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Investigates the effect of decision-making activities on improving decision-making abilities to meet bioethical issues in everyday situations. Uses worksheets for decision making that consists of six steps. Concludes that the resulting scores on decision-making were increased by the activities of the worksheets. (Contains 31 references.) (Author/YDS)

Pneumoperitoneum, free intra-abdominal air, usually results from the perforation of a hollow viscous. In approximately 10% of cases, however, pneumoperitoneum is not caused by gastrointestinal perforation. These cases of "spontaneous pneumoperitoneum" generally follow more benign course and may not require surgical intervention. Examples include cardiopulmonary resuscitation (CPR), malrotation, mechanical ventilator support, gynecologic manipulation, blunt abdominal trauma, and chronic intestinal pseudoobstruction in infancy (Sieber syndrome). But, it is extremely rare of spontaneous pneumoperitoneum secondary to idiopathic intestinal pseudoobstruction in adult. We herein report a patient with chronic idiopathic intestinal pseudoobstruction who developed a pneumoperitoneum.

Background/aims: We investigated the risk factors for short-term recurrence and analyzed the correlation between subjective clinical symtoms and objective radiological findings in patients with achalasia undergoing pneumatic balloon dilatation., Methods: Twenty patients who were treated by pneumatic balloon dilatation were enrolled. We compared prospectively various indices before and after the treatment as follows: 1) Eckardt symptom score and dysphagia grade, 2) The ratio of the maximal width in mid-esophageal lumen to the minimal width in distal esophagus around lower esophageal sphincter, and 3) the percentage of maximum activity retained in the esophagus at 30 seconds and T in esophageal scan two days after the treatment., Results: 1) Clinical indices and radiologic indices significantly improved after pneumatic dilatation. 2) There was no significant correlation between the clinical indices and the radiologic indices before and after the treatment. 3) The difference percentage of clinical indices did not show significant correlation with the difference percentage of the radiologic indices. 4) Compared to the group above 20% in the difference percentage of 30 second residual fraction, the one below 20% had a four-fold risk in short-term recurrence., Conclusions: Clinical symptoms and radiologic indices significantly improve after pneumatic dilatation but have no significant correlation to each other. The group below 20% in the difference percentage of 30 second residual fraction has a high risk of recurrence and may need careful examination and early repeated pneumatic dilation.

Objectives: This study aims to examine if a garbage dumping site has real and negative influence on the quality of life (QOL) for the nearby residents. The net effects of the residential distance from the garbage dumping site and from the garbage truck route were investigated for five domains of the QOL., Methods: Two hundred fifty seven Shin-dong Myeon residents, Chun-cheon Si, participated in a self-administrated survey. The Shin-dong Myeon garbage dumping site began operating in 1996. ANCOVA with generalized linear models and multiple regression analysis were performed., Results: Descriptive analyses show that a residence nearby a garbage dumping site is negatively associated with the physical and environmental domains of the QOL. The residential distance from the garbage truck route does not exert any significant effect on various domains of QOL, except for the environmental domain. On the multivariate analysis, the residents living near the garbage dumping site tended to have a significantly negative QOL in the physical and environmental domains. However, the distance from the garbage truck route did not show a significant nor substantial effect on the QOL. The demographic and socioeconomic control variables are associated with a number of the QOL domains, and their patterns are consistent with the general expectations., Conclusions: The results indicated that a garbage dumping site is considered to be an environmental hazard among the nearby residents according to the lower scores on the physical and environmental domains of the QOL. The findings from this study provide comprehensive\ understanding on the residents' QOL, and they may help politicians and policy makers make decisions for appropriate interventions.

Background/aims: The clinical significance of serum CA 125 levels in patients with chronic liver disease has not been widely appreciated in relation to the severity of the disease. We examined serum CA 125 levels in patients with chronic liver disease according to the severity of liver disease and the presence of ascites., Methods: Fasting serum CA 125 levels were measured by a commercial RIA kit in 92 patients with chronic liver disease: 22 with chronic hepatitis and 70 with liver cirrhosis (Child class A, 19; B, 28; C, 23). Forty-one patients (45%) had ascites., Results: The patients with Child class C liver cirrhosis had significantly higher mean serum CA 125 level than those with class A (p<0.05). In Child class B patients, the mean serum CA 125 level was significantly higher in patients with ascites than in those without (p<0.05). A multiple regression analysis showed that the presence of ascites, serum albumin, and prothrombin time were independent factors related to the increase of serum CA 125 levels., Conclusions: The presence of ascites is more closely related to the increase of CA125 levels in patients with liver cirrhosis than the severity of liver disease.