phe (fMLP) for 30 minute, 2 hours, 4 hours, and 20 hours. The level of IL-10 was determined in each of the cell-free supernatants by using the enzyme linked immunosorbent assay (ELISA) method. RESULTS: Non-stimulated PMNs generated 1.40 +/- 1.791pg/mL to 3.46 +/- 1.607 pg/mL of IL-10 over the time course. Stimulation with fMLP resulted in an increase in the constitutive PMN-derived IL-10 by 2.74 +/- 0.762 pg/mL, 1.27 +/- 0.262 pg/mL, 1.19 +/- 0.364 pg/mL, and 2.44 +/- 1.317 pg/mL at 30 min, 2 hr, 4 hr, and 20 hr after stimulation, respectively, but these increases were not statiscally significant. CONCLUSION: Human PMNs seem unable to induce release of the most potent anti-inflammatory cytokine, IL-10, and down-regulate inflammatory response due to the autocrine mechanism. This could partly account for the persistence of local inflammation, when PMNs are the main infiltrating cells.
Cytokines ; Down-Regulation ; Enzyme-Linked Immunosorbent Assay ; Humans* ; Inflammation ; Interleukin-10* ; Interleukins ; Neutrophils* ; Volunteers

PURPOSE: To demonstrate the usefulness of diffusion-weighted MR imaging(DWI) in patients with small acuteinfarction by comparing it with fast spin-echo T2-weighted MR imaging(FSE T2WI). MATERIAL AND METHOD: Weretrospectively analyzed the results of FSE T2WI in 26 consecutive patients who on DWI showed small discretehyperintensities of less than 1.5cm and whose final clinical diagnosis, within one week of clinical attack, wasacute inforction. Lacunar infarcts accounted for 24 cases and 2 small cortical infarcts for two. The onset ofsymptoms occurred within 12 hours (hyperacute stage) in two patients, within 24 hours in seven, within 3 days innine, and within one week in eight. Infarcts as seen on FSE T2WI were categorized as follows : (-) for cases ofimpossible localization with non-visualization ; (+/-) for cases of equivocal localization with faint visualizationand/or poor differentiation from combined chronic infarcts and chronic ischemic changes, or from subarachnoid CSFin cases of cortical infarction ; and (+) for cases of adequate localization with clear visualization andmoderately good differentiation from the associated brain changes, or from subarachnoid CSF in cases of corticalinfarction. These infarcts were analyzed according to the time of onset of symptoms. RESULT: For the localizationof small acute infarctions, DWI was markedly superior to the category(-), moderately superior to the category(+/-).With regard to the onset of symptoms, DWI was markedly or moderately superior to FSE T2WI in 2/2 (100%) ofhyperacute stage diagnosed within 12 hour of clinical attack, in 4/7(57%) diagnosed within 24 hours, in 5/9 (56%)diagnosed within 3 days, and in 1/8 (13%) diagnosed within 1 week(p<0.05). In 12/26 cases(46%), small acuteinfarcts were localized by DWI better than by FSE T2WI. CONCLUSION: Because the signal was unchanged or itsintensity was poor, small infarcts at the acute stage were frequently difficult to localize by FSE T2WI. Inaddition, differentiation of these from combined chronic infarcts and chronic ischemic change was poor. DWI canlocalize small acute infarcts even when the results of FSE T2WI are negative or inconclusive.
Brain ; Cerebral Infarction* ; Diagnosis ; Humans ; Infarction ; Magnetic Resonance Imaging* ; Stroke, Lacunar