The characteristics of asbestos-related disease claims made to the Korea Workers' Compensation and Welfare Service (KCOMWEL) from 2011 to 2015

BACKGROUND: This study aimed to enhance understanding of the epidemiologic characteristics of asbestos-related diseases, and to provide information that could inform policy-making aimed at prevention and compensation for occupational asbestos exposure, through analyzing asbestos-related occupational disease claims to Korea Workers’ Compensation and Welfare Service from 2011 to 2015. METHODS: We analyzed 113 workers who filed medical care claims or survivor benefits for asbestos exposure and occupational-related disease from 2011 to 2015. Among these claims, we selected approved workers’ compensation claims relating to malignant mesothelioma and lung cancer, and analyzed the general characteristics, exposure characteristics, pathological characteristics, and occupation and industry distribution. RESULTS: Malignant mesothelioma and lung cancer occurred predominantly in males at 89.7 and 94%, respectively. The mean age at the time of diagnosis for malignant mesothelioma and lung cancer was 59.5 and 59.7 years, respectively, while the latency period for malignant mesothelioma and lung cancer was 34.1 and 33.1 years, respectively. The companies involving exposed workers were most commonly situated within the Busan-Ulsan-Gyeongnam region. Histology results for lung cancer indicated adenocarcinoma as the most common form, accounting for approximately one half of all claims, followed by squamous cell carcinoma, and small cell lung cancer. The most common occupation type was construction in respect of malignant mesothelioma, and shipbuilding in respect of lung cancer. CONCLUSIONS: Considering the long latency period of asbestos and that the peak period of asbestos use in Korea was throughout the mid-1990s, damage due to asbestos-related diseases is expected to show a continued long-term increase. Few studies providing an epidemiologic analysis of asbestos-related diseases are available; therefore, this study may provide baseline data to assist in predicting and preparing for future harm due to asbestos exposure. TRIAL REGISTRATION: DUIH 2018–02–004-001. Registered 28 Februrary 2018.

Acute Osteomyelitis in the Hand Due to Dog Bite Injury: A Report of 3 Cases

As many people keep small dogs as pets, dog bites are common injuries, accounting for approximately 80%–90% of all animal bite injuries. These injuries usually occur on the upper extremities, most commonly on the fingers. Most of these injuries appear as simple lacerations or abrasions of the skin. Common symptoms include inflammatory reactions of the soft tissue, such as pain, swelling, erythema, and cellulitis. However, the complications of small dog bites may include joint or cartilage injuries, including acute osteomyelitis. Once osteomyelitis develops, it is difficult to diagnose since it has a latency period of approximately 2 weeks. Plain radiography, magnetic resonance imaging, and 3-phase bone scans should be performed when acute osteomyelitis is suspected, and broad-spectrum empiric antibiotic treatment should be administered for approximately 8–12 weeks. We report 3 very rare cases of acute osteomyelitis that occurred after a dog bite injury.

Acute Osteomyelitis in the Hand Due to Dog Bite Injury: A Report of 3 Cases

As many people keep small dogs as pets, dog bites are common injuries, accounting for approximately 80%–90% of all animal bite injuries. These injuries usually occur on the upper extremities, most commonly on the fingers. Most of these injuries appear as simple lacerations or abrasions of the skin. Common symptoms include inflammatory reactions of the soft tissue, such as pain, swelling, erythema, and cellulitis. However, the complications of small dog bites may include joint or cartilage injuries, including acute osteomyelitis. Once osteomyelitis develops, it is difficult to diagnose since it has a latency period of approximately 2 weeks. Plain radiography, magnetic resonance imaging, and 3-phase bone scans should be performed when acute osteomyelitis is suspected, and broad-spectrum empiric antibiotic treatment should be administered for approximately 8–12 weeks. We report 3 very rare cases of acute osteomyelitis that occurred after a dog bite injury.

Indolent B-Cell Lymphoid Malignancy in the Spleen of a Man Who Handled Benzene: Splenic Marginal Zone Lymphoma

We present the case of a 45-year-old man with a history of benzene exposure who developed splenic marginal zone lymphoma. For 6 years, he had worked in an enclosed space cleaning instruments with benzene. He was diagnosed with splenic marginal zone lymphoma 19 years after retirement. During his time of working in the laboratory in the 1980s, working environments were not monitored for hazardous materials. We indirectly estimated the cumulative level of past benzene exposure using job-exposure matrices and technical assumptions. Care must be taken in investigating the relevance of occupational benzene exposure in the occurrence of indolent B-cell lymphoma. Because of the long latency period and because occupational measurement data do not exist for the period during the patient's exposure, the epidemiological impact of benzene exposure may be underestimated.

