OBJECTIVES: The purpose of this study was to examine the effect of cognitive-behavioral group therapy on improving adolescents' behavioral problems, especially violent behavior. METHOD: The subjects were 27 middle school students referred by their teachers for behavioral problems. We devided them into 4 teams and treated them for 15 sessions of cognitive-behavioral group therapy. The control group were 20 middle school students who had no cognitive-behavioral therapy. We assessed their behaviors pre- and post intervention by two series of scale, ie. self ratings and teacher ratings. Self ratings included 'misbehavior scales' and 'violent behavior subscale'; teacher ratings included 'teacher-children rating scale' and 'detection of misbehavior scale'. RESULT: 1)In self-rating scales, the misbehavior of the subject group decreased more than the coltrol group, but not the violent scale. There were statistically significant group differences of improving effect in misbehavior scales. 2)In teacher rating scales, there was no significant decrease in the behavioral problems of the subject group. 3)By teams there were significant different intervention effects among 4 teams in self rating misbehavior scale. Team 2 improved on all scales except teacher-rating detection of misbehavior scale. 4)Determinant factors of intervention effect on behavioral problems were the degree of baseline behavioral problems, sex of subjects and therapist. CONCLUSION: The results from this study suggest that cognitive-behavioral group therapy was effective in decreasing the behavioral problems of adolescents. But the effect of therapy depends on sex, the degree of behavioral problems of subjects and the therapist.
Adolescent ; Humans ; Psychotherapy, Group* ; Violence ; Weights and Measures

Objective: To identify the factors affecting anger in post-traumatic stress disorder (PTSD) patients who underwent Clinician-Administered PTSD Scale (CAPS) and Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Methods: We retrospectively reviewed patients who underwent CAPS and MMPI-2 at Veteran Health Service Medical Center, Seoul, Korea. Based on the CAPS score, the patients were divided into the PTSD group (n=46) and the trauma exposed without PTSD group (n=29). After checking the correlation between anger, CAPS, and MMPI-2 scales, logistic regression analysis was performed to identify the risk factors for clinically relevant symptoms. Results: The PTSD group showed significant differences in schizophrenia-related symptoms, ideas of persecution, aggressiveness, psychoticism, and anger scales compared to the trauma-exposed without PTSD group. There was a significant correlation between anger, CAPS, and MMPI-2 except masculinity/femininity, disconstraint, and MacAndrew Alcoholism-Revised. In particular, anger has been shown to have a substantial connection with paranoia, schizophrenia-related symptoms, ideas of persecution, aberrant experiences, and psychoticism. Multiple regression analysis identified that the only significant risk factor for anger was the negative emotionalityeuroticism scale (odds ratio=1.152, p<0.001). Conclusion The PTSD group had increased anger compared to the trauma-exposed without PTSD group, and that negative emotions may be a risk factor for PTSD.

BACKGROUND/AIMS: Colonic perforation appears to be the most dangerous complication during colonoscopy. This study was designed to determine the optimal management for this infrequent accident. METHODS: We reviewed the medical records of 17,510 colonoscopies which were performed during recent one-year period and found eightcolonic perforations (0.05%). RESULTS: Six perforations (0.04%) related to 16,695 diagnostic procedures, whereas two (0.25%) occurred from therapeutic procedures (p=0.05). Operative measures were applied in six (75.0%) patients showing signs of peritonitis. Five patients received primary closure without diversion, and resection with primary anastomosis was performed in one patient who had underlying tuberculous colitis. In addition, one patient was treated conservatively with bowel rest and intravenous antibiotics. Endoscopic clipping was applied in one patient with rectal perforation. Seven patients recovered uneventfully, and one 69-year-old male patient died of cardiogenic shock after the operation. CONCLUSIONS: Although colonic perforation occurs infrequently during colonoscopy, it may sometimes results in a fatal outcome. Primary closure without diversion appears to be appropriate in most cases without comorbid colonic disease.
Aged ; Anti-Bacterial Agents ; Colitis ; Colon* ; Colonic Diseases ; Colonoscopy ; Fatal Outcome ; Humans ; Male ; Medical Records ; Peritonitis ; Shock, Cardiogenic

