INTRODUCTION: There has been an increasing interest in the relationship between sleep and suicidality. In addition, suicidal patients habitually report their sleep problems. Although sleep-related complaints and electroencephalographic changes are generally encountered in psychiatric disorders, sleep complaints such as insomnia, hypersomnia and nightmares are more common in suicidal patients. In current study, we aimed at investigating the relationship between self-reported sleep duration and suicidality in general population. METHODS: One thousand general population (male : female=500 : 500, mean age=39.6+/-11.6 years, ranged age=20-77 years) completed Center for Epidemiologic Study-Depression (CES-D), Beck Suicide Intent scale (BSI), Spielberger State-Trait Anger Expression Inventory (STAXI), Barratt Impulsiveness Scale (BIS), Morningness-Eveningness Scale (MES) and brief questionnaire of sleep habits. RESULTS: After controlling for age and sex, score of BSI was correlated positively with the score of CES-D, STAXI and BIS on partial correlation analysis (r(p)=0.251 ; p<0.001, r(p)=0.352 ; p<0.001, and r(p)=0.175 ; p<0.001, respectively). In addition, score of BSI was inversely correlated with the score of MES (r(p)=-0.066; p=0.037). However, score of BSI showed no significant correlation with sleep duration. However, regression analysis revealed that short (<6 hrs) or long (>10 hrs) sleep duration, the family history of psychiatric illness, the score of CES-D, and the score of STAXI predicted higher score of BSI significantly in total subjects (F=17.837, adjusted R2 =0.166 ; p=0.003, p=0.003, p<0.001, and p=0.003, respectively). This model was explained better in depressed subjects with 16 or higher score of CES-D (F=9.920, adjusted R2=0.298). CONCLUSION: Current result suggested that not only short sleep duration (<6 hrs) but also long sleep duration (>10 hrs) might be related to suicidality.
Anger ; Depression ; Disorders of Excessive Somnolence ; Dreams ; Humans ; Surveys and Questionnaires ; Republic of Korea ; Sleep Initiation and Maintenance Disorders ; Suicide

OBJECTIVES: Working at other times than the regular day shift has been reported to be a stressor associated with health consequences and mental disorders as well as disturbance of sleep. In current study, we aimed at investigating the relationship between work schedule, sleep quality and depression among police officers. METHODS: Eleven hundreds and forty five police officers (male:1040, female:105) completed questionnaires of basic socio-demographic data, Pittsburgh Sleep Quality Index (PSQI), Korean Scale of Occupational Stress (KOSS), Impact of Event Scale - Revised (IES-R) and Center for Epidemiologic Study-Depression (CES-D). RESULTS: After controlling for age, sex and educational level, score of CES-D was correlated positively with the score of KOSS, PSQI and IES-R on partial correlation analysis (r=-0.077;p=0.009, r=0.262;p<0.000 and r=0.421, p<0.000, respectively). Logistic regression analysis revealed that female sex, age, the score of KOSS and IES-R and schedule of rotating shift work predicted higher score than 16 score of CES-D significantly in total subjects (p=0.023, p=0.015, p=0.000, p=0.000 and p=0.022, respectively). CONCLUSION: Current result suggested that not only female sex, age, higher occupational stress and impact of event scale but also rotating shift work schedule might be related to depression among police officers.
Appointments and Schedules ; Depression ; Female ; Humans ; Logistic Models ; Mental Disorders ; Police ; Surveys and Questionnaires ; Risk Factors

