A Three-Year Longitudinal Study of Risk Factors for Suicidality in North Korean Defectors

Background@#This longitudinal study examined risk factors for future suicidality among North Korean defectors (NKDs) living in South Korea. @*Methods@#The subjects were 300 NKDs registered with a regional adaptation center (the Hana Center) in South Korea. Face-to-face interviews were conducted using the North Korean version of the World Health Organization’s Composite International Diagnostic Interview to diagnose mental disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Subjects were also asked about sociodemographic and clinical factors at baseline. At follow-up after three years, the NKDs (n = 172 respondents) were asked to participate in an online survey, responding to self-questionnaires about suicidality. Logistic regression analyses were used to explore associations between baseline variables and future suicidality among NKDs. @*Results@#Thirty (17.4%) of the 172 survey respondents reported suicidality at follow-up. The presence of health problems over the past year, any prior suicidality at baseline, a higher score on a trauma-related scale, and a lower score on a resilience scale at baseline were associated with greater odds of suicidality at follow-up after adjusting for age, sex, and educational level. Of all mental disorder categories, major depressive disorder, dysthymia, agoraphobia, and social phobia were also associated with significantly increased odds of suicidality at follow-up after adjusting for age, sex, educational level, and prior suicidality at baseline. @*Conclusion@#Resilience, a previous history of suicidality, and the presence of lifetime depressive disorder and anxiety disorder should be given consideration in mental health support and suicide prevention in NKDs.

The Stigma Against Social Withdrawal Syndrome (Hikikomori) Among Mental Health Practitioners / 신경정신의학

Objectives@#This study examined the stigma against social withdrawal syndrome (hikikomori) among mental health practitioners, and compared levels of stigma against social withdrawal syndrome versus mental illness. @*Methods@#The participants were 133 mental health practitioners (28 males, 105 females) with experience of social withdrawal syndrome that self-reported levels of stigma against social withdrawal syndrome and mental illness. @*Results@#Stigma against social withdrawal syndrome was generally significantly lower than stigma against mental illness. However, mental health practitioners tended to agree they would be reluctant to become personally involved with a person that had experienced social withdrawal syndrome (e.g., dating, hiring). Levels of stigma also differed across mental health occupations. @*Conclusion@#This study suggests although mental health practitioners may generally have less negative attitudes toward social withdrawal syndrome in the context of mental illness, that they may also have some reservations about personal interactions with individuals with social withdrawal syndrome.

Development and Validation of Loneliness and Social Isolation Scale / 신경정신의학

Objectives@#To develop a Loneliness and Social Isolation scale (LSIS) that can measure both social isolation and loneliness in order to understand the degree of social isolation in Korea. Exploratory and confirmatory factor analysis was used to examine the factorial validity of the scale. @*Methods@#The subjects of the study were 300 adults aged 19 or older who visited Samsung Medical Center and voluntarily expressed their willingness to participate in this research. Exploratory factor analysis (n=150) and confirmatory factor analysis (n=150) were conducted to construct the factorial structure model and to determine the model fit. @*Results@#Exploratory factor analysis showed a three-factor structure with a total variance of 65.8%; factor 1 consisted of social support, factor 2 of social networks, and factor 3 of items representing loneliness. After conducting confirmatory factor analysis on the three-factor models, a three-factor model consisting of 8 items (LSIS-8) and a three-factor model consisting of 6 items (LSIS-6) showed significant goodness-of-fit. Internal consistency for all items was good (Cronbach’s α=0.774), and correlations with existing social isolation and loneliness measures were significant. @*Conclusion@#This study is meaningful as provides a tool that comprehensively measures social support, social networks, and loneliness. We believe that the application of such tools that are relatively easy to apply in communities will aid understanding of the current state of social isolation and loneliness in Korea.

Social Isolation, Loneliness and Their Relationships with Mental Health Status in South Korea

Objective@#This study aims to investigate the prevalence and psychological impact of social isolation and loneliness in South Korea. Loneliness and social isolation have been regarded as a risk to both physical and mental health. However, most studies have focused on the elderly; hence, there are limited studies on the characteristics of socially isolated or lonely people considering age. @*Methods@#A sample of 1,700 participants was selected from three major cities in South Korea. In-person interviews were conducted to evaluate loneliness, social isolation and mental health status. @*Results@#Among the participants, the prevalence of social isolation and loneliness was 17.8% and 4.1%, respectively. Males decreased the odds of loneliness (AOR 0.49, 95% CI=0.28–0.87), while increasing the odds of social isolation (AOR 1.44, 95% CI=1.12–1.86) after adjusting for age and sex. Greater depressive and social phobic symptoms were associated with increased odds of loneliness and social isolation. @*Conclusion@#Social isolation and loneliness are prevalent among Koreans and associated with depression, social phobic symptoms, and suicidality. This study provides a foundation for further research to investigate nationwide prevalence and a more in-depth analysis of loneliness and social isolation.

