A 17-year-old spayed female Shih Tzu dog, weighing 5.0 kg, presented with frequent coughing and respiratory distress. Blood tests revealed mild thrombocytosis, and thoracic ultra-sonography and radiography confirmed a significant amount of pleural effusion. However,the thoracic radiographs showed no radiopaque nodules or interstitial patterns indicative ofthoracic tumors. Thoracentesis was performed to relieve effusion-induced thoracic pressure, yielding a hemorrhagic serosanguinous pleural fluid. The cytological analysis of this fluid re-vealed mesothelial cells, supporting the clinical diagnosis of mesothelioma in situ. To address the patient’s clinical symptoms, an aggressive management approach was implemented withchest tube placement to address recurrent pleural effusion after initial thoracentesis. Duringtreatment, the patient exhibited stable health and adapted well to daily life. To the best of our knowledge, this is the first reported case of mesothelioma in situ with hemorrhagic malignant pleural effusion in South Korea. Using a chest tube as an aggressive treatment successfullyalleviated dyspnea symptoms and provided symptomatic relief in a patient with mesothelioma in situ.

A 17-year-old spayed female Shih Tzu dog, weighing 5.0 kg, presented with frequent coughing and respiratory distress. Blood tests revealed mild thrombocytosis, and thoracic ultra-sonography and radiography confirmed a significant amount of pleural effusion. However,the thoracic radiographs showed no radiopaque nodules or interstitial patterns indicative ofthoracic tumors. Thoracentesis was performed to relieve effusion-induced thoracic pressure, yielding a hemorrhagic serosanguinous pleural fluid. The cytological analysis of this fluid re-vealed mesothelial cells, supporting the clinical diagnosis of mesothelioma in situ. To address the patient’s clinical symptoms, an aggressive management approach was implemented withchest tube placement to address recurrent pleural effusion after initial thoracentesis. Duringtreatment, the patient exhibited stable health and adapted well to daily life. To the best of our knowledge, this is the first reported case of mesothelioma in situ with hemorrhagic malignant pleural effusion in South Korea. Using a chest tube as an aggressive treatment successfullyalleviated dyspnea symptoms and provided symptomatic relief in a patient with mesothelioma in situ.

A 17-year-old spayed female Shih Tzu dog, weighing 5.0 kg, presented with frequent coughing and respiratory distress. Blood tests revealed mild thrombocytosis, and thoracic ultra-sonography and radiography confirmed a significant amount of pleural effusion. However,the thoracic radiographs showed no radiopaque nodules or interstitial patterns indicative ofthoracic tumors. Thoracentesis was performed to relieve effusion-induced thoracic pressure, yielding a hemorrhagic serosanguinous pleural fluid. The cytological analysis of this fluid re-vealed mesothelial cells, supporting the clinical diagnosis of mesothelioma in situ. To address the patient’s clinical symptoms, an aggressive management approach was implemented withchest tube placement to address recurrent pleural effusion after initial thoracentesis. Duringtreatment, the patient exhibited stable health and adapted well to daily life. To the best of our knowledge, this is the first reported case of mesothelioma in situ with hemorrhagic malignant pleural effusion in South Korea. Using a chest tube as an aggressive treatment successfullyalleviated dyspnea symptoms and provided symptomatic relief in a patient with mesothelioma in situ.

Freud originally defined countertransference as “a result of the patient’s influence on (the analyst’s) unconscious feelings.” The result of uncontrolled countertransference is a loss of analytic neutrality. Beginning circa 1950, the literature on countertransference reflected an increasing awareness of the clinical importance of the phenomenon, and there was a significant expansion of the meaning of the term beyond that in Freud’s original definition. Moreover, many clinicians began dealing with countertransference as a tool for understanding the analysand. In the 1980s and 1990s, countertransference emerged as an area of common ground among psychoanalysts with diverse theoretical perspectives. This convergence can be traced to the development of two key concepts– projective identification and countertransference enactment. Within the intersubjectivity theory, countertransference is an amalgam of the therapist’s response to therapeutic reality with the influence of past experiences on the immediate responses of both patient and therapist. Currently, although there are many differences among the diverse theoretical schools of psychoanalytic thought, there is an area of convergence regarding the usefulness of countertransference in understanding the analysand. In addition, there is widespread acknowledgement that an inevitable aspect of analysis is that a patient will treat the analyst as a transference object. Moreover, the analyst’s countertransference reaction is a joint creation that includes contributions from both patient and analyst.
Countertransference (Psychology)* ; Humans ; Joints

