Objective: Suicide is a huge nationwide problem that incurs a lot of socio-economic costs. Suicide also inflicts severe distress on the people left behind. The government of the Republic of Korea has been making many policy efforts to reduce suicide rate. The gatekeeper program, ‘Suicide CARE’, is one of the meaningful modalities for preventing suicide. Methods: Multidisciplinary research team collaborated to update the ‘Suicide CARE’ to version 2.0. Results: In the ‘Introductory part’, the authors have the time to think about the necessity and significance of the program before conducting full-scale gatekeeper training. In the ‘Careful observation’ part, trainees learn how to understand and recognize the various linguistic, behavioral, and situational signals that a person shows before committing suicide. In the ‘Active listening’ part, trainees learn how to ask suicide with a value-neutral attitude as well listening empathetically. In the ‘Risk evaluation and Expert referral’ part, trainees learn intervening strategies to identify a person’s suicidal intention, plan, and past suicide attempts, and connect the person to appropriate institutes or services. Conclusion Subsequent studies should be conducted to verify the efficacy of the gatekeeper program.

PURPOSE: To investigate whether causes of anaphylaxis vary according to regions and seasons in Korean adults. METHODS: Based on previous retrospective studies of anaphylaxis between 2007 and 2011 at the 15 university hospitals. Regions were classified into 4 groups: region I, Seoul; region II, Gyeonggi; region III, Chungcheong; and region IV, Chonnam and Busan. The cases induced by 5 major allergens including drugs, food, bee sting, radiocontrast media, and exercise, were analyzed in the present study. RESULTS: Among a total of 1,661 cases reported (53% male, 45.9+/-16.0 years), 367 (22.2%), 706 (42.5%), 319 (19.2%), and 269 cases (16.2%) were enrolled in regions I, II, III, and IV, respectively. Of the 5 major allergens, drugs (37.3%) were the most frequently reported, followed by food (25.7%), bee sting (17.9%), radiocontrast media (12.9%), and exercise (6.2%). There was no significant difference in the total occurrence of anaphylaxis in 4 seasons (374 in spring, 460 in summer, 460 in autumn, and 367 in winter). Multiple logistic regression analysis revealed that drug-induced anaphylaxis was significantly associated with the winter season (odds ratio [OR] 1.0 vs. OR 0.597, P<0.05 for spring; OR 1.0 vs. OR 0.481, P<0.01 for summer; OR 1.0 vs. OR 0.653, P<0.05 for autumn). Food-associated anaphylaxis was mainly reported in region I, whereas the frequency of insect sting was relatively higher in regions II, III, and IV than in region I. Older age and female gender were significantly associated with drug-induced anaphylaxis. CONCLUSION: Specific causative allergens of anaphylaxis in adults may vary according to age, gender, region, and season in Korea.
Adult* ; Allergens ; Anaphylaxis* ; Bees ; Bites and Stings ; Busan ; Contrast Media ; Female ; Geographic Locations ; Gyeonggi-do ; Hospitals, University ; Humans ; Insect Bites and Stings ; Jeollanam-do ; Korea ; Logistic Models ; Male ; Retrospective Studies ; Seasons* ; Seoul

PURPOSE: Differences in definitions of the condition, relevant triggers, and the geographical locations of study centers, cause estimates of the prevalence of anaphylaxis to vary. Recent epidemiological data indicate that the incidence of anaphylaxis is rising. METHODS: To investigate the causes and clinical features of anaphylaxis in Korean adults, factors associated with the severity of the condition, and serious outcomes, a retrospective medical record review was performed on adult patients diagnosed with anaphylaxis between 2007 and 2011 in 15 University Hospitals of South Korea. RESULTS: A total of 1,806 cases (52% male, age 16-86 years) were reported. Cutaneous symptoms (84.0%), combined with respiratory (53.9%) and/or cardiovascular (55.4%) symptoms, were the most frequent presentations. Using a recognized grading system, 1,776 cases could be classified as either mild, 340; moderate, 690; or severe, 746. Although eliciting factors varied significantly by age, gender, and regional and seasonal factors, drugs (46.5%; including nonsteroidal anti-inflammatory drugs, antibiotics, and radiocontrast media) were the most common cause of anaphylaxis, followed by foods (24.2%), insect stings (16.4%), exercise (5.9%), and unknown etiology (7.0%). All of age, multi-organ involvement, a history of allergic disease, and drug-induced anaphylaxis, were significant predictors of serious outcomes requiring hospital admission or prolongation of hospital stay. Epinephrine auto-injectors were prescribed for 7.4% of reported cases. CONCLUSIONS: The principal causes of anaphylaxis in Korean adults were drugs, food, and insect stings. Drug-associated anaphylaxis, a history of allergic disease, multi-organ involvement, and older age, were identified as predictors of serious outcomes.
Adult* ; Anaphylaxis* ; Anti-Bacterial Agents ; Epidemiology ; Epinephrine ; Hospitals, University ; Humans ; Incidence ; Insect Bites and Stings ; Korea ; Length of Stay ; Male ; Medical Records ; Prevalence ; Retrospective Studies* ; Seasons

