This treatise examined the intricate relationship between silence, solitude, and creativity in psychoanalytic perspective. Starting with an overview of how silence was understood, the paper subsequently explained in depth the interrelation among silence, solitude, and creativity and concluded with therapeutic implication. It focused on understanding the capacity to be alone not only as a mature or highly sophisticated phenomenon, but also a phenomenon of early life. While transitional phenomena have been extensively studied in relation to creativity, the current discourse attempts to convey that the nascent form of “being” also certainly is linked to creativity. It could be regarded as what Winnicott had sought to reach through his developing course of writings from 1958 to 1971. It seems that imposed silence, as an environment, is a prerequisite for fostering the capacity to be alone. There can also be chosen silence as a manifestation that contains solitude, the incommunicado element, and the core self. When this state manifested as chosen silence encounters a sensation or an impulse, creativity might be culminated. In brief, silence and capacity to be alone can develop in tandem into chosen silence of quietude and solitude, respectively. Using and rediscovering impulses into creative expressions are then feasible. Thus, in the interest of creativity, analysts should respect patient’s silence.

PURPOSE: We undertook this study to investigate discrepancies in C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values, and variations following intravenous immunoglobulin (IVIG) therapy in Kawasaki disease (KD). METHODS: A total of 123 KD patients were retrospectively enrolled. Patients were treated with IVIG 2 g/kg at 2 to 9 days after disease onset. We obtained white blood cell (WBC) count, percentage of neutrophils (% neutrophils), CRP, ESR, and N-terminal pro-brain natriuretic peptide (NT-proBNP) values before and 48 to 72 hours after IVIG treatment. Discrepancy was defined as CRP ≥10 mg/dL and ESR <50 mm/hr (Group 1), or CRP <10 mg/dL and ESR ≥50 mm/hr (Group 2). RESULTS: Thirty-six of 123 subjects (29.2%) had a discrepancy: 25 (20.3%) in Group 1 and 11 (8.9%) in Group 2. In Group 1, 15 patients (60%) had fever for <5 days (early presenter) and 10 (40%) had fever for ≥5 days (late presenter). There were six early presenters (55%) and five late presenters (45%) in Group 2. Late presenters had higher ESR than early presenters (34.3±21.0 mm/hr vs. 26.3±19.3 mm/hr, P=0.029). After IVIG treatment, elevated WBC count, % neutrophils, CRP, and NT-proBNP levels normalized. In contrast, ESR increased from 37.4±21.9 mm/hr to 48.0±22.7 mm/hr (n=36, P=0.051). CONCLUSIONS: A discrepancy may be related to the duration of fever. Due to discrepancies in CRP and ESR values in acute KD, both should be measured to assess the degree of inflammatory activity before IVIG treatment. After IVIG treatment, the ESR should not be used as a marker of response to therapy in KD.
Blood Sedimentation* ; C-Reactive Protein* ; Erythrocytes* ; Fever ; Humans ; Immunization, Passive* ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Leukocytes ; Mucocutaneous Lymph Node Syndrome* ; Neutrophils ; Retrospective Studies

The bcl-2 gene is a proto-oncogene which extends cell survival by blocking apoptosis. Bcl-2 expression has been detected in many types of nodal and MALT lymphoma. The p53 gene is a tumor suppressor gene and p53 mutation is the most common genetic alteration in human malignancies. The relationship between the expression of bcl-2 and p53 protein in primary gastric lymphoma has been rarely reported. The authors investigated the expression of bcl-2 and p53 protein in 37 cases of primary gastric lymphoma by immunohistochemical method using bcl-2 and p53 monoclonal antibodies. There were five cases of low grade B-cell MALT lymphomas and thirty two cases of high grade B-cell lymphomas. Fifteen of 37 cases (41%) showed bcl-2 protein expression in the cytoplasm of tumor cells and 26 cases (70%) showed p53 protein expression in the nucleus of tumor cells. Bcl-2 protein was detected in 4 of 5 (80%) low grade MALT lymphomas, and in 11 of 32 (34%) high grade lymphomas. There was no significant correlation between bcl-2 expression and histologic grade of primary gastric lymphomas (p>0.05). p53 protein was positive in 25 of 32 (78%) high grade lymphomas, and in 1 of 5 (20%) low grade MALT lymphomas. The expression of p53 protein is significantly higher in high grade lymphoma than in low grade MALT lymphoma (p<0.05). The p53 expression in the bcl-2 negative cases (86%) was significantly higher than in the bcl-2 positive cases (47%). There was an inverse relationship between bcl-2 and p53 expression in primary gastric lymphoma. These results suggest that bcl-2 and p53 expression in primary gastric lymphoma may be involved in the transition from low grade MALT lymphoma to high grade lymphoma.
Antibodies, Monoclonal ; Apoptosis ; B-Lymphocytes ; Cell Survival ; Cytoplasm ; Genes, bcl-2 ; Genes, p53 ; Genes, Tumor Suppressor ; Humans ; Lymphoma* ; Lymphoma, B-Cell ; Lymphoma, B-Cell, Marginal Zone ; Proto-Oncogenes

