Aging has become a global problem, and the interest in healthy aging is growing. Healthy aging involves a focus on the maintenance of the function and well-being of elderly adults, rather than a specific disease. Thus, the management of frailty, which is an accumulated decline in function, is important for healthy aging. The adaptation method was used to develop clinical practice guidelines on frailty management that are applicable in primary care settings. The guidelines were developed in three phases: preparation (organization of committees and establishment of the scope of development), literature screening and evaluation (selection of the clinical practice guidelines to be adapted and evaluation of the guidelines using the Korean Appraisal of Guidelines for Research and Evaluation II tool), and confirmation of recommendations (three rounds of Delphi consensus and internal and external reviews). A total of 16 recommendations (five recommendations for diagnosis and assessment, 11 recommendations for intervention of frailty) were made through the guideline development process. These clinical practice guidelines provide overall guidance on the identification, evaluation, intervention, and monitoring of frailty, making them applicable in primary care settings. As aging and “healthy aging” become more and more important, these guidelines are also expected to increase in clinical usefulness.

A clinical practice guideline for patients in the dying process in general wards and their families, developed through an evidence-based process, is presented herein. The purpose of this guideline is to enable a peaceful death based on an understanding of suitable management of patients’ physical and mental symptoms, psychological support, appropriate deci-sion-making, family care, and clearly-defined team roles. Although there are limits to the available evidence regarding medical issues in patients facing death, the final recommendations were determined from expert advice and feedback, considering values and preferences related to medical treatment, benefits and harms, and applicability in the real world. This guideline should be applied in a way that takes into account specific health care environments, including the resources of medical staff and differences in the available resources of each institution. This guideline can be used by all medical institutions in South Korea.

PURPOSE: Female lung cancers have different clinical features and therapeutic results as compared to those of male lung cancers. The aim of this study was to analyze the differences of Korean men and women with lung cancer. MATERIALS AND METHODS: We re-analyzed the results of a national survey of lung cancer conducted by the Korean Association for the Study of Lung Cancer in 2005. RESULTS: Of the 8,788 patients, 2,124 (24.2%) were female. The mean age at the diagnosis was 62.5 years for the females and 64.8 years for the males and the difference was significant (p<0.001). An age <50 years was more frequent for the women than for the men (16.2% vs. 7.9%, respectively; p=0.001). The stages between genders were different for the patients with non-small cell carcinoma (NSCLC) (p<0.001), but not for the patients with small cell carcinoma. The overall survival time was longer for woman than that for the man (p<0.001). However, the male patients had longer survival for the smokers with adenocarcinoma and the smokers with squamous cell carcinoma. The never smoker female patients had a better survival time than did the smoking female patients, but the male patient' survival was not influenced by the smoking status. The stage-specific survival rates were better for the women at all stages of NSCLC (p<0.001). The women who received chemotherapy had a longer survival time did the men who received chemotherapy (p<0.001). CONCLUSION: Women with lung cancer were relatively overrepresented among the younger patients and they smoked less intensively, raising the question of gender- specific differences in the carcinogenesis of lung cancer. Over-representation of adenocarcinoma was observed in the women regardless of their smoking status. Women with lung cancer had a better prognosis than men; however, the smoking females showed the worst prognosis. Gender and the smoking status are clearly important factors in the therapeutic approach to lung cancer.
Adenocarcinoma ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Female ; Humans ; Korea ; Lung ; Lung Neoplasms ; Male ; Prognosis ; Republic of Korea ; Smoke ; Smoking ; Survival Rate

PURPOSE: A study was designed to assess the effect of intraperitoneal instillation of ropivacaine in larparoscopic cholecystectomy patients using computerized patient controlled anesthesia (PCA). METHODS: From January 2009 to June 2009, 40 patients with uncomplicated, symptomatic cholecystitis with cholelithiasis who were referred to Chung-Ang University Medical Center for laparoscopic cholecystectomy were included in the study. Patients in group C (control group) received normal saline 100 ml and those in group I (instillation group) received intraperitoneal instillation of 2 mg/kg of ropivacaine diluted in 100 ml saline at the initiation of pneumoperitoneum. Patients were assessed for pain by blinded investigators at 6 time intervals after surgery; 2 hr, 4 hr, 8 hr, 12 hr, 24 hr, and 48 hr. The frequency at which patients pushed the button of the PCA on bolus requirement (FPB) was assessed by a patient-controlled module on the PCA machine. RESULTS: The mean total fentanyl consumption was lower in group I (367.39+/-85.88) than in group C (535+/-100.29) during the 48 hours (P<0.001). Fentanyl velocity and FPB showed significant difference between the groups (P<0.005). Visual analogue scale (VAS) measured pain scores were significantly lower in group I than in group C at 4 hr (P=0.027), 8 hr (P=0.010), 12 hr (P=0.011). CONCLUSION: Intraperitoneal instillation of ropivacaine at the beginning of laparoscopic cholecystectomy (LC) combined with normal saline infusion is an effective method for reducing pain after LC.
Academic Medical Centers ; Amides ; Anesthesia ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholelithiasis ; Fentanyl ; Humans ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Pneumoperitoneum ; Research Personnel