Compreensão psicodinâmica do ciclo vital de Daenerys Targaryen, personagem da série Game of Thrones / Psychodynamic understanding of "Daenerys Targaryen's" life cycle, character from the series "Game of Thrones"

Este artigo analisa os aspectos psicológicos da personagem Daenerys Targaryen, da série Game of thrones, buscando essencialmente avaliar sua evolução cognitiva, social e comportamental, bem como os conflitos vivenciados em seu ciclo vital e os respectivos mecanismos de enfrentamento das adversidades. Por meio da interpretação subjetiva das simbologias metafóricas citadas na narrativa, extrapola-se a leitura literal da obra, com vistas a compreender também as representações da esfera inconsciente da personagem. Daenerys tem infância conturbada pela morte dos pais, pela fuga da cidade natal, pelo exílio e pelos maus-tratos cometidos pelo irmão. Ademais, são-lhe impostos casamento e erotização precoces, eventos que desrespeitam seu tempo de amadurecimento psíquico, desencadeando encurtamento das fases do seu ciclo vital e desestabilização do processo de latência e desenvolvimento puberal. Contudo, as experiências que vivencia no período, tais quais a gestação e a emancipação por que passa, associadas a variantes inatas da sua personalidade - a exemplo do temperamento dócil, inteligência e autoconfiança na capacidade de resolução de vicissitudes -, permitem a expressão de uma figura icônica de resiliência, com ativação de defesas maduras frente a crises vitais ou acidentais. O estudo permitiu discutir aspectos da realidade contemporânea do desenvolvimento humano e proceder à observação de diversos mecanismos de funcionamento psíquico, além da interação entre variantes intrínsecas e extrínsecas moduladoras da expressão de resiliência frente às dificuldades. Este artigo visa a contribuir para o estudo da teoria psicodinâmica e deve interessar a profissionais da medicina e da psicologia.(AU)

This article analyzes the psychological aspects of character Daenerys Targaryen, from Game of Thrones' series, seeking essentially to evaluate her cognitive, social and behavioral evolution, as well as the conflicts experienced to each stage of her life cycle and related adversity coping mechanisms. Through subjective interpretation of metaphoric symbols mentioned in the narrative, the literal reading of the story is extrapolated in order to also comprehend representations of the character's unconscious domain. Daenerys goes through a troubled childhood due to her parents' death, fleeing from her home city, exile and mistreatment committed by her brother. Furthermore, events like marriage and early erotization are imposed to her, which disrespect her psychic development timing, causing shortening of her life cycle's stages, and destabilization of the latency phase process and her pubertal development. Nevertheless, the experiences she goes through in this period, such as pregnancy and emancipation, associated to innate variants of her personality - docile temperament, high cognition and self-confidence in the ability of resolving difficulties -, allow the expression of a resilient iconic figure, with the activation of mature defenses when facing vital or accidental crises. The study allows transpositions to contemporaneous reality of human development and observation of several mechanisms of psychic functions, besides the interaction between intrinsic and extrinsic variants, which modulate the expression of resilience when confronting distress. It contributes to the study of psychodynamic theory and may be of interest to doctors and psychologists, especially those directly involved in psychic development.(AU)

Therapy-related myeloid neoplasms in children and adolescents

BACKGROUND: This retrospective study aimed to characterize and analyze the outcome of therapy-related myeloid neoplasms (t-MNs) in children and adolescents. METHODS: The medical records of 16 patients under 21 years of age at the time of t-MN diagnosis were reviewed. RESULTS: The median patient age was 11.5 years (range, 1.6–20.4 yr). Twelve patients had therapy-related acute myeloid leukemia, 3 patients had myelodysplastic syndrome, and 1 patient had chronic myelomonocytic leukemia. The median latency period was 29 months (range, 11–68 mo). Fourteen patients had cytogenetic aberrations, 8 of whom had an 11q23 abnormality. Of the 13 patients treated with curative intent, 12 patients received myeloid-type induction therapy that led to complete remission (CR) in 8 patients. Nine patients underwent allogeneic transplantation; 4 patients did not undergo transplantation due to chemotherapy-related toxic death (N=3) or parental refusal (N=1). The 5-year overall survival and event-free survival of the 13 patients treated with a curative intent were 46.2% and 30.8%, respectively. For the 9 patients who underwent allogeneic transplantation, the 5-year event-free survival was 66.7%. CONCLUSION: A significant proportion of young patients with t-MNs can experience long-term survival, and allogeneic transplantation plays a key role for attaining cure in these patients.

