Heart failure (HF) is a major cause of mortality and morbidity in South Korea, imposing substantial physical, emotional, and financial burdens on patients and society. Despite the high burden of symptom and complex care needs of HF patients, palliative care and hospice services remain underutilized in South Korea due to cultural, institutional, and knowledge-related barriers. This position statement from the Korean Society of Heart Failure emphasizes the need for integrating palliative and hospice care into HF management to improve quality of life and support holistic care for patients and their families. By clarifying the role of palliative care in HF and proposing practical referral criteria, this position statement aims to bridge the gap between HF and palliative care services in South Korea, ultimately improving patient-centered outcomes and aligning treatment with the goals and values of HF patients.

Background: Because the etiologies of bronchiectasis and related diseases vary significantly among different regions and ethnicities, this study aimed to develop a diagnostic bundle for bronchiectasis in South Korea. Methods: A modified Delphi method was used to develop expert consensus statements on a diagnostic bundle for bronchiectasis in South Korea. Initial statements proposed by a core panel, based on international bronchiectasis guidelines, were discussed in an online meeting and two email surveys by a panel of experts (≥70% agreement). Results: The study involved 21 expert participants, and 30 statements regarding a diagnostic bundle for bronchiectasis were classified as recommended, conditional, or not recommended. The consensus statements of the expert panel were as follows: A standardized diagnostic bundle is useful in clinical practice; diagnostic tests for specific diseases, including immunodeficiency and allergic bronchopulmonary aspergillosis, are necessary when clinically suspected; initial diagnostic tests, including sputum microbiology and spirometry, are essential in all patients with bronchiectasis, and patients suspected with rare causes such as primary ciliary dyskinesia should be referred to specialized centers. Conclusion Based on this Delphi survey, expert consensus statements were generated including specific diagnostic, laboratory, microbiological, and pulmonary function tests required to manage patients with bronchiectasis in South Korea.

Purpose: To derive the optimized intraocular lens (IOL) constants from automated and manifest refraction after cataract surgery in Korean patients, and to evaluate whether there is a difference in optimized IOL constants according to the refraction method. Methods: This retrospective multicenter cohort study enrolled 4,103 eyes of 4,103 patients who underwent phacoemulsification and in-the-bag IOL implantation at 18 institutes. Optimized IOL constants for the SRK/T, Holladay, Hoffer Q, and Haigis formulas were calculated via autorefraction or manifest refraction of samples using the same biometry and IOL. The IOL constants derived from autorefraction and manifest refraction were compared. Results: Of the 4,103 eyes, the majority (62.9%) were measured with an IOLMaster 500 followed by an IOLMaster 700 (15.2%). A total of 33 types of IOLs were used, and the Tecnis ZCB00 was the most frequently used (53.0%). There was no statistically significant difference in IOL constants derived from autorefraction and manifest refraction when IOL constants were optimized with a large number of study subjects. On the other hand, optimized IOL constants derived from autorefraction were significantly smaller than those from manifest refraction when the number of subjects was small. Conclusions It became possible to use the IOL constants optimized from Koreans to calculate the IOL power. However, if the IOL constant is optimized using autorefraction in a small sample group, the IOL constant tends to be small, which may lead to refractive error after surgery.

The pneumonia severity index (PSI) and CURB-65 are widely used tools for the prediction of community-acquired pneumonia (CAP). This study was conducted to evaluate validation of severity scoring system including the PSI and CURB-65 scores of Korean CAP patients. In the prospective CAP cohort (participated in by 14 hospitals in Korea from January 2009 to September 2011), 883 patients aged over 18 yr were studied. The 30-day mortalities of all patients were calculated with their PSI index classes and CURB scores. The overall mortality rate was 4.5% (40/883). The mortality rates per CURB-65 score were as follows: score 0, 2.3% (6/260); score 1, 4.0% (12/300); score 2, 6.0% (13/216); score 3, 5.7% (5/88); score 4, 23.5% (4/17); and score 5, 0% (0/2). Mortality rate with PSI risk class were as follows: I, 2.3% (4/174); II, 2.7% (5/182); III, 2.3% (5/213); IV, 4.5% (11/245); and V, 21.7% (15/69). The subgroup mortality rate of Korean CAP patients varies based on the severity scores and CURB-65 is more valid for the lower scores, and PSI, for the higher scores. Thus, these variations must be considered when using PSI and CURB-65 for CAP in Korean patients.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Cohort Studies ; Community-Acquired Infections/*mortality ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Pneumonia/*mortality ; Prospective Studies ; Republic of Korea ; *Severity of Illness Index ; Young Adult

