Development of Group Therapy Program for North Korean Refugees with Posttraumatic Stress Disorder and Pre-Study on Its Effect / 신경정신의학

OBJECTIVES: We evaluated the design, application, and preliminary effect of a new group therapy program for assisting the psychological adaptation of North Korean refugees with posttraumatic stress disorder (PTSD). METHODS: We recruited 16 female participants from the student body of Hanawon (North Korean refugees) or K city refugee residents, both governed by the Ministry of Unification. Of the participants, 11 scored more than 28 points, the cut-off score, on the MMPI-II PTSD Keane (PK) scale. Another 5 females, who had been diagnosed with PTSD and received treatment, were included in the study. We divided the participants into 2 groups, each of whom participated in group therapy 10 times. Group (A) consisted of 8 Hanawon refugees, while the other group (B) consisted of 8 refugee residents of K City. To examine the therapy's effects, we utilized the Beck Depression Inventory, Beck Anxiety Inventory, Self-esteem Scale, and Impact of Event Scale-Revised, both before and after treatment. We analyzed the results using paired t-tests and repeated measures. RESULTS: Anxiety scores decreased significantly in group A after the group therapy (t=5.04, pbeta.01 ; t=5.44, pbeta.01). In Group B, there were no statistically significant changes on any scales after the treatment. Furthermore, there were no significant differences between the two groups on any measures, but group A showed lower mean SES scores and higher mean BDI and BAI scores than did group B. CONCLUSION: This was a preliminary application of this newly designed group therapy program for aiding the psychological adaptation of North Korean refugees, utilizing a small group of refugees with PTSD. In spite of many shortcomings and poor results, we expect further refinement and research of into treatment modalities despite this challenging developments.

The Expression of Transforming Growth Factor-beta1 and alpha-Smooth Muscle Actin is Increased in the Human Myxomatous Valve

BACKGROUND: In vitro experimental studies have reported that transforming growth factor-beta1 (TGF-beta1) stimulates the production of alpha-smooth muscle actin (alpha-SMA) in porcine valves. However, the relation between TGF-beta1 and alpha-SMA in myxomatous valves has not been elucidated. METHODS: We classified 27 subjects into two groups: 1) myxomatous group (M:F=11:12, mean age=55+/-15 years) and 2) rheumatic group (M:F=3:1, mean age=41+/-17 years) according to preoperative echocardiographic and postoperative histologic findings. Twenty-seven valve specimens from the patients who underwent valve replacement were obtained. Tissue samples were analyzed by immunohistochemistry for TGF-beta1 and alpha-SMA. The positively stained areas were measured using an image analysis program (Image Pro-Plus 4.5), and then the TGF-beta1 volume fraction (TGF-VF) and alpha-SMA volume fraction (alpha-SMA-VF) were calculated. RESULTS: TGF-VF in myxomatous valves was higher than in rheumatic valves (2,759+/-2,294 vs 864+/-276, p=0.04). alpha-SMA-VF in myxomatous valves was higher than in rheumatic valves (4,122+/-2,275 vs 2,421+/-844, p=0.002). There was a significant correlation between TGF-beta1 and alpha-SMA in myxomatous valves (r=0.38, p=0.04). There was no significant correlation between TGF-beta1 and alpha-SMA in rheumatic valves (r=-0.50, p=0.67). CONCLUSIONS: TGF-beta1 and alpha-SMA may be related to the pathogenesis of myxomatous valves. The activation of TGF-beta1 might increase the expression of alpha-SMA in human myxomatous valves.

A Case of Allopurinol Hypersensitivity Syndrome in a Patient with Chronic Renal Failure / 대한신장학회잡지

Allopurinol hypersensitivity syndrome is a rare but life-threatening complication. We here report a case of allopurinol hypersensitivity syndrome manifested with irreVersible change of renal function and severe toxic epidermal necrolysis in a patient with chronic renal faiure. A 29-year-old male patient with chronic renal failure due to chronic glomerulonephritis presented with high fever and skin rash. He had been taking allopurinol for 6 weeks due to asymptomatic hyperuricemia. Blood chemistry showed severe hepatic dysfunction and aggrevated renal function. Skin biopsy revealed consistent findings with allopurinol hypersenstivity syndorme. Allopurinol was discontinued and steroid was instituted. His cutaneous lesion and high fever, and hepatic dysfunction improved but renal function irreversibly progressed in end stage renal failure requiring maintenance hemodialysis treatment.

Clinical Significance of Routine Fistulography at Postoperative 1 Month in Patients Receiving Native Arteriovenous Fistula / 대한신장학회잡지

BACKGROUND: Fistulography is simple and accurate method detecting vascular access dysfunction. This study was performed to evaluate clinical significance of routine fistulography at postoperative 1 month in hemodialysis (HD) patients receiving native arteriovenous fistula (AVF). METHODS: This study enrolled 28 HD patients receiving native AVF operation who performed routine fistulography at postoperative 1 month before the first needling through the AVF. We investigated fistulographic findings and performed percutaneous angioplasty (PTA) in patients having severe stenosis more than 50 % of normal internal diameter. RESULTS: Of the total 28 patients, 8 patients showed normal findings and 20 patients showed stenosis in which 8 patients had severe stenosis requiring radiological or surgical correction. Of the 20 patients with stenosis, 12 patients had multiple lesions. Stenotic lesions were observed in AVF anastomosis site (n=6), proximal vein (n=5), artery near the AVF anastomosis site, and mixed lesions (n=6). PTA was performed in 5 of the 8 patients with severe stenosis and all stenostic lesions were completely corrected. CONCLUSION: Routine fistulography performed at postoperative 1 month is effective in detecting early native AVF and deciding treatment modalities.

Community screening for stress by using General Health Questionnaire / 예방의학회지

This study investigated the stress of community residents in Kwang-Ju and Chonnam areas by using the General Health Questionnaire(GHQ-60) as a instrument of stress measurement. The number of subject were 445 residents who lived in three areas (large city, middle city, and rural area) and they were individually interviewed in March, 1994. The result of study showed that the degrees of stress measured by GHQ-60 were statistically significant in the residents' area, age. sex variables: (a) the residents in middle city among three area had the highest level of stress: (b) the resident who were more than 60 in age had the highest level of stress: (c) the female resident had more stress than male residents: (d) particularly, the residents who were more than 60 years old in the middle city had the highest level of stress. Further, the results of factor analysis showed that there were three factors of social dysfunction, depression and anxiety, and psychosomatic symptom. The social dysfunction factor was statistically significant in both age and resident area variables. The depression and anxiety factor was statistically significant in the residents' area, age. sex variables. The psychosomatic symptom factor was statistically significant in both age and sex variables. The study suggested that they should give a special attention to solve the old people's stress because stress was closely related to residents age.