Rapid progress in modern medical technology has made it possible to sustain life and/or delay death using 'heroic' treatments. The availability of life-sustaining treatment brings several issues in end-of-life care such as 'dying with dignity' and an radical increase in health care costs. The use of Advance Directives(AD) have been widely heralded by health care providers, gerontologists, and advocacy groups as means of protecting patients' right to accept or refuse life-sustaining treatment in end-of-life care. The use of AD can not only improve patients' autonomy and quality of life but also bring efficiency in distributing health care resources. The proportion of older persons in Korean population has been increasing. Those 65 years of age or over were about 7 percent of the population. Death and dying is not limited to older persons, but it is more prevalent among them. In conjunction with an aging population and the increasing prevalence of death, the issues of death and dying will become crucial in near future in terms of 'dying with dignity', 'autonomy', and 'self-control'. This paper attempts to explode and establish the concept of advance directives (AD) based on literature review. Data sources are computer searches with the MEDLINE database. Due to the lack of prior study on AD for a Korean cases, studies abroad are reviewed. This paper suggests the need for future study on the possibility of the use of AD in Korea.
Advance Directives* ; Aging ; Surveys and Questionnaires ; Delivery of Health Care ; Health Care Costs ; Health Personnel ; Humans ; Korea ; Patient Rights ; Prevalence ; Quality of Life

Congenital hepatic fibrosis is an inherited, congenital disorder of the liver, and is occasionally associated with cystic disease of the liver and kidney. We present a case of congenital hepatic fibrosis with Caroli's disease. A 21-year-old woman had suffered from an episodic fever with headaches for 3 years. In laboratory examination, the liver function test was within the normal limits. Esophageal varix was noted by an endoscopic examination. Hepatosplenomegaly and multiple dilated bile ducts were seen by abdominal CT scanning. An orthotopic whole liver transplantation was done. The liver was fibrotic and enlarged. Multiple cystically dilated intrahepatic ducts were noted. Microscopically, diffuse portal fibrosis and widening with proliferation of bile ductules were seen. Intrahepatic bile ducts were markedly dilated and tortuous. The liver cell cords were well preserved.
Bile ; Bile Ducts ; Bile Ducts, Intrahepatic ; Caroli Disease* ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Esophageal and Gastric Varices ; Female ; Fever ; Fibrosis* ; Headache ; Humans ; Kidney ; Liver ; Liver Function Tests ; Liver Transplantation ; Tomography, X-Ray Computed ; Young Adult

Fungi have been recognized as a significant cause of external otitis and it may be the primary pathogen or be part of a mixed infection. In the immunocompromised host, fungus is capable of producing infection in inner ear or middle ear. Otomycoses are most frequently caused by Aspergillus spp. and Candida sap. There are few reports that Aspergillus species other than A. fumigatus, A. niger and f. flavus have caused chronic otitis media. We report two cases of chronic otitis media caused by Aspergillus ferrous in Korea. One case is a 7-year-old girl who had recurrent serous otorrhea and otalgia for 4 years, was reattended otolaryngology clinics with otorrhea of 3 days durations and another is a 6-year-old girl who had serous otorrhea for 2 months and 3 day fever, was attended otolaryngology clinics with them. Microscopic appearance and colony morphology from ear discharge cultures revealed A. ferrous. The infection responded well to topical ketoconazole therapy. This report should help to raise medical personnel's awareness of such human opportunistic fungal ear infections.
Aspergillus* ; Candida ; Child ; Coinfection ; Ear ; Ear, Inner ; Ear, Middle ; Earache ; Female ; Fever ; Fungi ; Humans ; Immunocompromised Host ; Ketoconazole ; Korea ; Niger ; Otitis Externa ; Otitis Media* ; Otitis* ; Otolaryngology ; Otomycosis

To evaluate the frequency of EM A and Ki-I antigen expression in the large cell lymphoma and to define the histologic characteristics of Ki-1 positive anaplastic large cell lymphoma, 40 cases of malignant lymphoma, diffuse large cell type were immunostained by Ki-I and EMA monoclonal antibodies. Eight cases of large cell lymphomas expressed EMA, among which 4 cases were positive for Ki-I antibody as well. The positive rate for EMA was much higher in T cell lymphomas than in B cell lymphomas. Among 4 cases of Ki-I positive lymphomas, 2 cases showing membrane staining of Ki-1 with prototypic histologic feature of anaplastic large cell lymphoma were classified as Ki-1 positive anaplastic large cell lymphoma(ALCL). Ki-I positive ALCL were T-cell in one and non-T, non-B cell type in the other, respectively. The remaining 2 cases of Ki-1 positive lymphomas showing cytoplasmic staining were classified as both B-cell centroblastic/centrocytic lymphoma and T-cell pleomorphic large cell lymphoma.

Promoting women's health lifestyles are important due to their connection to family health. The purpose of this study was to analyse women's health lifestyles(HLP) and their effects on women's life-cycle, so in order to develop a program in a women's health care center. The subjects included were 1080 women over 18 years old living in Wonju city, and were selected by stratified and purposive sampling. The data were collected through a questionnaire and interview. The Cronbach alpha, %, mean, ANOVA, Pearson's correlation, and regression in SPSS PC Win. package was used to analyze the data. The sample was sepernted into three groups premarital group 20.2%(premarital women between 18 and 40 years old), delivery and children rearing group 49.9%(marital women between 18 and 40 years old), over middle agedelderly group 29.9%(women over 41 years old). Significant difference were found in the HPL according to group. Also, relating variables, such as self-efficacy, family functions, health locus of control and gender role perception that were considered relating variables to HPL significantly differed among the tree groups. HLP significantly correlated with self-efficacy, family functions, HLOC and gender role perception in all participants and at all groups. The regression analysis of HPL was interpreted 40.6% with relating variables, self-efficacy, health attention, family functions, and internal locus of control, health perception, power other locus of control and chance locus of control in all participant. Self-efficacy, family functions, health attention were considered important variables in premarital group, self-efficacy, family functions, internal locus of control, health attention, health perception and power of control were important in delivery-rearing group. Self-efficacy, health attention, internal locus of control, family functions and health perception were important in middle aged-elderly group. As a result, we found the differences HPL scores and relating variables according to life-cycle groups. Therefore, we should prepare health promoting education programs for women according to women's life cycles. Also we suggest that women's health care centers based on communities was needed for proper management of women's health.
Adolescent ; Child ; Education ; Family Health ; Female ; Gangwon-do ; Gender Identity ; Humans ; Internal-External Control ; Life Cycle Stages ; Life Style* ; Surveys and Questionnaires ; Women's Health

