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: The authors evaluated the differences between K-wires and Cannulated screw, plate for fixing the proximal metatarsal chevron osteotomy of moderate and severe hallux valgus. MATERIALS AND METHODS: There were 62 patients (79 feet) who were moderate and severe degree hallux valgus according to the classification of Mann. They all got the proximal chevron osteotomy when correcting the deformity. We divided the patients into 4 groups, Two K-wire fixed group as A, one cannulated screw fixed group as B. Two cannulated screw fixed group as C, Plate fixed group as D, Group A were patients (26 feet) and Group B were patients (9 feet), Group C were patients (31 feet) and Group D were patients (13 feet). Preoperative, postoperative and follow-up hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured for each patient. ANOVA test and Student t-test were done for statistical analysis. RESULTS: Mean follow up period was 43.8 months (range: 12~82 months). Preoperative mean IMA was 16.4+/-3.5, 17.7+/-11.3, 17.3+/-5.9 and 16.6+/-2.3 degrees in respectively group A, B, C, D. Immediate postoperative mean IMA was 5.6+/-3.4, 7.3+/-4.4, 7.6+/-4.4 and 6.7+/-2.8 degrees in respectively group A, B, C, D. The final mean IMA was 8.9+/-4.5, 15.2+/-7.5, 10.3+/-4.4 and D 7.7+/-3.5 degrees in respectively group A, B, C, D. There were significant statistical increase in final mean IMA of group B and C (p<0.05). CONCLUSION: The IMA was significantly increased in the group which used one or two cannulated screw for fixation on follow up, therefore more caution should be needed when using one or two cannulated screw fixation technique after proximal chevron osteotomy.
Congenital Abnormalities ; Follow-Up Studies ; Hallux ; Hallux Valgus ; Humans ; Metatarsal Bones ; Osteotomy

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: The authors evaluated the clinical results and prognosis after amputating the lower extremity due to diabetic foot. MATERIALS AND METHODS:From 1991 to 2003, the patients who had suffered amputation of his lower extremity due to diabetic foot ulcer were evaluated retrospectively. 79 patients were male and 6 patients were female. The author evaluated the patient who had the ipsilateral additional surgery, contralateral amputation, level of blood sugar, combined disease and mortality rate within 5 years from medical record. Statistical analysis was done by Chi-square test and Kaplan-Meier survival test. RESULTS:Mean age of patients who had first experienced amputation was 63.4 years old. The mean duration of diabetes until amputation was 14.5+/-7.5 years. Major amputations were 50 cases and minor amputations 35 cases. 20 patients (23.5%) were suffered ipsilateral secondary surgery including revised stump. Overall 5-year mortality rate was 18.8% (16 cases). Death rate within 1 year was 8.2% (7 cases), mortality rate within 3 years was 14.1% (12 cases). 5-year mortality rate after major amputation was 20% (10 cases) and after minor amputation was 17.1% (6 cases). It was statistically significant (p<0.05). Patient who underwent more than 2 combined vascular related disease had higher mortality rate than diabetic amputee without combined disease (p<0.05). CONCLUSION: Mortality rate after major amputation was significant higher than amputation after minor amputation in diabetic patients from our data.
Amputation ; Amputees ; Blood Glucose ; Diabetic Foot ; Female ; Humans ; Lower Extremity ; Male ; Medical Records ; Prognosis ; Retrospective Studies ; Ulcer

