Evidence of the ethical appropriateness and clinical benefits of shared decision-making (SDM) are accumulating. This study aimed to not only identify physicians’ perspectives on SDM, and practices related to end-of-life care in particular, but also to gauge the effect of SDM education on physicians in Korea. Methods: A 14-item questionnaire survey using a modified Delphi process was delivered to nephrologists and internal medicine trainees at 17 university hospitals. Results: A total of 309 physicians completed the survey. Although respondents reported that 69.9% of their practical decisions were made using SDM, 59.9% reported that it is not being applied appropriately. Only 12.3% of respondents had received education on SDM as part of their training. The main obstacles to appropriate SDM were identified as lack of time (46.0%), educational materials and tools (29.4%), and education on SDM (24.3%). Although only a few respondents had received training on SDM, the proportion of those who thought they were using SDM appropriately in actual practice was high; the proportion of those who chose lack of time and education as factors that hindered the proper application of SDM was low. Conclusion: The majority of respondents believed that SDM was not being implemented properly in Korea, despite its use in actual practice. To improve the effectiveness of SDM in the Korean medical system, appropriate training programs and supplemental policies that guarantee sufficient application time are required.

The Korean Society for Electrolyte and Blood Pressure Research, in collaboration with the Korean Society of Nephrology, has published a clinical practice guideline (CPG) document for hyponatremia treatment. The document is based on an extensive evidence-based review of the diagnosis, evaluation, and treatment of hyponatremia with the multidisciplinary participation of representative experts in hyponatremia with methodologist support for guideline development. This CPG consists of 12 recommendations (two for diagnosis, eight for treatment, and two for special situations) based on eight detailed topics and nine key questions. Each recommendation begins with statements graded by the strength of the recommendations and the quality of the evidence. Each statement is followed by rationale supporting the recommendations. The committee issued conditional recommendations in favor of rapid intermittent bolus administration of hypertonic saline in severe hyponatremia, the use of vasopressin receptor antagonists in heart failure with hypervolemic hyponatremia, and syndrome of inappropriate antidiuresis with moderate to severe hyponatremia, the individualization of desmopressin use, and strong recommendation on the administration of isotonic fluids as maintenance fluid therapy in hospitalized pediatric patients. We hope that this CPG will provide useful recommendations in practice, with the aim of providing clinical support for shared decision-making to improve patient outcomes.

The Korean Society for Electrolyte and Blood Pressure Research, in collaboration with the Korean Society of Nephrology, has published a clinical practice guideline (CPG) document for hyponatremia treatment. The document is based on an extensive evidence-based review of the diagnosis, evaluation, and treatment of hyponatremia with the multidisciplinary participation of representative experts in hyponatremia with methodologist support for guideline development. This CPG consists of 12 recommendations (two for diagnosis, eight for treatment, and two for special situations) based on eight detailed topics and nine key questions. Each recommendation begins with statements graded by the strength of the recommendations and the quality of the evidence. Each statement is followed by rationale supporting the recommendations. The committee issued conditional recommendations in favor of rapid intermittent bolus administration of hypertonic saline in severe hyponatremia, the use of vasopressin receptor antagonists in heart failure with hypervolemic hyponatremia, and syndrome of inappropriate antidiuresis with moderate to severe hyponatremia, the individualization of desmopressin use, and strong recommendation on the administration of isotonic fluids as maintenance fluid therapy in hospitalized pediatric patients. We hope that this CPG will provide useful recommendations in practice, with the aim of providing clinical support for shared decision-making to improve patient outcomes.

Femoral neck stress fracture occured commonly in athlete and military recruit populations, some of them are bilateral. Bilateral femoral neck stress fracture that associated with other occupation is very uncommon. We report a bilateral femoral neck stress fracture case that presented with unilateral symptoms in a male shipman laborer. The patient was successfully treated conservatively. Stress fracture sometimes occur associated with an unexpected specific occupation. Consideration of bilateral involvement is highly important in managing stress fracture.
Athletes ; Femur Neck* ; Fractures, Stress* ; Humans ; Male ; Military Personnel ; Occupations