A Case of Eyelid Paraffinoma Misdiagnosed as a Chalazion

PURPOSE: Paraffinoma is a granulomatous reaction to paraffin or oily substances. We report delayed diagnosis of paraffinoma that was misdiagnosed as chalazion. CASE SUMMARY: A 49-year-old male presented with masses, swelling, and erythema in the right lower eyelid, masses and swelling in the right upper eyelid, and intermittent conjunctival injection that had appeared 3 months ago. The patient admitted having received paraffin injection to the right lateral canthal area and nasal bridge for cosmetic purposes by non-medical personnel 17 years prior to presentation. The mass showed partial response to intralesional triamcinolone injection but did not respond to systemic steroid. CONCLUSIONS: Paraffinoma can present diagnostic confusion given its protracted latency period and discordance of injection area and mass location. Detailed history taking is required and the possibility of paraffinoma should be considered for mass lesions of the eyelid.

Re-visitando a latência: reflexões teórico-clínicas sobre os caminhos da sexualidade / Re-visiting the latency: Clinical and theoretical reflections about the ways of the sexuality / Revisiter la latence: réflexions cliniques et théoriques sur les chemins de la sexualité / Re-visitando la latencia: reflexiones teóricas y clínicas sobre los caminos de la sexualidad

A proposta deste trabalho é revisitar o período do desenvolvimento psicossexual denominado por Freud de latência. Pretendemos demonstrar a partir de reflexões teórico-clínicas que, longe de ser um momento de parada caracterizado pela ausência da sexualidade, este é um momento-chave para a organização psíquica do adolescente e do adulto, que exige um grande trabalho psíquico e que leva a grandes conquistas intelectuais, a um reordenamento da personalidade e a uma abertura para o mundo. Pretendemos também apontar como dificuldades na vivência desta fase de desenvolvimento aparecem em manifestações clínicas...

The purpose of this work is to revisit the psychosexual development period that Freud called latency. We intend to demonstrate based on clinical and theoretical reflections that, far from being a stop-time characterized by the absence of sexuality, this is a key moment for the teenager and adult psychological organization, which requires a great psychic work and leads to great intellectual achievements, a reordering of the personality and an openness to the world. We also intend to point out how the difficulties on the experience of this stage of development appear in clinical manifestations...

Ce travail revisite la période du développement psychosexuel que Freud appelle la latence. À partir de réflexions cliniques et théoriques, nous cherchons à démontrer que, loin d'être un temps d'arrêt caractérisé par l'absence de sexualité, il s'agit d'un moment-clé pour l'organisation psychique des adolescents et des adultes. Il nécessite un grand travail psychique et il conduira à grandes réalisations intellectuelles, puisque c'est une réorganisation de la personnalité et une ouverture sur le monde. Nous soulignions aussi comment les difficultés à vivre ce moment du développement apparaissent comme des manifestations cliniques...

Latência, adolescência e saber / Latencia, adolescencia y saber / Latency, adolescence and knowledge

A partir da hipótese de que a relação com o saber durante o período de latência e na passagem à puberdade tem um papel fundamental nas vicissitudes constitutivas do sujeito e no transcurso da adolescência, este trabalho se propõe a traçar um breve percurso na teoria psicanalítica no lastro das articulações entre latência, adolescência e saber, a fim de delinear uma linhainvestigativa, nas obras de Freud e de Lacan, sobre a problemática da puberdade. Com isso, almeja-se compreender melhoros impasses e embaraços que se apresentam na adolescência na contemporaneidade.