Endovascular aneurysm repair (EVAR) for the treatment of abdominal aortic aneurysm (AAA) is a widely used method, and its decreased invasiveness compared to traditional surgical repair has brought about reduced rates of morbidity and mortality. Several vascular complications related to the procedure have been reported, but non-vascular complications have rarely occurred. We report herein the case of a 78-year-old man who underwent EVAR for AAA and presented with active duodenal ulcer bleeding and acute acalculous cholecystitis as complications after the procedure. We must consider that a wide spectrum of complications may occur following EVAR, and therefore it is important to evaluate the risks of complication and to take the necessary measures to minimize them.
Acalculous Cholecystitis ; Aged ; Aneurysm ; Aortic Aneurysm, Abdominal ; Duodenal Ulcer ; Hemorrhage ; Humans

Dermatofibrosarcoma protuberans is a rare tumor that occurs in the dermis or subcutaneous tissue of the trunk or extremities in relatively young adults. There are few reports of Dermatofibrosarcoma protuberans associated with pregnancy. We experienced a 28-year-old pregnant female patient with an abdominal wall mass, which grew rapidly during pregnancy. Excisional biopsy was performed and the pathologic diagnosis was fibrosarcoma transformed from Dermatofibrosarcoma protuberans. Dermatofibrosarcoma protuberans showed a positive CD34 immunostaining while fibrosarcoma showed a negative CD34. There was no recurrence or metastasis with the follow up period of 2 years. We report here a rare case of Dermatofibrosarcoma protuberans aggravated during pregnancy with a review of the literature.
Abdominal Wall ; Adult ; Biopsy ; Dermatofibrosarcoma ; Dermis ; Extremities ; Female ; Fibrosarcoma ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Pregnancy ; Recurrence ; Subcutaneous Tissue ; Young Adult

BACKGROUND: Medical skin care is essential for the treatment of skin diseases all over the world. Medical skin care is also part of medical practice and this must be differentiated from the simple skin care that is given for normal healthy skin. OBJECTIVE: We wanted to discuss medical skin care and the related medical devices and legal issues. METHODS: We reviewed the related laws and regulations, we consulted experts and associations and we analyzed the result of the survey. RESULTS: Legally, medical skin care and simple skin care are well classified. However, many illegal procedures are still performed by non-medical personnel and many adverse effects have been reported as a result. Furthermore, there are no legal restrictions for the performer based on the grade of each medical skin care procedure. CONCLUSION: For the best results and safe procedures, medical skin care must be performed by approved medical equipment under the supervision of a physician or medical personnel. Continuous control and guidance by the government is strongly needed.
Jurisprudence ; Organization and Administration ; Skin ; Skin Care ; Skin Diseases ; Social Control, Formal

