A Retrospective Study on the Decision to Prohibit Cardiopulmonary Resuscitation in Patients with Premenarcheal Cancer in a University Hospital

OBJECTIVE: Whether to perform cardiopulmonary resuscitation (CPR) or do-not-resuscitate (DNR) is not only a medical problem but also a decision that should be made carefully with self-autonomy in accordance with life values. We conducted a retrospective observational study to identify the characteristics of current CPR and DNR at a practical level. METHODS: We retrospectively analyzed data from medical records with regard to the clinical status of DNR decision in 356 patients with cancer who expired between October 2014 and September 2015 in Soonchunhyang University Bucheon Hospital. RESULTS: DNR was decided significantly more frequently in patients with solid cancers than in patients with hematological cancer (87.7% vs. 71.4%, P=0.003). No other significant factor influenced the DNR decision in this study. The main persons who signed the DNR consent form were mostly sons or daughters (60.7%), never the patients themselves. The median time from the DNR order to death was longer in the ward than in the intensive care unit (ICU; 3.0 days vs. 1.0 days). The mean time from the DNR order to death was 6.6 days (median, 2 days). Among the patients with a DNR order, 110 (36.7%) were hospitalized in the ICU and 73 (24.3%) were treated with ventilator support. CONCLUSION: Most patients expired 6.6 days after DNR permission was given and could not decide their treatment plan by themselves. For better end-of-life care, the sensitive DNR decision with consideration of the individualized environment of the patient for life-sustaining treatment should be settled in Korea.

A Novel Argininosuccinate Synthetase Gene Mutation in a Korean Family with Type I Citrullinemia

Citrullinemia type I is an urea cycle defect caused by mutations in the argininosuccinate synthetase (ASS1) gene. We report a novel argininosuccinate synthetase gene mutation in a Korean family with type I citrullinemia. Metabolic evaluation revealed significant hyperammonemia. Amino acid/acylcarnitine screening using tandem mass spectrometry showed high level of citrulline. Plasma amino acid analysis showed high level of citrulline and the urine organic acid analysis showed makedly increased level of orotic acid. To confirm diagnosis of citrullinemia we did mutation analysis of the ASS1 gene. The patient was found to have mutations of c.689G>C (p.G230A) and c.892G>A (p.E298K), which were new types of argininosuccinate synthetase gene mutation have never been reported in Korea. We report a novel case of argininosuccinate synthetase 1 gene mutation and suggest that the gene study to the family members is necessary to carry out when a patient is diagnosed as citrullinemia.

A Novel Argininosuccinate Synthetase Gene Mutation in a Korean Family with Type I Citrullinemia

Citrullinemia type I is an urea cycle defect caused by mutations in the argininosuccinate synthetase (ASS1) gene. We report a novel argininosuccinate synthetase gene mutation in a Korean family with type I citrullinemia. Metabolic evaluation revealed significant hyperammonemia. Amino acid/acylcarnitine screening using tandem mass spectrometry showed high level of citrulline. Plasma amino acid analysis showed high level of citrulline and the urine organic acid analysis showed makedly increased level of orotic acid. To confirm diagnosis of citrullinemia we did mutation analysis of the ASS1 gene. The patient was found to have mutations of c.689G>C (p.G230A) and c.892G>A (p.E298K), which were new types of argininosuccinate synthetase gene mutation have never been reported in Korea. We report a novel case of argininosuccinate synthetase 1 gene mutation and suggest that the gene study to the family members is necessary to carry out when a patient is diagnosed as citrullinemia.

Patient-Controlled Sedation versus Nurse-Administered Sedation with Propofol during Colonoscopy / 대한소화기내시경학회지

BACKGROUND/AIMS: Patient-controlled sedation (PCS) allows the patients to titrate the dosages of sedative drug according to their needs. The objective of this study was to compare the safety and the efficacy of nurse-administered propofol sedation (NAPS) with those of PCS. METHODS: Eighty one patients were randomly assigned to two groups. All patients received meperidine 25 mg and propofol 40 mg as an initial dose for sedation. Patients in PCS group were subsequently infused with propofol 15 mg over 80 seconds through infusion pump whenever they required. Patients in NAPS group were injected with 10~20 mg propofol by nurse with supervision by endoscopist. The dosage of propofol, cardiopulmonary parameters, procedure time, sedation score, pain score, the patients' and endoscopists' satisfaction scores were assessed. RESULTS: With regard to blood pressure, pulse rate and oxygen saturation, serious complications were not observed. Especially, there was no significant difference of mean total dose between two groups (NAPS group and PCS group received 76.7+/-24.7 mg and 82.5+/-26.6 mg respectively). Pain score was higher in woman than in man (p=0.03). CONCLUSIONS: 1.2~1.5 mg/kg of propofol with small dose of opioid during colonoscopy was effective and safe. NAPS was more practical and useful method of sedation than PCS during colonoscopy.