OBJECTIVES: Our aims of this study is to analyze the clinical characteristics and the prognos is of the disease which develops in patient swith chronic liver disease as acutely exacerbated hepat it is accompanied by myosit is. Finally we try to identify and is olate the causative agent. METHODS: The patient swith chronic liver diseases, who developed muscle weakness and paralysis, were classified to group A or group B, according to the level of creatinine kinase ( CK) activity. The group A consists of patients with less than 3-fold increase of normal CK activity and the group B includes patients with over 3-fold increase of it. We evaluated clinical characteristics, blood chemistry, clinical course, and causes of deathin patients of study groups, compared with those of patients with chronic liver disease with normal CK activity as controls. The causative agent was suggested by conventional culture and RT-PCR analysis in two cases of group B. RESULTS: 1. There was no significant differences in age, sex, underlying disease, or liver function test bet ween control and study group ( control and group A or B) before entry. 2. The clinical symptoms and signs , such as drowsy mental state, generalized weakness/myalgia caused by hepatic encephalopathy and myositis , occurred frequently in the study group. 3. Significant elevation of aspartic acid transaminase (AST ) and alaninetr ans aminase ( ALT ) was noted in Group B. AST / ALT ratio is over 2 in group A or B. Synthetic function of the liver such as prothrombin time ( PT ) or serum albumin level is significantly decreased. Blood urea nitrogen ( BUN) and creatinine were increased as a result of impaired renal function. 4. Culture of coxs ackievirus was positive by immunofluor escence as say IFA) as a caus ative agent and also was positive in reverse transcription-polymerase chain reaction (RT-PCR) analys is using universal primer of enterovirus in two recent cases of group B. 5. Death rate increased significantly in study group, compared with that of control group ( 20.7% versus 5.6%). Major cause of death, 12 patients died of which, is hepatic failure. CONCLUSION: The patients with chronic liver disease abruptly developed a exacerbated hepaticdys function and muscle paralysis and/or weakness. This exacerbated hepatitis accompanied by myositis was suggested to be caused by coxsackie B viral infection. Furthermore, this infection increase deathrate and resulted in poor prognosis. Thus, further study should be continue to confirm the causative agent and classify the subtype.
Aspartic Acid ; Blood Urea Nitrogen ; Cause of Death ; Chemistry, Clinical ; Creatinine ; Enterovirus ; Hepatic Encephalopathy ; Hepatitis* ; Humans ; Liver Diseases* ; Liver Failure ; Liver Function Tests ; Liver* ; Mortality ; Muscle Weakness ; Myositis* ; Paralysis ; Phosphotransferases ; Prognosis ; Prothrombin Time ; Serum Albumin

As an alternative to group psychotherapy, worked out by Dr. Moreno, the psychodrama is being carried on mainly for a large group of inpatients at 40-50% of the country's psychiatric and training hospitals. The authors have developed a Korean psychodrama model for a group mental health having following characteristics:(1) a one-time treatment, (2) open-group therapy, and (3) structured, large group approach. Korean psychodrama model was proved to be a low cost, highly effective approach in that patients could be dealt with en masse to quite a satisfactory degree: at the same time Korean psychodrama model is easily accessible for any psychiatric doctor or trainee in dealing with a patient. In addition, Korean psychodrama model is highly conducive to experiencing and training related people in psychotherapeutic practice as this model has shown up 79.4% approval rate among patients after treatment. Due to the recent crunch in medical insurance financing, psychotherapy is changing from individual long-term type to a more time-limited type. Despite the mental health law passed in 1995, from the human psychotherapy standpoint, the worsening economic situation has made it difficult for a psychiatrist to deal with patient on a one-to-one basis. As a result, the burden of most psychiatrists, is snowballing day by day. In this context psychodrama seems to be a promising, reliable alternative to group psychotherapy, both medically and economically. It will be a treatment modality for years to come.
Humans ; Inpatients* ; Insurance ; Jurisprudence ; Mental Health ; Psychiatry ; Psychodrama* ; Psychotherapy ; Psychotherapy, Group

