“Suicide CARE” (Standardized Suicide Prevention Program for Gatekeeper Intervention in Korea): An Update

Objective@#In 2011, “Suicide CARE” (Standardized Suicide Prevention Program for Gatekeeper Intervention in Korea) was originally developed for the early detection of warning signs of suicide completion, since there is a tendency to regard emotional suppression as a virtue of Korean traditional culture. A total of 1.2 million individuals completed the training program of “Suicide CARE” in Korea. @*Methods@#More sophisticated suicide prevention approaches according to age, sex, and occupation have been proposed, demanding for a more detailed revision of “Suicide CARE.” Thus, during the period from August 2019 to February 2020, “Suicide CARE” has been updated to version 2.0. The assessments on domestic gatekeeper training programs for suicide prevention, international gatekeeper training programs for suicide prevention, psychological autopsy interview reports between 2015 and 2018, and the evaluation of feedback from people who completed “Suicide CARE” version 1.6 training were performed. @*Results@#We describe the revision process of “Suicide CARE,” revealing that “Suicide CARE” version 2.0 has been developed using an evidence-based methodology. @*Conclusion@#It is expected that “Suicide CARE” version 2.0 be positioned as the basic framework for many developing gatekeeper training programs for suicide prevention in Korea in the near future.

Contents of the Standardized Suicide Prevention Program for Gatekeeper Intervention in Korea, Version 2.0

Objective@#Suicide is a huge nationwide problem that incurs a lot of socio-economic costs. Suicide also inflicts severe distress on the people left behind. The government of the Republic of Korea has been making many policy efforts to reduce suicide rate. The gatekeeper program, ‘Suicide CARE’, is one of the meaningful modalities for preventing suicide. @*Methods@#Multidisciplinary research team collaborated to update the ‘Suicide CARE’ to version 2.0. @*Results@#In the ‘Introductory part’, the authors have the time to think about the necessity and significance of the program before conducting full-scale gatekeeper training. In the ‘Careful observation’ part, trainees learn how to understand and recognize the various linguistic, behavioral, and situational signals that a person shows before committing suicide. In the ‘Active listening’ part, trainees learn how to ask suicide with a value-neutral attitude as well listening empathetically. In the ‘Risk evaluation and Expert referral’ part, trainees learn intervening strategies to identify a person’s suicidal intention, plan, and past suicide attempts, and connect the person to appropriate institutes or services. @*Conclusion@#Subsequent studies should be conducted to verify the efficacy of the gatekeeper program.

Severe Pulmonary Hypertension Caused by Pulmonary Artery Stenosis in a Patient with Behcet's Disease Treated by Balloon Angioplasty / 대한내과학회지

Pulmonary artery stenosis that causes pulmonary hypertension is usually observed in congenital anomalies and is seldom observed in adults. A 47-year-old female patient came to the hospital for aggravated dyspnea and peripheral edema. Severe pulmonary hypertension was found on an echocardiography examination, along with dilation of the main pulmonary artery and alias flow at the bifurcation sites of both pulmonary arteries. Under coronary angio-computed tomography, 70% high grade stenosis was observed on both sides of the proximal pulmonary arteries without showing atherosclerotic plaque or a thrombus. The patient's symptoms improved after performing pulmonary artery angiography and angioplasty. Thus, we report our experience of a patient with Behcet's disease and severe pulmonary hypertension caused by pulmonary artery stenosis, which was treated with percutaneous pulmonary angioplasty.

