Factors predicting meaningful suicide attempts: multiple attempts and index methods

Purpose@#This study investigated the association of the index method, defined as the method used in the first suicide attempt (SA), with the outcome of SAs among adolescents. @*Methods@#The study analyzed medical records of 227 adolescents aged 10-18 years with clear SAs who visited the emergency department of Severance Hospital in Seoul, Korea from January 2007 through February 2021, focusing on the index methods and meaningful SAs defined as hospitalization, death or transfer to another hospital for psychiatric hospitalization. The association of the index method with the meaningful SAs was quantified using logistic regression. @*Results@#Among the 227 adolescents, 80 underwent the meaningful SAs (35.2%). The adolescents with the meaningful SA chose drug intoxication, fall, and hanging as the index methods more frequently than those without the outcome, whereas they showed a reverse pattern in cutting (P < 0.001). The association of fall or cutting with the meaningful SAs remained significant after adjustment (fall: adjusted odds ratio, 6.93 [95% confidence interval, 1.70-28.26]; cutting: 0.39 [0.17-0.91]; compared with those undergoing drug intoxication). Multiple SAs were also associated with the meaningful SA (1.76 [1.04-3.13]). @*Conclusion@#This study identifies the index method and multiple SAs as factors associated with the meaningful SA among adolescents in the emergency department. This finding may be helpful in interviewing adolescents with SAs.

Beneficial effects of posttransplant dipeptidyl peptidase-4 inhibitor administration after pancreas transplantation to improve β cell function

Purpose@#Dipeptidyl peptidase-4 (DPP-4) inhibitors lower blood glucose levels and enhance the function of pancreatic βcells. Yet, it is unknown whether posttransplant administration of DPP4 inhibitors is beneficial for pancreas transplant recipients. @*Methods@#We thus retrospectively analyzed the records of 312 patients who underwent pancreas transplantation between 2000 and 2018 at Asan Medical Center (Seoul, Korea) and compared the metabolic and survival outcomes according to DPP-4 inhibitor treatment. @*Results@#The patients were divided into the no DPP-4 inhibitor group (n = 165; no treatment with DPP-4 inhibitors or treated for <1 month) and the DPP-4 inhibitor group (n = 147; treated with DPP-4 inhibitors for ≥1 month). There were no significant differences in levels of glucose, hemoglobin A1c, and insulin between the 2 groups during 36 months of follow-up. However, the level of C-peptide was significantly higher in the DPP-4 inhibitor group at 1, 6, and 24 months posttransplant (all P < 0.05). Moreover, the DPP-4 inhibitor group had significantly higher rates of overall (log-rank test, P = 0.009) and death-censored (log-rank test, P = 0.036) graft survival during a 15-year follow-up. @*Conclusion@#Posttransplant DPP-4 inhibitor administration may help improve the clinical outcomes including β cell function after pancreas transplantation.

Beneficial effects of posttransplant dipeptidyl peptidase-4 inhibitor administration after pancreas transplantation to improve β cell function

Purpose@#Dipeptidyl peptidase-4 (DPP-4) inhibitors lower blood glucose levels and enhance the function of pancreatic βcells. Yet, it is unknown whether posttransplant administration of DPP4 inhibitors is beneficial for pancreas transplant recipients. @*Methods@#We thus retrospectively analyzed the records of 312 patients who underwent pancreas transplantation between 2000 and 2018 at Asan Medical Center (Seoul, Korea) and compared the metabolic and survival outcomes according to DPP-4 inhibitor treatment. @*Results@#The patients were divided into the no DPP-4 inhibitor group (n = 165; no treatment with DPP-4 inhibitors or treated for <1 month) and the DPP-4 inhibitor group (n = 147; treated with DPP-4 inhibitors for ≥1 month). There were no significant differences in levels of glucose, hemoglobin A1c, and insulin between the 2 groups during 36 months of follow-up. However, the level of C-peptide was significantly higher in the DPP-4 inhibitor group at 1, 6, and 24 months posttransplant (all P < 0.05). Moreover, the DPP-4 inhibitor group had significantly higher rates of overall (log-rank test, P = 0.009) and death-censored (log-rank test, P = 0.036) graft survival during a 15-year follow-up. @*Conclusion@#Posttransplant DPP-4 inhibitor administration may help improve the clinical outcomes including β cell function after pancreas transplantation.