OBJECTIVES: Training group with mental health professionals includes didactic process, experience as a member(patient) and a leader(therapist). It is divided into four parts as like 1) lecture, case conference, book reading and seminar about theory and practice, 2) observation, 3) training group(including workshop), and 4) supervision. Among them, the training group and the supervision have been accepted as the most effective methods. Authors have developed and practiced the training group model for mental health professionals including psychiatric residents which aim for the activation of group psychotherapy in mental health area, psychiatrists' initiative in group psychotherapy area, and the training and nurturing of qualified mental health professionals. The objectives of this study are as follows;firstly, we examine the change of defense mechanism and ego function after performing group psychotherapy for mental health professionals;secondly, we analyze the therapeutic factors reported that participants were helped;thirdly, we analyze main features which include group content and process manifested in training group:lastly, we have objectives that the training group is settled down as an effective educational method to foster the personal growth and qualification as a specialist, and also that this study provides a basic research data to set up the training program and the requirements for group psychotherapy. METHODS: This study was performed 5 times from 1997 to 2000. The participants were composed of 37 mental health professionals including psychiatric residents. Among them, 29 participants(male 2, female 27) were chosen as the final subjects except 9 participants dropped out in the process of this study. At first, we take an application of pre-treatment/post-treatment experimental design to evaluate the personality change after performing the training group. EDMT(Ewha Defence Mechanism Test) and EC(Egogram Checklist), the objective questionnaires, were used as the evaluation scale. And 13-therapeutic factor scale and simple subjective questionnaires were performed just after each session and the self-report total assessment questionnaires were performed at the end of this study. RESULTS: To compare mean scores between pre-treatment and post-treatment in EDMT, the mature defense was increased significantly, the immature defense was decreased significantly, and the narcissistic defense and neurotic defense were not changed significantly. To compare mean scores between pre-treatment and post-treatment in EC, Nurturing Parent(NP), Adult(A) and Free Child(FC) were increased significantly. Therapeutic factors ranked highly were interpersonal learning, existential factor, Identification with therapist, catharsis, and socializing technique in order. The total assessment questionnaires reported that the 100% of participants were helped, the 48.3% of participants were changed in their lives, the 89.7% of participants would propose training group to others positively, and the 58.6% of participants had minds to join this kind of program if given again for them. CONCLUSIONS: This result showed that the defense mechanism and ego function of participants were changed. The training group experience makes participants reflect themselves, examine their conflicts and understand others. That also gives them chances of improving insight about group phenomena and understanding about therapeutic factors essential to the mental health professionals, having confidence on the group therapy by learning leadership and techniques, and improving understanding about the psychotherapy on the whole. Therefore, it is needed in the future that the training group would be widely adapted as an educational tool of psychotherapy and group psychotherapy for the mental health professionals as well as psychiatric residents in mental health area.
Catharsis ; Education ; Ego ; Female ; Humans ; Leadership ; Learning ; Mental Health* ; Organization and Administration ; Psychotherapy ; Psychotherapy, Group ; Surveys and Questionnaires ; Research Design ; Specialization

