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.

No abstract available.

Klinefelter syndrome is a congenital disease that is associated with the existence of an extra X chromosome, and is one of the most common causes of male primary hypogonadism. In addition to hypogonadism-associated manifestations such as testicular atrophy and infertility, it is also well known that this syndrome may be associated with other systemic comorbidities. In this report, we describe a typical case of Klinefelter syndrome that was differentially diagnosed as a cause of gigantism. A 20-year-old male was admitted to evaluate the cause of tall stature. His height was 193.4 cm, and all screening tests for gigantism were negative. Physical examination revealed no clear evidence of secondary sexual characteristics, and the results of a hormonal assay were highly suspicious for primary hypogonadism. Based on these findings, we performed a chromosomal analysis and confirmed Klinefelter syndrome with a 47, XXY karyotype.
Atrophy ; Chromosome Disorders ; Comorbidity ; Gigantism ; Humans ; Hypogonadism ; Infertility ; Karyotype ; Klinefelter Syndrome ; Male ; Mass Screening ; Physical Examination ; X Chromosome ; Young Adult

OBJECTIVES: The purpose of this study was to examine the effect of the vocational rehabilitation program on the quality of life of the chronic schizophrenics, and to evaluate how chronic schizophrenics felt about their lives. METHOD: The subjects were 39 chronic schizophrenics who had participated in the vocational rehabilitation program(participant group) and now lived in the community. The control group were 43 chronic schizophrenics who were outpatients without vocational rehabilitation(non-participant group). The scale for quality of life was divided into two subscales, i.e., the objective and the subjective areas. The subscales are composed of living situation, family situations, interpersonal relations, work, health, finances, leisure activities, autonomy, and self-esteem. RESULTS: 1) In the demographic characteristics such as age, sex, duration of illness, and duration of education, two groups were not different significantly. However, dosage of antipsychotics were lower in participant group than non-participant group. 2) In the objective quality of life subscale, the scores of living situation, interpersonal relations, work, health, economic state, and leisures were higher in participant group than non-participant group. But, family relations score were lower in participant group than in non-participant group. autonomy were not different between two groups. 3) In the subjective quality of life subscale, the score of living situation, family relations, interpersonal relations, work, health, economic states, leisure activities, and autonomy were all higher in participant group than in non-partcipant group. 4)Self-esteem was significantly higher in participant group than in non-participant group. CONCLUSION: The results from this study suggest that the objective and subjective quality of life of participant group in the vocational rehabilitation program were higher than those of non-participant group. The vocational rehabilitation program of Yong-In Mental Hospital seems to have been effective for the chronic schizophrenics. And the psychosocial rehabilitation program, vocational rehabilitation program, and family education program should be developed more and implemented in the community.
Antipsychotic Agents ; Education ; Family Relations ; Gyeonggi-do ; Hospitals, Psychiatric ; Humans ; Interpersonal Relations ; Leisure Activities ; Outpatients ; Quality of Life* ; Rehabilitation ; Rehabilitation, Vocational*

OBJECTIVE: This study assessed the efficacy of anterior cervical discectomy and fusion (ACDF) with cage alone compared with ACDF with plate instrumentation for radiologic and clinical outcomes in two-level cervical degenerative disease. METHODS: Patients with cervical degenerative disc disease from September 2004 to December 2009 were assessed retrospectively. A total of 42 patients received all ACDF at two-level cervical lesion. Twenty-two patients who underwent ACDF with cage alone were compared with 20 patients who underwent ACDF with plate fixation in consideration of radiologic and clinical outcomes. Clinical outcomes were assessed using Robinson's criteria and posterior neck pain, arm pain described by a 10 point-visual analog scale. Fusion rate, subsidence, kyphotic angle, instrument failure and the degenerative changes in adjacent segments were examined during each follow-up examination. RESULTS: VAS was checked during each follow-up and Robinson's criteria were compared in both groups. Both groups showed no significant difference. Fusion rates were 90.9% (20/22) in ACDF with the cage alone group, 95% (19/20) in ACDF with the plate fixation group (p = 0.966). Subsidence rates of ACDF with cage alone were 31.81% (7/22) and ACDF with plate fixation were 30% (6/20) (p = 0.928). Local and regional kyphotic angle difference showed no significant difference. At the final follow-up, adjacent level disease developed in 4.54% (1/22) of ACDF with cage alone and 10% (2/20) of ACDF with plate fixation (p = 0.654). CONCLUSION: In two-level ACDF, ACDF with cage alone would be comparable with ACDF with plate fixation with regard to clinical outcome and radiologic result with no significant difference. We suggest that the routine use of plate and screw in 2-level surgery may not be beneficial.
Arm ; Benzeneacetamides ; Diskectomy ; Follow-Up Studies ; Humans ; Neck Pain ; Piperidones ; Retrospective Studies