PURPOSE: This study was performed to assess the safety and efficacy of Endovascular Aneurysm Repair (EVAR) with a home-made stent graft. METHOD: The medical records of 17 patients who underwent EVAR at Seoul National University Hospital between January 1995 and December 2003 were analyzed retrospectively. The outcomes were measured with respect to efficacy (deployment success rate, technical success rate, conversion rate, and reintervention rates) and safety (30-day mortality rate, complication rate, endoleaks, graft thrombosis, stenosis, and migration). RESULT: The median follow-up of the patients was 42.8 months (range, 2.7~72.67 months). The male to female ratio was 7.5 (15:2). The deployment success rate was 100% and the technical success rate was 70.6% at discharge. Early complications were present in five patients (29%). Late complications occurred in 47% of the cases. Secondary intervention to treat complications was required in 29% of patients. Open repairs were performed in two patients (12%), one with an immediate type Ia endoleak and the other for migrations. The cumulative patient survival rate was 94.1%, 76.0% and 57.0% at 1, 3 and 5 years follow up. The overall clinical success rate during follow-up was 38.5%. CONCLUSION: Although EVAR with a home-made device in high-risk patients showed good early technical outcomes, there were complications. Continued device innovation, good compliance and close surveillance are required for these patients.
Aneurysm* ; Aortic Aneurysm, Abdominal* ; Blood Vessel Prosthesis ; Compliance ; Constriction, Pathologic ; Endoleak ; Female ; Follow-Up Studies ; Humans ; Male ; Medical Records ; Mortality ; Retrospective Studies* ; Seoul ; Survival Rate ; Thrombosis ; Transplants

BACKGROUND/AIMS: The aim of this study was to evaluate the role of an intraoperative colonoscopy for a single stage operation in patients with a left-side colon cancer obstruction. METHODS: From September 1999 to August 2002, 62 patients (mean age=61+/-14 year old, M:F=30:32) underwent an intraoperative colonoscopy during a single stage operation for a left side colon cancer. Intraoperative colonic irrigation method and colonoscopy with NICI (new intraoperative colonic irrigator, MITech Co., Ltd, Seoul, Korea) were used. RESULTS: The locations of the left-side colon cancers were the rectum in 33 (53.2%), sigmoid colon in 20 (32.3%), and descending colon in 9 (14.5%). Synchronous polyps were found in 31 patients (50%). Six patients (9.7%) had a synchronous colon cancer and 2 (3.2%) had a high grade dysplasia. Of these 62 patients, 11 (17.7%) required more extensive surgery than dictated by the primary tumor. Altered operative methods were a total colectomy in 2 patients, an extended resection in 8 patients, and a wedge resection in 1 patient. CONCULSIONS: An intraoperative colonoscopy in patients with a left-side colon cancer is a useful adjunct in diagnosing a synchronous lesions, which should allow a more appropriate surgical procedure.
Colectomy ; Colon* ; Colon, Descending ; Colon, Sigmoid ; Colonic Neoplasms* ; Colonoscopy* ; Humans ; Polyps ; Rectum ; Seoul

BACKGROUND/AIMS: Klebsiella pneumoniae (K. pneumoniae) has been emerging as the leading cause of liver abscess although the most common pathogen was Escherichia coli in the past. Our study was to clarify the significance of K. pneumoniae as a pathogen of pyogenic liver abscess. METHODS: We reviewed 157 cases of pyogenic liver abscess treated at Yeungnam University Hospital from 1996 to 2001. They were classified into two groups: K. pneumoniae group and non-K. pneumoniae group. The clinical presentations, characteristics of liver abscess, laboratory findings and the results of bacteriological studies were compared. RESULTS: The K. pneumoniae group included 60 (60.6%) cases among 99 cases with positive culture. We found higher incidence of alcoholics (45.0%) or diabetes millitus (35.0%) in K. pnemoniae group. Cryptogenic cause (61.7%) was the most frequent portal entry in K. pneumoniae liver abscess. On the other hand, in non-K. pneumoniae group, the cause of portal entry was usually the secondary (23.1%) following biliary disease (61.5%). Statistically, there was no significant difference in age, sex, symptom, characteristics of abscess, laboratory findings except total bilirubin level between the two groups. CONCLUSIONS: Liver abscess caused by K. pneumoniae has emerged as an important infectious disease with new clinical significance. When clinicians see pyogenic liver abscess in patients with alcoholics or diabetes millitus, K. pneumoniae should be considered first as a cause of liver abscess.
Aged ; Female ; Humans ; Klebsiella Infections/*diagnosis ; *Klebsiella pneumoniae ; Liver Abscess/diagnosis/*microbiology ; Male ; Middle Aged