Gender identity disorders are characterized by strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex), as well as a persistent discomfort with one's sex or sense of inappropriateness in the gender role of that sex. There are no well-established or exhaustive explanations for the development of gender identity disorder. Gender identity appears to be established and influenced by psychosocial factors during the first few years of life. However, many authors have argued for biological factors, if not causative, may predispose an individual to a gender identity disorder. Because most gender dysphoric individuals have adamant requests for sex reassignment (many often already taking opposite-sex hormones supplied by other physicians), it is extremely difficult to engage the patients in treatment with anything other than surgical reassignment as the goal. However, because surgery is irreversible, it is important to engage these patients in psychotherapy, even if surgery is indicated. The therapist should be careful to base the goals of therapy on what is desired by the patient. Behavior therapy has been used to modify specific cross-gender behaviors of child with gender identity disorder.
Behavior Therapy ; Biological Factors ; Child ; Diagnosis ; Gender Identity* ; Humans ; Psychology ; Psychotherapy

No abstract available.
Antipsychotic Agents* ; Drug Synergism* ; Humans ; Schizophrenia*

The incidence and etiology of parasite-associated gastroenteritis during 2004-2006 in Gyeonggi-do (province), South Korea was determined by means of antigen detection ELISA on 6,071 stool specimens collected from 6 general hospitals. At least 1 parasitic agent was detected in 3.4% (208/6,071) of the stool samples. Among these, Giardia lamblia was the most numerous (152 cases; 2.5%), followed by Entamoeba histolytica (25 cases; 0.4%), Cryptosporidium parvum (23 cases; 0.4%), and mixed infections (8 cases; 0.1%). Patients aged 1-5 years had the largest proportion (69.2%; 144/208) of parasite-positive stool specimens. Parasite-mediated gastroenteritis was most common from June to September. The detection rate gradually increased from 2004 to 2006. This study shows that parasite-mediated gastroenteritis may be significant among children in Korea and that parasite infection surveillance should be constantly performed.
Adolescent ; Adult ; Age Distribution ; Animals ; Child ; Child, Preschool ; Data Collection ; Eukaryota/*isolation & purification ; Feces/parasitology ; Gastroenteritis/*epidemiology/parasitology ; Humans ; Infant ; Protozoan Infections/*epidemiology/parasitology ; Republic of Korea/epidemiology ; Seasons ; Young Adult

BACKGROUND: Hepatocyte growth factor (HGF) is a potent mitogenic cytokine. C-met protein, which is known to be the HGF receptor has transmembrane tyrosine kinase activity and is encoded by the c-met oncogene. The HGF/c-met signaling pathway may play various roles in the carcinogenesis of various organs. METHODS: We examined HGF and c-met mRNA expression by utilizing reverse transcription polymerase chain reaction on 40 surgically resected intracranial meningiomas (25 benign, 10 atypical, and 5 anaplastic cases). RESULTS: An HGF overexpression was detected in 28%, 50%, and 80% of the benign, atypical and anaplastic meningiomas, respectively; a high expression of HGF or the coexpression of HGF/c-met was detected in the high grade meningiomas (the atypical and anaplastic cases, p=0.046, p=0.014). An HGF expression was statistically significant in the recurrent meningiomas (p=0.003), and HGF expression was significantly lower than c-met mRNA expression in benign meningiomas (p=0.034). CONCLUSIONS: There was no correlation between histologic subtypes and HGF/c-met expression. Determination of HGF expression can be used as a molecular predictor for recurrence of meningioimas. These results suggest that HGF and c-met expression in meningiomas may be associated with anaplastic progression.
Hepatocyte Growth Factor ; Hepatocytes ; Meningioma ; Neoplasm Recurrence, Local ; Oncogenes ; Polymerase Chain Reaction ; Protein-Tyrosine Kinases ; Proto-Oncogene Proteins c-met ; Recurrence ; Reverse Transcription ; RNA, Messenger

Insomnia is one of the most common sleep disorders, which is leading to significant clinical distress and impairment of daytime functioning and decreasing quality of life. This article reviews the current clinical treatment options of insomnia. Non-pharmacological treatment including stimulus control, sleep restriction, cognitive therapy, relaxation training, and education of sleep hygiene should be considered first for treatment of insomnia. Psychological and behavioral interventions tend to have longer-lasting treatment benefits, while drugs show immediate improvement of sleep disturbance. In pharmacotherapy, benzodiazepine receptor agonist, melatonin receptor antagonist, and 'off-label' drugs to treat insomnia are reviewed.
Behavior Therapy ; Cognitive Therapy ; Drug Therapy ; Quality of Life ; Relaxation ; Sleep Initiation and Maintenance Disorders* ; Sleep Wake Disorders