Myocardial atrophy in children with mitochondrial disease and Duchenne muscular dystrophy / 소아과

PURPOSE: Mitochondrial disease (MD) and Duchenne muscular dystrophy (DMD) are often associated with cardiomyopathy, but the myocardial variability has not been isolated to a specific characteristic. We evaluated the left ventricular (LV) mass by echocardiography to identify the general distribution and functional changes of the myocardium in patients with MD or DMD. METHODS: We retrospectively evaluated the echocardiographic data of 90 children with MD and 42 with DMD. Using two-dimensional echocardiography, including time-motion (M) mode and Doppler measurements, we estimated the LV mass, ratio of early to late mitral filling velocities (E/A), ratio of early mitral filling velocity to early diastolic mitral annular velocity (E/Ea), stroke volume, and cardiac output. A "z score" was generated using the lambda-mu-sigma method to standardize the LV mass with respect to body size. RESULTS: The LV mass-for-height z scores were significantly below normal in children with MD (-1.02+/-1.52, P<0.001) or DMD (-0.82+/-1.61, P=0.002), as were the LV mass-for-lean body-mass z scores. The body mass index (BMI)-for-age z scores were far below normal and were directly proportional to the LV mass-for-height z scores in both patients with MD (R=0.377, P<0.001) and those with DMD (R=0.330, P=0.033). The LV mass-for-height z score correlated positively with the stroke volume index (R=0.462, P<0.001) and cardiac index (R=0.358, P<0.001). CONCLUSION: LV myocardial atrophy is present in patients with MD and those with DMD and may be closely associated with low BMI. The insufficient LV mass for body size might indicate deterioration of systolic function in these patients.

Clinical Presentations and the Bacterial Meningitis Score in Children with Cerebrospinal Fluid (CSF) Pleocytosis

PURPOSE: The differential diagnosis between aseptic meningitis and bacterial meningitis in children is often very difficult. The current study was performed to investigate the clinical presentations, cerebrospinal fluid (CSF) and the Bacterial Meningitis Score (BMS) in children presenting with CSF pleocytosis (> or =10 WBC/mm3). METHODS: We retrospectively analyzed medical records of children (age three months-15 years) with CSF pleocytosis between January 2012 to January 2013 at Gangnam Severance Hospital. RESULTS: The dominant clinical symptoms were fever (92.5%), headache (87.5%), and vomiting (75%). Neck stiffness was noted in 20% of the patients. Three patients who were younger than three years old could not properly present meningeal signs. The majority (36 patients, 90%) were hospitalized, with a median stay of three days. There was no one who had bacterial meningitis. The BMS was calculated for all patients. Among them, 27 patients (67.5%) showed a BMS of 0 which represents very low risk for bacterial meningitis and the remaining 13 patients (32.5%) showed a BMS of 1. CONCLUSION: The BMS may be helpful to guide clinical decision making for the management of children with CSF pleocytosis. Additional multicenter studies in Korea are now needed to evaluate whether the BMS can be used to safely reduce hospital admission and antibiotic use for children with aseptic meningitis.

A Case of Brainstem Encephalitis Presented with Diplopia and Headache

Brainstem encephalitis is a rare disease and patients typically present with symptoms of areflexia, ataxia, and ophthalmoplegia. We experienced a case of brainstem encephalitis in a 7 years old girl, who presented with diplopia and headache. It can be reliably confirmed by magnetic resonance imaging(MRI) and CSF analysis. We report a case of brainstem encephalitis in a child, with a brief review of literature.