Social Isolation, Loneliness and Their Relationships with Mental Health Status in South Korea

Objective@#This study aims to investigate the prevalence and psychological impact of social isolation and loneliness in South Korea. Loneliness and social isolation have been regarded as a risk to both physical and mental health. However, most studies have focused on the elderly; hence, there are limited studies on the characteristics of socially isolated or lonely people considering age. @*Methods@#A sample of 1,700 participants was selected from three major cities in South Korea. In-person interviews were conducted to evaluate loneliness, social isolation and mental health status. @*Results@#Among the participants, the prevalence of social isolation and loneliness was 17.8% and 4.1%, respectively. Males decreased the odds of loneliness (AOR 0.49, 95% CI=0.28–0.87), while increasing the odds of social isolation (AOR 1.44, 95% CI=1.12–1.86) after adjusting for age and sex. Greater depressive and social phobic symptoms were associated with increased odds of loneliness and social isolation. @*Conclusion@#Social isolation and loneliness are prevalent among Koreans and associated with depression, social phobic symptoms, and suicidality. This study provides a foundation for further research to investigate nationwide prevalence and a more in-depth analysis of loneliness and social isolation.

Prevalence of DSM-IV Major Psychiatric Disorders among North Korean Defectors in South Korea

Objective@#The aim of this study was to estimate the prevalence of major psychiatric disorders among North Korean defectors (NKD) settled in South Korea. @*Methods@#The study population consisted of 294 North Korean defectors, aged 18 to 64 years settled in South Korea for 3 years or less. Between June 1, 2016 and October 31, 2016, face-to-face interviews were conducted using the North Korean version of the WHO-Composite International Diagnostic Interview (NK-CIDI) to diagnose DSM-IV psychiatric disorders. @*Results@#The lifetime prevalence of any DSM-IV psychiatric disorders was 62.2% in NKD and 25.0% in the general Korean population. The prevalence of specific disorders in NKD and general Korean population was as follows: 22.3% and 4.9% for major depressive disorder (MDD), 12.2% and 1.4% for post-traumatic stress disorder (PTSD), 18.0% and 4.8% for nicotine dependence, and 14.5% and 11.2% for alcohol abuse. The incidence of every single psychiatric disorder varied in each country. For instance, the generalized anxiety disorder, specific phobia, and alcohol use disorder occurred more frequently in North Korea whereas PTSD was more prevalent in other countries. @*Conclusion@#The prevalence of psychiatric disorders among NKD was quite higher than in the general population of South Korea.

Prevalence and Correlates of Suicidal Thoughts and Behaviors among North Korean Defectors

OBJECTIVE: Despite the increasing number of North Korean defectors, research on their mental health conditions and suicidal thoughts and behaviors has not been conducted systematically. We examined the prevalence and risk factors of suicidal thoughts and behaviors in North Korean defectors. METHODS: This study focused on 300 North Korean defectors recruited from regional resettlement centers in South Korea. In-person interviews based on the North Korean version of the Composite International Diagnostic Interview were conducted to diagnose mental disorders and assess suicidal thoughts and behaviors. Logistic regression analyses were performed to evaluate the association between suicidal thoughts and behaviors and socio-demographic variables, and DSM-IV mental disorders. RESULTS: Lifetime prevalence of suicidal ideation, plans, and attempts were 28.3, 13.3, and 17.3%, respectively. Female sex (OR: 2.0, 95% CI: 1.0–3.9), presence of health problems in the past year (2.6, 95% CI: 1.4–4.6), and absence of both South Korean acquaintances (1.9, 95% CI: 1.0–3.4) and North Korean family (1.7, 95% CI: 1.0–2.9) were associated with higher odds of suicidal thoughts and behaviors, after adjusting for participant age, sex, and education. Presence of a mental disorder was associated with a significantly increased odd of suicide ideation, plan, and attempt. Of all mental disorder categories, agoraphobia had the strongest association with suicidal ideation (6.5, 95% CI: 2.0–21.6), plans (7.7, 95% CI: 2.5–23.2) and attempts (12.0, 95% CI: 3.5–40.8). CONCLUSION: Suicidal thoughts and behaviors among North Korean defectors are higher than the general population in South Korea, especially show high rates in transit countries. Further study should focus on the changes in suicidal thoughts and behaviors according to the settlement process and early prevention.