The Optimal Anti-emetic Dose of Ramosetron for Prevention of Postoperative Nausea and Vomiting Following Gynecolgic Surgery / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting (PONV) is one of the most frequent and distressing side effects of surgery, and approximately 50-70% of patients who undergo gynecologic surgery suffer from PONV. In this study, we evaluated the effects of various doses of ramosetron on postoperative nausea and vomiting following gynecologic surgery. METHODS: This study evaluated a randomized placebo-controlled study comprised of 200 patients who underwent gynecologic surgery under general anesthesia. The patients were divided into the following 4 groups; placebo group (saline 4 ml), R15 group (ramosetron 0.15 mg), R30 group (ramosetron 0.3 mg) and R45 group (ramosetron 0.45 mg). Each patient was administered the study drug intravenously at the completion of the operation and the presence and severity of PONV were then evaluated 24 and 48 hours after the operation. RESULTS: The incidence of PONV during the first 24 hours following surgery was lower in patients in the R30 group (44%) than in patients in the placebo group (68%)(P < 0.05). In addition, the incidence of PONV 24 to 48 hours after the operation was lower in patients in the R30 group (12%) and the R45 group (14%) than in patients in the placebo group (44%)(P < 0.05) Moreover, common side effects of 5-HT3 receptor antagonist such as headache, dizziness, and constipation did not develop in any of the groups. CONCLUSIONS: The results of this study indicate that 0.3 mg of ramosetron is the most effective dose for preventing PONV during to the first 48 hours following gynecologic surgery.

Clinical Efficiency after Fixation with Cable in Patellar Fracture

PURPOSE: To evaluate the clinical results of cable fixation in patellar fractures followed by early ROM exercise and early weight bearing. MATERIALS AND METHODS: We analyzed 46 patients who had operation for transverse or comminuted patellar fractures with cable fixation from April 1995 to January 2003. Mean term of follow up was 15 months (range, 15~24 months). We reviewed the clinical and radiologic bony unions, ROM, time of weight bearings retrospectively. All cases were fixed with Dall-Miles' cable, and additional fixation was done with K-wires in 25 cases and with screws in 11 cases. At next day after surgery, all patients started CPM, except 3 cases who had severly comminuted fractures. Full weight bearing was started 2-3 days after surgery with LMB in full extended state. RESULTS: We gained bony union in all cases, Average ROM was 115 degree(80-130 degree) at postoperative 2nd week, all patients showed more than 130 degree at 8th week and final results showed normal ROM compared with opposite knee. During follow up, K-wires were migrated in 2 cases, but there was no difference in ROM or bony union compared with other patients. CONCLUSION: Fixations using Dall-Miles' cable for transverse or comminuted patellar fractures are considered to be enough stable for early ROM exercise and early weight bearing without major complications.

Bronchoscopic Electrocautery with Electroprobe and Diathermic Snare in Patients with Malignant Airway Obstruction / 결핵및호흡기질환

BACKGROUND: Endobronchial tumors cause?life-threatening dyspnea and can lower the quality of life due to central airway obstruction.?In those cases with an intraluminal tumor, various bronchoscopic techniques are available for tumor debulking. The therapeutic effect of bronchoscopic electrocautery for palliation in patients with a symptomatic tumor obstruction was studied. METHOD: Nineteen patients with bronchogenic carcinomas (n=15) and metastatic tumors affecting the bronchi (n=4), between March 2002 and March 2005, were enrolled in this study. Electrocautery was performed under local anesthesia using an electroprobe and diathermic snare. Using flexible bronchoscopy, a follow-up bronchoscopic examination was performed 3-4 days later. Symptom improvement was evaluated by FEV1, FVC and dyspnea score (Modified Borg Category Scale (0~10)), both before and after the electrocautery. RESULTS: The success rate of electrocautery on the follow up examination was 84%. Patients with endoluminal airway lesions had a mean overall decrease in the size of the obstruction to 47.8+/-15.7%. The mean Improvement in the dyspnea score immediately after the endobronchial tumor debulking was 2.78+/-1.42.The average improvements in the FEV1 and FVC after electrocautery were 0.32+/-0.19L and 0.5+/-0.22L, respectively. There were 2 cases of complications related with electrocautery (one each of pneumothorax and pneumonia). CONCLUSION: Electrocautery using an electroprobe and diathermic snare was an effective and safe palliative treatment for a symptomatic endoluminal airway obstruction in lung cancer.

