Purpose: This study investigated knowledge of and attitudes toward advance directives (ADs) among middle-aged women in South Korea, their willingness to write ADs in the future, and the factors related to knowledge of and attitudes toward ADs. Methods: Data were collected using a self-administrated questionnaire completed by 154 middle-aged women aged 50 to 64 from February to March 2020. The questionnaire asked about participants’ knowledge of and attitude toward ADs, willingness to write ADs in the future, experiences with life-sustaining treatment within their families, experience making decisions about life-sustaining treatment, and demographic characteristics. Results: Scores for both knowledge of and attitude toward ADs were relatively high. About 60% of participants gave wrong answers when asked if attorneys were required for writing ADs. A higher knowledge score was significantly associated with a higher attitude score (r=0.227, P＜0.01).The women were more likely to be willing to write ADs in the future when they reporteda middle income level rather than a lower income level (odds ratio [OR]=5.952, P＜0.01), considered themselves unhealthy (OR=5.873, P＜0.01), and graduated college or higher (OR=4.096, P＜0.05). Furthermore, women who thought that ADs would have an impact on treatment (OR=1.869, P＜0.05) and on their families (OR=1.447, P＜0.05) were morelikely to be willing to write an AD. Conclusion This study shows that wrong information about ADs persists among middle-aged women, and significant factors associated with knowledge of and attitude toward ADs were identified. Targeted education programs about ADs need to be developed for middle-aged women.

Purpose: This study investigated knowledge of and attitudes toward advance directives (ADs) among middle-aged women in South Korea, their willingness to write ADs in the future, and the factors related to knowledge of and attitudes toward ADs. Methods: Data were collected using a self-administrated questionnaire completed by 154 middle-aged women aged 50 to 64 from February to March 2020. The questionnaire asked about participants’ knowledge of and attitude toward ADs, willingness to write ADs in the future, experiences with life-sustaining treatment within their families, experience making decisions about life-sustaining treatment, and demographic characteristics. Results: Scores for both knowledge of and attitude toward ADs were relatively high. About 60% of participants gave wrong answers when asked if attorneys were required for writing ADs. A higher knowledge score was significantly associated with a higher attitude score (r=0.227, P＜0.01).The women were more likely to be willing to write ADs in the future when they reporteda middle income level rather than a lower income level (odds ratio [OR]=5.952, P＜0.01), considered themselves unhealthy (OR=5.873, P＜0.01), and graduated college or higher (OR=4.096, P＜0.05). Furthermore, women who thought that ADs would have an impact on treatment (OR=1.869, P＜0.05) and on their families (OR=1.447, P＜0.05) were morelikely to be willing to write an AD. Conclusion This study shows that wrong information about ADs persists among middle-aged women, and significant factors associated with knowledge of and attitude toward ADs were identified. Targeted education programs about ADs need to be developed for middle-aged women.

It is difficult to analyze the chemical compositions of aqueous humor because of the impossibility of collection of aqueous humor in normal situation, lack of analyzing technique, limited amount of aqueous humor. We measured the glucose concentration of aqueous humor both in cataractous patients with diabetes mellitus and in cataractous patients without diabetes mellitus, thus we compared and analyzed glucose concentration in aqueous humor and correlation between blood glucose con centration and aqueous humor glucose concentration in cataractous patients with diabetes. The mean concentration of glucose in aqueous houmor in diabetics was 92.81 +/- 35.58mg/dl and that of non-diabetics was 53.62 +/- 34.42mg/dl. Aqueous glucose concentration in diabetics was statistically significantly higher than that in non-diabetics.
Aqueous Humor* ; Blood Glucose ; Cataract* ; Diabetes Mellitus ; Glucose* ; Humans

OBJECTIVE: To provide normal reference values of the sonographic diameters and cross sectional area (CSA) of the posterior tibialis tendon (PTT) in Korean adults for early diagnosis and treatment of PTT dysfunction. METHOD: 240 feet from 120 healthy volunteers (63 males; 57 females, mean age: 36.40+/-11.37) were included in this study. Those with a previous history of surgery or trauma to the lower extremities and systemic disease, such as, hypertension, diabetes, or rheumatoid arthritis were excluded. PTT was examined through ultrasonograhy with the patient placed in the prone oblique position, with the knee extended, and ankle dorsiflexed to neutral angle. We evaluated the anterioposterior (AP) and transverse diameter and CSA of the PTT along the line that connected from the posteroinferior angle of the medial malleolus to the heel. RESULTS: The AP diameter of PTT measured by sonography was 3.42+/-0.03 mm and the transverse diameter of the PTT was 9.20+/-0.08 mm. The CSA was 21.46+/-0.26 mm2. Differences in diameters and CSA related to sidedness, sex did not show statistical significance (p>0.05). There was weak linear relationship in AP and transverse diameter and CSA with weight, height, leg and foot length. CONCLUSION: The normal Korean reference values of the PTT diameter and CSA that we obtained from ultrasonography can be used as useful reference data in diagnosing early pathologic conditions of PTT dysfunction.
Adult ; Animals ; Ankle ; Arthritis, Rheumatoid ; Early Diagnosis ; Female ; Foot ; Heel ; Humans ; Hypertension ; Knee ; Leg ; Lower Extremity ; Reference Values ; Tendons