From the hypothesis that the relation with knowledge during the latency period and the transition to puberty has a key role in the vicissitudes of the subjective constitution and in the course of adolescence, this work intends to draw a short route in psychoanalytic theory in the ballast of the joints between latency, adolescence and knowledge, in order to outline a research line in the works of Freud and Lacan, about the problems of puberty. With this, it aims to better understand the dilemmas and difficulties that arise in adolescence in contemporary times.

A partir de la hipótesis de que la relación con el saber durante el periodo de latencia y en el pasaje de la pubertad, tiene un papel fundamental en las vicisitudes constitutivas del sujeto y en el transcurso de la adolescencia. Este trabajo se propone trazar un breve recorrido en la teoría psicoanalítica, teniendo como base las articulaciones entre latencia, adolescencia y saber, a fin de perfilar una línea investigativa, en las obrasde Freud y Lacan, sobre la problemática de la pubertad. De esta forma, se busca comprender mejor los impases y obstáculos que se presentan en la adolescencia en la contemporaneidad.

A realização imaginária do desejo inconsciente num grupo terapêutico de crianças em idade pré-escolar / Imaginary achievement of unconscious desire in a therapy group of pre-school-aged-children

Alguns teóricos têm observado que os grupos, assim como os sonhos, podem fornecer um espaço privilegiado para a realização imaginária de desejos inconscientes de seus membros. Por meio de relatos de sessões de um grupo terapêutico formado por crianças em idade pré-escolar, objetivou-se conhecer as formas de organização e de expressão do grupo que possibilitaram a realização imaginária de desejos inconscientes de seus membros. Mediante Análise Textual Qualitativa, constatou-se que a realização dos desejos foi possível pela articulação dinâmica entre desejos manifestos, formas de expressão e modos pelos quais o grupo organiza seus processos, influenciados pelas características do desenvolvimento psicossexual das crianças.

A few theoreticians have observed that groups, as well as dreams, may provide a privileged space for the imaginary achievement of their members' unconscious desires. Through reports of sessions of a therapy group comprising children at pre-school age, this study aimed at learning the organization and expression forms of the group that rendered possible the imaginary achievement of their members' unconscious desires. Qualitative Textual Analysis led to find out that the achievement of desires was possible through the dynamic articulation among the expressed desires, forms of expressions and ways in which the group organizes its processes, influenced by the characteristics of the children's psychosexual development.

Effects of electroacupuncture combined psycho-intervention on cognitive function and event-related potentials P300 and mismatch negativity in patients with internet addiction / 中国结合医学杂志

<p><b>OBJECTIVE</b>To observe the effects of comprehensive therapy (CT) with electroacupuncture (EA) in combination with psycho-intervention (PI) on the cognitive function and event-related potentials (ERP), P300 and mismatch negativity (MMN), in patients with internet addiction (IA) for a preliminary exploration of the possible mechanism of the therapy.</p><p><b>METHODS</b>One hundred and twenty patients with IA were randomly divided into three groups, and a total of 112 subjects reached the final analysis of the trial, the EA group (39 patients), the PI group (36 patients) and the CT group (37 patients). EA was applied at acupoints Baihui (GV20), Sishencong (EX-HN1), Hegu (LI4), Neiguan (PC6), Taichong (LR3) and Sanyinjiao (SP6), once every other day; PI with the cognitionbehavior mode was implemented every 4 days; both EA and PI were used in the CT group. The treatment course for all patients was 40 days. Changes before and after treatment in terms of scoring by the IA self-rating scale, short-term memory capacity, short-term memory span, and the latency and amplitude of P300 and MMN in patients were observed.</p><p><b>RESULTS</b>After treatment, in all groups, the IA score was lowered significantly (P <0.05) and scores of short-term memory capacity and short-term memory span increased significantly (P <0.05), while the decreased IA score in the CT group was more significant than that in the other two groups (P <0.05). ERP measurements showed that P300 latency was depressed and its amplitude raised in the EA group; MMN amplitude increased in the CT group (all P<0.05).</p><p><b>CONCLUSION</b>The EA in combination with PI could improve the cognitive function of IA patients, and its mechanism might be related to the speedup of cerebral discrimination on external stimulus and the enhancement of effective resource mobilization during information processing of the brain.</p>

An unrelated Clone of 20q Deletion Following Successful Treatment of Leukemia in Patients with t(8;21), t(15;17) or t(9;22) / 임상검사와정도관리

