• Title/Summary/Keyword: Aggravation

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Mid-term and Long-term Outcomes of Posterior Plication Annuloplasty(Modified Davila Annuloplasty) for Functional Tricuspid Regurgitation (기능성 삼첨판막부전증에 대한 삼첨판후판륜주름술(Davila Technique)의 중장기결과)

  • Lee, Mi-Kyung;Kim, Jong-Hun;Kim, Min-Ho;Jo, Jung-Ku;Choi, Jong-Bum
    • Journal of Chest Surgery
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    • v.41 no.5
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    • pp.580-585
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    • 2008
  • Background: Many types of tricuspid annuloplasty are used in surgical correction of functional tricuspid regurgitation (FTR). We evaluated the mid-term and long-term outcomes in patients treated with a posterior annular plication technique (a modified Davila technique) for FTR. Material and Method: Between January 1991 and August 2006, 58 adult patients (male, 22; female, 36) with FTR of grade 2/4 or more or with tricuspid annular dilatation of more than 5.0cm in diameter, even with an FTR of less than grade 2, had received a posterior annular placation. Preoperatively, 26 patients (44.8%) had a grade 3 or more FTR. All patients had received a mitral valve replacement, and 20 (34.5%) had concomitant aortic valve replacement. Result: During the mean follow-up period of $101.4{\pm}51.6$ months, FTR disappeared or remained trivial in 28 patients (49.1%), was grade $2{\sim}3$ (${\geq}$grade 2 and $2.66{\pm}0.73\;vs.\;0.82{\pm}0.89$; p<0.0001). Patients did not require a second surgery for FTR and did not show further FTR aggravation. Conclusion: The modified Davila posterior annular plication technique for FTR has reasonable mid-term and long-term results and is a useful surgical procedure.

Active Prosthetic Valve Endocarditis: The Clinical Profile, Laboratory Findings and Mid-term Surgical Results (활동성 인공판막 심내막염: 임상 양상, 검사 소견 및 중기 수술 성적)

  • Kim, Hwan-Wook;Joo, Seok;Kim, Hee-Jung;Choo, Suk-Jung;Song, Hyun;Lee, Jae-Won;Chung, Cheol-Hyun
    • Journal of Chest Surgery
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    • v.42 no.4
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    • pp.447-455
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    • 2009
  • Background: Prosthetic valve endocarditis usually presents with clinical symptoms that are more severe than native valve endocarditis, and prosthetic valve endocarditis shows the spread of infection into the surrounding tissue as well as into the superficial endocardial layers. The postoperative prognosis is especially poor for valve re-replacement for the cases of active endocarditis that are unable to receive a full-course of pre-antibiotic therapy due to complications and the ensuing clinical aggravation. The aim of this study was to evaluate the clinical profiles, laboratory findings and mid-term surgical results of active prosthetic valve endocarditis. Material and Method: Among the 276 surgically treated infective endocarditis patients who were treated during the period from January 1998 to July 2008, 31 patients were treated for prosthetic valve endocarditis. Among these patients, 24 received surgical treatment for an 'active' state, and they were selected for evaluation. Result: The most frequently encountered symptom was a febrile sensation. Eight cases (33.3%) were accompanied by systemic thromboembolism, among which 5 cases (20.8%) had an affected central nervous system. 'Vegetations' were most commonly found on transesophageal echocardiography, and the 'Staphylococcus species' were the most frequent pathogens. There were 4 deaths in the immediate postoperative period, and an additional 4 patients died during the follow-up period (Mean$\pm$SD, 42.1$\pm$36.9 months). The cumulative survival rate was 79% at 1 year, 73% at 3 years, 66% at 5 year, and 49.5% at 7 years. Conclusion: The cases of active prosthetic valve endocarditis that were unable to receive a full course of preoperative antibiotics therapy generally have a poor prognosis. Nevertheless, early surgery and extensive resection of all the infected tissue is pivotal in improving the survival rate of patients with surgically treated active prosthetic valve endocarditis.