The Dandy-Wlaker syndrome is a developmental disoeder characterized by cystic dilatation of the fourth ventricle and agenesis or hypoplasia of the cerebellar vermis and is usually associated with hydrocephalus. This syndrome is also associated with intracranial malformations such as agenesis of corpus callosum, and extracranial malformations such as facial anormalies (cleft palate, cleft lip, and ocular anomalies), polycystic kidney, and cardiac anormalies. Reported associated ophthalmic anomalies are microphthalmos, coloboma, and congenital cataract.We experienced a case of infantile esotropia in abnormal insertion and direction of lateral rectus muscle as a variant of the Dandy-Walker syndrome accompanied by cleft palate and cleft lip in a 19-month-old male infant. Subsequent treatment of the 30delta esodeviation and left inferior oblique muscle overaction, including resection of the lateral rectus muscle in both eyes and the myectomy of the inferior oblique muscle in the left eye, yielded satisfactory results, so we report this case, with a review of the pertinent literature, as the first case of Dandy-Walker syndrome associated with esotropia with abnormal course of lateral rectus muscle in Korea.
Agenesis of Corpus Callosum ; Cleft Lip ; Cleft Palate ; Coloboma ; Dandy-Walker Syndrome* ; Dilatation ; Esotropia* ; Fourth Ventricle ; Humans ; Hydrocephalus ; Infant ; Korea ; Lip ; Male ; Microphthalmos ; Polycystic Kidney Diseases

Leiomyomas of vagina and vulva are rare solid tumors, but most common mesenchymal tumors in adult woman. Most of the reported cases have been benign. The tumors were firm, well-defined submucosal masses in a majority of patients. We experienced two cases of vulvar and vaginal leiomyoma, thus it is presented with a brief review of the cases and its literatures.
Adult ; Female ; Humans ; Leiomyoma* ; Vagina* ; Vulva*

Kawasaki disease (KD) is an acute systemic vasculitis of unknown etiology. We report a case of KD with acute respiratory distress syndrome (ARDS) after intravenous immunoglobulin (IVIG) infusion. Lung manifestations associated with KD have previously been reported in the literature. Although IVIG infusion is an effective therapy for acute KD, there are some reported complications related to IVIG infusion: hypotension, aseptic meningitis, acute renal failure, hemolytic anemia, etc. The case of KD reported here was treated with IVIG and aspirin. A few days after recovery from KD, the patient developed fever and maculopapular rash. A diagnosis of relapse KD was made and retreated with IVIG infusion. However, the patient developed ARDS four days after the second IVIG infusion. The patient recovered from ARDS after nine days of ICU care, which included high frequency oscillation ventilation with inhaled nitric oxide, steroid treatment and other supportive care.
Acute Kidney Injury ; Anemia, Hemolytic ; Aspirin ; Diagnosis ; Exanthema ; Fever ; High-Frequency Ventilation ; Humans ; Hypotension ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Lung ; Meningitis, Aseptic ; Mucocutaneous Lymph Node Syndrome* ; Nitric Oxide ; Recurrence ; Respiratory Distress Syndrome, Adult* ; Systemic Vasculitis

BACKGROUND: Various tools for the acute response system (ARS) predict and prevent acute deterioration in pediatric patients. However, detailed criteria have not been clarified. Thus we evaluated the effectiveness of bradycardia as a single parameter in pediatric ARS. METHODS: This retrospective study included patients who had visited a tertiary care children's hospital from January 2012 to June 2013, in whom ARS was activated because of bradycardia. Patient's medical records were reviewed for clinical characteristics, cardiologic evaluations, and reversible causes that affect heart rate. RESULTS: Of 271 cases, 261 (96%) had ARS activation by bradycardia alone with favorable outcomes. Evaluations and interventions were performed in 165 (64.5%) and 13 cases (6.6%) respectively. All patients in whom ARS was activated owing to bradycardia and another criteria underwent evaluation, unlike those with bradycardia alone (100.0% vs. 63.2%, p = 0.016). Electrocardiograms were evaluated in 233 (86%) cases: arrhythmias were due to borderline QT prolongation and atrioventricular block (1st and 2nd-degree) in 25 cases (9.2%). Bradycardia-related causes were reversible in 202 patients (74.5%). Specific causes were different in departments at admission. Patients admitted to the hemato-oncology department required ARS activation during the night (69.3%, p = 0.03), those to the endocrinology department required ARS activation because of medication (72.4%, p < 0.001), and those to the gastroenterology department had low body mass indexes (32%, p = 0.01). CONCLUSIONS: Using bradycardia alone in pediatric ARS is not useful, because of its low specificity and poor predictive ability for deterioration. However, bradycardia can be applied to ARS concurrently with other parameters.
Arrhythmias, Cardiac ; Atrioventricular Block ; Body Mass Index ; Bradycardia* ; Electrocardiography ; Endocrinology ; Gastroenterology ; Heart Arrest ; Heart Rate ; Hospital Rapid Response Team ; Humans ; Medical Records ; Pediatrics ; Retrospective Studies ; Sensitivity and Specificity ; Tertiary Healthcare