Cases of clonal cytogenetic abnormalities in Philadelphia-negative cells during the treatment of Philadelphia-positive CML have been previously reported. However, clonal abnormalities unrelated to the original t(8;21) or t(15;17) karyotype are not common. Deletion of 20q (del(20q)) is one of the most common recurrent cytogenetic abnormalities in myeloid neoplasms. Here we describe 3 patients with t(8;21), t(15;17), or t(9;22) who developed unrelated del(20q) after successful treatment of leukemia. We retrospectively reviewed the cytogenetic results of 23 AML patients with t(8;21)(q22;q22), 28 AML patients with t(15;17)(q22;q12), and 47 CML patients with t(9;22)(q34;q11.2). We identified 3 patients with del(20q) as the only clonal aberration unrelated to the primary karyotype when they achieved complete morphologic and cytogenetic remission. The latency period between diagnosis and emergence of del(20q) was 1, 114, and 35 months for the 3 patients, respectively. There was no evidence of therapy-related MDS/AML during the follow-up period. In 1 AML patient with t(8;21), relapse occurred in a t(8;21)(q22;q22) clone and the del(20q) clones were lost. The clinical significance of del(20q) as an unrelated clonal aberration is unknown, but our study suggests that del(20q) does not cause therapy-related MDS/AML or indicate disease progression.

OccIDEAS: An Innovative Tool to Assess Past Asbestos Exposure in the Australian Mesothelioma Registry

Malignant mesothelioma is an uncommon but rapidly fatal disease for which the principal aetiological agent is exposure to asbestos. Mesothelioma is of particular significance in Australia where asbestos use was very widespread from the 1950s until the 1980s. Exposure to asbestos includes occupational exposure associated with working with asbestos or in workplaces where asbestos is used and also 'take-home' exposure of family members of asbestos exposed workers. Asbestos exposure may also be non-occupational, occurring as a consequence of using asbestos products in non-occupational contexts and passive exposure is also possible, such as exposure to asbestos products in the built environment or proximity to an environmental source of exposure, for example an asbestos production plant. The extremely long latency period for this disease makes exposure assessment problematic in the context of a mesothelioma registry. OccIDEAS, a recently developed online tool for retrospective exposure assessment, has been adapted for use in the Australian Mesothelioma Registry (AMR) to enable systematic retrospective exposure assessment of consenting cases. Twelve occupational questionnaire modules and one non-occupational module have been developed for the AMR, which form the basis of structured interviews using OccIDEAS, which also stores collected data and provides a framework for generating metrics of exposure.

Drug Rash with Eosinophilia and Systemic Symptoms Syndrome in a Patient on Sulfasalazine for Ulcerative Colitis

Drug rash with eosinophilia and systemic symptoms (DRESS) is a life-threatening systemic drug reaction characterized by fever, rash, hematological abnormalities, lymphadenopathy, and multiple internal organ involvement. Unfortunately, a long latency period as well as clinicians' unawareness of the disease entity often results in a delay of prompt diagnosis and treatment in clinical practice. A search of the literature revealed only few reports on DRESS in patients with inflammatory bowel diseases. The pathogenesis of the disease is not clearly understood, although several possible mechanisms, such as drug detoxification, slow acetylation, and reactivation of human herpes viruses, have been proposed in its development. Here, we present a rare case of DRESS associated with viral reactivation and defects in drug metabolism in a 22-year-old man who had been on sulfasalazine for 6 weeks to treat ulcerative colitis.

A Field Study of the Conditions of the Elderly in Rural Community ; The Correlation between of Sleep Quality and Quality of Life / 신경정신의학

OBJECTIVES: This study aimed to investigate how sleep quality affects quality of life in the elderly of rural communities. METHODS: 877 elderly people aged 60 or over living in C towns participated in the study. They responded to the Pittsburgh Sleep Quality Index, EuroQol-5 dimension, Korean version of the short from of Geriatric Depression Scale, Mini-Mental State Examination for Dementia Screening and the presence of urinary incontinence. RESULTS: Most scores of the items of the quality of life index, except self-management, showed significant correlations with the total score of the sleep quality test. Statistically significant differences were found between the positives and the negatives of the sleep quality test in the scores of all the detailed items of the quality of life index. Among the detailed items of quality of sleep, subjective quality of sleep showed the highest correlation. CONCLUSION: The present study found that the subjective indicators such as subjective sleep quality and sleep disturbance affected quality of life in the rural lives of elderly people more than the objective indicators such as sleep durations or sleep latency periods. Based on the results of these studies, we concluded that a methodological approach and a management model to treating insomnia to improve the quality of life of the elderly would need to be developed and applied.