Increased amount of pleural effusion during head-down tilt position in ovarian cancer patient with ascites: A case report

Pseudo-Meigs syndrome is accompanied with pleural effusion, ascites and a benign or malignant tumor of ovary, tubes, uterus, round ligament or colon. We reported a case of hypoxia in an ovarian cancer patient with moderate ascites after head-down tilt position for central venous catheterization under general anesthesia. Massive pleural effusion was detected on portable chest X-ray, which was not observed in a preoperative radiologic test. The patient had no respiratory symptoms and breath sound was normal in both lungs prior to surgery. The pleural effusion was resolved by a chest tube insertion.

A case of postoperative serotonin syndrome following the administration of fentanyl, palonosetron, and meperidine: A case report

Serotonin syndrome is an unexpected adverse reaction of serotonergic medication. Some drugs used by anesthesiologists may cause serotonin syndrome. Serotonin syndrome is known to be related to 5-hydroxytryptamine 1A and 5-hydroxytryptamine 2A agonism. However, recent research has revealed evidence that 5-hydroxytryptamine 3 (5-HT3) antagonism can also play a role in serotonin syndrome. Among the 5-HT3 antagonists, palonosetron is the most highly specific. In this study, we present the first case of fentanyl- and meperidine-induced serotonin syndrome precipitated by palonosetron in general anesthesia.

Comparison of oxycodone and fentanyl for postoperative patient-controlled analgesia after laparoscopic gynecological surgery / 대한마취과학회지

BACKGROUND: Opioids are widely used in boluses and patient-controlled analgesia (PCA) for postoperative pain control. In this study, we compared the effects of oxycodone and fentanyl on postoperative pain in patients with intravenous patient-controlled analgesia (IV-PCA) after laparoscopic gynecological surgery. METHODS: Seventy-four patients undergoing elective total laparoscopic hysterectomy or laparoscopic myomectomy were randomly assigned to the administration of either fentanyl or oxycodone using IV-PCA (potency ratio 1 : 60). The cumulative dose administered in the patient-controlled mode during the initial 48 hours after the operation was measured. Patients were also assessed for postoperative pain severity, adverse effects, and patient satisfaction. RESULTS: No significant differences were observed in patient satisfaction with the analgesia during the postoperative period. Patients in the oxycodone group experienced significantly more dizziness compared to the fentanyl group. Patients in the oxycodone group showed significantly lower consumption of opioid in the patient-controlled mode (10.1 +/- 8.5 ml vs. 16.6 +/- 12.0 ml, P = 0.013). CONCLUSIONS: Our data suggest that oxycodone and fentanyl demonstrated similar effects, and therefore oxycodone may be a good alternative to fentanyl in postoperative pain management. Further studies in various clinical settings will be needed to determine the adequate potency ratio.

A case of primary hepatic actinomycosis: an enigmatic inflammatory lesion of the liver

Primary hepatic actinomycosis is one of the chronic abscess-forming infections of the liver. Accurate diagnosis is frequently delayed due to its indolent course and nonspecific clinical and radiological manifestations. We report a case of a 57-year-old man presenting with asymptomatic multiple hepatic masses on follow-up abdominal computed tomography performed 1 year after stomach cancer surgery. Although a percutaneous liver biopsy procedure was conducted twice in order to obtain confirmative pathology, only a nonspecific organizing abscess with plasma cell infiltration was revealed, without identification of any organism in the tissue cultures. Ultimately, actinomycosis was diagnosed following the detection of sulfur granules on open surgical biopsied tissue. This case suggests that primary hepatic actinomycosis should be considered as one of the possible causes for enigmatic inflammatory lesions of the liver.

Severe hemodynamic deterioration caused by cardiac herniation during endoscopic thoracic sympathicotomy in a patient with previously undiagnosed congenital pericardial defect / 대한마취과학회지

No abstract available.