PURPOSE: The authors evaluated the differences between K-wires and Bold screw for fixing the proximal metatarsal chevron osteotomy of moderate and severe hallux valgus. MATERIALS AND METHODS: There were 59 patients (81 feet) who were moderate and severe degree hallux valgus according to the classification of Mann. They all got the proximal chevron osteotomy when correcting the deformity. All patients were followed up at least 6 months. We divided the patients into 2 groups, K-wires fixed group as A, Bold screw fixed group as B. Group A were 42 patients (63 feet) and Group B were 18 patients (19 feet). Among the Group B, 2 feet who were failed to fix the oetotomy site with Bold screw, were fixed with K-wires during operation. We measured the AOFAS score preoperatively, postoperatively and at final follow-up, VAS score at 2 weeks after the operation. Also preoperative, postoperative and follow-up hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured for each patients. RESULTS: Mean follow up period was 1.34 year (range: 6 months-6.16 years). Mean VAS score of group A was 3.21+/-1.7 and group B 1.76+/-1.0. Preoperative mean AOFAS score of group A was 45.61+/-8.3, group B 44.41+/-8.9, the final mean score of group A was 88.87+/-8.3 and group B 92.47+/-4.4. Preoperative mean HVA was 30.82+/-6.6 degrees in group A and 32.88+/-14.5 degrees in group B, the final mean angle of group A was 14.89+/-8.3 degrees and group B 17+/-4.4 degrees. The preoperative mean IMA of group A was 13.69+/-3.6 degrees and group B 12.35+/-5.2, the final mean angle of group A was 9.26+/-3.6 degrees and group B 12.35+/-5.8 degrees. CONCLUSION: There were no statistical differences in radiologic and clinical results (p>0.05) but, group B exceeded group A in VAS score (p=0.0007) and had no statistical significance in terms of reduction angle loss (p=0.06). Early returning to normal life activity may be possible for patients using Bold screws.
Congenital Abnormalities ; Follow-Up Studies ; Foot ; Hallux ; Hallux Valgus ; Humans ; Metatarsal Bones ; Osteotomy

We report a case of an 86-year-old man diagnosed with bilateral elastofibroma dorsi who was managed conservatively after a two year follow-up. An elastofibroma dorsi is a benign, slow-growing tumor that is most often located in the inferior periscapular area in elderly patients. It should be considered to differentiate them from other soft tissue tumors located at the inferior periscapular region. Increased awareness of these characteristics will decrease the incidence of a misdiagnosis of elastofibroma dorsi as a malignancy and avoid unnecessary surgery.
Aged ; Aged, 80 and over ; Diagnostic Errors ; Follow-Up Studies ; Humans ; Incidence ; Shoulder* ; Unnecessary Procedures

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

PURPOSE: The purpose of this study was to detect the amount of the saline which was injected into a knee joint and made the patella ballottable. MATERIALS AND METHODS: From January 2002 to June 2003, into 37 knees, saline was instilled through a needle inserted at 2 cm distant form superolateral aspect of the patella. The patellar ballottement was examined after every 1 cc injection of the saline. We checked the amount of the injected saline when the ballottement of the patella was developed and when ballottement was disappeared by milking fluid distally from suprapatellar pouch.my. RESULTS: The patella tap test was positive when the amount of instilled saline was between 14 cc and 45cc, and the pattern of distribution was biphasic. A patella tap disappeared if more than 39~110 cc of fluid was injected, which showed triphasic pattern of the distribution. CONCLUSION: The amount of knee effusion between 14~110 cc got the patella ballottable. And the pattern of distribution was variable. Therefore we need more numbers of data to analyze the differences.
Knee Joint* ; Knee* ; Milk ; Needles ; Patella

PURPOSE: To evaluate the clinical and radiological results of the treatment of mid-shaft clavicular nonunions using intramedullary fixation with threaded Steinmann pin and bone grafting. MATERIAL AND METHODS: In 16 patients treated with intramedullary fixation of threaded Steinmann pin and autogenous iliac bone grafting for the mid-shaft clavicular nonunions, 10 patients with follow-up over 1 year were investigated. All patients (10 clavicle fractures) underwent conservative treatment initially. The average age of patients was 56 years old (range, 18~70 years old). Eight cases were atrophic nonunions, two hypertrophic. A clinical assessment was evaluated postoperatively after 5 months according to the evaluation method of Kona et al. RESULTS: According to the evaluation method of Kona et al, four cases achieved excellent results, five cases good, and one case achieved a fair result. The average period until bony union was 9 weeks (range, 7~12.5 weeks) without infection, pin migration or breakage. One case showed skin irritation by lateral margin of Steinmann pin, which was subsided by pin removal after bony union. CONCLUSION: We obtained satisfactory results and have concluded that intramedullary fixation with threaded Steinmann pin and bone grafting could appropriately treat nonunions of the mid-clavicular fracture occurred after conservative treatment, because it minimizes soft tissue injury, gets relatively stable fixation and early ROM, predicts early bone union, facilitates pin removal under local anesthesia.
Anesthesia, Local ; Bone Transplantation* ; Clavicle ; Follow-Up Studies ; Humans ; Middle Aged ; Skin ; Soft Tissue Injuries