PURPOSE: One of the popular and widespread treatments for intra- & extra-hepatic duct (IEHD) stone associated gallbladder (GB) stone is laparoscopic cholecystectomy (LC) with stone removal through endoscopic retrograde cholangiopancreatography (below ERCP). Because LC with stone removal through percutaneous transhepatic biliary drainage (below PTBD) is well known for its safety and feasibility in removing IEHD stones, we did this study to see the significance (safety, feasibility, effectiveness etc) of PTBD and stone removal. METHODS: We compared the odds by collecting 71 retrospective cases, victims of IEHD stone associated GB stone from January, 2004 to December, 2007 in Chung-Ang University Hospital. Comparative analysis took place in 51 cases who underwent PTBD and 20 cases treated with ERCP. We excluded 6 patients who underwent PTBD for intra hepatic duct stone. Age, sex, American Society of Anesthesiologists score, pain, nausea, pre- and post- laboratory value, symptoms, size, location and number of stones, diameter of extra hepatic duct, recurrence and clearance rate, frequency of each procedure, complications, cost were investigated in this study. RESULTS: There were no statistical differences in each group in recurrence and clearance rate or frequency of procedure. However post-procedure pancreatitis and amylase level were significantly difference in each group. PTBD group experienced much longer hospital stay but was not significantly different. Although procedure cost is three times more expensive than that of PTBD group, there were no differences in total cost and patients' expenses between the two groups. CONCLUSION: PTBD would be an alternative solution in managing IEHD stone associated with GB stone for its lower rate of complication, higher clearance with minimal discomfort.
Amylases ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy, Laparoscopic ; Dioxolanes ; Drainage ; Fluorocarbons ; Gallbladder ; Hepatic Duct, Common ; Humans ; Hypogonadism ; Length of Stay ; Mitochondrial Diseases ; Nausea ; Ophthalmoplegia ; Pancreatitis ; Recurrence ; Retrospective Studies

PURPOSE : Lung Cancer has been the leading cause of cancer deaths in South Korea since the year 2000, and its incidence continues to rise. Here we report the result of national survey of lung cancer conducted by Korean association for the study of lung cancer (KASLC). MATERIALS AND METHODS : A total of 8,788 lung cancer patients diagnosed in 2005 were registered using a web based case report form issued to hospitals equipped with more than 400 beds. RESULTS : The age distribution ranged from 11 to 105 years (64.7+/-0.7 years), 75.8% (6,664) of the patients were male and 28.9% of patients were never smokers. Subjective symptoms at the time of diagnosis included coughing (3,350 patients), dyspnea (2,105), chest pain (1,067), hemoptysis (805), weight loss (789), general weakness (498) and hoarseness (190), while 12% (1,015) of patients had no subjective symptoms. Of the carcinomas grouped into non-small cell lung carcinoma (NSCLC), adenocarcinoma including bronchoalveolar cell carcinoma (1.3%) was the most frequent (36.1%) histopathologic type, followed by squamous cell lung carcinoma (32.1%), large cell carcinoma (1.5%), unclassified non-small cell carcinoma (13.2%) and others (3.7%). In addition, 13.5% of all of the patients were afflicted with small cell lung carcinoma (SCLC). The stage at diagnosis was IA (7.3%), IB (10.2%), IIA (1.3%), IIB (6.1%), IIIA (12.8%), IIIB (21.6%), and IV (40.6%) in the NSCLC group. In SCLC group, 44.6% of the patients were in the limited stage, while 55.4% of the patients were in the extensive stage. The initial treatments included surgery (22.1%), radiation therapy (7.8%), chemo-radiation therapy (5.4%) and chemotherapy (38%), however, 26.6% of the patients were transferred or recorded to have supportive care only. Therefore we compared the outcomes of the Treatment Group (TG, 73.4%) and the Supportive Group (SG, 26.6%). The median survival time (MST) in months (m) was 28 (95% confidence interval 26.5~29.5 m). Multivariate analysis indicated that the independent prognostic factors for NSCLC were age, gender, ECOG PS score, stage, histopathologic type, and treatment or supportive care. In the SCLC group, age, PS score, stage, treatment or supportive care were significant prognostic factors. The TG group showed significantly superior survival when compared to the SG group, even in patients with stage IV disease and in patients that were >75 years old. CONCLUSION : Adenocarcinoma was found to be the most frequent histopathologic type, and active treatments were found to improve the survival of patients with lung cancer, even when they were in advanced stages or elderly
Adenocarcinoma ; Age Distribution ; Aged ; Carcinoma, Large Cell ; Chest Pain ; Cough ; Diagnosis ; Drug Therapy ; Dyspnea ; Hemoptysis ; Hoarseness ; Humans ; Incidence ; Korea* ; Lung Neoplasms* ; Lung* ; Male ; Multivariate Analysis ; Small Cell Lung Carcinoma ; Weight Loss