The large animal model with benign biliary stricture (BBS) is essential to undergo experiment on developing new devices and endoscopic treatment. This study conducted to establish a clinically relevant porcine BBS model by means of endobiliary radiofrequency ablation (RFA). Endoscopic retrograde cholangiography (ERC) was performed on 12 swine. The animals were allocated to three groups (60, 80, and 100 W) according to the electrical power level of RFA electrode. Endobiliary RFA was applied to the common bile duct for 60 seconds using an RFA catheter that was endoscopically inserted. ERC was repeated two and four weeks, respectively, after the RFA to identify BBS. After the strictures were identified, histologic evaluations were performed. On the follow-up ERC two weeks after the procedure, a segmental bile duct stricture was observed in all animals. On microscopic examination, severe periductal fibrosis and luminal obliteration with transmural inflammation were demonstrated. Bile duct perforations occurred in two pigs (100 W, n = 1; 80 W, n = 1) but there were no major complications in the 60 W group. The application of endobiliary RFA with 60 W electrical power resulted in a safe and reproducible swine model of BBS.
Animal Experimentation ; Animals ; Bile Ducts ; Catheter Ablation* ; Catheters ; Cholangiography ; Common Bile Duct ; Constriction, Pathologic* ; Electrodes ; Endoscopes ; Fibrosis ; Follow-Up Studies ; Inflammation ; Models, Animal ; Phenobarbital ; Swine*

Hepatitis C virus (HCV) is one of the main viral causes of hepatocellular carcinoma (HCC) and is associated with lymphoproliferative disorder such as non-Hodgkin's lymphoma (NHL). However, there are only few case reports on concomitantly induced NHL and HCC by HCV. Herein, we report a case of synchronous NHL and HCC in a patient with chronic hepatitis C which was unexpectedly diagnosed during liver transplantation surgery. This case suggests that although intrahepatic lymph node enlargements are often considered as reactive or metastatic lymphadenopathy in chronic hepatitis C patients with HCC, NHL should also be considered as a differential diagnosis.
Antineoplastic Agents/therapeutic use ; Carcinoma, Hepatocellular/complications/*diagnosis/radiotherapy ; Drug Therapy, Combination ; Embolization, Therapeutic ; Fluorodeoxyglucose F18 ; Gadolinium DTPA ; Genotype ; Hepatitis B virus/genetics ; Hepatitis C, Chronic/complications/*diagnosis/*virology ; Humans ; Liver Neoplasms/complications/*diagnosis/radiotherapy ; Lymph Nodes/pathology ; Lymphoma, Non-Hodgkin/complications/*diagnosis/drug therapy ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Positron-Emission Tomography ; Tomography, X-Ray Computed

The stomach is the most common site of gastrointestinal tract lymphoma, while synchronous mucosa-associated lymphoid tissue (MALT) lymphomas of the stomach and duodenum are very rare. A literature review found no reported case of synchronous gastroduodenal MALT lymphomas with involvement of the bone marrow and spleen. Here, we describe the case of a 62-year-old male who was diagnosed with synchronous MALT lymphomas of the stomach and duodenum based on upper gastrointestinal endoscopy and pathology. Other staging evaluations, including colonoscopy, abdominopelvic and chest computed tomography (CT), 18F fludeoxyglucose-positron emission tomography (FDG-PET), and a bone marrow examination, showed involvement of the bone marrow and spleen. We diagnosed stage EIV MALT lymphoma and began systemic chemotherapy. We report the first case of MALT lymphomas arising synchronously in both the stomach and duodenum with bone marrow involvement and review the literature.
Bone Marrow Examination ; Bone Marrow* ; Colonoscopy ; Drug Therapy ; Duodenum ; Endoscopy, Gastrointestinal ; Gastrointestinal Tract* ; Humans ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Male ; Middle Aged ; Pathology ; Spleen ; Stomach ; Thorax