OBJECTIVES: Group psychotherapy is more economic than individual psychotherapy and effective to adolescents especially. Group psychotherapy with adolescents will be used widely when adolescents problems are becoming more important so that government focuses on them. This article aims for the readers to understand group psychotherapy easily. METHODS: This article is based on reviewing lots of articles related to adolescent group psychotherapy published at home and abroad and our researches and practical experiences in regard with inpatient and outpatient group with adolescents for a long time. This article is described in order of history, theory, model, development stage, and therapeutic factor. RESULTS: Theories of group psychotherapy have been affected by about 200 psychotherapy theories. Among a lot of theories, psychoanalytic theory and cognitive-behavioral theory have been accepted as a perennial effective therapeutic modality. In Korea, structuralized cognitive-behavioral group therapy is currently pervaded in Youth Counselling Center or General Social Welfare Center. But because that is generally consist of skill training and problem solving centered approach, it is difficult to achieve therapeutic goal of ultimate behavioral change in basis of genetic insight. On the contrary, it is known that psychoanalytic group therapy has more benefit to raise adolescent universal value, group norms, group rules, confidentiality, and community consciousness for adolescents. and that group therapy provides adolescents with more secure and caring conditions. Here and now, adolescent group therapists apply wide theories and various techniques with flexible attitudes to go together with unapproachable adolescents. Models of group psychotherapy have various mode related to age, disorders, functional level, developmental level, clinical environment, structural modalities, and intervention goal. Developmental stages of the group psychotherapy consist of formal stage, conflictual stage, normal stage, and performing stage. And then those are divided with the first stage, middle stage, and the last stage in an adolescent group. Therapeutic factors of an adolescent group are as follows. Interpersonal learning, catharsis, existential factor, and group cohesiveness are highly evaluated in an encounter group and a long-term group for personality change. And catharsis, universality, identification, and group cohesiveness are highly evaluated in a short-term group. To handle the adolescent group, therapist capability is very critical. Special knowledge, technique, and endurance are needed for the group therapist to lead an adolescent group. Even though some therapist lead the adult group for a long time, they have to get special training and supervision to lead the adolescent group. CONCLUSIONS: Group psychotherapy has been formally accepted as one of therapeutic modalities that must be as equally effective as individual psychotherapy even if it derives from individual psychotherapy. Adolescent group psychotherapy is currently accepted as one of the most important therapeutic modalities although it is not highlighted as same as adult group psychotherapy. Group therapy is the most desirable therapeutic method for adolescents because they go through a transitional critical time for change and they are especially affected by peer group.
Adolescent* ; Adult ; Catharsis ; Confidentiality ; Consciousness ; Humans ; Inpatients ; Korea ; Learning ; Organization and Administration ; Outpatients ; Peer Group ; Problem Solving ; Psychoanalytic Theory ; Psychotherapy ; Psychotherapy, Group* ; Sensitivity Training Groups ; Social Welfare

OBJECTIVES: This study is designed to develop a large group phychodrama for light delin-quent adolescents (hereinafter called as "Psychodrama") thereby determining therapeutic factors for dealing with them. METHODS: The study was conducted in the program of Seoul Metropolitan Youth Centre called "the class of love" during the period of July through December, 1998. The subjects consisted of a total of 827 young delinquents (759 boys and 68 girls, with the average age of 15.9 years old). To develop "this psychodrama", after we composed of therapeutic team centered by psychiatrists, we prepared from January to June, 1998 by practicing psychodrama with delinquent adolescents and by analyzing the results. "This psychodrama" has three basic steps: (1) warming-up (small group me-eting), (2) action (situation drama and main drama), (3) sharing. A survey of treatments, from a pool of participating adolescents, based on evaluation sheets and 13 therapeutic factors scale followed every session of this psychodrama. RESULTS: "This psychodrama" was helpful for 47.4%, interesting for 49.2%, not helpful for 12.1% and not interesting for 16%. In the whole group of subjects, the important therapeutic factors were existential factor, universality, identification with the therapist and the instillation of hope in the order of rank. When categorized in four different groups (audience, participants in situation drama, auxiliary egos, participants in sharing) the 4 groups displayed different results to one another. First, the therapeutic factors of audience were similar to that of the whole group. Second, participants in situation drama showed a higher catharsis than others. Third, auxiliary egos were leading in the guidance of members and therapists. Fourth, participants in sharing displayed higher group cohesiveness. CONCLUSION: As it is getting harder to find program's suitable for the treatment of increasing number of delinquents due to limited budget and experts, this psychodrama could be more cost-effective than any other measures.
Adolescent* ; Budgets ; Catharsis ; Drama ; Ego ; Female ; Hope ; Humans ; Psychiatry ; Psychodrama* ; Seoul