BACKGROUND: The aim of this study was to investigate the prevalence, clinical and laboratory findings of hereditary hemolytic anemia (HHA) in Korea from 1997 to 2006 and to develop the appropriate diagnostic approach for HHA. METHODS: By the use of questionnaires, information on the clinical and laboratory findings ofHHA diagnosed from 1997 to 2006 in Korea was collected and analyzed retrospectively. A total of 431 cases were enrolled in this study from 46 departments of 35 hospitals. RESULTS: The overall frequency of HHA did not change through the 10-year period for pediatrics but did show an increasing tendency for internal medicine. The overall male to female sex ratio did not show sex predominance (1.17:1), but a significant male predominance with a ratio of 1.49:1 was seen for pediatrics while a significant female predominance with a ratio of 1:1.97 was seen forinternal medicine. Of the total cases, 74.2% (282/431) were diagnosed before the age of 15 years. The etiologies of HHA were classified as red cell membrane defects, hemoglobinopathies, red cell enzyme deficiencies and unknown causes. There were 382 cases (88.6%) of red cell membrane defects with 376 cases (87.2%) of hereditary spherocytosis and 6 cases (1.4%) of hereditary elliptocytosis, 20 cases (4.6%) of hemoglobinopathies with 18 cases (4.2%) of beta-thalassemia, a case (0.2%) of alpha-thalassemia and a case (0.2%) of Hemoglobin Madrid, 7 cases (1.6%) of red cell enzyme deficiencies with 5 cases (1.2%) of glucose-6- phosphate dehydrogenase (G-6-PD) deficiency, a case (0.2%) of pyruvate kinase (PK) deficiency and a case (0.2%) of enolase deficiency, and 22 cases (5.1%) of unknown causes. The most common chief complaint in pediatric patients was pallor and that in adult patients was jaundice. In the red cell membrane defect group of patients, the level of hemoglobin was significantly higher than in adult patients. The mean corpuscular volume, mean corpuscular hemoglobin, corrected reticulocyte count, total and indirect bilirubin level and lactate dehydrogenase levels in the hemoglobinopathy group of patients were significantly lower than the values in the red cell membrane defect group of patients. The mean concentration of G-6-PD was 0.8+/-0.7U/1012RBC in the G-6-PD deficient patients, PK was 1.7U/1010 RBC in the PK deficient patient, and the level of enolase was 0.04U/g of Hb in the enolase deficient patient. CONCLUSION: The most prevalent cause of HHA in Korea during 1997 to 2006 was hereditary spherocytosis, but HHA by other causes such as hemoglobinopathy and red cell enzyme deficiency gradually increased with the development of molecular diagnostic methods and increasing general interest. However, the etiologies of HHA need to be pursued further in 5.1% of the patients. An systematic standard diagnostic approach is needed in a nationwide prospective study for correct diagnoses and appropriate management of HHA.
Adult ; alpha-Thalassemia ; Anemia, Hemolytic, Congenital* ; beta-Thalassemia ; Bilirubin ; Cell Membrane ; Diagnosis ; Elliptocytosis, Hereditary ; Erythrocyte Indices ; Female ; Hemoglobinopathies ; Humans ; Internal Medicine ; Jaundice ; Korea* ; L-Lactate Dehydrogenase ; Male ; Oxidoreductases ; Pallor ; Pathology, Molecular ; Pediatrics ; Phosphopyruvate Hydratase ; Prevalence ; Pyruvate Kinase ; Reticulocyte Count ; Retrospective Studies* ; Sex Ratio ; Surveys and Questionnaires