OBJECTIVES: This research was performed in order to develop the social perception scale which could detect the deficits of the social perception, composed of visual perception and contextual perception, in the patients with schizophrenia and might have the desirable reliability and discriminating power between the patients with schizophrenia and the normal controls, and so as to be appropriate to the schizophrenics' cognitive rehabilitation strategy of Brenner, et al. METHODS: We selected 10 photographs among 30 photographs which could show the variable social situations according to the consensus of the staff members of the Integrated Psychological Therapy. Then we developed the questions, composed of visual perception subscale and contextual perception subscale, which we called preliminary social perception scale. We tested the above scale to the 20 patients with schizophrenia in the chronic mental hospital. Then we tested the above scale to both the 20 patients meeting DSM-IV criteria for schizophrenia in the closed ward of the university psychiatric hospital and the 20 normal controls. We developed the final social perception scale to exclude the items of inadequate reliability. We compared the item difficulties of social perception scale between the patients in the chronic mental hospital and those in the university psychiatric hospital. finally, we compared the scores of social perception scale between the patients with schizophrenia and the normal controls. RESULTS: The final 6 items were selected to become the social perception scale according to the values of the item-total correlation, test-retest reliability, and interrater reliability. The final social perception scale showed similar rank of item difficulties between two groups with schizophrenia. The patient group differed significantly fiom the normal control group on the scores of contextual perception subscale(t=-3.09, p<.01) and the total scores of social perception scale(t= -3.33, p<.01). CONCLUSION: This study suggests that the above social perception scale which has excellent internal consistency, test-retest reliability, interrater reliability and the discriminating power. This scale can be applied to both the cognitive rehabilitation strategy in the patients with schizophrenia and the evaluation of the effectiveness of the cognitive rehabilitation.
Consensus ; Diagnostic and Statistical Manual of Mental Disorders ; Hospitals, Psychiatric ; Humans ; Rehabilitation* ; Schizophrenia* ; Social Perception* ; Visual Perception

To evaluate the coronary vasomotor tone in vasospasic angina, we compared the diameters of non-spastic segments of vasospastic group with those of control group. The internal diameters of each segment of three major coronary arteries were measured on the basal coronary angiogram, and nitroglycerin administration after provocation with ergonovine or acetylcholine. The vasospastic angina group consisted of 26 patients(20 males, 6 females, mean age of 54 years) and control group consisted of 25 patients (7 males, 18 females, mean age of 55 years). The basal coronary arterial diameters in vasospastic angina group were smaller than those in control group(p<0.05) except the distal segment of right coronary artery. The percent dilation ratio in vasospastic angina group was greater than that in control group(p<0.05). In vasospastic angina group there was no significant difference in the degree of constriction after provocation with ergonovine or acetylcholine between proximal and distal segment. These observations suggest that in vasospastic angina, basal coronary arterial tone is increased in the entire coronary arterial tree and the localized spasm may reflect local hyperrespon siveness.
Acetylcholine ; Constriction ; Coronary Vessels ; Ergonovine ; Female ; Humans ; Male ; Nitroglycerin ; Spasm

Fracture of odontoid process is relatively common, but fracture of axis body without fracture of odontoid precess is known to be exceptionally. Recently, we have experienced a case of axis body fracture complicating typical Brown-Sequard syndrome below the level of C4, and we present the case with the review of literature.
Axis, Cervical Vertebra* ; Brown-Sequard Syndrome* ; Odontoid Process

BACKGROUND: The pneumoperitoneum created by CO2 insufflation during laparoscopic cholecystectomy has several potential hemodynamic and respiratory consequences. The purpose of this study is to investigate the effects of augmented minute ventilation on cardiovascular and ventilatory changes and to prevent hypercarbia due to CO2 insufflation during laparoscopic cholecystectomy. METHODS: Thirty-six patients were divided into three groups according to the level of minute ventilation. The three groups were: control group C (minute ventilation 100 ml/kg, respiratory rate 12 per minute), group R (MV 150 ml/kg, RR is 18 per minute) and group V (MV 150 ml/kg, tidal volume is 1.5 times as much as group C). We repeatedly measured mean arterial pressure , pulse rate , arterial blood gas analysis and end tidal carbon dioxide and peak inspiratory airway pressure before CO2 insufflation, 15 and 30 minutes after CO2 insufflation and 15 minutes after CO2 deflation. RESULTS: During CO2 insufflation, MAP significantly increased but PR showed little changes in all three groups. PaCO2 and PetCO2 increased in group C, whereas in group R and V, they remained unchanged during CO2 insufflation. But the level of PaCO2 in group V decreased more than in the other two groups after CO2 deflation,. PIP in group V increased 3 times as much as the control value. CONCLUSIONS: These results suggest that augmented minute ventilation in group R and V, prevented hypercarbia during CO2 insufflation and increasing the tidal volume in controlled ventilation was more effective than increasing respiratory rate after CO2 deflation.
Anesthesia, General* ; Arterial Pressure ; Blood Gas Analysis ; Carbon Dioxide ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Heart Rate ; Hemodynamics ; Humans ; Insufflation ; Laparoscopy ; Pneumoperitoneum ; Respiratory Rate ; Tidal Volume ; Ventilation*