A Case of Gastrojejunocolic Fistula as a Complication after Gastrojejunostomy / 대한소화기내시경학회지

Gastrocolic and gastrojejunocolic fistula are well-recongnized but rare complications of a variety of diseases, and surgical or endoscopic procedures We had a case of gastrojejunocolic fistulae associated with marginal ulcer following gastrectomy with Billroth II gastrojejunostomy for recurrent peptic ulcer disease. He had chronic watery diarrhea, weight loss and fecal eructation and gastrojejunocolic fistula was dignosed by gastroscopy, barium enema, upper gastrointestinal series and abdominal CT scan. He underwent subtotal gastrectomy with Roux-en-Y gastrojejunal anastomosis and en-bloc resection including the fistula and surrounding colon, jejunum and gastric segments. Hereafter, he showed disappearance of diarrhea, along with slow rate of weight gain.

The Effect of Fibular Malreduction on Ankle Joint after Tibial Interlocking IM Nailing of Tibial and Fibular Fractures

PURPOSE: To investigate the effect of fibular malreduction on ankle joint after tibia interlocking IM nailing of tibial and fibular fractures according to type of fibular fractures at preoperation. MATERIALS AND METHODS: Thirty-nine patients who had ipsilateral tibiofibular fracture were analyzed clinically and radiographically. The talocrural angle and the distance from joint line to the tip of fibular were measured on both ankle standing AP view. The difference of angle and distance of both ankle were analyzed by paired t-test and correlation between defference and AOFAS score by Spearman correlation coefficients. RESULTS: The difference of The talocrural angle and the distance from joint line to the tip of fibular of both ankle was statistically significant (p0.05). CONCLUSION: In tibia interlocking IM nailing of tibia and fibula fracture, malreduction of fibula could cause the change of ankle joint.

Dislocation of the Polyethylene Bearing of the Medial Unicompartmental Knee Arthroplasty: A Case Report

Treatment methods of unicompartmental osteoarthritis of knee joint are arthroscopy, osteotomy, unicompartmental arthroplasty, and total arthroplasty. Among them the rate of unicompartmental arthroplasty is increased and many complications are reported recently. Polyethylene wear and component loosening, and infection are the common failure mechanism, but dislocation of meniscal polyethylene is rare, and not reported. So we report the case of the dislocation of polyethylene and study the cause and preventive method.

A Case of Marchiafava-Bignami Disease with Personality Change / 대한정신약물학회지

Marchiafava-Bignami Disease is a rare disorder characterized pathologically by demyelination of the corpus callosum. This disease could be related with chronic alcoholism although a proven etiology has not been reported. Marchiafava-Bignami Disease (MBD) could cause the fatal acute phase symptoms (seizure, coma, and death), various neurological symptoms (tremor, dysarthria, gait disturbance, apraxia), and cognitive impairments (memory impairment, disorientation). It is also reported that MBD causes a dementia. Approximately 250 cases have been reported regarding the MBD since it was first reported in 1903. However, only 20 cases have revealed a favorable prognosis. We found a case of MBD with personality change and chronic alcoholism subsequent to the repeated improvement and aggravation for 4 years. This case is demonstrated a atrophy of splenium of corpus callosum by Magnetic Resonance Imaging. The case also is diagnosed the personality changes, such as emotional irritability, impulsivity, and indignation-expose due to general medical condition, as described in Diagnostic and Statistic Manual of Mental Disorder 4th edition (DSM-IV). However, in early phase this diagnosis did not revealed. The patient was improved in impulse control and behavior by treatment with the Carbamazepine. We investigate the etiology, pathogenesis, symptom &sign, and treatment regarding the MBD in neuropsychiatric aspect.