Clinical Characteristics of Pulmonary Histiocytosis X (폐조직구증식증의 임상적 특징)

  • Hwang, Yong-Ii;Park, Gun-Min;Yim, Jae-Joon;Yoo, Chul-Gyu;Lee, Choon-Taek;Kim, Young-Whan;Han, Sung-Koo;Shim, Young-Soo
    • Tuberculosis and Respiratory Diseases
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    • v.51 no.4
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    • pp.346-353
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    • 2001
  • Background : Pulmonary Langerhans cell histiocytosis forms part of a spectrum of diseases that are characterized by a monoclonal proliferation and infiltration of organs by Langerhans cells. Several organ systems may be involved in Langerhans cell histiocytosis, including the lungs, bone, skin, pituitary gland, liver, lymph nodes and thyroid. Pulmonary histiocytosis X represents 2.8% of interstitial lung disease. Here we present the clinical, radiological, therapeutic aspects of pulmonary histiocytosis X. Method : Fourteen cases of biopsy-proven pulmonary histiocytosis X patients who were diagnosed in Seoul National University Hospital during the period from January 1990 to December 1998 were analyzed retrospectively. Result : There were 12 men and 2 women in this study. The initial presenting symptoms were dyspnea, cough, chest pain, which was associated with the pneumothorax, and chest radiography abnormalities. Only 8 patients (57%) were smokers. There were 5 patients with extra-pulmonary histiocytosis (pituitary, bone, skin). Eight patients had received the chemotherapy. There were no mortalities and only one patient experienced an aggravation of symptom during the follow-up period. Conclusion : In contrast to previous reports from other countries, the patients with pulmonary histiocytosis X in this study presented with several different clinical characteristics, such as a male predominance, relatively low smoker's rate, and a better prognosis.

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The Clinical Outcome of Pulmonary Thromboendarterectomy for the Treatment of Chronic Pulmonary Thromboembolism (만성 폐동맥 색전증 환자에서의 폐동맥 내막절제술의 임상적 결과)

  • Bang, Jeong-Hee;Woo, Jong-Soo;Choi, Pil-Jo;Jo, Gwang-Jo;Park, Kwon-Jae;Kim, Si-Ho;Yie, Kil-Soo
    • Journal of Chest Surgery
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    • v.43 no.3
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    • pp.254-259
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    • 2010
  • Background: Diagnosing chronic pulmonary embolism at an early stage is difficult because of the patient’s nonspecific symptoms. This condition is not prevalent in Korea, and in fact, there have been only a few case reports on this in the Korean medical literature. We analyzed the surgical outcome of performing pulmonary thromboendarterectomy in patients with chronic pulmonary embolism. Material and Method: The study subjects included those patients who underwent surgery for chronic pulmonary embolism from 1996 to 2008. For making the diagnosis, echocardiography, chest CT and a pulmonary perfusion scan were performed on the patients who complained of chronic dyspnea. Result: Pulmonary endarterectomy was performed as follows: by incision via a mid-sternal approach (7 patients); by incision via a left posterolateral approach (1 patient); using the deep hypothermic circulatory arrest technique (4 patients); under ventricular fibrillation (3 patients); and under cardioplegic arrest (1 patient). The postoperative systolic pulmonary artery blood pressure significantly decreased from a preoperative value of $78.9{\pm}14.5\;mmHg$ to $45.6{\pm}17.6\;mmHg$ postoperatively (p=0.000). The degree of tricuspid regurgitation was less than grade II after surgery. Two patients died early on, including one patient who had persistent pulmonary hypertension without improvement and right heart failure. Conclusion: Patients who have chronic pulmonary embolism are known to have a poor prognosis. However, we think that early surgical treatment along with making the proper diagnosis before the aggravation of right heart failure can help improve the quality of a patient's life.

Ototoxicity in children receiving cisplatin chemotherapy (Cisplatin을 포함한 항암치료를 받은 소아에서 이독성)

  • Jang, Hee Jin;Cho, Hyung Rae;Lee, Jae Hee;Bae, Kun Yuk;Seo, Jong Jin;Moon, Hyung Nam;Im, Ho Joon
    • Clinical and Experimental Pediatrics
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    • v.53 no.2
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    • pp.210-214
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    • 2010
  • Purpose : Cisplatin is highly effective for the treatment of solid tumors in children. However, the clinical use of cisplatin is limited by its ototoxicity. The aim of this study was to evaluate the ototoxicity in children treated with cisplatin. Method : We performed a single institution retrospective analysis of pediatric oncology patients who received cisplatin therapy between January 2001 and January 2008. Thirty-seven patients with sufficient medical and audiologic data were included in this study. Results : The median age at the time of diagnosis was 10.7 (range 3.8-6.7) years. There were 16 males and 21 females. The underlying diseases were osteosarcoma (15 cases), medulloblastoma (14 cases), germ cell tumors (7 cases), and hepatoblastoma (1 case). The median individual dose was $100mg/m^2$/cycle (56-200). The median cumulative dose was $480mg/m^2$ (200-1,490). Sixteen patients (43%) received cranial radiotherapy. Of the 37 patients, 17 developed hearing loss, leading to an overall incidence of 46%. Logistic regression showed that age at treatment (P =0.04) and cumulative dose of cisplatin (P =0.005) were the significant risk factors in predicting hearing loss in children treated with cisplatin. In all the patients who had hearing loss, there was neither improvement nor aggravation during the follow-up (3-8 months). Conclusion : The cumulative dose of cisplatin (>$500mg/m^2$) and younger age at treatment (<12 years) were 2 most important risk factors for ototoxicity in patients treated with cisplatin. Serial audiometric evaluations are needed in the patients with risk factors during and after cisplatin treatment.