As younger preterm infants are able to survive, more extremely preterm infants are at risk of developing retinopathy of prematurity (ROP). To investigate the incidence, progression and risk factors of ROP in extremely preterm infants in Korea, the medical records of infants born before 25 weeks gestation were retrospectively reviewed. The criteria for laser treatment agreed with type 1 ROP as defined by the Early Treatment for Retinopathy of Prematurity study. Of the 121 infants included in the analysis, 119 (98.4%) infants developed any stage ROP, including 78 infants (64.5%) with type 1 ROP. The mean postmenstrual age (PMA) at the onset of any ROP and type 1 ROP were 33.5 and 36.1 weeks, respectively. All but one infant developed type 1 ROP after 31 weeks PMA. Univariate analysis showed that duration of total parenteral nutrition and onset of any ROP (PMA) were associated with the development of type 1 ROP. In conclusion, this study shows high incidence of ROP in extremely preterm infants and suggests that, although current screening protocols are feasible for most preterm infants born before 25 weeks gestation, earlier screening before 31 weeks PMA may be necessary in infants with an unstable clinical course.
Asian Continental Ancestry Group ; Birth Weight ; Female ; Gestational Age ; Humans ; Incidence ; Infant, Extremely Premature ; Infant, Newborn ; Intensive Care Units, Neonatal ; Kaplan-Meier Estimate ; Logistic Models ; Male ; Republic of Korea/epidemiology ; Retinopathy of Prematurity/*epidemiology/mortality ; Retrospective Studies ; Risk Factors ; Severity of Illness Index

BACKGROUND AND OBJECTIVES: There are many possible causes of sudden deafness such as viral infection, vascular occlusion, immune-mediated mechanism and abnormal cellular stress response in the cochlea. Viral hypothesis is one of the potential mechanisms for explaining sudden deafness. The aims of this study were to investigate the usefulness of viral IgM antibodies to evaluate the clinical findings and prognosis in sudden sensorineural hearing loss and to identify the more useful viral IgM antibodies. SUBJECTS AND METHOD: A retrospective study was carried out for 283 patients with sudden deafness. The results of serologic tests performed for the following were studied: Ebstein barr virus (EBV), Measles, Mumps, Toxoplasma, Rubella, Cytomegalovirus, Varicella zoster virus, Herpes simplex virus, and human immunodeficiency virus. Results of blood tests and audiologic tests taken initially and 2 months after the onset of sudden deaf were studied as well. RESULTS: Positive ratio of Viral IgM antibodies was 4.9% (13/283). Clincial findings and prognosis of viral IgM positive patients were not different from other sudden deafness patients except for the age factor. EBV Viral capsid antigen, EBV Early antigen-diffuse and restrict complex were common positive viral markers in sudden hearing loss patients. One third of the patients (4/13) had viral markers for Measles, Mumps and Toxoplasma. CONCLUSION: In sudden deafness, the positive ratio of serologic tests for viral IgM antibodies was less than 5% and viral IgM positive patients had similar clinical findings and prognosis to viral IgM negative patients. However, viral origins of Measles, toxoplasam and Mumps as well as EBV should be considered in sudden deafness patients with the symptoms and signs of viral infection.
Age Factors ; Antibodies ; Biomarkers ; Capsid ; Cochlea ; Cytomegalovirus ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden ; Hematologic Tests ; Herpesvirus 3, Human ; Herpesvirus 4, Human ; HIV ; Humans ; Immunoglobulin M ; Measles ; Methylmethacrylates ; Mumps ; Polystyrenes ; Prognosis ; Retrospective Studies ; Rubella ; Serologic Tests ; Simplexvirus ; Toxoplasma ; Viruses

A 71-year-old woman with minimal change disease visited our clinic complaining of pleuritic chest pain. Cefepime was given under the impression that she had pneumonia. Three days after cefepime administration, she became unconscious. A brain MRI scan was non-revealing and an EEG showed triphasic waves. As there was no evidence of septic, uremic or hepatic encephalopathy, we suspected cefepime-induced neurotoxicity. Cefepime was stopped and she underwent hemodialysis to decrease the blood levels of the drug. Following hemodialysis, she regained consciousness.
Aged ; Brain ; Cephalosporins ; Chest Pain ; Consciousness ; Electroencephalography ; Female ; Hepatic Encephalopathy ; Humans ; Magnetic Resonance Imaging ; Nephrosis, Lipoid ; Neurotoxicity Syndromes ; Pneumonia ; Renal Dialysis ; Unconscious (Psychology)