OBJECTIVES: The aim of this study was to identify influences of stress, anxiety, depression, and personality trait on nausea, vomiting, and retching of breast cancer patients perceiving chemotherapy. METHODS: Breast cancer patients who were admitted to Ewha Womans University Cancer Center for women to receive chemotherapy participated in the study. In addition to sociodemographic and clinical factors, self-reported questionnaires, including Type D personality Scale 14, Hospital Anxiety and Depression Scale, and Global Assessment of Recent Stress scale were used to evaluate psychological factors of the subjects. For examination of anticipatory and post chemotherapy nausea, vomiting, and retching, the subjects filled out the Rhodes Index of Nausea, Vomiting, and Retching and Visual Analogue Scale. RESULTS: No significant influence of type D personality, anxiety, or depression on nausea, vomiting, and retching was observed. If the patient experienced more severe stress, higher scores for anticipatory and post chemotherapy nausea, vomiting, and retching were recorded. The tendency was retained after adjusting for the cycle number of chemotherapy, the emetic risk of the chemotherapy regimen, type D personality, anxiety, and depression. Specifically, financial problems, unusual happenings, ordinary daily stress, and general stress were significantly related to nausea, vomiting, and retching. CONCLUSION: Assessment of life stress, especially for financial problems, unusual happenings, and ordinary daily stress of patients receiving cancer chemotherapy can be used as an effective way to reduce the risk of nausea, vomiting, and retching related during chemotherapy.
Anxiety* ; Breast Neoplasms* ; Breast* ; Depression* ; Drug Therapy* ; Female ; Humans ; Nausea* ; Surveys and Questionnaires ; Stress, Psychological ; Vomiting* ; Vomiting, Anticipatory

OBJECTIVES: In this study, we identified the symptoms of insomnia, anxiety, and depressed mood in newly diagnosed women breast and thyroid cancer patients. METHODS: The subjects of this study were 1794 women patients who visited the Ewha Womans University Cancer Center for Women. They included 1119 newly diagnosed primary breast cancer patients and 675 newly diagnosed primary thyroid cancer patients. The patients completed the National Cancer Center Psychological Symptom Inventory (NCC-PSI) during their first follow-up visit after surgery, before starting chemotherapy or radiotherapy. The NCC-PSI is composed of the modified distress thermometer (MDT) and the modified impact thermometer (MIT) for insomnia, anxiety, and depressed mood. RESULTS: Anxiety severity was found to be greater in breast cancer patients than in thyroid cancer patients. Significant levels of anxiety, depressed mood and insomnia were present in 28, 24.5, and 20.7% in all the subjects, respectively. Moreover, anxiety symptoms, depressed mood and insomnia interfered with the daily lives of 20, 18.4, and 14.2% of all the subjects, respectively. Dealing with anxiety (18.8%) was found to need the most help, followed by dealing with insomnia (8.9%) and depressed mood (8.7%). CONCLUSIONS: A significant level of distress was found in about 40% of the total subjects. Nearly 30% of newly diagnosed breast cancer patients reported significant anxiety symptoms and interferences with daily living caused by anxiety, which most commonly needed special care. Early assessment and management of psychological distress, especially anxiety, in breast and thyroid cancer treatment are very important to establish integrated cancer care.
Anxiety* ; Breast Neoplasms* ; Breast* ; Depression ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Radiotherapy ; Sleep Initiation and Maintenance Disorders* ; Thermometers ; Thyroid Gland* ; Thyroid Neoplasms*

PURPOSE: To evaluate the clinical outcome of high-dose-rate (HDR) interstitial brachytherapy (IBT) in patients with oral cavity cancer. MATERIALS AND METHODS: Sixteen patients with oral cavity cancer treated with HDR remote-control afterloading brachytherapy using 192Ir between 2001 and 2013 were analyzed retrospectively. Brachytherapy was administered in 11 patients as the primary treatment and in five patients as salvage treatment for recurrence after the initial surgery. In 12 patients, external beam radiotherapy (50-55 Gy/25 fractions) was combined with IBT of 21 Gy/7 fractions. In addition, IBT was administered as the sole treatment in three patients with a total dose of 50 Gy/10 fractions and as postoperative adjuvant treatment in one patient with a total of 35 Gy/7 fractions. RESULTS: The 5-year overall survival of the entire group was 70%. The actuarial local control rate after 3 years was 84%. All five recurrent cases after initial surgery were successfully salvaged using IBT +/- external beam radiotherapy. Two patients developed local recurrence at 3 and 5 months, respectively, after IBT. The acute complications were acceptable (< or =grade 2). Three patients developed major late complications, such as radio-osteonecrosis, in which one patient was treated by conservative therapy and two required surgical intervention. CONCLUSION: HDR IBT for oral cavity cancer was effective and acceptable in diverse clinical settings, such as in the cases of primary or salvage treatment.
Brachytherapy* ; Humans ; Mouth Neoplasms ; Mouth* ; Radiotherapy ; Recurrence ; Retrospective Studies