BACKGROUND: To know the effect of droperidol and ondansetron on nausea and sedation in postoperative patients, we studied 120 gynecological patients receiving patient-controlled analgesia (PCA) with morphine and droperidol or ondansetron. METHODS: Subjects were randomly allocated to one of four groups according to PCA regimen, morphine 0.5 mg/cc alone (group M); morphine plus droperidol 0.034 mg/morphine 1 mg (group D); morphine plus ondansetron 0.132 mg/morphine 1 mg (group O1); morphine plus ondansetron 0.066 mg/morphine 1 mg (group O2). The PCA device, WalkMed was set at basal rate 2 ml/hr (1 mg/hr), bolus dose 1 ml (0.5 mg), lockout time 10min, 1 hour maximum dose 4 mg. The severity of nausea, sedation and pain were assessed at 1h, 4h, 8h, 12h, 24h, and 48h postoperatively. RESULTS: The occurrence of nausea was not different among groups. But there were statistical differences in the nausea severity (p<0.05). The group D and group O1 had lower nausea scores, and between them there was no difference. The scores for sedation were significantly lower in the group O1 compared with group M and group D (p<0.05). Overall pain scores were not different among groups. CONCLUSIONS: Ondansetron and droperidol are effective in reducing nausea. Ondansetron is superior to droperidol in avoiding excessive sedation.
Analgesia, Patient-Controlled* ; Droperidol* ; Humans ; Morphine ; Nausea ; Ondansetron* ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting*

Background: Post-dural puncture headache (PDPH) is one of the well-known complication of spinal anesthesia. Epidural blood patch is the treatment of choice for PDPH but is rarely used for the prevention of PDPH after spinal anesthesia. The purpose of this study is to observe the effectiveness of epidural blood patch for prevention of PDPH and to evaluate the complications after epidural blood injection. Methods: Three hundred patients (ASA I or II) receiving spinal anesthesia were studied. They were randomly devided into two groups. Patients in Group I, the control group, were maintained in a supine position for 24 hour after spinal anesthesia. Patients in Group II, the study group, received 3 ml of autologous blood in the epidural space after spinal anesthesia. PDPH was evaluated for 5 days. The incidence, location, onset, and duration of headache in the patients presenting with PDPH were measured for 5 days, and the complications following epidural blood patch in Group II were observed for 2 weeks. Results: The incidence of PDPH in group I was 11%, but 0% in group II. There were no specific complications following epidural blood patch in Group II. Conclusions: This study suggest that the 3 ml epidural autologous blood patch is an useful method for the prevention of PDPH in patients with spinal anesthesia.
Anesthesia, Spinal* ; Blood Patch, Epidural ; Epidural Space ; Headache ; Humans ; Incidence ; Post-Dural Puncture Headache ; Punctures* ; Supine Position

The purpose of this study was to compare the sleep characteristics between the prone and the supine position in healthy newborns. The 48 newborns were observed in the prone position and the supine position respectively on the 2nd day after birth. The data were collected from January to May, 1999. The state of a newborn was classified and categorized to 6 states (deep sleep, light sleep, drowsy, quiet alert, active alert, crying) by Barnard. The movements of eyes, face and extremities, pulse and arterial oxygen were observed and recorded continuously from the start of sleep after feeding until the time of being woken for the next feeding by a trained nurse. The data was analyzed by using paired t-test. The results of this study were as follows; 1. There was no significant difference in the length of sleeping time between the prone and the supine position. 2. There was no significant difference in the length and frequencies of each states(deep sleep, light sleep, drowsy, quiet alert, active alert, crying) between the prone and the supine position. But the frequency of light sleep in the supine position was significantly higher than that of the prone position. 3. There was no significant difference in the numbers of eyes movements between the prone and the supine sleep position. But the amount of facial and extremity movement in the supine position was significantly higher than those in the prone position 4. There was no significant difference in the arterial oxygen content between the prone and the supine sleep position. 5. There was no significant difference in the heart rates between the prone and the supine sleep position. The above results indicated that the newborns in the prone position moved less and slept deeper than those in the supine position, though there was no difference in the length of sleep or arterial oxygen content between the prone and the supine sleep position. But, Nurses and mothers should consider the relationship between the sleep position and SIDS suggested by previous researches. The infant's 'awakening' during sleep is a normal process and rather valuable because it can provide an opportunity to promote a stronger relationship between mother and baby. So, It is suggested that the supine sleep position is better than the prone sleep position for infants.
Extremities ; Heart Rate ; Humans ; Infant ; Infant, Newborn* ; Mothers ; Oxygen ; Parturition ; Prone Position ; Sudden Infant Death ; Supine Position ; Child Health

No abstract available.
Abdominal Wall* ; Diagnosis* ; Fetus*

No abstract available.
Pregnancy*