BACKGROUND: The evidence for H. pylori as a gastrointestnal pathogen is now very strong, if not overwhelming. Among the pathogenic factors of H. pylori, flagella and urease are considered to be major factors causing the gastrododenal disease. We observed the gene diversity of H. pylori using the PCR-amplified 1.4Kb fla A gene and 0.9Kb ure B gene and examined the relationship between the gene pattern and the gastroduodenal disease. METHOD: Fifty-one cases of isolated strains were cultured at the Helicobacter-selective blood agar plates. To compare the gene diversity among the isolates of gastroduodenal disease genotypes was analyzed by PCR-based RFLP. 1.4Kb fla A gene and 0.9Kb ure B genes from isolates were amplified by PCR and digested with Hae 3 restriction enzymes to observe the restriction fragment length polymophysm. Protein patterns were also compared to examine the antigenic variations. Total cell proteins, and octyl-glucose extracts from isolates were analyzed by SDS-PAGE gel electrophoresis. RESULTS: 41 cases (80.4%) of H. pylori were isolated in the 51 cases of gastroduodenal diseases. We could classify theses isolates 3 types of PCR-RFLP in the fla A gene, 900+500bp, 500+500+400bp, 600+800bp, and 9 types in the ure B gene. PCR-RFLP in the fla A gene and ure B gene of the isolates was different from the standard strain of Australia and the genetic diversity was not related to the types of the gastroduodenal disease. We demonstrated variations in the protein pattern and antigenic profiles among the isolates by SDS-PAGE analysis. These data also did not show any relationship between protein pattern and types of gastroduodenal diseases. CONCLUSION: Tese studies showed many different gene diversity in the flagella and urease gene without any relationship with the types of gastoduodenal disease. And variable protein pattern were noted among the strains of H. pylori. Further studies to demonstrate the pathgenecity of H. pylori should be continued even if there was no relationship between the genomic diversity of the flagella or urease and the types of gastroduodenal disease.
Agar ; Australia ; DNA* ; Electrophoresis ; Electrophoresis, Polyacrylamide Gel ; Flagella ; Genes, vif ; Genetic Variation ; Genotype ; Helicobacter pylori* ; Helicobacter* ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Urease

Injury of the ankle ligaments is one of the most common sports-related injuries. Although there are some debates as to the best initial treatment for an acute tear of a lateral ligament, persistent functional instability of the ankle develops in approximately 20% of patients regardless of the type of initial treatment. In these patients, late reconstruction of the lateral ankle ligaments may become necessary. Among 13 cases which have been operated with Larsen procedure using peroneus brevis tendon from March 1991 to February 1993, the 11 cases followed up over 1 year were examined clinically and radiologically. We introduced the clinical analysis and results with the brief review of the literatures. 1. The indication of surgical treatment was the ankle instability which had differences over 10° in talar tilting angle or over 3mm in anterior displacement compared wit the uninjured site. 2. The postoperative results were 5 cases in excellent and 4 in good. 3. The Larsen procedure was considered a good method to anatomically and simply stabilize both the ankle and subtalar joint and to fix tendon depending on the type of instability.
Ankle ; Collateral Ligaments ; Humans ; Ligaments ; Methods ; Subtalar Joint ; Tears ; Tendons

In the paget's disease involving the vertebra, the symptom and sign of compression come from encroachment on the spinal cord due to the enlarging vertebral bodies, pedicles and laminae. The cord compression appears to be preceded by a long insidious period of noncharacteristic clinical symptoms with minor neurologic dysfunction. The lumbar syndrome of Paget's disease is classified according to its severity, clinical findings, biochemical factors and radiologic patterns. The severity of neurologic complication in Paget's disease involving the vertebra varies according to the level involved. The outcome depends on the suddeness of symptom onset and the effectiveness of decompression. We have experienced a case of Paget's disease involving long bones and lumbar spine in 56 year old male patient, in which surgical decompression produced improvement. We report a case of spinal stenosis in paget's disease with brief review of literature.
Decompression ; Decompression, Surgical ; Humans ; Male ; Neurologic Manifestations ; Spinal Cord ; Spinal Stenosis ; Spine