Consent for Emergency Patients; How Far Must We Go?

PURPOSE: The number of medical malpractice suits on violation of informed consent is on the rise. While the medical community can encourage its members on informing their patients, the legal community has a considerable amount of studies on the subject. However, there has not been any systematic debate on the subject for emergency medical situations. The exemption of informed consent in emergency medical situations seems to be the common notion. Nevertheless, the recently enacted Emergency Medical Services Law mandates the provision of informed consent in emergency medical situations by the emergency medical personnel. Therefore, a systematic research focusing on the informed consent in emergency medical service was necessary. METHOD: This was a qualitative study by survey. The results of the opinions of emergency physicians surveyed was compared to previous studies by the legal community on informed consent. RESULTS: The legal community view informed consent as a legal duty. But the emergency physicians view it as a part of much professionalized medical act, so the professional ethics should guide the acquisition of informed consent. The legal community and the judicial precedents exempted informed consent in an emergency. But the emergency physicians see informed consent in emergency medical service equal to that of any other medical situation, only that it can be delayed. The emergency physicians have to provide an explanation for each step of the process, but the method varies and the unified form of informed consent provided by the law is not suitable. Informed consent should be acquired even in an emergency like cardiopulmonary resuscitation (CPR), but it can be delayed until the end. Professional ethics should guide the initiation of CPR, but the termination of CPR should be under the informed consent. Non-urgent patients should be informed even in an overcrowded emergency room. The duty is not released or relieved solely on the reason that it is the emergency room. CONCLUSION: There is a difference in opinion between the legal and the medical community, but for the benefit of the emergency patients a compromise should reached.

Peripheral Neutrophil Count and Respiratory Failure in Preterm Infant

PURPOSE: The purpose of this study was to analyze the association of peripheral neutrophil count with the development of respiratory failure in preterm infants. METHODS: A retrospective study was conducted from January 1993 to December 1999 on 44 preterm infants, who were admitted to the neonatal intensive care unit of St. Francisco hospital. Preterm infants(birth weight 500 to 1,350 gm) who had a complete blood count obtained within 2 hours after delivery. Patients in the lowest of neutrophil count(early neutropenia, <1.0X10(9)/L) were compared with patients in the remaining group. RESULTS: Low neutrophil count were transient in early neutropenia group. The concentration the circulating neutrophil count rose from 0.85+/-0.11X10(9)/L at average of 2 hours after delivery to 5.3+/-2.7X10(9)/L at 24 hours after delivery in the early neutropenia group and from 3.6+/-1.6X10(9)/L to 5.8+/-3.2X10(9)/L in the non-neutropenia group during the same time period. Compare to the non-neutropenia group, the neutropenia group had a lower birth weight(1,046.50+/-180.76 gm Vs 1,156.70+/-124.99 gm), a lower Apgar score(1 min : 3.41+/-1.18 Vs 4.30+/-1.46, 5 min : 5.41+/-0.87 Vs 6.15+/-0.95), and a higher incidence of bronchopulmonary dysplasia(27.27% Vs 7.0%). Patients who had early neutropenia were more likely to require mechanical ventilation, supplemental oxygen and hospital stay. Also, main effect factors for the two groups were birth weight(Odds ratio=5.457, 95 % CI=1.551-27.525), initial peripheral blood white cells(odds ratio=8.308, 95% CI=2.054-52.699), and bronchopulmonary dysplasia(odds ratio=0.099, 95% CI=0.017-0.397). CONCLUSION: A low count of neutrophil in the systemic circulation of premature infants within 2 hours of birth is associated with more severe respiratory distress.

Production of Soluble VEGF Receptor Mutants for Inhibition of Angiogenesis / 대한암학회지

PURPOSE: Vascular endothelial growth factor (VEGF) is a potent angiogenic factor of many solid tumors, promoting vascularization and formation of metastases. In an attempt to generate effective VEGF inhibitors, the authors constructed the VEGF receptor mutants, expressed in E. coli and Sf9 insect cells, and examined their binding to VEGF. MATERIALS AND METHODS: The cDNA fragment encoding FLT-1 extracellular domain was cloned from human umbilical vein endothelial (HUVE) cell total RNA using RT-PCR. PCR- subcloning was performed using this template, in order to generate the deletion mutants by introducing FLT-1 partial sequences into E.coli expression vector pET-21d and baculovirus transfer vactors, pBAC-1 and pBAC-3. Two mutant proteins from baculovirus-infected insect cells were purified by heparin sepharose chromatography and immobilized into nitrdegrees Cellulose membrane followed by 125I-VEGF binding assay. RESULTS: Two mutant receptors, sFLT (1~7) and sFLT (2~4) expressed in E.coli appeared in inclusion body as insoluble proteins. The soluble mutant receptors were produced in low yield by baculovirus/insect cell expression system. Both immobilized mutant receptors, sFLT (1~7) and sFLT (2~4) were able to bind VEGF. CONCLUSION: These results suggest that a small soluble mutant receptor, sFLT (2~4), as well as sFLT (1~7) may be used effectively for bldegrees Cking angiogenic function of VEGF.