No abstract available.
Anesthesia, Spinal ; Humans ; Hypertension ; Pheochromocytoma

BACKGROUND: Partially paralyzed patients may be placed in the risk of pharyngeal dysfunction. Bupivacaine acts as acetylcholine receptor ion channel blocker and may synergistically interact with rocuronium to augment NM blockade. Thus, this study aims to elucidate whether or not, at a therapeutic concentration, bupivacaine by itself may cause NM blockade and reduce an effective concentration of rocuronium. METHODS: Twenty-two left phrenic nerve-hemidiaphragms (Male SD rats, 150-250 g) were hung in Krebs solution. Three consecutive ST, 0.1 Hz and one TT, 50 Hz for 1.9 s were obtained before drug application and at each new drug concentration. A concentration of bupivacaine in Krebs solution (n = 5) was cumulatively increased by way of 0.01, 0.1, 1, (1, 2, 3, 4, 5, 6, 7) x 10 microM. In a Krebs solution, pre-treated with bupivacaine 0 (n = 5), 0.1 (n = 5), 1.0 (n = 5), 10 (n = 2) microM, and then concentrations of rocuronium were cumulatively increased by way of 1, 3, 5, 7, 9, 12, 14, 16, 18, 20 microM. EC for each experiment were determined by a probit. The EC50's of rocuronium were compared using a Student's t-test with Bonferroni's correction. Differences were considered significant when P < 0.05. RESULTS: The potency of bupivacaine for normalized TF was 11.4 (+/- 1.1) microM. Below 30 microM of bupivacaine, the single twitch potentiation sustained despite the development of tetanic fade and partial inhibition of PTT. Bupivacaine significantly facilitated the NM blockade induced by rocuronium. CONCLUSIONS: Clinicians should be aware that bupivacaine by itself at its therapeutic concentration inhibit NM conduction and enhances rocuronium-induced muscle relaxation.
Acetylcholine ; Androstanols ; Animals ; Bupivacaine ; Humans ; Ion Channels ; Isotonic Solutions ; Muscle Relaxation ; Neuromuscular Blockade ; Rats ; Refractory Period, Electrophysiological

Background/Aims: Globus is often linked with gastroesophageal reflux disease, which influences its treatment strategies. This study aims to investigate clinical characteristics of patients with refractory proton pump inhibitor (PPI) globus to better understand its etiology. Methods: Between 2017 and 2023, 122 out of 592 patients with globus from the Samsung Medical Center outpatient clinic who were unresponsive to 8 weeks of PPI treatment were analyzed. Patients underwent 24-hour esophageal pH monitoring and high-resolution manometry (HRM). They were divided into acid reflux, non-acid reflux, and no reflux groups, with basal impedance (BI) measurements taken at 3, 9, and 15 cm along the esophagus. These values were compared against data of healthy volunteers to identify significant differences across groups. Results: The acid reflux group displayed a median impedance of 1152 Ω at 3 cm, which was significantly lower than the median impedance of the non-acid reflux group (2644 Ω) and the no-reflux group (3083 Ω) (P = 0.015). Most patients in non-acid reflux and no-reflux groups showed higher impedance levels at both 3 cm and 15 cm compared to the first quartile of healthy individuals with significant differences (P = 0.032 and P = 0.029, respectively). Proximal BI was significantly lower than distal BI in both groups: 2278 Ω vs 2644 Ω in the non-acid reflux group (P = 0.035) and 2387 Ω vs 3083 Ω in the no-reflux group (P < 0.001). Conclusions Reduced proximal BI values compared to distal BI values suggest increased permeability in globus patients. Further studies with a larger cohort of refractory PPI patients and healthy volunteers are needed to explore these findings and their implications on globus etiology.