Hydrogeochemical Research on the Characteristic of Chemical Weathering in a Granitic Gatchment (水文化學的 資料를 통한 花崗岩質 流域의 化學的 風化特性에 關한 硏究)

  • Park, Soo-Jin
    • Journal of the Korean Geographical Society
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    • v.28 no.1
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    • pp.1-15
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    • 1993
  • This research aims to investigate some respects of chemical weathering processes, espcially the amount of solute leaching, formation of clay minerals, and the chemical weathering rate of granite rocks under present climatic conditions. For this purpose, I investigated geochemical mass balance in a small catchment and the mineralogical composition of weathered bedrocks including clay mineral assemblages at four res-pective sites along one slope. The geochemical mass blance for major elements of rock forming minerals was calculated from precipitation and streamwater data which are measured every week for one year. The study area is a climatically and litholo-gically homogeneous small catchment($3.62Km^2$)in Anyang-shi, Kyounggi-do, Korea. The be-drock of this area id Anyang Granite which is composed of coarse-giained, pink-colored miner-als. Main rock forming minerals are quartz, K-Feldspar, albite, and muscovite. One of the chracteristics of this granite rock is that its amount of Ca and Mg is much lower than other granite rock. The leaching pattern in the weathering profiles is in close reltion to the geochemical mass balance. Therefore the removal or accumulation of dissolved materials shows weathering patterns of granite in the Korean peninsula. Oversupplied ions into the drainage basin were $H^+$, $K^+$, Fe, and Mn, whereas $Na^2+$, $Mg^2+$, $Ca^2+$, Si, Al and $HCO-3^{-}$ were removed from the basin by the stream. The consumption of hydrogen ion in the catchment implies the hydrolysis of minerals. The surplus of $K^+$ reflects that vegetation is in the aggravation stage, and the nutrient cycle of the forest in study area did not reach a stable state. And it can be also presumed that the accumulation of $K^+$ in the top soil is related to the surplus of $K^+$. Oversupplied Fe and Mn were presumed to accumulate in soil by forming metallic oxide and hydroxide. In the opposite, the removal of $Na^+$, Si, Al resulted from the chemical weathering of albite and biotite, and the amount of removal of $Na^+$, Si, Al reflected the weathering rate of the bedrock. But $Ca^2+$ and $Mg^2+$ in stream water were contaminated by the scattered calcareous structures over the surface. Kaolinite is a stable clay mineral under the present environment by the thermodynamical analysis of the hydrogeochemical data and Tardy's Re value. But this result was quite different from the real assemblage of clay miner-als in soil and weathered bedrock. This differ-ence can be explained by the microenvironment in the weathering profile and the seasonal variation of climatic factors. There are different clay forming environments in the stydy area and these differences originate from the seasonal variation of climate, especially the flushing rate in the weathering profile. As it can be known from the results of the analysis of thermodynamic stability and characteristics of geochemical mas balance, the climate during winter and fall, when it is characterized by the low flushing rate and high solute influx, shows the environmental characteristics to from 2:1 clay minerals, such as illite, smectite, vermiculite and mixed layer clay minerals which are formed by neoformation or transformation from the primary or secondary minerals. During the summer and spring periods, kaoli-nite is a stable forming mineral. However it should consider that the other clay minerals can transformed into kaolinite or other clay minerals, because these periods have a high flushing rte and temperature. Materials which are directly regulated by chemical weathering in the weathered bedrock are $Na^+$, Si, and Al. The leaching of Al is, however, highly restricted and used to form a clay mineral, and that of Si falls under the same category. $Na^+$ is not taked up by growing veget ation, and fixed in the weathering profile by forming secondary minerals. Therefore the budget of $Na^+$ is a good indicator for the chemical weathering rate in the study area. The amount of chemical weathering of granite rocks was about 31.31g/$m^2+$/year based on $Na^+$ estimation.