PURPOSE: The use of pre- and intraoperative vitreous bevacizumab injection and combined lens extraction with vitrectomy in patients with proliferative diabetic retinopathy (PDR) is increasing. In this study we analyzed the incidence and risk factors of neovascular glaucoma (NVG) after vitrectomy for PDR. METHODS: Patients who underwent vitrectomy for PDR from January 2004 to June 2011 were retrospectively reviewed. The minimum follow-up was 12 months. The cumulative incidence of NVG was calculated using the Kaplan-Meier survival analysis. The patients were divided into 4 groups according to lens status (preoperative pseudophakic group, simultaneous cataract surgery group, sequential cataract surgery group, non-cataract surgery group). The differences in incidence between the groups were determined by the Chi-square test. Finally, to analyze the risk factors associated with the occurrence of NVG, the Cox's regression model was used. RESULTS: Of the 614 eyes (402 patients), 284 were males and 330 were females. The mean age was 55.8 +/- 10.46 years (range 30-81 years) and the mean follow-up period was 36.6 months (range 1-93 months). Thirty-four of 614 patients (5.5%) developed postoperative NVG after vitrectomy. The probability of NVG occurrence at 6 and 12 months after vitrectomy was 0.7% and 2.5%, respectively. The incidence between the 4 groups did not show a statistically significant difference. The risk factors for postoperative NVG were male gender (RR = 3.01 p = 0.004), preoperative intravitreal bevacizumab injection (RR = 7.20, p < 0.001), and reoperation (RR = 3.18, p = 0.0037). CONCLUSIONS: The frequency of NVG after vitrectomy in patients with PDR was 5.5%. Lens status was not associated with NVG occurrence. The risk factors related to NVG were male gender, preoperative intravitreal bevacizumab injection, and reoperation.
Cataract ; Diabetic Retinopathy* ; Female ; Follow-Up Studies ; Glaucoma, Neovascular* ; Humans ; Incidence ; Male ; Phacoemulsification ; Reoperation ; Retrospective Studies ; Risk Factors* ; Vitrectomy* ; Bevacizumab

Brown-Séquard-plus syndrome is characterized by hemiparesis, contralateral spinothalamic sensory deficits with additional abnormal findings of other organs. We report a case of an 81-year-old man who had right hemiparesis, left sensory deficit and Horner syndrome on right eye. Diffusion-weighted MRI of the cervical spine and lower medulla confirm the diagnosis of anterior unilateral cervical spinal cord infarction. It is very rare that the unilateral long spinal cord infarction at the C1-C4 associated with Brown-Séquard-plus syndrome.
Aged, 80 and over ; Diagnosis ; Horner Syndrome ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Paresis ; Spinal Cord* ; Spine ; Vertebral Artery

BACKGROUND: The purpose of this study was to clarify whether the patients' age is an independent prognostic factor in curatively resected gastric adenocarcinoma. METHODS: Clinicopathologic information was reviewed for consecutive patients undergoing curative gastrectomy for gastric cancer during 6-year period (Jan. 1996-Dec. 2001) at the Keimyung University School of Medicine at Daegu. Overall survival was examined by the Kaplan-Meier method, and multivariate analysis by Cox proportional hazards was used to identify whether age had independent prognostic significance for survival. RESULTS: The patients were divided into two groups: 838 patients (72.4%) with age of less than 65 years old, and 320 patients (27.6%) with age more than 65 years old. In these two groups, there were statistically differences in WHO classification, Lauren classification, vascular invasion, T stage, total stage, operational morbidity and mortality, and overall survival rate. The 5-year overall survival rate of age less than 65 years old was 87.8%, and 83.0% of age more than 65 years old (p=0.019). Multivariate Cox regression analysis revealed that age was an independent prognostic factor to predict overall survival in curatively resected gastric cancer (p=0.038). However, after excluding cases who died within 1 month after gastric resection, overall survival rate was significantly different between two groups (p=0.050), but Cox regression analysis showed that age was not an independent prognostic factor (p=0.054). CONCLUSION: The age is not an independent prognostic factor in curatively resected gastric cancer patients, and survival differences are due to an increased operative mortality in elderly patients.
Adenocarcinoma ; Aged ; Classification ; Daegu ; Gastrectomy ; Humans ; Mortality ; Multivariate Analysis ; Prognosis ; Stomach Neoplasms* ; Survival Rate