• Korean Journal of Psychosomatic Medicine
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• v.20 no.2
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• pp.112-119
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• 2012

Objectives : Delirium is a disorder defined as a sudden disturbance in thinking, speaking, acting and sleep pattern due to altered level of consciousness and cognitive function. The objective of this study is to analyze characteristics and therapeutic methods of the delirious patients during the recent 5 years, and provide basic data for further studies and investigation regarding delirium in the occurrence and treatment. Methods : We retrospectively reviewed medical records of 475 patients who were consulted for delirium in Kyunghee University Medical Center from January 2007 to December 2011. Results : During the 5 years, among the 475 patients who were diagnosed as delirium, men were more common(61.7%). The most commonly consulted reason and cause were sleep disturbance(80.8%) and post-operational delirium(30.9%), respectively. The medication prescription percentage was 76.6% and was significantly increased year after year. Ratio of using antipsychotics were 76.4% among prescribed medication and the most frequently prescribed antipsychotic drug was quetiapine(46.8%). Other specialists commonly misdiagnosed delirium when the patient was previously diagnosed as dementia(6.8%). Conclusions : In our study, post-operational delirium was the most commonly referred reason and the percentage of medication prescription tended to increase. Patients with history of dementia were more easily misdiagnosed as diseases other than delirium. Our study suggests that we should evaluate symptoms, causes, reasons of consultation, management tendency of delirium. We should also closely observe changes in sleep patterns and establish the prevention strategies for post-operational delirium and therapeutic bases for pharmacotherapy.

• Korean Journal of Psychosomatic Medicine
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• v.21 no.1
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• pp.11-17
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• 2013

Objectives : This study was designed to investigate the prevalence of depressive symptoms in patients with breast cancer and to identify demographic variables and clinical characteristics impact on depressive symptoms and health related quality of life in patients with breast cancer in a university hospital. Methods : Fourty-one patients with breast cancer were selected, who had visited the department of General surgery of the Wonkwang University hospital with a diagnosis of breast cancer regularly during the period November, 2010-May, 2011. All of subjects were evaluated for the depression, anxiety and the health related quality of life with Beck Depression Inventory(BDI), anxiety subscale of Personality Assessment Inventory(PAI) and Short-Form 36 Health Survey-Korean version(SF-36-K). Patients were divided into depressive symptoms and non-depressive symptoms group according to the BDI score. We compared SF-36-K between two groups, and analized multiple regression with depression and health related quality of life as criterion variables and demographic and clinical characteristics. Results : The prevalence of depression in patients with breast cancer in a University hospital was 36.4%. Compared to the non-depression, depressed patients with breast cancer appeared significantly lower mean scores on six subscales in SF-36-K : Physical function(p<.01), Role-physical(p<.001), General health(p<.05), Social function(p<.001), Role-emotional(p<.001) and Mental health(p<.001). But there was no significant difference between two groups in Vitality and Bodily pain. Anxiety, level of education and presence of enforcement of chemotherapy(63.6%) were significant explanation variables for depressive symptoms. And type of surgery and age(55.8%) were significant explanation variables for health related quality of life. Conclusions : The prevalence of depressive symptoms in patients with breast cancer in a University hospital was 36%. The depressive symptoms had not only negative impact on the health related quality of life but also important explanation variable for health related quality of life. These results suggest that depressive symptoms in patients with breast cancer should be evaluated and treated for improving patient's health related quality of life.

• Korean Journal of Psychosomatic Medicine
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• v.25 no.2
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• pp.210-217
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• 2017

Objectives : Although the Attention Network Test(ANT) has been widely used to assess selective attention including alerting, orienting, and conflict processing, data on its test-retest reliability are lacking for clinical population. The objective of the current study was to investigate test-retest reliability of the ANT in healthy controls and patients with schizophrenia. Methods : Fourteen patients with schizophrenia and 23 healthy controls participated in the study. They are tested with ANT twice with 1 week interval. Test-retest reliability was analyzed with Pearson and Intra-class correlations. Results : Patients with schizophrenia showed high test-retest correlations for mean reaction time, orienting effect, and conflict effect. Also, they showed moderate to high test-retest correlations for mean accuracy and moderate test-retest correlations for alerting effect and conflict error rate. On the other hand, healthy controls revealed high test-retest correlations for mean reaction time and moderate to high test-retest correlations for conflict error rate. In addition, they revealed moderate test-retest correlations for alert effect, orienting effect, and conflict effect. Conclusions : The mean reaction time, alerting effect, orienting effect, conflict effect, and conflict error rate of ANT showed acceptable test-retest reliabilities in healthy controls as well as patient with schizophrenia. Therefore, the analyses of these reliable measures of ANT are recommended for case-control studies in patients with schizophrenia.

