BACKGROUND: Many physicians hesitate to discuss do-not-resuscitate (DNR) orders with patients or family members in critical situations. In the intensive care unit (ICU), delayed DNR decisions could cause unintentional cardiopulmonary resuscitation, patient distress, and substantial cost. We investigated whether the timing of DNR designation affects patient outcome in the medical ICU. METHODS: We enrolled retrospective patients with written DNR orders in a medical ICU (13 bed) from June 1, 2014 to May 31, 2015. The patients were divided into two groups: early DNR patients for whom DNR orders were implemented within 48 h of ICU admission, and late DNR patients for whom DNR orders were implemented more than 48 h after ICU admission. RESULTS: Herein, 354 patients were admitted to the medical ICU and among them, 80 (22.6%) patients had requested DNR orders. Of these patients, 37 (46.3%) had designated DNR orders within 48 hours of ICU admission and 43 (53.7%) patients had designated DNR orders more than 48 hours after ICU admission. Compared with early DNR patients, late DNR patients tended to withhold or withdraw life-sustaining management (18.9% vs. 37.2%, p = 0.072). DNR consent forms were signed by family members instead of the patients. Septic shock was the most common cause of medical ICU admission in both the early and late DNR patients (54.1% vs. 37.2%, p = 0.131). There was no difference in in-hospital mortality (83.8% vs. 81.4%, p = 0.779). Late DNR patients had longer ICU stays than early DNR patients (7.4 ± 8.1 vs. 19.7 ± 19.2, p < 0.001). CONCLUSIONS: Clinical outcomes are not influenced by the time of DNR designation in the medical ICU. The late DNR group is associated with a longer length of ICU stay and a tendency of withholding or withdrawing life-sustaining treatment. However, further studies are needed to clarify the guideline for end-of-life care in critically ill patients.
Advance Directives ; Cardiopulmonary Resuscitation ; Consent Forms ; Critical Illness* ; Hospital Mortality ; Humans ; Intensive Care Units ; Resuscitation Orders* ; Retrospective Studies ; Shock, Septic

PURPOSE: Although the pudendal nerve terminal motor latency (PNTML) is normally used, there is no definite test that accurately reflects the function of the pudendal nerve. This study was undertaken to determine the relative accuracy of the various methods in measuring the function of the pudendal nerve. METHODS: Thirty one female patients (age 51.3+/-15.7) with a defecation disorder (constipation 20, fecal incontinence 11) were evaluated prospectively using a neurophysiologic test and balloon reflex manometry. Five parameters such as the right and left PNTML, anal mucosal electrosensitivity, latency and the amplitude of the rectoanal contractile reflex (RACR) were analyzed statistically for their correlation. RESULTS: There was no significant inter-test correlation among the parameters. However, the intra-test correlations between the parameters such as the right and left PNTML (r=0.9629, P<0.001)/latency and the RACR amplitude (r= -0.3770, P=0.0366) were found to be significant. CONCLUSION: The accuracy of these tests in evaluating the pudendal neuropathy could not be determined. However, because it can be assumed that a measurement of the RACR in addition to RNTML is technically accurate, it there will need to be more study for it to be used as an alternative to a PNTML measurement.
Defecation ; Fecal Incontinence ; Female ; Humans ; Manometry ; Prospective Studies ; Pudendal Nerve* ; Pudendal Neuralgia ; Reflex

PURPOSE: This study was undertaken to evaluate the effect of L-dopa in amblyopic children for whom occlusion treatment failed. METHODS: We studied nine amblyopic children (11 eyes) for whom part-time occlusion (4~8 hours/day) treatment for a minimum period of 6 months had failed. The types of amblyopia included: anisometropic (1 patient, 1 eye), stimulus deprivation (4 patients, 6 eyes) and mixed (anisometropic and strabismic: 2 patients, 2 eyes; anisometropic and organic: 2 patients, 2 eyes). Best corrected visual acuity before treatment was between 0.05 and 0.5. They received, with full informed consent of the parent, levodopa (2~4 mg/kg) for 8 weeks combined with part-time occlusion. RESULTS: The children were between 4 and 11 years old (mean 5.8+/-2.05). Of the subjects, 45.5% (4 patients, 5 eyes) had improved visual acuity after 8 weeks of treatment. In one patient with anisometropic, two patients with mixed (anisometropic and strabismic), and one patient with stimulus deprivation (ametropic) amblyopia, visual acuity improved by one to five lines. CONCLUSIONS: In anisometropic, strabismic amblyopes and mild deprivational amblyopes for whom occlusion treatment failed, L-dopa improved visual acuity. L-dopa may be an additional option for treatment of amblyopic patients with a guarded visual prognosis.
Amblyopia ; Child* ; Humans ; Informed Consent ; Levodopa* ; Parents ; Prognosis ; Visual Acuity

SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome designates a group of articular and osseous manifestations frequently combined with skin disorders. Its fundamental component is inflammatory, pseudoinfectious, and sterile osteitis. The anterior chest wall is the most frequent localization and all the components of this structure may be involved. Palmoplantar pustulosis, psoriasis, acne conglobata, acne ulcerans, acne fulminans, pyoderma gangrenosum can be associated with the characteristic bone lesions. We report two cases of SAPHO syndrome : A 40-year-old female presented with both buttock pain with hyperostosis, costochondritis, synovitis and pustulosis palmaris and a 23-year-old male presented with migrating polyarthritis with costochondritis, synovitis, acne, pustulosis.
Acne Vulgaris ; Acquired Hyperostosis Syndrome* ; Adult ; Arthritis ; Buttocks ; Female ; Humans ; Hyperostosis ; Male ; Osteitis ; Psoriasis ; Pyoderma Gangrenosum ; Skin ; Synovitis ; Thoracic Wall ; Young Adult

The purpose of this study is to enable children and adolescents to experience anatomy and clinics. For the purpose, the ways to use the anatomy educational resources (comics, 3-dimensional images, and 2-dimensional images) and diagnostic tools (stethoscope, sphygmomanometer, pen light, and reflex hammer) were described in a guide book. Following the guide book, students experienced anatomy and clinics in a course of the science museum. They learned anatomy with the comics, then did virtual dissection with the 3-dimensional and 2-dimensional images. Sequentially, with the diagnostic tools, they listened to heart sound, measured blood pressure, and performed light reflex and knee jerk. Through this study, we have found that anatomy and clinics should be experienced pleasantly. The complimentary guide book is expected to be further improved in future, so as to achieve better experience at home, science museum, and school.
Adolescent* ; Blood Pressure ; Child* ; Heart Sounds ; Humans ; Knee ; Museums ; Reflex ; Sphygmomanometers

BACKGROUND: The role of beta2-agonist is still important to control bronchoconstriction in asthma. Polymorphisms at aminoacid positions 16 and 27 of the beta2-adrenoceptor gene are associated with asthma phenotype. Glu 27 allele is associated with negatively with bronchial hyperresponsiveness(BHR) in asthmatic subjects and Gln 27 allele is associated positively with IgE levels, and Gly16 Gln27 haplotype is suggested to be positively associated with BHR in a population study. And Gly16 Gln27 haplotypes are positively associated with nocturnal cough in atopic subjects. To evaluate the association between beta2-adrenoceptor polymorphisms as asthmatic phenotypes, the frequency of beta2-adrenoceptor polymorphsisms at 2 sites(Arg16->Gly 16 and Gln 27 -> Glu 27) were examined in asthmatic and normal children. METHODS: Ninty nine asthmatic children and seventy three normal children were enrolled. Asthma phenotypes were determined by physician and bronchial responsiveness and genotypes of beta2-adrenoceptor polymorphisms were determined with PCR based methods. RESULTS: The polymorphisms at aminoacid 16 and 27 of beta2-adrenoceptor gene was not different between asthmatic and normal children. The haplotype frequency of aminoacid 16 and 27 polymorphisms of beta2-adrenoceptor gene was not different between asthmatic and normal children. Haplotypes of aminoacid 16 and 27 was not associated with total eosinophil count, eosinophil %, and total IgE in asthmatic children. Haplotypes of aminoacid 16 and 27 was not associated with PC20, and response of FEV1 after beta2-agonist in asthmatic children. CONCLUSION: beta2-adrenoceptor polymorphisms is not associated with the expression of asthma, atopy, bronchial hyperresponsiveness, and response to beta2-agonist in Korean children.
Alleles ; Asthma ; Bronchoconstriction ; Child* ; Cough ; Eosinophils ; Genotype ; Haplotypes ; Humans ; Immunoglobulin E ; Korea* ; Phenotype ; Polymerase Chain Reaction

Hypothyroidism may be accompanied by different rheumatic syndromes such as neuropathy. Arthropathy and myopathy. Sebere myopathy with high elevations of creatine kinase (CK) is rarely seen in hypothyroidism. Authors experinced a case of myopathy with hypothyroidism. Similar to rheumatoid arthritis or polymyositis like syndrome. We have treated with thyroid hormone replacement (Levothyroxine sedium 100ug/day) for 10 months. The initial serology resulted in : free T4 0.51ng/dl, TSH 110ulU/ml, LDH 465 units, and CK 4385 units. After tratment, we gained free T4 1.60ng/dl, TSH 0.14uIU/ml, LDH 110 units, and CK 80 utits and musculoskeletal symptoms are much improved We reprort this patient with a review of literatures.
Arthritis, Rheumatoid ; Creatine Kinase ; Humans ; Hypothyroidism ; Muscular Diseases* ; Polymyositis ; Thyroid Gland