PURPOSE: We investigated the statistical methods to compose the functional brain map of human working memory and the principal factors that have an effect on the methods for localization. MATERIALS AND METHODS: Repeated PET scans with successive four tasks, which consist of one control and three different activation tasks, were performed on six right-handed normal volunteers for 2 minutes after bolus injections of 925 MBq H0 at the intervals of 30 minutes. Irnage data were analyzed using SPM96 (Statistical Parametric Mapping) imple-mented with Matlab (Mathworks Inc., U.S.A.). Images from the same subject were spatially registered and were normalized using linear and nonlinear transformation methods. Significant difference between control and each activation state was estimated at every voxel based on the general linear model. Differences of global counts were removed using analysis of covariance (ANCOVA) with global activity as covariate. Using the mean and variance for each condition which was adjusted using ANCOVA, t-statistics was performed on every voxel To interpret the results more easily, t-values were transformed to the standard (saussian distri-bution (Z-score). RESULTS: All the subjects carried out the activation and control tests successfully. Average rate of correct answers was 95%. The numbers of activated blobs were 4 for verbal memory I, 9 for verbal memory II, 9 for visual memory, and 6 for canjunctive activation of these three tasks. The verbal working memory activates predominantly left-sided slruetures, and the visual memory activates the right hernisphere. CONCLUSION: We conclude that rCBF PET imaging and statistical parametric mapping method were useful in the localization of the brain regions for verbal and visual working memory.
Brain Mapping* ; Brain* ; Electrons* ; Healthy Volunteers ; Humans ; Linear Models ; Memory ; Memory, Short-Term ; Positron-Emission Tomography*

PURPOSE: This study was performed to examine if CT classification of renal blunt injury could aid in expectation of hemodynamic stability and clinical decision of whether to intervene surgically. MATERIALS AND METHODS: Over a 80-month period between July 1987 and March 1994, 41 patients were admitted to our hospital with the diagnosis of renal blunt injury. The renal blunt injuries were classified on Fedede's three-point scale CT classification methods :grade I, contusion, intrarenal hematoma, segmental infarction, and small subcapsular hematoma;grade II, complete or incomplete laceration, large subcapsular hematoma, and renal fracture;grade Ill, shattered kidney and renal pedicle injury. Hemodynamic stability, treatment method and clinical outcome of the patients with different CT grade were analyzed retrospectively. RESULTS: All 34 patients with grade I or II CT findings were hemodynamically stable and were successfully managed with conservative method. Among 7 patients with grade III CT findings, 6 patients were hemodynamically unstable. Out of the 6, One patient with grade IIIb or renal pedicle injury was expired before surgical intervention due to ischemic shock. Four patients were intervened surgically with one failure to thrive. The remaining one patient refused to be intervened surgically, and was discharged against medical advice. Only one out of 7 patients was hemodynamically stable and was managed conservatively. CONCLUSION: The patients with grade I or II CT findings are prone to be hemodynamically stable and to be managed with conservative method. But the patients with grade III CT findings are more likely to be hemodynamically unstable. Therefore patients with grade III CT findings should be closely monitored and be pre- pared for the possibility of immediate surgical intervention
Classification* ; Contusions ; Diagnosis ; Failure to Thrive ; Hematoma ; Hemodynamics ; Humans ; Infarction ; Kidney ; Lacerations ; Retrospective Studies ; Shock ; Wounds, Nonpenetrating

No abstract available.
Antibodies* ; Coxiella burnetii* ; Coxiella* ; Korea* ; Prevalence* ; Q Fever*

