Korea has the highest suicide rate amongst the OECD countries. Yet, its research on suicidal behaviors has been primitive. While the Interpersonal Psychological Theory of Suicide has gained global attention, there has only been a few researches, which examined its applicability in Korea. In this article, we review the previous studies on suicide and examine the association between the Interpersonal Psychological Theory of Suicide and traditional Korean culture, with an emphasis on Collectivism and Confucianism. We propose that pathways to suicide might vary depending on cultural influences. Clinical implications and suggestions for future research will be discussed.
Confucianism ; Korea* ; Organisation for Economic Co-Operation and Development ; Psychological Theory* ; Suicide*

Objective: Patients with post-traumatic stress disorder (PTSD) showed inconsistencies in their cortisol level, an index of the hypothalamic-pituitary-adrenal axis function. This study examined the relationship between dissociation, childhood trauma, and morning cortisol levels in PTSD patients. Methods: This study included 69 (23 males and 46 females) patients and 82 (22 males and 60 females) healthy controls (HCs). Clinical assessments, including the Childhood Trauma Questionnaire (CTQ) and Peri-traumatic Dissociative Experiences Questionnaire scores, and morning cortisol levels were evaluated. The morning cortisol levels were compared between PTSD with high dissociation and low dissociation (PTSD-LD) groups. The effect of CTQ subtype on morning cortisol levels was analyzed. Results: The PTSD with high dissociation group showed significantly lower cortisol levels than that of the PTSD-LD and HC groups. A significant inverse correlation was found between cortisol levels and dissociation. A significant positive correlation was found between dissociation and physical abuse and sexual abuse scores. Morning cortisol levels showed a significant positive correlation with emotional abuse, emotional neglect, and physical neglect, respectively. There was no moderating or mediating effect of CTQ on the relationship between cortisol level and dissociation. Conclusion These findings suggest that dissociation is a significant factor related to hypocortisolism in PTSD patients.Additionally, basal morning cortisol levels and dissociation scores were closely associated with childhood trauma.

Cushing disease in children and adolescents, especially with multiple pituitary adenomas (MPAs), is very rare. We report 17-year-old boy with MPAs. He presented with a vertebral compression fracture, weight gain, short stature, headache, and hypertension. On magnetic resonance imaging (MRI), only a left pituitary microadenoma was found. After surgery, transient clinical improvement was observed but headache and hypertension were observed again after 3 months later. Follow-up MRI showed a newly developed right pituitary microadenoma 6 months after the surgery. The need for careful clinical and radiographic follow-up should be emphasized in the search for potential MPAs in patients with persistent Cushing disease.
Adolescent* ; Child ; Follow-Up Studies ; Fractures, Compression* ; Headache ; Humans ; Hypertension ; Magnetic Resonance Imaging ; Male ; Pituitary ACTH Hypersecretion* ; Pituitary Neoplasms* ; Weight Gain

Spinal dural arteriovenous fistula (SDAVF) is rare but still the most commonly encountered vascular malformation of the spinal cord. A 31-year-old male developed gait disturbance due to weakness of his lower extremities, voiding difficulty and sexual dysfunction with a progressive course since 3 months. He showed areflexia in both knees and ankles. Electromyographic findings were suggestive of multiple root lesions involving bilateral L2 to S4 roots of moderate degree. Magnetic resonance images showed high signal intensity with an ill-defined margin in T2-weighted images and intensely enhanced by a contrast agent through the lumbosacral spinal cord. Selective spinal angiography confirmed a dural arteriovenous fistula with a nidus at the L2 vertebral level. After selective endovascular embolization, his symptoms drastically improved except sexual dysfunction. We report a rare case of cauda equina syndrome due to spinal arteriovenous fistula with drastic improvement after endovascular embolization.
Adult ; Angiography ; Animals ; Ankle ; Arteriovenous Fistula ; Cauda Equina ; Central Nervous System Vascular Malformations ; Gait ; Humans ; Knee ; Lower Extremity ; Magnetic Resonance Spectroscopy ; Male ; Polyradiculopathy ; Spinal Cord ; Vascular Malformations