PURPOSE: We investigated the causes, clinical features, and risk factors of bee venom anaphylaxis in Korea. METHODS: The medical records of the diagnosis of anaphylaxis during a 5-year period from the 14 hospitals in Korea have been retrospectively reviewed. Cases of bee venom anaphylaxis were identified among anaphylaxis patients, and subgroup analyses were done. RESULTS: A total of 291 patients were included. The common cause of bee species was vespid (24.6%) in bee venom anaphylaxis, followed by honeybee and vespid (8.8%), apitherapy (7.7%), and honeybee (2.0%), although the causative bee species were commonly unknown (56.9%). The severity of anaphylaxis was mostly mild-moderate (72.9%), and common clinical manifestations included cutaneous (80.6%), cardiovascular (39.2%), respiratory (38.1%), and gastrointestinal (13.1%) symptoms. Portable epinephrine auto-injectors were prescribed to 12.1% of the patients. Subject positive to both vespid and honeybee showed more severe symptoms and higher epinephrine use (P<0.05). The severity was significantly associated with older age, but not with gender, underlying allergic disease, or family history. Apitherapy-induced anaphylaxis showed a higher rate of hospitalization and epinephrine use than bee sting anaphylaxis (P<0.05). CONCLUSION: Vespid is the most common cause of bee venom anaphylaxis in Korea. It is suggested that positivity to honeybee and vespid may be associated with more severe symptoms.
Adult* ; Anaphylaxis* ; Apitherapy ; Bee Venoms ; Bees ; Bites and Stings ; Diagnosis ; Epinephrine ; Hospitalization ; Humans ; Hymenoptera* ; Korea ; Medical Records ; Retrospective Studies* ; Risk Factors ; Venoms*

Squamoid cyst of the pancreas is a very rare disease and it has been proposed only recently as a distinct pathologic lesion. We herein present a case of pancreatic squamoid cyst in a patient who underwent laparoscopic resection. A 60-year-old woman had an abdominal computed tomography (CT) scan for a routine check-up, and a multi-cystic lesion of 1.8-cm in size was incidentally found in the tail of the pancreas. Biochemical laboratory tests were within normal limits. At first, we presumed that the most likely diagnosis of the cystic lesion was an intraductal papillary mucinous neoplasm. To treat this lesion, we performed laparoscopic spleen-saving distal pancreatectomy. The patient showed the usual routine postoperative course and she was discharged 10 days after surgery. On examination of the resected specimen, a well-defined, oligolocular cystic mass was found in the pancreatic tail, without a solid portion. Histologic examination revealed that the cysts had linings ranging from flat squamoid cells to transitional cells with non-keratinization. After immunohistochemical staining, the final diagnosis was confirmed to be squamoid cyst of the pancreas. This lesion appears to be regarded as a benign entity, thus an extended operation should be avoided and resection of the lesion can be performed minimally.
Diagnosis ; Female ; Humans ; Middle Aged ; Mucins ; Pancreas ; Pancreatectomy ; Pancreatic Neoplasms ; Rare Diseases

BACKGROUND: The skin temperature is often decreased during anesthesia because of a cool ambient temperature in the operating room. Contractility of the muscles may be affected by lowering the muscle temperature. This study was designed to verify that efforts to maintain normothermia on the monitored arm can make recovery from deep neuromuscular blockade more reliable. METHODS: A total of 60 patients were enrolled in this study. Each patient was randomly assigned to group 1 (the monitored arm was shielded with a passive warming protector) or group 2 (the monitored arm was was exposed to the ambient operating room temperature). Conventional inhalation anesthesia was induced with propofol and alfentanil, and this was maintained with O2, N2O and isoflurane. The twitch response of the adductor pollicis muscle was recorded. After calibration of the TOF watch(R), 0.6 mg/kg of rocuronium was injected. During anesthesia, the post tetanic count (PTC) was checked every 5 to 6 minutes until the first response to a train-of-four (TOF) stimulations appeared. The ambient operating room temperature, the core temperature and the skin temperature were checked simultaneously. RESULTS: The skin temperature of group 2 was lower than that of group 1 (33.89 +/- 0.81 degreesC and 35.41 +/- 0.45 degreesC, respectively, P < 0.05). When the data was plotted with the equation y=be(-ax), this equation well represented the data of group 1 (R2 = 0.82), but it did not well represent the data of group 2 (R2 = 0.54). CONCLUSIONS: During recovery from deep neuromuscular blockade with using rocuronium, it may be desirable to maintain normothermia at the thenar area for a better recovery time from a given PTC.
Alfentanil ; Androstanols ; Anesthesia ; Anesthesia, Inhalation ; Arm ; Calibration ; Factor IX ; Humans ; Hypothermia ; Isoflurane ; Monitoring, Intraoperative ; Muscles ; Neuromuscular Blockade ; Operating Rooms ; Propofol ; Skin Temperature