A latência na atualidade: considerações sobre crianças encaminhadas para psicoterapia / Latency today: considerations on children in psychotherapy

A latência é o período do desenvolvimento menos abordado pela literatura psicanalítica e menos compreendido, apesar de corresponder à idade na qual ocorre a maior procura por atendimento psicológico. Além disso, questiona-se um possível encurtamento do período da latência em nossa cultura. Partindo desses apontamentos, este estudo tem como objetivo descrever os conflitos e as defesas de crianças que buscaram atendimento psicoterápico em um serviço-escola, verificando se estas apresentariam as características típicas da latência. Foi realizado um estudo de caso coletivo com oito crianças com idade entre 7 e 9 anos, o qual consistia em um encontro de testagem para a aplicação dos testes psicológicos CBCL, Teste de Bender, Desenho da Figura Humana e Teste das Fábulas. Como resultado, foi possível identificar que algumas crianças apresentaram características típicas da latência, demonstrando intenso uso de mecanismos de defesa a fim de lidar com os conflitos advindos do Complexo de Édipo

The latency period is the least developed on psychoanalytic literature and also the least comprehended, although is the age which constitutes the largest proportion of psychological demand care in childhood. Moreover, the issue about a possible shortening of the latency period in our culture is being thought. Based on these ideas, the present study aims to describe the conflicts and the defenses of children who sought psychotherapy at a service-school, verifying if such children would present the characteristics of a work of latency. This was a collective case study with eight children aged between 7 and 9 years, which consisted on a testing date for application of psychological tests CBCL, Teste de Bender, Desenho da Figura Humana e Teste das Fábulas. As a result, it was possible to identify some children who had typical features of this period, showing intense use of defense mechanisms to deal with conflicts derivated from the Oedipus complex

Effects of Neuromuscular Electrical Stimulation on Distracted Bone after Mandibular Distraction Osteogenesis in Canine Model

Reflexões de uma psicanalista sobre a criança na sociedade ocidental de hoje / Reflexiones de una psicoanalista sobre el niño en la sociedad occidental de hoy / Reflections of a psychoanalyst on children in today’s western society

Este trabalho investiga as consequências das mudanças estruturais na sociedade ocidental, focando no impacto da tecnologia de comunicação e estruturas familiares cada vez mais frágeis. Descreve a dissolução de relações sociais e relações humanas íntimas, que acredita-se estejam sofrendo um processo de de-simbolização. Esta erosão das relações humanas confronta os indivíduos com novas demandas no aspecto econômico de seus instintos pulsionais e com novas formas de ansiedade. A autora argumenta que a globalização da comunicação virtual muda radicalmente a conexão com a realidade e a verdade e que o risco de mentalidade de grupo, em contraste com responsabilidade pessoal está aumentado. É colocada ênfase especial no desaparecimento do período de latência na sociedade contemporânea. Para Freud o período de latência – há cem anos – era baseado no desenvolvimento sexual difásico, repressão e Nachtrãglichkeit, alicerces da elaboração de sua teoria de neurose infantil e neurose transferencial. O trabalho discute as consequências das mudanças contemporâneas para a clínica e teoria hoje, assim como o impacto destas mudanças na transferência/contratransferência no tratamento analítico de crianças e adolescentes

This paper investigates the consequences of the structural changes in western society by focussing on the impact of communication technology and increasingly fragile family structures. It describes the dissolution of social relations and intimate human relationships, which are thought to undergo a process of de-symbolization. This undermining of human relationships is supposed to confront individuals with new demands on the economic aspect of their instinctual drives and with new kinds of anxiety. The author argues that the globalization of virtual communication radically changes the connection with reality and truth, and that the risk of “group mentality” in contrast to personal responsibility is increased. Special emphasis is given to the vanishing of the latency period in contemporary society. For Freud the latency period – a hundred years ago – was the basis of diphasic sexual development, repression and Nachtrãglichkeit, which his theory of infantile neurosis and transference neuroses was built upon. The paper discusses the consequences of the contemporary changes for clinical work and theory today as well as the impact of these changes on the transference/counter-transference situation in the analytical treatment of children and adolescents