Carney complex is an autosomal dominant disease that displays such characteristic features as cardiac and cutaneous myxomas and spotty pigmentation of the skin. We report here on a case of Carney complex that was accompanied by increased myxoid fibroadenomas in the breast and multiple intracranial aneurysms.
Adult ; Breast Neoplasms/*complications/diagnosis ; Female ; Fibroadenoma/*complications/diagnosis ; Humans ; Intracranial Aneurysm/*complications ; Magnetic Resonance Imaging ; Pigmentation Disorders/*complications ; Syndrome

Acute epiglottitis is a life threatening inflammatory disease of the upper airway mainly in children, however, the recent reports about acute epiglottitis in adults are increasing. The common symptoms are sore throat, dysphagia, dyspnea and salivary drooling. As the laryngeal edema progresses, the patient sits up, leans forward, with the chin thrust forward, having obvious difficulty breathing. Early recognition and proper airway maintenance until the inflammatory edema subsides are essential steps to avoid a possible life threatening upper airway obstruction. We experienced two cases of acute epiglottitis with sitting up position, chin thrust forward, having dyspnea.
4-Acetamido-4'-isothiocyanatostilbene-2,2'-disulfonic Acid ; Adult ; Airway Obstruction ; Child ; Chin* ; Deglutition Disorders ; Dyspnea* ; Edema ; Epiglottitis* ; Humans ; Laryngeal Edema ; Pharyngitis ; Respiration ; Sialorrhea

BACKGROUND: Intravascular ultrasound(IVUS) provides high resolution cross-sectional images of the vessels and permits the quantiative and qualitative assessment of coronary artery disease. Stent is a figid endovascular lattice that effectively prevents elastic recoil at treated sites, but in-stent restenois is a major limitation. The purpose of thecurrent study is to assess the contribution of neointimal hyperplasia for in-stent restenosis and the distribution and morphological characteristics of neointimal hyperplasia in deployed stents. METHODS: Thirty patients(male 25 & female 5;31 leions) deployed with intracoronary stents underwent intravascular ultrasound imaging at follow-up at least 4 months after stenting ([mean+/-SD] 8.3+/-2.9 months). RESULTS: 1) In-stent restenosis occurered in 15 lesions out of 31 lesions at follow-up coronary angiography. There was no difference in clinical characteristics between the restenotic and the non-restenotic groups. 2) There was no difference in angiographic profiles between two groups. Deployed stents were as follows ; 16 Palmaz-Schatz(P-S) stents, 12 Gianturco-Roubin(G-R) stents, 2 Cordis stents, and I Microstent II. Average diameter of stents in the restenotic and the non-restenotic groups were 3.07+/-0.26mm and 3.16+/-0.30mm, respectively(p=0.38). 3) There was no difference of stent cross-sectional areas(CSA) between the non-restenotic and the restenotic groups(p=0.476), but luminal CSA of the restenotic group was significantly smaller than that of the non-restenotic group(p=0.006). 4) In the restenotic group, there were no differences of the maximal and the minimal diameters of stents, and the mean CSAs of stents smong proxiaml, mid and distal segments. But the mean CSA of neointimal hyperplasia at the mid segment was larger than that at the distal segment(p<0.05). There was a tendency thatthe mean CSA of neointimal hyperplasia at the mid segment was larger than that at the proximal segment(p=0.187). These findings were the same in the non-restenotic group. 5) In the restenotic group deployed with P-S stents, there were no differences of the maximal and the minimal diameters of stents, and the mean cross-sectional areas(CSA) of stents between each segment. But, the mean CSA of neointimal hyperplasia at the mid segment was larger than that at the distal segment(p<0.005) and there was a tendency that the mean CSA of neointimal hyperplasia at the mid segment was larger than that at the proximal segment(p=0.354). 6) In the morphology of neointimal hyperplasia of the restenotic group, eccentric form(77%) was more common than concentric form(22%). Neointimal hyperplasia occurred in focal or diffuse patterns(7 versus 8 cases). CONCLUSIONS: In-stent restenosis resulted from neointimal hyperplasia which almost mainly occurred eccentrically at the mid segment of stents and in focal or diffuse patterns. Intravascular ultrasound imaging was a useful method for recognition of distribution and morphological characteristics of neointimal hyperplasia at follow-up of deployed stents.
Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels* ; Female ; Follow-Up Studies ; Humans ; Hyperplasia* ; Phenobarbital ; Stents* ; Ultrasonography*