• Korean Journal of Psychosomatic Medicine
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• v.25 no.2
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• pp.129-135
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• 2017

Objectives : Little is known about the influence of urinary incontinence and depression on individual's QOL(Quality of life). We aimed to clarify how the interaction between urinary incontinence and depression influences one's QOL. Methods : A total of 1262 patients were enrolled in this study from April, 2011 to July, 2011. We estimated the severity of depressive symptoms and QOL, using SGDS-K, EQ-5D. We also investigated the morbidity of urinary incontinence for each patient in person or by questionnaire. Comparisons of QOL between groups with or without depression, with or without urinary incontinence were established using t-test, ANOVA and Scheffe's post hoc analysis. The interaction between urinary incontinence and depression was analyzed by each domain of QOL, using multiple regression analysis. Results : Patients with depression and urinary incontinence showed significantly higher EQ-5D scores on every domain of QOL than other patients, which means significantly lower QOL. Patients with depression, no urinary incontinence reported lower QOL, especially in the domain of 'usual activity', 'anxiety' and 'visual analogue scale(VAS)', whereas those with urinary incontinence, no depression showed lower QOL in 'motility', 'usual activities' and 'pain' domain. Statistically significant interaction effects of two diseases were observed in the domain of 'VAS', 'self care' and 'anxiety'. Conclusions : Comorbidity of urinary incontinence and depression showed significantly lower QOL of patients, compared with urinary incontinence or depression respectively, which implies additive interaction effects of the two diseases. Optimal diagnosis and treatment of depression should be emphasized for patients with urinary incontinence.

• The Korean Journal of Pain
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• v.5 no.1
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• pp.37-43
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• 1992

Postoperative hypoxemia in the absence of hypoventilation occurs more often after thoracic or upper abdominal surgery than lower abdominal operations or surgery on extremities. Although the factors which produce postoperative alveolar collapse have not been fully evaluated, the dominant factor of postoperative hypoxemia is shunt of blood passing collapsed alveoli and the postoperative pain is associated with restriction of depth of breathing, sighing and movement. In 1979, the first successful clinical usage of epidurally administered morphine for control of postoperative pain was reported by Behar and associates. This study was carried out for twenty patients who received posterolateral thoracostomy with bleb resection between May 1990 and May 1991 and who were primary spontaneous recurrent pneumothoraxes under general endotracheal anesthesia. For the relief of post-thoracotomy pain following of the general anesthesia, we selected ten patients as control group which were treated intermittently IM with injection of pethidine(50 mg) according to the conventional method and another ten patients as study group which were managed with thoracic epidural analgesia. The tip of the catheter was inserted to T4-5 epidural space through T12-L1 or L1-2 interspinous region before the induction of the general anesthesia and then the epidural analgesics(0.25% bupivacaine 15 ml+morphine 3 mg) was injected once a day via the catheter until 4 th POD in the study group. The epidural catheters were removed at postoperative 4 th day in study group. Clinical observations were done about vital signs, ABG, tidal volume, FVC and occurence of adverse effects during postoperative 2hr, 8hr, 1st day, 2nd day, 7th day in both groups. The results were as follows; (1) The values of $V_T$ and FVC were significantly improved in study group(85% and 66%) as compared with control group(76% and 61%) during the postoperative 4 day of the epidural analgesia. (2) After the end of the epidural analgesia(7th POD), the values of FVC were improved invertly rather in control group(98%) than study group(84%). It suggested that the reduction of FVC in study group were caused by the raised pain sensitivity following the end of epidural analgesia. (3) The side effects of epidural analgesia such as transient urinary retention(2 cases), itching sensation(1) and headache(1) were noted.