Stereotactic cardiac radiation for ablation (radioablation) of life-threatening ventricular arrhythmia was recently introduced into clinical practice. A 76-year-old male patient with apical hypertrophic cardiomyopathy at burnout stage, who received defibrillator implantation for the secondary prevention of sudden arrhythmic death, was admitted for repeated defibrillator therapy. Radiofrequency catheter ablation was unsuccessful due to the induction of ventricular fibrillation (VF) and hemodynamically unstable sustained monomorphic ventricular tachycardia (VT). However, intracardiac activation mapping for the induced VT revealed the earliest ventricular activation at the apical aneurysm. Radioablation was performed to control VT and VF storm refractory to antiarrhythmic drug therapy. A total of 24 Gray was radiated, divided into three fractions around the apical aneurysm. The onset of electrical modulation was instantaneous and the antiarrhythmic effect was maintained for at least 6 months without significant radiation toxicities. This case suggests that radioablation may be considered as a rescue therapy for VT and VF storm refractory to other treatment modalities.

OBJECTIVE: This study was designed to evaluate the cause of mortality in patients with dementia, including Alzheimer's disease and multi-infarct dementia, and those without dementia. METHOD: Hospital records of geriatric patients (> or =65) in nursing home having dementia were reviewed retrospectively for 6 years. The total number of patients was 351 (the number of demented patients was 146 and those without dementia was 68). Of the ones with dementia, 146 had dementia of Alzheimer's type, 101 patients had vascular dementia, and 36 patients had non-specific dementia. This study focused on the different complications associated with Alzheimer's disease and cerebrovascular dementia. RESULT: 1) The average age at death of demented patient is higher than the non-demented population;however, there is no difference in age between Alzheimer's disease and vascular dementia. 2) There is no difference in time spent in the nursing home among the non-demented group, Alzheimer's disease and vascular dementia group from admission to death. The life expectancy of male patients with Alzheimer's disease after admission to the nursing home is significant shorter than their female counterpart. 3) Patients with vascular dementia have a higher incidence of hypertension, atherosclerotic disease, and diabetes than the Alzheimer's patients. 4) The main overall causes of the death (in nursing home patients) are infection and sepsis. In Alzheimer's disease's, sepsis is the major cause of death, while in vascular dementia, atherosclerotic disease is the number one cause. CONCLUSION: Knowledge of the causes of the death in demented patients may help the management of the possible complications associated with the different types of dementia. However, long-term research is then needed to analyze the survival rates of demented nursing home patients.
Alzheimer Disease ; Cause of Death ; Dementia* ; Dementia, Multi-Infarct ; Dementia, Vascular ; Female ; Hospital Records ; Humans ; Hypertension ; Incidence ; Life Expectancy ; Male ; Mortality* ; Nursing Homes* ; Nursing* ; Retrospective Studies ; Sepsis ; Survival Rate

Acute appendicitis is very rare in premature neonates. Preoperative diagnosis of this condition is difficult, and then it leads to high morbidity and mortality. We report 9-day-old premature male with ruptured acute appendicitis presented with pneumoperitoneum on plain films of the abdomen. Awareness of this rare condition and possible differential diagnosis in this age group is also discussed.
Abdomen ; Appendicitis ; Diagnosis, Differential ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Male ; Pneumoperitoneum

PURPOSE: This study was performed to determine the optimal radiation therapy field for the treatment of malignant astrocytoma and glioblastoma multiforme. MATERIALS AND METHODS: From Jan. 1994 to Mar. 2000, 21 patients with malignant astrocytoma and glioblastoma multiforme, confirmed as recurrent by follow up MRI after surgery and radiation therapy, were analyzed. The distance from the margin of the primary lesion to the recurrent lesion was measured. The following factors were analyzed to investigate the influence of these factors to recurrence pattern; tumor size, degree of edema, surgical extent, gamma knife radiosurgery and multiple lesions. RESULTS: Among the 21 patients, 18 (86%) were recurred within 2 cm from the primary lesion site. 12 within 1 cm, 6 between 1 and 2 cm. The other 3 patients all with multiple lesions, were recurred at 3, 4, 5 cm, from the primary lesion site. The recurrence pattern was not influenced by the factors of tumor size, extent of edema, surgical extent, or gamma knife radiosurgery. However, patients with multiple lesions showed a tendency of recurrence at sites further from the primary lesion. CONCLUSIONS: Most (86%) of the recurrences of malignant astrocytoma and glioblastoma multiforme occurred within 2 cm from the primary lesion site. The width of treatment field does not need to be changed according to tumor size, degree of edema, surgical extent, or gamma knife radiosurgery. However, the treatment field for multiple lesions appears to be wider than that for a single lesion.
Astrocytoma* ; Edema ; Follow-Up Studies ; Glioblastoma* ; Humans ; Magnetic Resonance Imaging ; Radiosurgery ; Recurrence