A Study of Anger, Alexithymia, and Depression in the Functional Dyspepsia

BACKGROUND: Functional dyspepsia (FD) is a commonly encountered disturbance of gut function and has been shown to be associated with psychological disturbance such as depression and anxiety. Of particular importance to clinicians are the relationship between anger, alexithymia, and depression. In this study, we investigated anger, alexithymia, and depression in patients with functional dyspepsia. METHODS: Thirty patients who visited Wonkwang University Hospital from January 2001 to June 2001, were diagnosed with functional dyspepsia by a gastroenterologist and compared with 37 healthy control group. Medical investigation of FD including gastrofiberscopy, esophageal manometry, and ambulatory 24-hours intraesophageal reflux test were negative. All subjects were evaluated for depression, anxiety, anger and anger expression, and alexithymia. The measures included Beck Depression Inventory (BDI), Spielberger State-Trait Anxiety Inventory (STAI), Spielberger State-Trait Anger Expression Scale (STAXI), and Toronto Alexithymia Scale (TAS). RESULTS: The FD patients reported significantly more symptoms of depression, more difficulty describing feeling to others in TAS, less anger-in and anger-out expression in STAXI than the control subjects. Depressive symptoms in FD were positively correlated with state anxiety, trait anxiety, alexithymia, state anger, trait anger, and anger-in expression. In multiple regression model, state anger and trait anxiety together accounted for 69.1% of the depression in FD. CONCLUSION: The FD patients reported more depressive symptoms, and the depressive symptoms were related to anxiety, anger and anger-in, and alexithymia. These finding lend support that FD is a syndrome in which biopsychosocial process and affect dysregulation may play a role in features of FD.

A Case of Primary Gastric Lymphoma in Puberty / 대한소아소화기영양학회지

Primary gastric lymphoma is relatively uncommon, accounting for 3% to 8% of all malignancies arising in the stomach. The most common symptom is abdominal pain, closely followed by weight loss, anorexia, weakness due to anemia, nausea, and vomiting. The diagnosis of gastric lymphoma usually requires a biopsy at the time of gastroscopy or laparotomy. Microscopically, the vast majority of gastric lymphoid tumors are non-Hodgkin's lymphomas of B cell origin. Survival rates for all types of gastric lymphoma generally exceed those for adenocarcinoma and other malignancies of the stomach. We experienced one case of primary gastric lymphoma in puberty with a brief review of the literature.

A Case of Congenital Factor VII Deficiency Associated with Intraventricular Hemorrhage and Hydrocephalus

Congenital factor Vll deficiency is a rare bleeding disorder with an estimated incidence of 1 in 500,000. It is inherited as an autosomal recessive pattern with variable expression and high penetrance. In severely affected patients, repeated hemarthroses, chronic crippling hemarthropathy, and dangerous hematomas can occur. Other types of hemorrhage include epistaxis, menorrhagia, hematuria, gastrointestinal and gingival bleeding. Fetal cerebral hemorrhage has been reported, although less frequently than in severe hemophilia A or B. It is characterized by normal partial thromboplastin time and prolonged prothrombin time. Definitive diagnosis rests on a specific assay for factor Vll clotting activity. Replacement therapy is necessary to control the hemorrhage. Conventional prophylaxis and therapy in this disorder have consisted of fresh frozen plasma (FFP) or prothrombin complex concentrate. We experienced a case of intraventricular hemorrhage and hydrocephalus in a 4-year-old girl who had been diagnosed with congenital factor Vll deficiency during her neonatal period. She presented with episodes of frontal headache, frequent vomiting and malnutrition. We report this case with a brief review and related literatures.

CLINICAL STUDY ON POLYDACTYLY OF THE FOOT

Polydactyly is one of the most common congenital anomalies of the foot, but there are few papers on polydactyly of the foot reported in Korea. Forty-six supernummerary toes in thirty-semen patients were operated at Department of Plastic and Reconstructive Surgery, Korea University Guro Hospital, from May 1985 to May 1995. A clinical review was performed on these cases and the results were as follows : 1. Of the 37 patients, the proportion of unilateral involvement to bilateral was 28(76%) to 9 (24%). 2. Of the 46 toes, postaxial type was a majority involving 35 toes(76%) followed by the preaxial type 7 (15%) and central type 4(9%). 3. In anatomical pattern, Wassel's type IV and Stelling and Turek's type II were the most common ones in 7 toes of preaxial type and 39 toes of central and postaxial types. 4. The excellent results could be made by individualized reconstructive methods performed before walking age.

EXPERIMENTAL STUDY OF HISTOLOGICAL CHANGES OF TCA CHEMICAL PEEL AND EFFECTS OF RETINOIC ACID

No abstract available.