Severe hemodynamic deterioration caused by cardiac herniation during endoscopic thoracic sympathicotomy in a patient with previously undiagnosed congenital pericardial defect / 대한마취과학회지

No abstract available.

A Case of Metastatic Hepatocellular Carcinoma of the Orbit / 영남의대학술지

Orbital metastasis from hepatocellular carcinoma is very rare, with only 14 biopsy-proven cases from hepa tocellular carcinoma cases reported in English literature and three cases reported in Korea. Common symptoms of orbital metastasis are proptosis, visual loss, ocular pain and oculomotor dysfunction. For its precise diagnosis, we can perform fine needle aspiration biopsy, orbit CT or MRI, and ultrasonography. Radiotherapy is the mainstay in the treatment of orbital metastasis. In addition, chemotherapy, hormonal therapy and surgical intervention can play a role in the treatment of orbital metastasis according to the primary cancer and symptoms. However, the prognosis of orbital metastasis is poor. We report herein a rare case of a patient with orbital metastasis from hepatocellular carcinoma, which was treated with various modalities that included resection, and who had good clinical and radiological responses to radiation therapy and sorafenib (Nexavar, Bayer HealthCare).

Renal Parenchymal Malakoplakia Presenting with Abscesses and Hepatic Extension Misdiagnosed as a Malignant Tumor: A Case Report / 대한내과학회지

Malakoplakia is a chronic inflammatory disorder that usually affects the urinary tract in immunocompromised patients and rarely extends to adjacent organs. Due to its mass-like presentation, malakoplakia is often clinically misdiagnosed as a neoplastic lesion. We describe the case of a 51-year-old female with renal malakoplakia and hepatic extension and large intraperitoneal abscesses that had been misdiagnosed as malignancy. She was diagnosed with myasthenia gravis 12 years prior and had been treated with oral corticosteroids and immunosuppressants. Radical nephrectomy concomitant with abscess drainage was performed. The final pathology was compatible with malakoplakia, and the patient was successfully treated with antibiotics. Although renal malakoplakia is a rare disease, it should be included in the differential diagnosis of patients with a renal mass who have a history of recurrent urinary tract infections or evidence of immunosuppression.

Renal Parenchymal Malakoplakia Presenting with Abscesses and Hepatic Extension Misdiagnosed as a Malignant Tumor: A Case Report / 대한내과학회지

Malakoplakia is a chronic inflammatory disorder that usually affects the urinary tract in immunocompromised patients and rarely extends to adjacent organs. Due to its mass-like presentation, malakoplakia is often clinically misdiagnosed as a neoplastic lesion. We describe the case of a 51-year-old female with renal malakoplakia and hepatic extension and large intraperitoneal abscesses that had been misdiagnosed as malignancy. She was diagnosed with myasthenia gravis 12 years prior and had been treated with oral corticosteroids and immunosuppressants. Radical nephrectomy concomitant with abscess drainage was performed. The final pathology was compatible with malakoplakia, and the patient was successfully treated with antibiotics. Although renal malakoplakia is a rare disease, it should be included in the differential diagnosis of patients with a renal mass who have a history of recurrent urinary tract infections or evidence of immunosuppression.

Sarcoidosis Occured after Treatment of Tuberculous Lymphadenitis / 결핵및호흡기질환

Sarcoidosis is a multisystemic disorder characterized by the presence of non-caseating granulomas in the involved organ. Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis and is characterized by granuloma with caseous necrosis. The clinical and histological similarity between sarcoidosis and tuberculosis has stimulated research searching for an association between mycobacterium and sarcoidosis. We report a case of a 38-year-old male with sarcoidosis that developed soon after treatment of tuberculous lymphadenitis. He was diagnosed as tuberculous lymphadenitis by microbiological confirmation. He showed clinical improvement after treatment for tuberculosis. One year later, his chest radiography showed bilateral hilar enlargement with diffuse bilateral nodules. A noncaseating granuloma was confirmed by endobronchial ultrasound guided transbronchial needle aspiration and he was diagnosed with sarcoidosis. To our knowledge, this is the first report describing sarcoidosis after treatment of tuberculosis in South Korea.