Clinical Review of the Etiologic Factors in Patients with Aambiguous Genitalia / 대한산부인과학회잡지

OBJECTIVE: To review and evaluate the etiologic factors in patients with ambiguous genitalia METHODS: We reviewed the medical records of the patients in whom ambiguous genitalia was identified in Asan Medical Center from Jan, 1989 to Dec, 2002. Patients with isolated cryptorchidism, isolated hypospadias, or congenital fatal anomalies involving multiple organs were excluded in our series. RESULTS: A total of 58 cases were evaluated. The most common cause was congenital adrenal hyperplasia (CAH) (18 cases, 31.0%), followed by partial androgen insensitivity syndrome (AIS) (16 cases, 27.6%), true hermaphroditism (9 cases, 15.5%), and mixed gonadal dysgenesis (5 cases, 8.6%). Morphologic abnormalities observed in patients with ambiguous genitalia were hypospadias (52.5%), clitoromegaly (47.5%), palpable gonads (45.8%), bifid scrotum (23.7%), penoscrotal transposition (22%), cryptorchidism (18.6%), vaginal wall abnormality (10.2%), and M llerian remnant (3.4%). By karyotyping, 46XX, 46XY, and Y containing mosaicism were found in 24, 22, and 9 patients, respectively. All of the 18 patients with CAH were found to have 21-hydroxylase deficiency and all cases of androgen insensitivity syndrome were partial type. CONCLUSION: These findings suggest that etiologic background might be different in patients with ambiguous genitalia in Korea.

Expression of Vascular Endothelial Growth Factor Receptor mRNA in Eutopic and Ectopic Endometrial Tissues of Patients with Endometriosis / 대한산부인과학회잡지

OBJECTIVE: To Investigate the expression of vascular endothelial growth factor receptor-1, -2, and -3 (VEGFR-1, -2, and -3) mRNA in the eutopic and ectopic tissues in women with endometriosis. METHODS: At the time of laparoscopy or laparotomy for endometriosis, infertility or other benign gynecologic conditions, a biopsy specimen was taken from the endometrial cavity and a peritoneal endometriotic implant simultaneously whenever appropriate. For control samples, endometrial tissues were obtained from women without visual evidence of endomtriosis. We employed real time quantitative RT-PCR to quantify VEGFR gene expression of these tissues. Comparisions between each group were made using ANOVA (analysis of variance) and Kruskal-Wallis test and statistical significance was defined as p<0.05. RESULTS: The expression of VEGFR-1, -2, and, -3 mRNA was significantly higher in both eutopic and ectopic endometrial tissues of women with endometriosis than in control endometrial tissues during both proliferative and mid-secretory phase. In ectopic endometrial tissue, VEGFR-1 mRNA expression was significantly increased during the mid-secretory phase compared to the proliferative phase. There was a marked increase especially in VEGFR-3 mRNA expression in ectopic endometriotic lesions during the proliferative phase but its expression decreased during the mid-secretory phase. CONCLUSION: mRNA for VEGFR-1, -2, and -3 in an endometriotic lesions might be differentially expressed and their expression appears to be associated with the development of endometriosis.

A Case of Combined Ectopic Gestation with Cervical and Tubal Components / 대한불임학회지

Ectopic pregnancy is a common medical problem that is difficult to diagnose and potentially may lead to significant mortality or morbidity. The incidence of ectopic pregnancy is definitely increasing due to the rise in pelvic inflammatory disease (PID), pelvic surgery, intrauterine device (IUD), and assisted reproductive technologies, such as in vitro fertilization and embryo transfer (IVF-ET). Combined ectopic gestations are much rare and their true incidence is unknown. Multiple ectopic gestations may occur in a variety of locations. The majority involve one or both fallopian tubes. We report a case of combined tubal and cervical pregnancies, and discuss their management.

