The Stress Perception, Depressive Symptoms and Medical Comorbidity in Healthcare Center / 정신신체의학

OBJECTIVES: We surveyed this study for knowing the relation within stress, depression and medical comorbidities, and finding the risk factors of major depression. METHODS: 1764 subjects were enrolled from Jan. 2009 to Dec. 2009 who visit Korea University Guro hospital healthcare center. The subjects answered the questionnaire of PSS(Perceived Stress Scale), PHQ-9(Patient Health Questionnaire-9) and the demographic data. We categorized them as the stress group, depressive group, medical comorbidity group and analyzed the correlation analyses and logistic regression analyses. RESULTS: 198 of 1764 subjects(11.8%) were applied to major depression, and the depressive group showed the higher mean stress score(23.19) and mean depression score(12.95) than the normal group. The total PHQ-9 score was increased by perceiving more stress, having more medical comorbidities. The subjects with female, visiting due to recent health problems, irregular exercise, current smoking, history of angina and cerebrovascular disease showed the increased risk of major depression. CONCLUSIONS: In this study, we find the PSS, PHQ-9 were valuable for mental health screening in healthcare center. As perceiving more stress and having more medical comorbidity, risk of major depression were increased. Accordingly the individuals with medical diseases or unhealthy lifestyle would need the mental health screen.

A Study of Psychiatric Treatment Compliance in Referred Patients at a General Hospital / 정신신체의학

OBJECTIVES: The present study investigates the status of inpatient psychiatric consultations at a general hospital in order to find factors that contribute to treatment compliance related to psychiatric consultations. METHODS: The subjects were 333 patients who were hospitalized at Korea University Medical Center Ansan Hospital from 1 September 2009 to 31 July 2010.The patients were referred for psychiatric consultation during hospitalization. This study investigates demographic data, request department, referral causes, requestor, psychiatric history and diagnosis, andpsychiatric treatment compliance. Treatment compliance was defined as whether or not the patient had accepted psychiatric treatment during hospitalization or outpatient department(OPD) follow-up. This study ascertains the factors that have impact on compliance, by taking binary logistic regression with compliance and other variables. RESULTS: Among the patients that were offered psychiatric treatment during hospitalization(N=310), treatment compliance was 82.9%. Among the patients that were offered OPD treatment(N=111), compliance was 55.8%. Elderly group(>65 years) showed better compliance to treatment during hospitalization than the younger patient group(OR=4.838, p=0.004). Patients with secondary psychiatric disorders showed better OPD follow-up compliance than patients with secondary psychiatric disorders(OR=8.520, p=.008). CONCLUSION: Elderly patients showed better compliance for psychiatric treatment during hospitalization. However they commonly have disorders such as delirium and mood disorders that have impact on the patient's physical state, hence further active measures should be carried out. Patients referred due to primary psychiatric disorders showed poor OPD compliance. Therefore clinicians have to suggest multidisciplinary interventions that will improve treatment compliance of such patients.

A Case of Duodenal Adenosquamous Carcinoma / 한국간담췌외과학회지

Adenosquamous carcinoma in the duodenum is extremely rare disease entity and only 6 cases were reported all over the world so far. Recently we encountered a 62 year-old female patient with duodenal adenosquamous carcinoma. The patient subsequently underwent Whipple's operation. Histopathologic examination revealed two pathologic components composed of adenocarcinoma and squamous cell carcinoma. The metastatic foci of lymph nodes were composed of pure squamous cell carcinoma. For differential diagnosis, we performed several special stains including high molecular weight cytokeratin(HMWCK), low molecular weight cytokeratin(LMWCK), carcinoembryogenic antigen( CEA), mucicarmine, periodic acid-Schiff(PAS). Immunohistochemical stains demonstrated LMWCK, CEA, mucicarmine positivity for glandular component and HMWCK for squamous component. Weak positivity for squamous component was observed with PAS stain. The pathogenesis of adenosquamous carcinoma is controversial issue and not resolved yet, so we discussed the histogenesis of adenosquamous carcinoma.

Therapeutic Effect of OK-432 for Lymphangioma in Children

Lymphangioma is a congenital malformation of the lymphatic system that easily expands into surrounding tissue similar to malignancies. Surgical excision has been the treatment of choice, but the results of surgical resection have been unsatisfactory due to incomplete resection, fluid collection and recurrence after surgery. Intralesional injection of OK-432(lyophilized incubation mixture of group A. streptococcus pyogenes of human origin) was employed in treating 24 patients with lymphangiomas between 1992 and 1997. The therapy was used as a primary therapy in 21 patients. Also it used in 3 patients with unresectable or recurrent lymphangioma. The results of intralesional injection of OK-432 were excellent in 8 patients (33.3%), good in 7 patients (21.8%) and poor in 7 patients (21.8%). The side effects were fever under 39.0degrees C and a local inflammation, however, were subsided in a few days without serious complications. These data suggest that intralesional injection of OK-432 is safe and effective for lymphangioma as a primary therapy and unresectable or recurrent lymphangioma as a secondary therapy.

A Case of Intravenous Leiomyomatosis

Intravenous leiomyomatosis is a rare benign smooth muscle tumor arising from uterine muscle or vascular wall. The disease grows into pelvic venous channel, and can extend to inferior vena cava, and, in exceptional cases, right side of the heart. A case of intravenous leiomyomatosis is presented with a brief review of literatures. A 42-year-old woman presented with one month history of vague right lower quadrant pain and leg swelling. Six years before admission, she had undergone total abdominal hysterectomy for leiomyoma of the uterus and excision of recurred mass and right salpingo-oophorectomy 32 months ago. During the follow-up, right adnexa mass was detected and the size grew progressively, so transferred to our hospital. CT scan and venograpy revealed out the large pelvic cavity mass and intravenous extension to right common iliac vein, bifurcation of IVC. Preoperative tumor embolization followed by resection of recurred pelvic tumor, removal of intravenous tumor via internal iliac vein venotomy and left salpingo-oophorectomy were done. After the operation, the symptoms were relieved and the patient resumed her normal activity.