Mast cells are involved in allergic responses, protection against pathogens and autoimmune diseases. Dexamethasone (Dex) and other glucocorticoids suppress FcepsilonRI-mediated release of inflammatory mediators from mast cells. The inhibition mechanisms were mainly investigated on the downstream signaling of Fc receptor activations. Here, we addressed the effects of Dex on Fc receptor expressions in rat mast cell line RBL-2H3. We measured mRNA levels of Fc receptors by real-time PCR. As expected, Dex decreased the mRNA levels of activating Fc receptor for IgE (FcepsilonR) I and increased the mRNA levels of the inhibitory Fc receptor for IgG FcgammaRIIb. Interestingly, Dex stimulated transcriptions of other activating receptors such as Fc receptors for IgG (FcgammaR) I and FcgammaRIII. To investigate the mechanisms underlying transcriptional regulation, we employed a transcription inhibitor actinomycin D and a translation inhibitor cycloheximide. The inhibition of protein synthesis without Dex treatment enhanced FcgammaRI and FcgammaRIII mRNA levels potently, while FcepsilonRI and FcgammaRIIb were minimally affected. Next, we examined expressions of the Fc receptors on cell surfaces by the flow cytometric method. Only FcgammaRIIb protein expression was significantly enhanced by Dex treatment, while FcgammaRI, FcgammaRIII and FcepsilonRI expression levels were marginally changed. Our data showed, for the first time, that Dex regulates Fc receptor expressions resulting in augmentation of the inhibitory receptor FcgammaRIIb.
Animals ; Autoimmune Diseases ; Cycloheximide ; Dactinomycin ; Dexamethasone ; Glucocorticoids ; Immunoglobulin E ; Immunoglobulin G ; Mast Cells ; Rats ; Real-Time Polymerase Chain Reaction ; Receptors, Fc ; RNA, Messenger

BACKGROUND AND OBJECTIVES: Sudden cardiac death (SCD) is one of the most common causes of death in patients with heart failure (HF). However, there are no available data on SCD in previous Korean HF registries. Additionally, although widely used, the utility of left ventricular (LV) ejection fraction (EF) in risk stratification for SCD is limited. SUBJECTS AND METHODS: The Korean non-invasive Risk Evaluation study for sudden cardiac DEath From INfarction or heart failurE (KREDEFINE) is the first Korean prospective, nationwide multicenter registry, primarily focused on SCD. The registry consists of 2 groups of patients presenting with (1) acute HF or (2) acute myocardial infarction (MI) at 25 tertiary referral cardiovascular centers. Using the HF-group data of the K-REDEFINE registry, the incidence and risk factors of SCD in patients with HF will be assessed. In particular, the efficacy of Holter-based ECG variables, such as T-wave alternans (marker of repolarization heterogeneity) and heart rate turbulence/ variability (maker of autonomic function), in risk stratification for SCD will be evaluated. Other cardiovascular outcomes will also be analyzed, including atrioventricular arrhythmias, HF-related admission, stroke, and overall deaths. CONCLUSION AND PERSPECTIVE: The K-REDEFINE registry will pave the way for better management of patients with HF at high risk of SCD by elucidating the burden and risk factors of SCD and the clinical utility of various non-invasive ambulatory ECG-based parameters in risk stratification for SCD in this patient population.
Arrhythmias, Cardiac ; Cause of Death ; Death, Sudden, Cardiac* ; Electrocardiography ; Heart Failure* ; Heart Rate ; Heart* ; Humans ; Incidence ; Infarction* ; Myocardial Infarction ; Prospective Studies ; Referral and Consultation ; Registries ; Risk Factors ; Stroke

BACKGROUND AND OBJECTIVES: Despite significant advances in the treatment of acute myocardial infarction (MI), the prevention of sudden cardiac death (SCD), the most common mode of death in patients with MI, remains challenging. Furthermore, previous Korean MI registries did not address the issue of post-MI SCD. Additional risk stratifiers of post-MI SCD are still required to compensate for the limitation of using left ventricular ejection fraction to predict lethal arrhythmic events. SUBJECTS AND METHODS: We designed the first Korean prospective nationwide multicenter registry primarily focused on SCD; the Korean noninvasive Risk Evaluation study for sudden cardiac DEath From INfarction or heart failurE (K-REDEFINE). The registry consists of 2 groups of patients presenting with (1) acute MI or (2) acute heart failure (HF) at 25 tertiary referral cardiovascular centers. The primary endpoint of the MI group study of K-REDEFINE registry is the incidence and risk factors of post-MI SCD. In particular, the association between the risk of SCD and non-invasive Holter-based electrocardiogram (ECG) variables will be evaluated, such as T-wave alternans (marker of repolarization heterogeneity) and heart rate turbulence/variability (a marker of autonomic function). Other secondary study outcomes include atrioventricular arrhythmias, HF-related admission, repeated myocardial ischemic events, stroke, and overall deaths. CONCLUSION AND PERSPECTIVE: The K-REDEFINE registry will provide new prospects for the better management of MI patients with high risk of SCD by clarifying the burden and predictors of SCD and the clinical utility of various non-invasive ambulatory ECG-based variables in risk stratification for SCD in this patient population.
Arrhythmias, Cardiac ; Death, Sudden, Cardiac* ; Electrocardiography ; Heart Failure* ; Heart Rate ; Heart* ; Humans ; Incidence ; Infarction* ; Myocardial Infarction* ; Prospective Studies ; Referral and Consultation ; Registries ; Risk Factors ; Stroke ; Stroke Volume