Update in Tissue Engineering Methods for Meniscal Tear of knee Joint / 대한정형외과연구학회지

Meniscal tear of knee joint has been known to be one of the most important risk factors to cause knee osteoarthritis. For meniscal tear, in vascular peripheral zone meniscal repair for healing is recommended to preserve knee articular cartilage and in avascular central zone it is recommended partial meniscectomy that preserves intact meniscal rim as much as possible. Recent strategy for meniscal lesion has been established from meniscectomy to meniscal repair as the role of meniscus for preserving articular cartilage has proved to be critical. Even after total meniscectomy, the efforts to preserve meniscus do not decrease and in these cases, meniscal allograft is transplanted to meniscal deficient knee. Although there are so many methods to preserve meniscus, the clinical results are doubtful about cartilage degeneration due to low regenerative potency of meniscus. Nowdays, tissue engineering is reported to be promising treatment modality for not only stimulating lesion healing but also replacing entire meniscus by tissue engineered prosthesis. The authors introduced recent tissue engineering methods for healing torn meniscus and total replacement of meniscus with respect to substituting cells and stimulating growth factors, scaffolds for meniscal regeneration, tissue engineering for meniscal healing, meniscal prosthesis.

Results of Total Knee Arthroplasty using NexGen(R) System / 대한정형외과학회잡지

Purpose: To prospectively evaluate the survival rate, follow-up rate, clinical and radiographic results of NexGen(R) total knee replacement arthroplasty (TKRA). Materials and Methods: Between June 1998 and March 2002, 434 knees in 278 patients after TKRA performed by a single-surgeon using the same implant were evaluated prospectively. The preoperative diagnosis was primary osteoarthritis in 399 knees, osteonecrosis in 17 knees, rheumatoid arthritis in 12 knees and post-traumatic arthritis in 6 knees. Data collection, physical examination and radiographic evaluation were carried out at postoperative 1, 2, 3 and 5 years. A telephone survey was carried out for the patients who could not visit the outpatient clinic, and the mean follow-up duration was 4.3 years (3-7 years). The follow-up rate and survival rate was analyzed using the Kaplan-Meier method with the reimplantation cases being counted as a failure. The clinical results were evaluated by the Knee Society Score, and the range of motion and status of the implants were assessed by a radiographic evaluation. Results: The total follow up rate was 91.0% (395/434). The survival rate was 98.3% at 5 years after surgery and the survival rate excluding the infection cases was 99.0% 5 years after surgery. The Knee Society Total Score improved to 96.8 in the cruciate retaining (CR) type and to 95.2 in the Legacy posterior stabilized (LPS) type. The Knee Society Function Score improved to 82.6 in the CR type and to 73.8 in the LPS type on the final follow up. The average preoperative further flexion was 122.6, which improved to 125.4. The radiographic evaluation revealed 6 cases (1.5%) of osteolysis with reimplantation being performed in 2 cases. Conclusion: In this prospective study, with a high follow-up rate (91.0%), the survival rate of TKRA using the NexGen(R) implant was relatively high and satisfactory in terms of the functional improvement. However, a long-term follow-up evaluation will be needed.

Results of ACL Reconstruction with Autologous Hamstrings Fixed by Two Bioabsorbable Cross Pins on the Femoral Side and a Bioabsorbable Interference Screw with Additional Fixation on the Tibial Side / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical outcomes of an anterior cruciate ligament reconstruction using autologous hamstring tendons with stable fixation. MATERIALS AND METHODS: Seventy-six ACL reconstructions using autologous hamstring tendons were reviewed for an average of 16.5 months (Range, 12-35.6 months) postoperatively. All the patients were examined using standard clinical techniques and evaluated by stress radiography, Cybex(TM), Lysholm score, and International Knee Documentation Committee (IKDC) ratings. RESULTS: In all cases, there were no limitations in the range of motion. The mean Lysholm score was 72.9 preoperatively, which later improved to 91.1 postoperatively. According to the IKDC grade, 74 cases were categorized as 'normal' or 'nearly normal' postoperatively. In addition, the CybexTM study showed that at an angular velocity of 60degrees/sec, the strength deficit of the hamstrings decreased to 16% from 24% while the strength deficit of the quadriceps decreased to 27% from 31%. The mean side-to-side difference in stress radiography was 2.4 mm postoperatively. There was a single case of graft failure resulting from a deep infection. CONCLUSION: ACL reconstructions using autologous hamstrings using stable fixation techniques showed satisfactory results at the 16.5 months follow-up. However, further studies will be needed to confirm these findings over a longer follow-up period.