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Purpose@#The Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life came into force in February 2018 in Korea. This study reviews the practices of end-of-life care for patients who withdrew or withheld lifesustaining treatment at a tertiary care hospital, addresses the limitations of the law, and discusses necessary steps to promote patient-centered self-determination. @*Methods@#We retrospectively analyzed the medical records of patients who died after agreeing to withhold lifesustaining treatment in 2018 at our university hospital. The cause of death, the intensity of end-of-life care, and other characteristics were reviewed and statistically analyzed. @*Results@#Of a total of 334 patients, 231 (69%) died from cancer. The decision to stop life-sustaining treatment was made by family members for 178 patients overall (53.3%) and for 101 (43.7%) cancer patients, regardless of the patient’s wishes. When the patient decided to stop lifesustaining treatment, the time from the authorization to withhold life-sustaining treatment to death was longer than when the decision was made by family members (28.7±41.3 vs 10.5±23.2 days, P＜0.001). @*Conclusion@#In many cases, the decision to discontinue lifesustaining treatment was made by the family, not by the patient. In order to protect human dignity based on the patients’ self-determination, it is necessary for patients to understand their disease based on careful explanations from physicians. Ongoing survey-based research will be necessary in the future.
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Background/Aims@#The molecular underpinnings of colorectal cancer (CRC) vary according to the tumor location. The advantages of a palliative primary tumor resection in patients with metastatic CRC are controversial. This study examined the survival outcomes of a palliative primary tumor resection based on the tumor location in patients with metastatic CRC. @*Methods@#The medical records of 600 patients diagnosed with metastatic CRC between January 2000 and June 2018 were reviewed retrospectively. Patients undergoing surgery for both the primary tumor and metastatic lesions were excluded. The clinical factors affecting the long-term outcomes were evaluated according to the primary tumor location, and the long-term survival was compared between patients with and without a palliative primary tumor resection. The data were analyzed using the Kaplan-Meier estimator and multivariate Cox regression models. @*Results@#The median follow-up duration was 18 months (interquartile range, 10-28). Patients with right-sided CRC had a poor overall- and progression-free survival compared to those with left-sided CRC. In multivariate Cox regression analysis, the palliative primary tumor resection was an independent prognostic factor predicting better overall survival in patients with metastatic CRC, regardless of the primary tumor location. @*Conclusions@#The primary tumor location influences the prognosis, and that a primary tumor resection can improve the overall survival in patients with metastatic CRC, regardless of the primary tumor location.
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Objectives@#White-coat hypertension is defined as high blood pressure (BP) on clinical assessment but normal BP elsewhere or on ambulatory measurement. Autonomic dysfunction may be one of the mechanisms causing white-coat hypertension.Slowed heart rate recovery and excessive BP response during exercise test are associated with autonomic dysfunction.The purpose of this study was to determine the association between white-coat hypertension and abnormal autonomic nervous system response. @*Methods@#We assessed 295 patients stratified into three groups via 24hr ambulatory BP monitoring, following 2017 ACC/AHA guidelines : normal BP group, white-coat hypertension group, and a hypertension group. We analyzed medical history, blood test, echocardiography, 24hr ambulatory BP monitoring, and exercise test data. @*Results@#There was no difference in basement characteristics and echocardiography among the groups. Blunted heart rate recovery of each group showed a significant difference. Control group had 0% blunted heart rate recovery, but 33.3% in white coat group and 27.6% in true hypertension group (P < 0.001). Also, in the control group, 4.5% showed excessive BP response, but 31.5% in the white coat hypertension group and 29.3% in the true hypertension group (P < 0.001). Excessive BP response during the exercise test or blunted heart rate recovery, which is an indicator of autonomic nervous system abnormality, was more common in the hypertensive group and white-coat hypertension group than in the normal BP group. @*Conclusions@#These results confirmed that white-coat hypertension has an autonomic nervous system risk. Therefore, white-coat hypertension can be a future cardiovascular risk factor.
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Objectives@#White-coat hypertension is defined as high blood pressure (BP) on clinical assessment but normal BP elsewhere or on ambulatory measurement. Autonomic dysfunction may be one of the mechanisms causing white-coat hypertension.Slowed heart rate recovery and excessive BP response during exercise test are associated with autonomic dysfunction.The purpose of this study was to determine the association between white-coat hypertension and abnormal autonomic nervous system response. @*Methods@#We assessed 295 patients stratified into three groups via 24hr ambulatory BP monitoring, following 2017 ACC/AHA guidelines : normal BP group, white-coat hypertension group, and a hypertension group. We analyzed medical history, blood test, echocardiography, 24hr ambulatory BP monitoring, and exercise test data. @*Results@#There was no difference in basement characteristics and echocardiography among the groups. Blunted heart rate recovery of each group showed a significant difference. Control group had 0% blunted heart rate recovery, but 33.3% in white coat group and 27.6% in true hypertension group (P < 0.001). Also, in the control group, 4.5% showed excessive BP response, but 31.5% in the white coat hypertension group and 29.3% in the true hypertension group (P < 0.001). Excessive BP response during the exercise test or blunted heart rate recovery, which is an indicator of autonomic nervous system abnormality, was more common in the hypertensive group and white-coat hypertension group than in the normal BP group. @*Conclusions@#These results confirmed that white-coat hypertension has an autonomic nervous system risk. Therefore, white-coat hypertension can be a future cardiovascular risk factor.
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Staphylococcus aureus is now a major community-acquired pathogen worldwide, notably associated with skin and soft tissue infections. Staphylococci are present in the form of colonizers or environmental contaminants at home and increase the risk of recurrent infection. We are describing recurrent familial furunculosis caused by Panton-Valentine Leukocidin-positive methicillin susceptible S. aureus ST1 in Korea. An infant, his father and mother had furunculosis due to methicillin-sensitive S. aureus (MSSA) infection with identical susceptibility patterns. ST1 accounted for all 3 isolates and they were confirmed of having agr group I. Both sec and seh were detected in all isolates using polymerase chain reaction (PCR) assays, and all isolates contained Panton-Valentine leukocidin (PVL) genes. Risk factors for the household spread of S. aureus include skin conditions and close physical contact among household members. The relationship between S. aureus colonization of household contacts and the occurrence of S. aureus infection should be studied into more detail.