PURPOSE: To evaluate the efficacy of radiotherapy, and the factors affecting survival in patients of extrahepatic bile duct cancer, by analyzing the results of postoperative radiotherapy. MATERIALS AND METHODS: Between October 1991 and July 2001, 21 patients with extrahepatic bile duct cancer, who received radiotherapy after a radical resection, were retrospectively reviewed. The patients' ages ranged from 39 to 75 years, with a median of 61 years, and a male to female ratio of 16 to 5. The numbers of patients with proximal and distal bile duct cancer were 14 and 7, respectively. From the postoperative pathological examination, 19 of the patients were found to have microscopic residues, and 7 to be lymph node positive. Patients with AJCC stages I, II and III were 10, 10 and 1, respectively. The total radiation dose administered was 4,500~6,300 cGy, with a median dose of 5,040 cGy. The follow up period was 20~81 months, with a median of 57.5 months. RESULTS: The overall and disease free survival rates at 3 and 5 years were 41.0 and 29.3%, and 41.6 and 29.7%, respectively. The influences of age, sex, tumor location, differentiation, microscopic residue, neural invasion, T and N stage, the stage itself, the dose of radiation and chemotherapy, on survival were evaluated. The T stage and the stage itself were found to be significant from a univariate analysis (p< 0.05), but the degree of significance was limited by the small number of patients. A recurrence occurred in 12 patients (57.1%), 5 in locoregional sites, 4 in distant sites and 3 in a combination of locoregional and distant sites, and the sites of distant metastasis were the liver, 6, and the bone, 1. Grade 2 or 3 acute leucopenias occurred in 2 patients and grade 2 chronic peptic ulcers occurred in 4, who were all recovered by conservative management. CONCLUSION: Postoperative radiotherapy is feasible in extrahepatic bile duct cancer, with tolerable toxicity, but prospective studies, with a large patient enrollment, are needed for the evaluation of the effects of postoperative radiotherapy and the related prognostic factors.
Bile Duct Neoplasms ; Bile Ducts, Extrahepatic* ; Disease-Free Survival ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Liver ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Peptic Ulcer ; Radiotherapy* ; Recurrence ; Retrospective Studies ; Treatment Outcome*

OBJECTIVE: We performed a cross-sectional study to examine the relationship between premorbid personality and behavioral and psychological symptoms in dementia (BPSD) in Korean patients with Alzheimer's disease (AD). METHODS: We assessed 103 patients diagnosed with AD for the presence of BPSD over the disease course by using the caregiver-rated Korean version of the Neuropsychiatric Inventory (K-NPI) and for the premorbid personality by using a retrospective version of the NEO-Five Factor Inventory questionnaire completed by informants. RESULTS: Premorbid neuroticism was significantly correlated with delusion, agitation, anxiety, disinhibition, total K-NPI score (p<0.05), and sleep disturbances (p<0.01). Lower premorbid conscientiousness was significantly correlated with symptoms of hallucinations and sleep disturbances in AD patients (p<0.05). However, premorbid neuroticism and low premorbid conscientiousness did not act as independent predictors for "psychosis, hyperactivity," or "moods, apathy, frontal" factors of BPSD. CONCLUSION: Premorbid personality was associated with the K-NPI score, but was not observed to be potential predictors of BPSD.
Alzheimer Disease* ; Anxiety ; Apathy ; Cross-Sectional Studies ; Delusions ; Dementia* ; Dihydroergotamine ; Hallucinations ; Humans ; Surveys and Questionnaires ; Retrospective Studies