No abstract available.
Cicatrix* ; Endometriosis* ; Female

No abstract available.
Cicatrix* ; Endometriosis* ; Female

Myofibroblasts are mesenchymal spindle cells that share morphologic and functional features with fibroblasts and smooth muscle cells, especially in relation to matrix production and contractility. Myofibroblastic sarcomas have been described recently and such lesions are relatively rare and almost unknown, especially developed in the skin. Most examples of myofibrosarcoma occur de novo. We herein report a case of solitary myofibrosarcoma occurred after several laser and pharmacological treatment of a wart. A 28-year-old woman had a 10-month history of small firm painless papule on the lower margin of her nostril. Her lesion was once treated with laser at a local clinic. At first visit to our hospital, the lesion was 0.4 x 0.3 cm solitary skin colored keratotic flat papule and it was diagnosed as a wart and ablated with carbon dioxide laser. Two subsequent recurrences occurred within 6 months and repeatedly ablated with the same laser. One year later the patient appeared with 1.5 x 1.5 cm pale red rubbery-firm nodule on the same site. On punch biopsy, it showed thickened collagen with mild inflammatory infiltrate. We performed intra-lesional triamcinolone injection every three weeks under the impression of hypertrophic scar after the wart removal, and no improvement was made and the lesion's growth was accelerated. On exicisional biopsy of lesion, a myofibroblastic tumor of uncertain malignant potential was suggested and subsequent wide excision and lateral lip advancement flap was done. The patient has been free of recurrence 14 months after wide excision. This report emphasizes the possibility that iatrogenic manipulation of the normal wound healing process may well contribute to the development of myofibrosarcoma.
Adult ; Biopsy ; Cicatrix, Hypertrophic ; Collagen ; Female ; Fibroblasts ; Humans ; Lasers, Gas ; Lip ; Myocytes, Smooth Muscle ; Myofibroblasts ; Recurrence ; Sarcoma ; Skin ; Triamcinolone ; Warts* ; Wound Healing

BACKGROUND: In cardiac arrest, the survival rate increases with the provision of bystander cardiopulmonary resuscitation (CPR), of which the initial response and treatment are critical. Telephone CPR is among the effective methods that might increase the provision of bystander CPR. This study aimed to describe and examine the improvement of neurological outcomes in individuals with out-of-hospital acute cardiac arrest by implementing the nationwide, standardized telephone CPR program. METHODS: Data from the emergency medical service-based cardiac arrest registry that were collected between 2009 and 2014 were used. The effectiveness of the intervention in the interrupted time-series study was determined via a segmented regression analysis, which showed the risk ratio and risk difference in good neurological outcomes before and after the intervention. RESULTS: Of 164,221 patients, 148,403 were analyzed. However, patients with unknown sex and limited data on treatment outcomes were excluded. Approximately 64.3% patients were men, with an average age of 63.7 years. The number of bystander CPR increased by 3.3 times (95% confidence interval [CI], 3.1–3.5) after the intervention, whereas the rate of good neurological outcomes increased by 2.6 times (95% CI, 2.3–2.9 [1.6%]; 1.4–1.7). The excess number was identified based on the differences between the observed and predicted trends. In total, 2,127 cases of out-of-hospital cardiac arrest (OHCA) after the intervention period received additional bystander CPR, and 339 cases of OHCA had good neurological outcomes. CONCLUSION: The nationwide implementation of the standardized telephone CPR program increased the number of bystander CPR and improved good neurological outcomes.
Cardiopulmonary Resuscitation* ; Emergencies ; Heart Arrest ; Humans ; Male ; Odds Ratio ; Out-of-Hospital Cardiac Arrest* ; Survival Rate ; Telephone*