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Clinical Investigation about the Result of Surgically Treated Myasthenia Gravis (중증 근무력증의 수술적 치료결과에 대한 임상적 고찰)

  • 김대현;황은구;조규석;김범식;박주철
    • Journal of Chest Surgery
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    • v.36 no.1
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    • pp.15-20
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    • 2003
  • Myasthenia gravis is a rare autoimmune disease involving acetylcholine receptor and its autoantibody on neuromuscular junction. The methods of treatment are medical treatment and surgical thymectomy. In this paper we analyzed the result of thymectomy and the factors affecting the postoperative symptom improvement. Material and method : This study obtained medical records of 37 patients who received the thymectomy for myasthenia gravis from March 1986 to December 1998. Result Out of 37 cases, 21 cases(57%) showed improvement, of which 8 cases (50%) in the group of thymoma(n=16), and 13 cases (62%) in the group of thymic hyperplasia(n=21) showed the improvement of symptoms. Postoperative complications were respiratory insufficiency due to aggravation of symptoms after operation, including tracheal intubation for ventilator support in 9 cases, pneumonia in 3 cases, pneumothorax in 2 cases and left vocal cord palsy in 1 case. There was one postoperative mortality. The relation between postoperative improvement and sex(P=0.3222), age(P=0.7642), thymic pathologic variants,(P=0.4335) and classification of thymoma(P=0.20) showed no statistically significant correlation. However, the lower grade of preoperative symptoms can predict the lower grade of postoperative symptoms significantly(P=0.0032). Follow up study to 36 postoperative survivors was performed in October 2002 based on the out-patient records and call with patients. Out of 36 cases, 33 cases(91.7%) could be investigated and 3 cases could not. Mean follow up period was 83.2 months. Out of 33 cases, 25 cases(75.8%) showed symptomatic improvement, of which 8 cases(53.3%) in the group of thymoma(n=15) and 17 cases(94.4%) in the group of thymic hyperplasia(n=18) showed the improvement of$\boxUl$ symptoms. Conclusion : In myasthenia gravis, thymectomy showed the good improvement, and more important factor affecting the improvement of symptoms was the grdae of preoperative symptoms. Also midterm and long term follow up results showed good symptomatic improvement.

Triple Detector SPECT Imaging with $^{99m}Tc-DMSA$ in Adult Patients with Urinary Tract Infection (성인 요로 감염 환자에서 $^{99m}Tc-DMSA$ 삼중검출기 SPECT 영상의 유용성)

  • Ryu Jin-Sook;Bae, Won-Gyu;Moon Dae-Hyuk;Lee, Myung-Hae;Kim, Soon-Bae,;Park, Su-Kil;Park, Jung-Sik;Hong, Chang-Gi D.;Cho, Kyung-Sik
    • The Korean Journal of Nuclear Medicine
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    • v.26 no.2
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    • pp.290-298
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    • 1992
  • Although early diagnosis of urinary tract infection is important, the radiologic evaluation is still controversial because of the low sensitivity and the lack of cost-effectiveness. This study was carried out to evaluate the clinical utility of high resolution triple head $^{99m}Tc-DMSA$ SPECT imaging in urinary tract infection. We prospectively performed $^{99m}Tc-DMSA$ planar and SPECT imaging, ultrasound of kidney (US), intravenous pyelography (IVP) and voiding cystourethrography (VCU) in all 60 adult patients with UTI [26 with first episode of acute pyelonephritis (APN), 22 with recurrent APN, and 12 persistent asymptomatic pyuria] and 25 normal persons. To assess reversibility of the renal cortical defect (RCD), $^{99m}Tc-DMSA$ SPECT was repeated 1 to 8 months later in those patients with abnormal initial findings. Overall detection rate of $^{99m}Tc-DMSA$ SPECT imaging was 83% (50/60), but planar, US, IVP and VCU showed abnormal findings in 68%, 28%, 32% and 13%, respectively. 25 out of 27 patients with normal or single RCD were all normal in other radioligic studies. Only two patients showed vesicoureteral reflux (VUR) on VCU (grade I) and mild hydronephrosis on IVP. But, high proportion of those with multiple RCD showed abnormal findings on US (17/33), IVP (18/33), and VCU (7/33): 67% in any of these 3 studies. Especially, 3 out 7 patients with VUR showed multiple RCD on $^{99m}Tc-DMSA$ SPECT without any abnormality on IVP or US. 25 normal persons showed normal findings in all studies except one false positive finding on $^{99m}Tc-DMSA$ SPECT imaging. Follow-up $^{99m}Tc-DMSA$ SPECT was done in 28 patients (13 with single RCD, 15 with multiple RCD). All 13 patients with single RCD showed improvement. Those with multiple RCD presented improvement in 4, no change in 10, and aggravation in 1 on follow-up studies. With these results, we conclude: 1) $^{99m}Tc-DMSA$ SPECT imaging is superior to planar imaging, US, IVP or VCU in detection of renal lesion in urinary tract infection. $^{99m}Tc-DMSA$ SPECT is useful as a initial diagnostic tool in adult patients with urinary tract infection. 2) The multiple RCD on $^{99m}Tc-DMSA$ SPECT represent the high probability of irreversible tissue change and need of extensive urological work-up.

