Purpose: This study aimed to develop a counseling program called Motivational Interviewing-Cognitive Behavioral Therapy Integrated Counseling Program (MICBT-CP) and evaluate its effectiveness in post-case management of individuals who have attempted suicide. Methods: Twenty-eight participants with a history of suicide attempts and high scores on Beck’s Scale for Suicidal Ideation were divided into three groups: an experimental group (EG), control group 1 (CG1), and control group 2 (CG2). Each group received different interventions: MICBT-CP for the EG, cognitive-behavioral treatment-based case management (CBT-CM) for CG1, and general case management (GCM) for CG2. Measurements of suicidal ideation, depression, hopelessness, problem-solving competence, life motivation, and perceived motivation were taken at baseline (T1), 6 weeks (T2), and 18 weeks (T3). Results: Significant improvements in life motivation, perceived motivation, and problem-solving competence were observed in the EG compared to CG1 and CG2. Moreover, the EG showed significant reductions in suicidal ideation, hopelessness, and depression. The treatment of CG2 with GCM did not yield significant results, indicating the limitations of current GCM in post-suicide attempt case management. Conclusion The study emphasizes the need for effective programs such as MICBT-CP and improved practitioner skills in post-suicide case management.

Malignant gastrointestinal stromal tumors (GISTs) are rare non-epithelial, mesenchymal neoplasms of the gastrointestinal tract that metastasize or recur in 30% of patients who undergo surgical resection with curative intent. A 59-year-old man visited our hospital for an examination of a palpable mass in the left abdomen. Fourteen months prior to his visit, the patient underwent gastric wedge resection to remove a GIST of the gastric cardia. At the time of surgery, no evidence of metastatic disease was observed and the pathological interpretation was a high-risk GIST. A follow-up computed tomography scan of the abdomen revealed a partially necrotic solid mass (9.8 x 7.6 cm) and enhancing mass in the spleen (2.3 cm). On exploration, multiple masses were found in the liver, greater omentum, and mesentery. Here, we report a case of recurring GIST of the stomach that metastasized to the spleen. To the best of our knowledge, few reports of metastasis to the spleen exist.
Abdomen ; Cardia ; Follow-Up Studies ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Humans ; Liver ; Mesentery ; Middle Aged ; Neoplasm Metastasis ; Omentum ; Spleen ; Stomach

Purpose: Radiation-induced oral mucositis limits delivery of high-dose radiation to targeted cancers. Therefore, it is necessary to develop a treatment strategy to alleviate radiation-induced oral mucositis during radiation therapy. We previously reported that inhibiting reactive oxygen species (ROS) generation suppresses autophagy. Irradiation induces autophagy, suggesting that antioxidant treatment may be used to inhibit radiation-induced oral mucositis. Materials and Methods: We determined whether treatment with N-acetyl cysteine (NAC) could attenuate radiation-induced buccal mucosa damage in vitro and in vivo. The protective effects of NAC against oral mucositis were confirmed by transmission electron microscopy and immunocytochemistry. mRNA and protein levels of DNA damage and autophagy-related genes were measured by quantitative real-time polymerase chain reaction and western blot analysis, respectively. Results: Rats manifesting radiation-induced oral mucositis showed decreased oral intake, loss of body weight, and low survival rate. NAC intake slightly increased oral intake, body weight, and the survival rate without statistical significance. However, histopathologic characteristics were markedly restored in NAC-treated irradiated rats. LC3B staining of rat buccal mucosa revealed that NAC treatment significantly decreased the number of radiation-induced autophagic cells. Further, NAC inhibited radiation-induced ROS generation and autophagy signaling. In vitro, NAC treatment significantly reduced the expression of NRF2, LC3B, p62, and Beclin-1 in keratinocytes compared with that after radiation treatment. Conclusion NAC treatment significantly inhibited radiation-induced autophagy in keratinocytes and rat buccal mucosa and may be a potentially safe and effective option for the prevention of radiation-induced buccal mucosa damage.

OBJECTIVES: The aim of this study was to evaluate the morphometric changes in neuroforamen in grade I isthmic spondylolisthesis by anterior lumbar interbody fusion (ALIF). METHODS: Fourteen patients with grade I isthmic spondylolisthesis who underwent single level ALIF with percutaneous pedicle screw fixation were enrolled. All patients underwent standing lateral radiography and magnetic resonance imaging (MRI) before surgery and at 1 week after surgery. For quantitative analysis, the foraminal height, foraminal width, epidural foraminal height, epidural foraminal width, and epidural foraminal area were evaluated at the mid-portion of 28 foramens using T2-weighted sagittal MRI. For qualitative analysis, degree of neural compression in mid-portion of 28 foramens was classified into 4 grades using T2-weighted sagittal MRI. Clinical outcomes were assessed using Visual Analogue Sale (VAS) scores for leg pain and Oswestry disability index before surgery and at 1 year after surgery. RESULTS: The affected levels were L4-5 in 10 cases and L5-S1 in 4. The mean foraminal height was increased (p<0.001), and the mean foraminal width was decreased (p=0.014) significantly after surgery. The mean epidural foraminal height (p<0.001), epidural foraminal width (p<0.001), and epidural foraminal area (p<0.001) showed a significant increase after surgery. The mean grade for neural compression was decreased significantly after surgery (p<0.001). VAS scores for leg pain (p=0.001) and Oswestry disability index (p=0.001) was decreased significantly at one year after surgery. CONCLUSION: Foraminal stenosis in grade I isthmic spondylolisthesis may effectively decompressed by ALIF with percutaneous pedicle screw fixation.
Commerce ; Constriction, Pathologic ; Humans ; Leg ; Magnetic Resonance Imaging ; Radiography ; Spondylolisthesis*