Because most of modern peoples are busy with many their task according to specialization and complexity of society, it is impportant to determine optimal and comfortable time of colonoscopy. So this study was designed to compare efficacy of colonic cleansing and patient acceptance according to the time of colonoseopy. Among 140 peoples who underwent colonoscoyy in Busan St. Benedict Hospital between March 1995 to August 1995, two groups of 70 peoples were randomly assigned to undergo colonoscopy either at A.M. or ~P.M. The results were as follows: 1) In view of efficacy rate of colonic cleansing, the group at P.M, was superior to the group at A.M.. 2) In view of patients acceptance and side effects, the group at P.M. showed better acceptance and less side effects than the group at A.M.. In conclusion, this study showed that the colonoscopy at P.M. is better than at A.M., especially when patient is poor systemic condition or low acceptance to colonoscopic cleansing preparation. However, it may be also acceptable undergoing colonoscopy at A.M. if patient condition is good and patient is busy with his task.
Busan ; Colon* ; Colonoscopy* ; Humans ; Prospective Studies*

A survey was conducted to study perception and attitudes of health workers towards health centers activities and organization of health services, from August 15 to September 30, 1994. The study population was 310 health workers engaged in seven urban health centers in Taegu City area. A questionnaire method was used to collect data and response rate was 81.3 percent or 252 respondents. The following are summaries of findings: Profiles of study population: Health workers were predomina1itly female(62.3%); had college education(60. 3%); 'and held medical and nursing positions(39.6%), technicians(30.6%) and. public health/administrativc positions(29.8%). Perceptions on health center's resources: Slightly more than a half(51.1%) of respondents expressed that physical facilities of the centers are inadequate; equipments needed are short(39.0%); human resource is inadequate(44.8%); and health budget allocated is insufficient(38.5%) to support the performance of health center's activities. Decentralization and health services: The majority revealed that the decentralization of government system would affect the future activities of health centers(51.9%) which may have to change. However, only one quarter of respondents(25.4%) seemed to view the decentralization positively as they expect that it would help perform health activities more effectively. The majority of the respondents(78.6%) insisted that the function and organization of the urban health centers should be changed. Target workload and job satisfaction: A large proportion (43.3%) of respondents felt that present target setting systems for various health activities are unrealistic in terms of community needs and health center's situation while only 11.1 percent responded it positively; the majority(57.5%) revealed that they need further training in professional fields to perform their job more effectively; more than one third(35.7%) expressed that they enjoy their professional autonomy in their job performance; and a considerable proportion (39.3%) said they are satisfied with their present work. Regarding the personnel management, more worker (47.3%) perceived it negatively than positive(11.5%) as most of workers seemed to think the personnel management practiced at the health centers is not fair or justly done. Health services rendered: Among health services rendered, health workers perceived the following services are most successfully delivered; they are, in order of importance, Th controi, curative services, and maternal and child health care. Such areas as health education, oral health, environmental sanitation, and integrated health services are needed to be strengthening. Regarding the community attitudes towards health workers, 41.3 percent of respondents think they are trusted by the community they serve. New areas of concern identified which must be included in future activities of health centers are, in order of priority, health care of elderly population, home health care, rehabilitation services, and such chronic diseases control programs as diabetes, hypertension, school health and mental health care. In conclusion, the study revealed that health workers seemed to have more negative perceptions and attitudes than positive ones towards organization and management of health services and activities performed by the .urban health centers where they are engaged. More specifically, the majority of health workers studied revealed to have the following areas of health center's organization and management inadequate or insufficient to support effective performance of their health activities: Namely, physical facilities and equipments required are inadequate; human and financial resources are insufficient; pefsonnel management is unsatisfactory; setting of service target system is unrealistic in terms of the community needs. However, respondents displayed a number of positive 'perceptions, particularly' to those areas as further training needs 'and implementation of decentralization of government system which will bring more autonomy of local government as they perceived these change would bring the necessary changes to future activities of the health center. They also displayed positive perceptions in their job autonomy and have job satisfactions.
Aged ; Budgets ; Child ; Child Health ; Chronic Disease ; Daegu ; Surveys and Questionnaires ; Delivery of Health Care ; Health Education ; Health Priorities ; Health Services ; Humans ; Hypertension ; Job Satisfaction ; Local Government ; Mental Health ; Nursing ; Oral Health ; Personnel Management ; Politics ; Professional Autonomy ; Rehabilitation ; Sanitation ; School Health Services ; Urban Health*