This study sought to demonstrate bone mineral density (BMD) conditions in elderly female patients with knee osteoarthritis (OA) undergoing total knee arthroplasty (TKA). In addition, we sought to determine whether their BMD conditions differ from those of community-based females without knee OA. Finally we sought to determine whether clinical statuses are related to BMD in the knee OA patients. BMD conditions in 347 female patients undergoing TKA and 273 community-based females were evaluated. Additionally, comparative analyses of BMD between age and body mass index-matched knee OA groups (n=212) and the control groups (n=212) were performed. In the pre-matched knee OA group, regression analyses were performed to determine whether preoperative clinical statuses were related to BMD. Considerable prevalence of coexistent osteoporosis (31%) was found in the pre-matched knee OA patients undergoing TKA. We found no significant differences of the BMD T-scores and the prevalence of osteoporosis between the age and body mass index-matched knee OA and control groups. In the pre-matched knee OA patients, poorer preoperative clinical scores were related to poorer BMD T-scores in the proximal femur and/or lumbar spine. Our study suggests that more attention should be paid to identify and treat osteoporosis in elderly female patients with advanced knee OA undergoing TKA.
Aged ; Aged, 80 and over ; *Arthroplasty, Replacement, Knee ; Body Mass Index ; Bone Density ; Female ; Humans ; Knee Joint/pathology/surgery ; Osteoarthritis, Knee/*epidemiology/*surgery ; Osteoporosis/*epidemiology

Background: The existing literature has comprehensively examined the benefits of specialized wound-care services and multidisciplinary team care. However, information on the development and integration of wound-dressing teams for patients who do not require specialized wound care is scarce. Therefore, the present study aimed to elucidate the benefits of a wound-dressing team by reporting our experiences with the establishment of a wounddressing team. Methods: The wound-dressing team was established at Korea University Guro Hospital.Between July 2018 and June 2022, 180,872 cases were managed for wounds at the wounddressing team. The data were analyzed to assess the types of wounds and their outcomes.In addition, questionnaires assessing the satisfaction with the service were administered to patients, ward nurses, residents/internists, and team members. Results: Regarding the wound type, 80,297 (45.3%) were catheter-related, while 48,036 (27.1%), 26,056 (14.7%), and 20,739 (11.7%) were pressure ulcers, dirty wounds, and simple wounds, respectively. In the satisfaction survey, the scores of the patient, ward nurse, dressing team nurse, and physician groups were 8.9, 8.1, 8.2, and 9.1, respectively.Additionally, 136 dressing-related complications (0.08%) were reported. Conclusion The wound dressing team can enhance satisfaction among patients and healthcare providers with low complications. Our findings may provide a potential framework for establishing similar service models.

OBJECTIVE: This study evaluated the psychometric properties of the Korean Anxiety Screening Assessment (K-ANX) developed for screening anxiety disorders. METHODS: Data from 613 participants were analyzed. The K-ANX was evaluated for reliability using Cronbach’s alpha, item-total correlation, and test information curve, and for validity using focus group interviews, factor analysis, correlational analysis, and item characteristics based on item response theory (IRT). The diagnostic sensitivity and specificity of the K-ANX were compared with those of the Beck Anxiety Inventory (BAI) and Generalized Anxiety Disorder 7-item scale (GAD-7). RESULTS: The K-ANX showed excellent internal consistency (α=0.97) and item-total coefficients (0.92–0.97), and a one-factor structure was suggested. All items were highly correlated with the total scores of the BAI, GAD-7, and Penn State Worry Questionnaire. IRT analysis indicated the K-ANX was most informative as a screening tool for anxiety disorders at the range between 0.8 and 1.6 (i.e., top 21.2 to 5.5 percentiles). Higher sensitivity (0.795) and specificity (0.937) for identifying anxiety disorders were observed in the K-ANX compared to the BAI and GAD-7. CONCLUSION: The K-ANX is a reliable and valid measure to screen anxiety disorders in a Korean sample, with greater sensitivity and specificity than current measures of anxiety symptoms.
Anxiety Disorders* ; Anxiety* ; Focus Groups ; Mass Screening* ; Psychometrics ; Sensitivity and Specificity