The objective of this study was to find out whether the unilateral distraction of mandible has an influence on temporomandibular joint and if it does, how significant the influence is. Four beagle dogs were used in this study. Each dog had two implants placed into the left mandible. The mandible was distracted for 14days with an distraction device as an amount of 0.75mm, twice per day after osteotomy between two implants. Each animals were sacrificed at the second, fourth, sixth and eighth week after the total distraction amount of 10.5mm were gotten. Upon embedding and staining, the specimens were evaluated with a light microscope. The results were as follows. 1. For the second week group, the articular cartilage and osteoid seam of temporal bone and condyle were relatively well maintained. There were not any significant differences between distraction side and non distraction side. 2. For the fourth week group, the periosteal reaction was activated and the articular cartilage and osteoid seam of temporal bone and condyle were severely thickened-especially at posterior portion of distraction side. This findings revealed that the unilateral distraction forces has more influence on distraction side than on non distraction side, and on posterior portion than on anterior portion. 3. For the sixth and eighth week group, the thickness of meniscus in distraction side gradually recovered to the initial level. The thickened articular cartilage and osteoid seam of temporal bone and condyle were decreased in distraction side and showed relatively stable in non distraction side. From this results, we suggest that several considerations are required such as using an occlusal splint, maintaining the stability of bone distraction device and evaluating bone distraction rate to minimize the damages of temporomandibular joint tissues in early stage of distraction side.
Animals ; Cartilage, Articular ; Dogs ; Mandible* ; Occlusal Splints ; Osteotomy ; Temporal Bone ; Temporomandibular Joint*

Background: Synovial osteochondromatosis (SOC) of the shoulder is a rare condition with unclear characteristics. This study evaluated the clinical features and postoperative functional outcomes of SOC of the shoulder that are distinct from SOC of other joints. Methods: The characteristics of 28 shoulders with SOC that underwent arthroscopy were retrospectively assessed. Ten shoulders (35.7%) had rotator cuff tears (RCTs) and underwent concomitant arthroscopic rotator cuff repair. The mean follow-up period was 83.6 months (range, 24–154 months). Demographic characteristics and loose bodies localized under arthroscopy were compared between cases with and without concomitant RCTs. Radiography, ultrasonography, or magnetic resonance imaging were performed preoperatively and postoperatively. Visual analog scale (VAS) scores for pain and satisfaction were evaluated for all cases, and functional scores were assessed in shoulders with concomitant RCTs. Results: The average age was 36.2 ± 15.6 years among patients without RCTs and 58.3 ± 7.2 years among patients with RCTs.Seven shoulders (7%) had osteoarthritis. Arthroscopy revealed loose bodies in multiple spaces, including the glenohumeral joint, subacromial (SA) space, and biceps tendon sheath. Overall, loose bodies were found in multiple spaces in 12 shoulders (42.9%). Loose bodies were found in the SA space only in 4 shoulders (22.2%) without RCTs and in 7 shoulders (70.0%) with RCTs. VAS for pain decreased significantly from 3.9 ± 2.3 to 1.1 ± 1.3 (p < 0.001). The functional scores increased significantly after arthroscopic management for patients with concurrent RCTs (all p < 0.05). Recurrence of SOC occurred in 3 of the 22 shoulders (13.6%) who underwent postoperative imaging, but no patient had a recurrent RCT. Conclusions Pain relief and patient satisfaction were achieved via arthroscopic management. Unlike in other joints, loose bodies can occur simultaneously in several spaces in the shoulder, including the glenohumeral joint, SA space, and biceps tendon sheath. Early diagnosis of SOC of the SA space can help prevent osteoarthritis and RCT progression.