Purpose: The purpose of this study was to describe the technique of intraoperative transpyloric optic navigation (TPON) and determine its efficacy and feasibility during totally laparoscopic distal gastrectomy (TLDG) in patients with gastric cancer. Methods: Seventy-nine patients who underwent laparoscopic gastrectomy with transpyloric optic localization of the tumor from January 2016 through December 2018 were enrolled in this study. After resecting the first portion of the duodenum, the distal part of the stomach was exteriorized through an extended supraumbilical trocar site, and a balloon trocar was introduced from the pylorus to determine the location of tumor and determine its resection margin. The clinicopathologic and surgical outcomes were analyzed. Results: The tumor was located in the lower third of the stomach in 39 cases, the middle third in 34 cases, and the upper-third in six cases. Tumor localization was successful in 67 patients. The mean proximal margin was 41.7 ± 26.8 mm. There was no morbidity related to the technique. By the fifth postoperative day, the average white blood cell count was within the normal range and the average level of C-reactive protein showed a decreasing pattern. Conclusion TPON of the tumor during TLDG is an effective and feasible method to determine the tumor location and to obtain an adequate resection margin.

Purpose: The purpose of this study was to describe the technique of intraoperative transpyloric optic navigation (TPON) and determine its efficacy and feasibility during totally laparoscopic distal gastrectomy (TLDG) in patients with gastric cancer. Methods: Seventy-nine patients who underwent laparoscopic gastrectomy with transpyloric optic localization of the tumor from January 2016 through December 2018 were enrolled in this study. After resecting the first portion of the duodenum, the distal part of the stomach was exteriorized through an extended supraumbilical trocar site, and a balloon trocar was introduced from the pylorus to determine the location of tumor and determine its resection margin. The clinicopathologic and surgical outcomes were analyzed. Results: The tumor was located in the lower third of the stomach in 39 cases, the middle third in 34 cases, and the upper-third in six cases. Tumor localization was successful in 67 patients. The mean proximal margin was 41.7 ± 26.8 mm. There was no morbidity related to the technique. By the fifth postoperative day, the average white blood cell count was within the normal range and the average level of C-reactive protein showed a decreasing pattern. Conclusion TPON of the tumor during TLDG is an effective and feasible method to determine the tumor location and to obtain an adequate resection margin.

Follow-Up Studies ; Humans ; Jaw ; Orthognathic Surgery

A 31-year-old woman had a history of fatigue and hypokalemia and metabolic alkalosis and hypocalciuria. The patient had a subtotal thyroidectomy and denied ingestion of diuretic medication. Her clinical and laboratory findings were consistent with Gitelman's syndrome. Normal blood pressure, hypokalemic metabolic alkalosis, hypocalciuria were present. She confessed to us that she had been taking a pill due to constipation for 7 years. She was afraid that her husband know it. But we don't know the reason why she had concealed it Surreptious ingestion of diuretics must be excluded in any adult patient in whom a diagnosis of Bartter's or Gitelman's syndrome is considered.
Adult ; Alkalosis ; Bartter Syndrome ; Blood Pressure ; Constipation ; Diagnosis ; Diuretics ; Eating ; Fatigue ; Female ; Gitelman Syndrome* ; Humans ; Hypokalemia ; Spouses ; Thyroidectomy

Most bronchogenic cysts originate in the mediastinum, while 15% to 20% occur in the lung parenchyma. According to the literature, most intrapulmonary cysts occur in the lower lobes. But, they are rarely located in an extrathoracic site, such as subdiaphragmatic retroperitoneal area. We describe a paraesophageal intra-abdominal bronchogenic cyst, first considered as gastric submucosal tumor. Resection was successfully realized by laparoscopy. A 20-year-old female was admitted to our hospital with incidentally detected gastric submucosal tumor. At operation, there was a 2.5x2 cm sized cystic tumor that was isolated from the gastric wall. We performed tumor resection laparoscopically. The postoperative course was uneventful and the patient was discharged on the second postoperative day. Histological examination reported a bronchogenic cyst. We, herein, report this case.
Bronchogenic Cyst ; Female ; Humans ; Laparoscopy ; Lung ; Mediastinum ; Young Adult

Acute mitral regurgitation associated with rupture of papillary muscle is a rare complication of blunt chest trauma. Echocardiographic information is very useful in the diagnosis of papillary muscle rupture, evaluation of left ventricular function and other abnoramlity of heart. The value of transthoracic echocardiography in blunt chest trauma is limited because patients with severe chest wall injury often have suboptimal echocardiographic fingings. But transesophageal echocardiography can provide high quality images when the transthoracic echocardiographic image quality is poor. We report 27 year-old female with papillary muscle rupture after blunt chest trauma in whom transthoracic echocardiography could not provide a prompt diangosis, but definitive evidence of papillary muscle rupture was demonstrated by transesophageal echocardiography.
Adult ; Diagnosis ; Echocardiography ; Echocardiography, Transesophageal* ; Female ; Heart ; Humans ; Mitral Valve Insufficiency ; Papillary Muscles* ; Rupture* ; Thoracic Wall ; Thorax* ; Ventricular Function, Left