The Correlation of Ovarian Follicular Concentrations of IGF-II, IGFBP-1, and 3 between Cumulative Embryo Score in Patients Undergoing IVF-ET / 대한산부인과학회잡지

OBJECTIVE: To investigate the correlation between the concentrations of insulin-like growth factor-II (IGF-II), insulin-like growth factor binding protein-1, 3 (IGFBP-1, 3) in the follicular fluid and the cumulative embryo score (CES) in the patient who underwent in vitro fertilization and embryo transfer (IVF-ET). MATERIALS AND METHODS: A total of 21 cycles of 18 patients which underwent IVF-ET cycle after controlled ovarian hyperstimulation (COH) were included in this study. Using immunoradiometric assay (IRMA), we measured the concentrations of IGF-II, IGFBP-1, 3 in the follicular fluid. The patients were grouped into the pregnant and non-pregnant group. The concentrations of IGF-II, IGFBP-1, 3 in the follicular fluid were compared between the two groups and the correlations of the follicular concentrations of IGF-II, IGFBP-1, 3 and cumulative embryo score were evaluated. Results were analyzed with Mann-Whitney U test and Spearman's rank correlation coefficient and statistical significance was defined as p<0.05. RESULTS: There were no statistical significance in the follicular concentrations of IGF-II, IGFBP-1, 3 between the pregnant group and non-pregnant group. There were signifiant correlation between the follicular concentration of IGF-II and cumulative embryo score (p=0.001). There might be correlations between the follicular concentration of IGFBP-3, and free IGF-II and cumulative embryo score (p=0.053, p=0.056, respectively). CONCLUSION: The follicular IGF-II and free IGF-II might have an influence to development of good- quality embryos in patients undergoing IVF-ET.

Successful Full-term Live Birth after Selective Fetal Reduction Procedure in Patient with Heterotopic Cornual Pregnancy / 대한산부인과학회잡지

Heterotopic pregnancy refers to the simultaneous occurrence of an ectopic gestation with an intrauterine one. The incidence of heterotopic pregnancy in the general population is about 1 to 30,000 pregnancies, but it has been increased due to the rise in pelvic inflammatory disease (PID), pelvic surgery, intrauterine device (IUD), and assisted reproductive technologies (ART), such as in vitro fertilization and embryo transfer (IVF-ET). However, an interstitial or cornual pregnancy accounts for only 2-4% of all tubal pregnancies and has been described only rarely in the setting of a heterotopic pregnancy. We have experienced a case of heterotopic pregnancy with cornual pregnancy after IVF-ET which was successfully treated by selective fetal reduction (SFR) procedure while maintaining the viability of the intrauterine gestation. We presented with brief review of literatures.

The Concentration of Estradiol, Testosterone and Insulin-like Growth Factor-I in Follicular Fluid of Patients with Polycystic Ovarian Syndrome Undergoing Controlled Ovarian Hyperstimulation / 대한산부인과학회잡지

OBJECTIVE: To evaluate microenvironment of follicular fluid, such as estradiol(E2), testosterone(T), and insulin-like growth factor-I(IGF-I) of patients with polycystic ovary syndrome(PCOS) undergoing controlled ovarian hyperstimulation(COH) for in vitro fertilization and embryo transfer(IVF-ET). MATERIALS AND METHODS: From January 1996 to June 1998, follicular concentrations of E2, T, and IGF-I on the day of transvaginal ovum aspiration were measured in 40 patients undergoing COH for IVF-ET. The patients were grouped into the control(n=20) and the PCOS(n=20) groups. Statistical analysis was performed using Student's t-test, Fisher's exact test, and X2 test as appropriate. Statistical significance was defined as p<0.05. RESULTS: There were no significant differences in the follicular concentrations of E2, T, and IGF-I between the control and the PCOS groups. CONCLUSION: IGF-I might be not a main component of the local regulatory mechanisms involved in the pathogenesis of PCOS.