In this study, the rate of bone formation and the pattern of bone to implant contact surface around HA coated implant and pure Ti implant inserted into the irradiated tibia of rabbit were compared. Sixteen mongrel mature male rabbits were used as experimental animal. Each rabbit received 15 Gy of irradiation. Four weeks after irradiation, two holes were prepared on the tibia of each rabbit for placement of HA coated type and pure Ti type implants. Prior to implant placement, one group received steroid irrigation and the control group was similarly irrigated with normal saline. This was immediately followed by placement of the two different types of implants. Postoperatively, tetracycline was injected intramuscularly for 3 days. For fluorescent labelling, 3 days of intramuscular alizarine red injection was given. 2 weeks before sacrifice, followed by intramuscular calcein green on the last 3 days before specimen collection. Each rabbit was sacrificed on the second, fourth, sixth and eighth week after the implantation. The specimens were observed by the light microscope and the fluorescent microscope. The results were as follows; 1. All implants inserted into the irradiated tibia of rabbit were free from clinical mobility and no signs of bony resorption were noted around the site of implant placement. 2. Under the light microscope, new bone formation proceeded faster around implants that received steroid irrigation compared to the control group irrigated with saline. Bone to implant contact surface was greater in the steroid irrigated group than the saline irrigated group. Therefore, better initial stabilization was observed in the group pretreated with steroid irrigation. 3. Under the light microscope. HA coated implants showed broader bone to implant contact surface than pure Ti implants, and HA coated implants had better bone healing pattern than pure Ti implants. 4. In the steroid pretreated group, acceleration of bone formation was demonstrated by fluorescent microscopy around the 2, 4 weeks group and the 6 weeks HA coated implant group. The difference in the rate of bone formation proved to be statistically significant (P<0.05). Faster bone formation was noted in the saline irrigated group in the 6 weeks pure Ti implants and 8 weeks group. The difference was not statistically significant(P<0.05). 5. For the rabbits that were sacrificed on the second and fourth week after the implant placements, the rates of bone formation around HA coated implants proceeded faster than those around pure Ti implants under the fluorescent microscopy. For the rabbits that were sacrificed on the sixth week after the implant placements, the rates of bone formation around pure Ti implants proceeded faster than those around HA coated implants under the fluorescent microscopy. But this result did not show statistical significance (P<0.05) For the rabbits that were sacrificed on the eighth week after the implant placements, the rates of bone formation around HA coated implants proceeded faster than those around pure Ti implants under the fluorescent microscopy. This result was statistically significant (P<0.05).
Acceleration ; Animals ; Humans ; Male ; Microscopy ; Osteogenesis* ; Rabbits ; Specimen Handling ; Tetracycline ; Tibia*

BACKGROUND: Rehabilitation and overuse of the shoulder after rotator cuff repair are a concern in patients with comorbid disability in other extremities. Improvement of outcomes can be hampered in this situation. This study was to describe the clinical outcomes of rotator cuff repair in patients with comorbid disability in other extremities. METHODS: In two tertiary institutions, 16 patients with comorbid disability (9 men and 7 women; mean age of 57.1 years [range, 45 to 71 years]; 14 dominant arms; mean follow-up of 18 months [range, 12 to 38 months]) underwent rotator cuff repair. There were 5 massive tears, 1 large tear, 9 medium tears, and 1 small tear. Open repair was performed in 3 patients and arthroscopic repair in 13. The most common comorbid condition was paralysis (n = 7). Eight patients walked with crutches preoperatively. Anatomical outcome was investigated in 12 patients using either magnetic resonance imaging or ultrasonography at least 6 months postoperatively. RESULTS: Range of motion, visual analogue scale for pain and satisfaction, and all functional scores improved significantly. Healing failure occurred in 4 patients (2 large-to-massive and 2 medium size tears), but none required revision surgery. All 4 retears involved the dominant side, and 3 patients were crutch users. CONCLUSIONS: The current data suggested favorable outcome of rotator cuff repair in patients with comorbid disability. Careful surgical planning and rehabilitation is particularly important for crutch users and in the case of dominant arm involvement in disabled patients.
Arm ; Crutches ; Extremities* ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Paralysis ; Range of Motion, Articular ; Rehabilitation ; Rotator Cuff* ; Shoulder ; Tears ; Treatment Outcome ; Ultrasonography