Background/Aims: Globus is often linked with gastroesophageal reflux disease, which influences its treatment strategies. This study aims to investigate clinical characteristics of patients with refractory proton pump inhibitor (PPI) globus to better understand its etiology. Methods: Between 2017 and 2023, 122 out of 592 patients with globus from the Samsung Medical Center outpatient clinic who were unresponsive to 8 weeks of PPI treatment were analyzed. Patients underwent 24-hour esophageal pH monitoring and high-resolution manometry (HRM). They were divided into acid reflux, non-acid reflux, and no reflux groups, with basal impedance (BI) measurements taken at 3, 9, and 15 cm along the esophagus. These values were compared against data of healthy volunteers to identify significant differences across groups. Results: The acid reflux group displayed a median impedance of 1152 Ω at 3 cm, which was significantly lower than the median impedance of the non-acid reflux group (2644 Ω) and the no-reflux group (3083 Ω) (P = 0.015). Most patients in non-acid reflux and no-reflux groups showed higher impedance levels at both 3 cm and 15 cm compared to the first quartile of healthy individuals with significant differences (P = 0.032 and P = 0.029, respectively). Proximal BI was significantly lower than distal BI in both groups: 2278 Ω vs 2644 Ω in the non-acid reflux group (P = 0.035) and 2387 Ω vs 3083 Ω in the no-reflux group (P < 0.001). Conclusions Reduced proximal BI values compared to distal BI values suggest increased permeability in globus patients. Further studies with a larger cohort of refractory PPI patients and healthy volunteers are needed to explore these findings and their implications on globus etiology.

Background/Aims: Globus is often linked with gastroesophageal reflux disease, which influences its treatment strategies. This study aims to investigate clinical characteristics of patients with refractory proton pump inhibitor (PPI) globus to better understand its etiology. Methods: Between 2017 and 2023, 122 out of 592 patients with globus from the Samsung Medical Center outpatient clinic who were unresponsive to 8 weeks of PPI treatment were analyzed. Patients underwent 24-hour esophageal pH monitoring and high-resolution manometry (HRM). They were divided into acid reflux, non-acid reflux, and no reflux groups, with basal impedance (BI) measurements taken at 3, 9, and 15 cm along the esophagus. These values were compared against data of healthy volunteers to identify significant differences across groups. Results: The acid reflux group displayed a median impedance of 1152 Ω at 3 cm, which was significantly lower than the median impedance of the non-acid reflux group (2644 Ω) and the no-reflux group (3083 Ω) (P = 0.015). Most patients in non-acid reflux and no-reflux groups showed higher impedance levels at both 3 cm and 15 cm compared to the first quartile of healthy individuals with significant differences (P = 0.032 and P = 0.029, respectively). Proximal BI was significantly lower than distal BI in both groups: 2278 Ω vs 2644 Ω in the non-acid reflux group (P = 0.035) and 2387 Ω vs 3083 Ω in the no-reflux group (P < 0.001). Conclusions Reduced proximal BI values compared to distal BI values suggest increased permeability in globus patients. Further studies with a larger cohort of refractory PPI patients and healthy volunteers are needed to explore these findings and their implications on globus etiology.

BACKGROUND: Spinal anesthesia is the most common regional anesthesia conducted for many surgical procedures. Multiple factors can affect the success, the side effects, and patient satisfaction with the procedure. This study was undertaken prospectively to discover factors affecting dissatisfaction and refusal of spinal anesthesia. METHODS: Starting in December 2007, patients who underwent spinal anesthesia in the operating rooms of our hospital were surveyed over a period of a year. Before attempting the procedure, patient characteristics and previous history of anesthesia were recorded. Spinal anesthesia was administered with 0.5% heavy bupivacaine combined with fentanyl 0-20 microgram. Intraoperative data and postoperative data on the day after surgery were collected. The patients were also asked about their general satisfaction with spinal anesthesia, causes of dissatisfaction with the procedure, and causes of their refusal to have spinal anesthesia again. RESULTS: Six patients among 1,197 cases were excluded from the study because of spinal anesthesia failure. The dissatisfaction rate of spinal anesthesia was 3.7%, and its risk factors were more than three puncture attempts, paresthesia at puncture, postoperative nausea and vomiting, and postoperative backache. The refusal rate to have spinal anesthesia again was 3.2%, and its risk factors were postoperative backache and dissatisfaction. CONCLUSIONS: Although spinal anesthesia was conducted safely during the study and revealed a high rate of patient satisfaction (96.3%), side effects still occurred. Therefore, attending anesthesiologists must perform the procedure carefully and always pay attention to patients under spinal anesthesia.
Anesthesia ; Anesthesia, Conduction ; Anesthesia, Spinal ; Back Pain ; Bupivacaine ; Disulfiram ; Fentanyl ; Humans ; Operating Rooms ; Paresthesia ; Patient Satisfaction ; Postoperative Nausea and Vomiting ; Prospective Studies ; Punctures ; Risk Factors