The common carotid artery is an artery which supplies the head and neck with oxygenated blood. Although unilateral common carotid artery occlusion or bilateral internal carotid artery occlusion have been reported, the incidence of both common carotid artery occlusion is very rare. As previous report which reviewed 5400 carotid duplex ultrasonograms, 2.5% of internal carotid artery occlusion, 0.24% of unilateral common carotid artery occlusion and none of bilateral common carotid artery occlusion were reported. Common carotid and subclavian arteries are important in the blood supply to the vasculatures of head and upper extremities. Bilateral common carotid artery occlusion might be a cause of stroke, transient ischemic attack or other neurologic sequalae. Cerebral oximetry is a simple method of measuring regional cerebral oxygen saturation (rSO2), which appears to reflect changes in cerebral perfusion and it has been increasingly applicated in many clinical situations such as vascular surgeries involving head/ neck and operations adopting cardiopulmonary bypass. This case describes a successful anesthetic management in a patient with occlusion of bilateral common carotid and subclavian arteries using continuous cerebral oxygenation monitoring during laparoscopic cholecystectomy.
Anesthesia ; Arteries ; Cardiopulmonary Bypass ; Carotid Artery, Common ; Carotid Artery, Internal ; Cholecystectomy, Laparoscopic ; Equipment and Supplies ; Head ; Humans ; Incidence ; Ischemic Attack, Transient ; Neck ; Oximetry ; Oxygen ; Perfusion ; Stroke ; Subclavian Artery ; Upper Extremity

OBJECTIVE: Anterior abdominal wall defects are classified into three basic types: omphalocele, gastroschisis and bodystalk anomaly. Its incidence and prognosis are different according to each type of anomaly. We aimed at investigating its demographic characteristics and risk factors. METHODS: From Jan. 1996 to Jun. 2002, 20 cases of anterior abdominal wall defects were diagnosed by prenatal ultrasonography and all ultrasonographic findings and delivery records were reviewed. RESULTS: We had experienced 13 cases of omphalocele, 5 cases of gastroschisis and 2 cases of bodystalk anomaly. Mean maternal age was 29.9 (+/-5.5) years in omphalocele, 25.6 ( +/- 1.7) in gastroschiss, 32 ( +/- 4.2) in bodystalk anomaly. The median gestational weeks at the time of diagnosis was 17.6 for omphalocele, 20 for gastroschisis, 14.5 for bodystalk anomaly. Live born cases were 3 in omphalocele, 1 in gastroschisis and none in bodystalk anomaly. Of the 13 cases of chromosomal analyses, there was one case of trisomy 18 in omphalocele. Multiple anomalies were found in all bodystalk anomalies including kyphoscoliosis, facial defect, central nervous system defects. 54% of associated anomalies were found in omphalocele and no associated anomaly in gastroschisis. CONCLUSION: Omphaloceles were most frequently detected in abdominal wall defects and the gastroschisises were the next. Our results suggested that the pathogenesis of anterior abdominal wall defect might be different one another, but we could not find out definite risk factors for the individual type of defect.
Abdominal Wall* ; Central Nervous System ; Diagnosis ; Gastroschisis ; Hernia, Umbilical ; Incidence ; Maternal Age ; Prognosis ; Risk Factors ; Trisomy ; Ultrasonography, Prenatal

The Holt-Oram syndrome or cardiomelic syndrome is characterized by the association of upper limb and heart malformations. Most frequently, abnormalities of the thumb and secundum atrial septal defects are associated with the disease. The mode of inheritance is autosomal dominant. The etiology of this disease is unknown but is most likely of multifactorial origin. Here we report a case Holt-Oram syndrome with affected mother which was diagnosed at 18th gestational weeks by prenatal ultrasonograpy. Fetal ultrasonography revealed abnormalities of upper limbs, and heart. The upper limbs were shorter than normal, syndactyly of both hands were seen and both wrists were markedly angulated. Ventricular septal defect was suspicious. After genetic counselling her pregnancy was terminated at 22nd gestational week.
Hand ; Heart ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Humans ; Mothers* ; Pregnancy ; Syndactyly ; Thumb ; Ultrasonography* ; Ultrasonography, Prenatal ; Upper Extremity ; Wills ; Wrist

Traditionally postpartum hemorrhage is a bleeding more than 500 ml that occurs immediately after the placenta is delivered. It remains one of the most common causes of maternal mortality. Morbid adhesion of the placenta is emerging as a major cause of massive postpartum hemorrhage unresponsive to medical therapy. We experienced three cases of major postpartum hemorrhage over 5,000 ml, developed from anterior placenta previa totalis with adhesion of placenta. The hemorrhage had been controlled successfully by compressing abdominal aorta intermittently with the operator's hand during Cesarean hysterectomy. In immediate life- threatening postpartum hemorrhage this simple and safe technique can be used in slowing the bleeding while stabilizing the patient and preparing for definitive treatment.
Aorta, Abdominal ; Hand ; Hemorrhage ; Humans ; Hysterectomy ; Maternal Mortality ; Placenta ; Placenta Previa ; Postpartum Hemorrhage* ; Postpartum Period*