BACKGROUND AND PURPOSE: Subclinical atherosclerotic plaques are common in patients with pontine infarctions (PIs) but without basilar artery (BA) stenosis. We hypothesized that BA plaque locations may differ by PI type and vertical location as well as vertebrobasilar artery geometry. METHODS: Ninety-six patients with PI but without BA stenosis on magnetic resonance imaging (MRI) and magnetic resonance angiography were enrolled. PIs were classified by type (paramedian, deep, or lateral) and vertical location (rostral, middle, or caudal). Patients underwent high-resolution MRI to evaluate BA plaque location (anterior, posterior, or lateral). The mid-BA angle on anteroposterior view and angle between the BA and dominant vertebral artery (BA-VA angle) on lateral view were measured. RESULTS: The PIs were paramedian (72.9%), deep (17.7%), and lateral (9.4%) type with a rostral (32.3%), middle (42.7%), and caudal (25.0%) vertical location. The BA plaque locations differed by PI type (P=0.03) and vertical location (P < 0.001); BA plaques were most frequent at the posterior wall in paramedian (37.1%) and caudal (58.3%) PIs and at the lateral wall in lateral (55.5%) and middle (34.1%) PIs. The BA-VA and mid-BA angles differed by BA plaque and PI vertical location; the greatest BA-VA angle was observed in patients with posterior plaques (P < 0.001) and caudal PIs (P<0.001). Greatest mid-BA angles were observed with lateral BA plaques (P=0.03) and middlelocated PIs (P=0.03). CONCLUSIONS: Greater mid-BA angulation may enhance lateral plaque formation, causing lateral and middle PIs, whereas greater BA-VA angulation may enhance posterior plaque formation, causing paramedian or caudal PIs.
Arteries ; Basilar Artery ; Brain Stem Infarctions ; Constriction, Pathologic ; Hemodynamics ; Humans ; Infarction ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Plaque, Atherosclerotic ; Vertebral Artery

BACKGROUND AND PURPOSE: Carotid plaques are a strong risk factor for ischemic stroke, and plaque rupture poses an even higher risk. Although many studies have investigated the pathogenic mechanisms of carotid plaque formation, few have studied the differences in molecular mechanisms underlying the rupture and non-rupture of carotid plaques. In addition, since early diagnosis and treatment of carotid plaque rupture are critical for the prevention of ischemic stroke, many studies have sought to identify the important target molecules involved in the rupture. However, a target molecule critical in symptomatic ruptured plaques is yet to be identified. METHODS: A total of 79 carotid plaques were consecutively collected, and microscopically divided into ruptured and non-ruptured groups. Quantitative polymerase chain reaction array, proteomics, and immunohistochemistry were performed to compare the differences in molecular mechanisms between ruptured and non-ruptured plaques. Enzyme-linked immunosorbent assay was used to measure the differences in ATP-binding cassette subfamily A member 1 (ABCA1) levels in the serum. RESULTS: The expression of several mRNAs and proteins, including ABCA1, was higher in ruptured plaques than non-ruptured plaques. In contrast, the expression of other proteins, including β-actin, was lower in ruptured plaques than non-ruptured plaques. The increased expression of ABCA1 was consistent across several experiments, ABCA1 was positive only in the serum of patients with symptomatic ruptured plaques. CONCLUSIONS: This study introduces a plausible molecular mechanism underlying carotid plaque rupture, suggesting that ABCA1 plays a role in symptomatic rupture. Further study of ABCA1 is needed to confirm this hypothesis.
Biomarkers ; Carotid Arteries ; Early Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunohistochemistry ; Polymerase Chain Reaction ; Proteomics ; Risk Factors ; RNA, Messenger ; Rupture ; Stroke

BACKGROUND: Many physicians hesitate to discuss do-not-resuscitate (DNR) orders with patients or family members in critical situations. In the intensive care unit (ICU), delayed DNR decisions could cause unintentional cardiopulmonary resuscitation, patient distress, and substantial cost. We investigated whether the timing of DNR designation affects patient outcome in the medical ICU. METHODS: We enrolled retrospective patients with written DNR orders in a medical ICU (13 bed) from June 1, 2014 to May 31, 2015. The patients were divided into two groups: early DNR patients for whom DNR orders were implemented within 48 h of ICU admission, and late DNR patients for whom DNR orders were implemented more than 48 h after ICU admission. RESULTS: Herein, 354 patients were admitted to the medical ICU and among them, 80 (22.6%) patients had requested DNR orders. Of these patients, 37 (46.3%) had designated DNR orders within 48 hours of ICU admission and 43 (53.7%) patients had designated DNR orders more than 48 hours after ICU admission. Compared with early DNR patients, late DNR patients tended to withhold or withdraw life-sustaining management (18.9% vs. 37.2%, p = 0.072). DNR consent forms were signed by family members instead of the patients. Septic shock was the most common cause of medical ICU admission in both the early and late DNR patients (54.1% vs. 37.2%, p = 0.131). There was no difference in in-hospital mortality (83.8% vs. 81.4%, p = 0.779). Late DNR patients had longer ICU stays than early DNR patients (7.4 ± 8.1 vs. 19.7 ± 19.2, p < 0.001). CONCLUSIONS: Clinical outcomes are not influenced by the time of DNR designation in the medical ICU. The late DNR group is associated with a longer length of ICU stay and a tendency of withholding or withdrawing life-sustaining treatment. However, further studies are needed to clarify the guideline for end-of-life care in critically ill patients.
Advance Directives ; Cardiopulmonary Resuscitation ; Consent Forms ; Critical Illness ; Hospital Mortality ; Humans ; Intensive Care Units ; Resuscitation Orders ; Retrospective Studies ; Shock, Septic