• Journal of Korean Physical Therapy Science
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• v.9 no.3
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• pp.107-119
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• 2002

Astrocyte, which shares the greatest part of the brain (about 25%), is a land of glial cell that composes the central nervous system along with microglia, ependymal cell and oligodendroglia. It has 7-9nm of fibers in its cytoplasma, which are composed of glial fibrillary acidic protein (GFAP) and vimentin. As for the functions of the astrocyte, it has, so far, been supposed that the astrocyte will play a cytoskeletal role in maintaining the structure of the cerebrum, play a role as a blood-brain barrier so that it can induce migration of the neuron in its development and substances in the blood cannot go into the nervous tissue, and a role of immunology and phagocytosis. However, it was revealed today that it will be a role in preventing expansion of injury by attaching itself to the connective tissue such as the vessel and the pia mater when the nervous tissue or the arachnoid is injured. Microcurrent stimulation can control current, on the basis of A unit. That is, with such devices using it, it is possible to sense, from the outside, the injured current(wound current) of the lesion and to change it into the normal current, thereby promoting the restoration of the cells. In order to examine the effects of microcurrent stimulation on the injured astrocytes in the rabbits, this study was conducted with 24 New Zealand White Rabbit as its subjects, which were divided into 8 animals of the experiment group and 16 animals of the control group. After the animals in the experiment group were fixed to the stereotaxic apparatus, their hair was removed and their premotor area(association area) perforated by the micro-drill for skull-perforation with the depth of 8mm from the scalp. In one week after the injury, 4 animals in the control group and 8 animals in the experiment group were sacrificed and examined with immunohistochemical method. And in three weeks, the remaining 4 animals in the control group and 8 animals in the experiment group were also sacrificed and examined with the same way. The conclusion has been drawn as follows : In the control group sacrificed in one week after the injury, the astrocytes somewhat increased, compared with the normal animals, and in the group sacrificed in three weeks after the injury, they increased more (p < 0.05). The experiment group A in one week showed a little increase, but there was no significant differences, but the experiment group in three weeks showed more increase, compared with the experiment group in one week (p < 0.05). The experiment group B in one week showed more increase than the control group or the experiment group A, and the experiment group in three weeks showed more increase than the experiment group in one week (p < 0.05). Among the astrocytes, fibrous astrocytes were mostly observed, increasing as they are close to the lesion, and decreasing as they are remote from it. The findings show that microcurrent can cause the astrocytes to proliferate and that it will be more effective to stimulate the cervical part somewhat remote from the lesion rather than to directly stimulate the part of the lesion. Thus, microcurrent stimulation can be one of the methods that can activate the reaction of astrocytes, which is one of the mechanism for treating cerebral injury with hemorrhage. Therefore, this study will be used as basic research data for promoting restoration of functions in the patient with injury in the central nervous system.

• Clinical and Experimental Pediatrics
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• v.48 no.10
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• pp.1061-1067
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• 2005

Purpose : We studied a clinical analysis of pediatric patients who visited the emergency medical center of Yeungnam University Hospital to compare the characteristics of pediatric emergency patients after year 2000 with the previous studies. Methods : We reviewed 7,034 children under the age of 15 years who visited the emergency medical center of Yeungnam University Hospital during the 2 year period from January 2001 to December 2002, and then we performed a clinical and statistical analysis. We analyzed the pediatric patients according to gender, age, season, day of the week, time of the visit, the disease classification and the final disposition of the patients. Results : Among the patients who visited the emergency room, 15.6% of the total emergency patients were under the age of 15. The male to female ratio was 1.6 : 1. Among the 7,034 pediatric patients, the most common age group was between 1 year and under 3 years of age(26.9%). The peak seasonal incidence was early summer and spring, especially during June(11.2%) and May(10.6 %). The peak incidence day of the week was Sunday(24.8%) and the peak time when the emergency pediatric patients visited the emergency room was between 20 and 24 o'clock(28.8%). The distribution of diseases, according to ICD-10 system, were injury and poisoning(30.4%), diseases of the respiratory system(22.8%), and diseases of the digestive system(14.6%). 30% of total pediatric patients were admitted to the hospital. Conclusion : After year 2000, as compared with the previous studies, the proportions of emergency pediatric patients has decreased. The distribution of diseases was not much different from the previous studies and the proportions of non-urgent diseases, such as acute nasopharyngitis or acute gastroenteritis, were still high. These result have come about due to the declining birth rate and changes of the medical system in Korea.