Este trabajo investiga las consecuencias de los cambios estructurales en la sociedad occidental, enfocando el impacto de la tecnología de comunicación y estructuras familiares cada vez más frágiles. Describe la disolución de relaciones sociales y relaciones humanas íntimas que se considera sufran un proceso de desimbolización. Esta erosión de las relaciones humanas enfrenta a los individuos a nuevas demandas en el aspecto económico de sus instintos pulsionales y a nuevas formas de ansiedad. La autora argumenta que la globalización de la comunicación virtual cambia radicalmente la conexión con la realidad y la verdad, y que el riesgo de “mentalidad de grupo”, en oposición a responsabilidad personal está en aumento. Se subraya especialmente el desaparecimiento del periodo de latencia en la sociedad contemporánea. Para Freud, el periodo de latencia – hace cien años – se basaba en el desarrollo sexual difásico, represión y Nachtrãglichkeit, cimientos de la elaboración de su teoría de neurosis infantil y neurosis transferencial. El trabajo discute las consecuencias de los cambios contemporáneos para la clínica y teoría hoy, así como el impacto de estos cambios en la transferencia/contratransferencia en el tratamiento analítico de niños y adolescentes

Liver Flukes and Cholangiocarcinoma: Mechanism of Carcinogenesis / 대한내과학회지

It has been clarified that chronic infection with viruses such as hepatitis B virus, bacteria such as Helicobacter pylori and parasites contribute to carcinogenesis in human. Three helminth infections have been classified as definitely carcinogenic to humans (group I carcinogens), namely Schistosoma haematobium, which is associated with urinary bladder cancer and liver flukes Clonorchis sinensis and Opisthorchis viverrini associated with cholangiocarcinoma of the liver. Opisthorchis viverrini which has been extensively studied the association with cholangiocarcinoma is endemic in Southeast Asian countries including Thailand, Vietnam and Cambodia. Clonorchis sinensis infection which is common in rural areas of Korea and China has also been reported its definite association with cholangiocarcinoma. Carcinogenesis associated with liver flukes infections is a complex process hard to be studied because of long latency period and numerous other factors can play a role although chronic inflammation has been known as a key feature. Mechanical injury from the activities of migrating and sucking flukes contributes to biliary damage and chronic inflammation. The liver fluke also secretes or excretes metabolic products, some of which are highly immunogenic, toxic and promoting biliary epithelial cell proliferation. Host immune responses and immunopathological processes are also likely associated with chronic inflammation and carcinogenesis. Escape from host anti-tumor immune response and shift to Th2 response of Th1-Th2 balance are related with carcinogenesis. Biliary cell and its DNA damage can be induced by oxygen free radicals such as nitric oxide released from effector cells activated by inflammatory cytokines. Exogenous carcinogen suchas nitrosamine seemed also closely related with cholangiocarcinoma development in liver fluke infected individuals. In this paper, various and stepwise mechanisms of carcinogenesis by liver flukes and its potential targets can be intervene were reviewed.

A Case of Therapy-related Myeloid Neoplasm after Successful Treatment of Acute Promyelocytic Leukemia

Acute promyelocytic leukemia (APL) is considered as a curative disease after combined chemotherapy based on all-trans retinoic acid (ATRA) and anthracycline. However, as long-term survivors continue to increase, reports on sporadic cases of therapy-related myeloid neoplasm (t-MN) after successful APL treatment are also increasing. Recently, we have experienced one patient who developed t-MN 7 yr after APL diagnosis. Even though he had not been exposed to alkylating agents at all, he showed alkylating agents-associated features such as long latency period (>5 yr), first presentation as myelodysplatic phase (multilineage dysplasia with increased blasts), and complex karyotype including monosomy 5 and 7. He received only supportive care and expired 3 months after the diagnosis of t-MN (6 months of survival after the onset of cytopenias). t-MN after complete remission of APL is a rare but fatal complication, and patients with complex karyotypes show ominous prognosis in particular. For the early diagnosis of t-MN, long-term and close monitoring of the patient is needed. One should suspect this late complication whenever any unknown cytopenia develops, and should perform bone marrow biopsy and cytogenetic analysis.