BACKGROUND AND OBJECTIVES: The Osborn wave is the name designated to the wave formation produced when there is a large, prominent deviation of the J point from the baseline. The wave has been reported in many countries, but only 2 cases have been reported in Korea. Thus, the purpose of our study was to evaluate the clinical characteristics and therapy of hypothermia employing the Osborn wave with Koreans. SUBJECTS AND METHODS: Between February 2001 and April 2001, five patients visiting our department with hypothermia were enrolled in this study. We analyzed these patients for their distribution, symptoms and signs, associated disorders, risk factors, electrocardiogram and laboratory findings. RESULTS: All 5 patients were male with an average age was 44.8+/-12.7 years. Three patients had a semi-comatose mentality and 2 cases had a comatose mentality. Their associated disorders were diabetes (2 cases), psychotic problems (1 case) and nutritional deficiency (1 case). Risk factors were alcohol abuse (3 cases) and drug in toxication (1 case). Laboratory abnormalities were acidosis (4 cases), increased serum glucose levels (all 5 cases) and increased serum potassium levels (3 cases). After active core rewarming by a line heat exchanger, 3 of the 5 patients completely recovered from hypothermia, 1 case immediately expired following admission and 1 case survived for 10 days, but later expired due to acute respiratory distress syndrome. The Osborn wave was persistent in 1 case and disappeared in 3 cases. CONCLUSION: We experienced 5 cases of hypothermia with an Osborn wave. The mortality of patients displaying an Osborn wave is expected to decrease if this anomaly is immediately found and treated by an appropriate method.
Acidosis ; Alcoholism ; Blood Glucose ; Coma ; Electrocardiography* ; Hot Temperature ; Humans ; Hypothermia* ; Korea ; Male ; Malnutrition ; Mortality ; Potassium ; Respiratory Distress Syndrome, Adult ; Rewarming ; Risk Factors

OBJECTIVES: The pharmacologic treatment of obsessive-compulsive disorder(OCD) with serotonergic antidepressant agents is well established in clinical psychiatry on the basis of serotonin hypothesis. Studies on predictive factors of treatment response to OCD are relatively scarce. The author compared the demographic factors, age of onset, length of illness, family history of mental illness, previous drug history for OCD, severity and type of symptoms between the drug responders and non-responders to find out the predicitive factors that may be related to treatment response. METHODS: The subjects were 31, both inpatients and outpatients who met the diagnostic criteria for OCD by DSM-IV and scored 20 or higher on the Yale-Brown Obsessive-Compulsive Scale(Y-BOCS) completed 12-week trial of sertraline. Y-BOCS, National Institute of Mental Health Obsessive-Compulsive Scale(NIMHOCS), Clinical Global Impression Scale(CGI) were scored to measure the changes of obsessive-compulsive symptoms, and Hamilton Anxiety Scale(HAM-A) was measured at each visit. RESULTS: 1) The responders, defined as achieving at least a 40% decrease in the Y-BOCS total score and more than a 2 point decrease in CGI score, were 17(54.8%), and non-responders were 14(45.2%). Responders tended to show later onset(p<0.1), and shorter duration of illness(p<0.05), and less previous drug therapy for OCD(p<0.05) than non-responders. There were no significant differences in family history of mental illness between the two groups. 2) The baseline Y-BOCS compulsive score was significantly lower in responders(p<0.05), although there was no significant difference in the baseline severity of other measures. 3) The obsession of contamination and washing behaviors were more frequent, but compulsive counting was not shown, in responders(p<0.05). The pathological doubt tended to be more common in nonresponders(p<0.1). CONCLUSIONS: In summary, the patients with shorter duration of illness, less prior drug therapy for OCD, and less severe compulsive behaviors, and the obsession of contamination and washing behaviors are expected to be better outcome with sertraline, whereas compulsive counting are the predictor of poor response.
Age of Onset ; Anxiety ; Compulsive Behavior ; Demography ; Diagnostic and Statistical Manual of Mental Disorders ; Drug Therapy ; Humans ; Inpatients ; National Institute of Mental Health (U.S.) ; Obsessive Behavior ; Obsessive-Compulsive Disorder* ; Outpatients ; Serotonin ; Sertraline*