• Journal of Korean Ophthalmic Optics Society
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• v.12 no.2
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• pp.1-12
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• 2007

Object of this research is to estimate the effect of myopia correction and safety on reverse geometry contact lens fitting in school children. This research include 53(106eyes) schoolchildren among 7 to 18 years who has low to moderate myopia(-1.00D~-5.00D) and prescribed reverse geometry contact lens for purpose on orthokeratology between January to July 2004 and had 3months full follow up examination. They were tested for slit lamp examinations, BUT(Break up time), direct ophthalmoscopy, retinoscopy, uncorrected visual acuity, best corrected visual acuity, autorefraction, autokeratometry and corneal topography in each examination(1day, 1week, 2weeks, 1, 2, and 3months) of before-and-after lens wearing to find out the effect of myopic correction and side effect. The results came out as follow. The average of uncorrected visual acuity was $0.0938{\pm}0.378$ before lens wear and $0.3136{\pm}0.283$ after 1day lens wear, and there was fast improvement after 1week($0.7925{\pm}0.301$) and little improvement after 2weeks period but still they shows better uncorrected visual acuity(p<0.01). The result of this study, the reverse geometry lens is very useful to correct refractive error and control the progression of myopia temporally among low to moderate myopic patient. The side effects were relatively rare but further study should be necessary with long term lens wear effect on eye health. For the lens prescription, the clinical fitting process had higher rate of success with consideration of eccentricity and corneal topography.

• Clinical and Experimental Pediatrics
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• v.48 no.10
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• pp.1121-1125
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• 2005

Purpose : Rotavirus is the main cause of infantile diarrheal disease worldwide, especially in patients 3-24 months of age. Infants younger than 3 months of age are relatively protected by transplacental antibody. So the purpose of this study is to evaluate the clinical features and severity of neonatal rotaviral gastroenteritis less than 1 month of age. Methods : A retrospective chart review was established of 62 neonates less than 1 month of age and with a diagnosis of rotaviral gastroenteritis who had been admitted to Pochon CHA University between June 2002 through July 2004. The rotavirus was examined by stool latex agglutination. Results : During 2 years, the total number of admitted patients for rotaviral gastroenteritis was 688 and among these, less than 1 month of age accounted for 9%(62). The occurrence was generally even distribution from January to July($7.14{\pm}1.0$) but since then decreased($2.4{\pm}1.8$). The most common chief complaint was mild fever(46%) when admitted which subsided within 1 hospital day in most patients. 4 patients had seizure and cyanosis with no typical symptoms of rotaviral gastroenteritis. During admission, all the patients had diarrhea. 17% of the patients had leukocytosis and positive C-reactive protein. In one patient, stool occult blood test was positive but there was no necrotizing gastroenteritis evidence. The mean period of hospital day was $5.8{\pm}2.5$ and breast-milk feeding was 62.9%. Conclusion : Neonatal rotaviral gastroenteritis is not a rare disease. Most patients have fever and diarrhea and improve through conservative therapy but a few patients may have severe complications so we must be more cautious about the hygiene for prevention.

• Clinical and Experimental Pediatrics
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• v.45 no.4
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• pp.466-472
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• 2002

Purpose : The diagnosis of Meckel's diverticulum is difficult and delayed because it presents with various clinical symptoms. We evaluated clinical, imaging and pathologic findings of Meckel's diverticulum to facilitate detection of Meckel's diverticulum in children. Methods : Review of clinical, imaging, surgical and pathological findings in 10 children aged 7 days to 14 years with Meckel's diverticulum during an 8-year period, 1993-2001, at Ewha Womans University Hospital was undertaken. Results : The male to female ratio was 2.3 : 1. The chief complaint was painless lower gastrointestinal( GI) bleeding; others were abdominal pain, abdominal distention and vomiting, in order of frequency. The diagonsis before surgery were Meckel's diverticulum in 5 patients, non-reducible intussusception in 3 patients and intestinal obstruction in 2 patients. The diverticulum was located between 35 cm to 70 cm proximal to the ileocecal valve. The length of the diverticulum ranged from 4 cm to 12 cm and 80% of it was within 5 cm. A Meckel scan($^{99m}Tc-pertechnetate$ scintigraphy) after cimetidine administration was done in 6 cases. All 5 cases that presented with lower GI bleeding had ectopic gastric mucosa confirmed on pathology. Out of 5 cases of ectopic gastric mucosa, only 4 cases were positive on the Meckel's scan. Conclusion : In cases of unexplained GI bleeding, obstruction, or inflammation diagnostic workup should be carried out to rule out Meckel's diverticulum. Laparoscopy, high resolution ultrasonography and computed tomography of the abdomen may be indicated in the assessment of pediatric patient with lower GI bleeding, especially in patients with suspected bleeding from Meckel's diverticulum showing negative Meckel's scan.