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Investigation of Soil Contamination of Some Major Roadsides in Seoul -II. Major Roadsides in Gangdong-, Gwangjin-, Nowon-, Seodaemun- and Seongdong-gu- (서울시 주요 도로변 토양오염 조사 -II.강동구, 광진구, 노원구, 서대문구, 성동구 내 주요 도로변 토양-)

  • Kim, Kwon-Rae;Lee, Hyun-Haeng;Jung, Chang-Wook;Kang, Ji-Young;Park, Soon-Nam;Kim, Kye-Hoon
    • Applied Biological Chemistry
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    • v.45 no.2
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    • pp.92-96
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    • 2002
  • Present contamination levels of soils along the major roadsides of Seoul, Korea were investigated, and base-line data were accumulated for future use. Topsoil $(1{\sim}5$ cm) and subsoil $(20{\sim}50$ cm) from five districts (Gangdong-, Gwangjin-, Nowon-, Seodaemun- and Seongdong-gu) were sampled. The collected samples were airdried, passed through 2-mm sieves, and analyzed to determine the physicochemical properties including pH, EC, CEC, exchangeable cations (Ca, Mg, K, and Na), and heavy metal contents (Cd, Cu, Pb, and Zn). Soil textures of topsoils and subsoils were mainly loamy sand and sandy loam, respectively. The range of pH was $4.5{\sim}10$.0 with an average of 7.5 for both topsoil and subsoil, which is much higher than that of the forest soils in Seoul. The ranges of 0.1 N HCI extractable Cd, Cu, Pb, and Zn contents for both topsoils and subsoils were $0.0l{\sim}l.19$, N.D. (not $detected){\sim}228$.99, $N.D.{\sim}352$.54, and $2.97{\sim}332$.96 mg $kg^{-1}$, respectively. Most of the average heavy metal contents were lower than the concern level of the Soil Environment Conservation Act of Korea, but were much higher than those of the , forest soils in Seoul. Some sites were higher in heavy metal contents than the concern levels; in particular, the average Cu content in Seongdong-gu was much higher than the concern level, 50 mg $kg^{-1}$. Careful management of the soil to prevent the aggravation of the present contamination level and the dissemination of contamination is highly recommended.

DNR (Do-Not-Resuscitate) Order for Terminal Cancer Patients at Hospice Ward (호스피스 병동에서 시행되는 말기 암 환자의 DNR (Do-Not-Resuscitate) 동의)

  • Shim, Byoung-Yong;Hong, Seok-In;Park, Jin-Min;Cho, Hong-Joo;Ok, Jong-Sun;Kim, Seon-Young;Han, Sun-Ae;Lee, Ok-Kyung;Kim, Hoon-Kyo
    • Journal of Hospice and Palliative Care
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    • v.7 no.2
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    • pp.232-237
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    • 2004
  • Purpose: DNR order is generally accepted for cancer patients near the end of life at Hospice Ward. It means not only no CPR when cardiopulmonary arrest develops but no aggressive meaningless medical interventions. Usually on admission, we discuss with the patients' family about DNR order at the Hospice Ward. Recently, we experienced a terminal lung cancer patient who had been on the ventilator for two months after pulmonary arrest. CPR and artificial ventilation were performed because patient's family refused DNR order. There is no consensus when, who, and how DNR order could be written for terminal cancer patients in Korea, yet. Methods: Hospice charts of 60 patients who admitted between Jan and Jun 2003 to Hospice Ward were reviewed retrospectively. Results: The median age was 66(range $31{\sim}93$) and there were 31 males and 29 females. Their underlying cancers were lung (12), stomach (12), biliary tract (7), colon (6), pancreas (4) and others (19). The persons who signed DNR order were son (22), spouse(19), daughter (16) and others (3). But, there was no patients who signed DNR order by oneself. Thirty families of 60 patients signed on day of admission and 30 signed during hospitalization when there were symptom aggravation (19), vital sign change (4), organ failure (3) and others (4). There were 13 patients who died within 5 days after DNR order. Most of patients died at our hospice ward, except in 1 patient. The level of care was mostly 1, except in 2 patients. (We set level of care as 3 categories. Level 1 is general medical care: 2 is general nursing care: 3 is terminal care.) Conclusion: We have to consider carefully discussing DNR order with terminal cancer patients in the future & values on withholding futile intervention.

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