Psychological Attitude to Self-appraisal : Permanent versus Temporary Stoma Patients

최근 수 년 간, 많은 논문에서 장루를 가진 환자들의 정신적 문제점들이 다루어졌다. 그러나 장루 복원이 불가능한 영구 장루를 가진 환자들과 장루 복원술이 가능한 임시 장루를 가진 환자들의 정신적, 정서적 영향의 차이를 비교한 연구는 거의 없었다. 본 연구는 장루 환자의 신체상, 자아 존중감 및 우울감 정도를 측정하고, 이를 바탕으로 영구 장루를 가진 환자들과 임시 장루를 가진 환자들의 정서 및 정신적 태도를 비교 분석하여 장루를 가진 환자들의 지지 요법의 방향을 제시하고자 시행되었다. 2009년 1월부터 2012년 2월까지 장루술을 시행 받은 환자들 중 본 연구에 동의한 환자들을 대상으로 전향적 연구를 진행하였다. 환자들이 느끼는 신체상, 자아 존중감, 그리고 우울감을 측정하고 평가하기 위하여 정신과 전문의와 상의하여 설문 항목을 결정하고 설문지를 준비하였다. 수술 후 4주 째 퇴원 전이나 퇴원 후 외래에서 설문지를 작성하도록 하였고, SPSS 프로그램을 이용하여 카이제곱 비교분석법, 독립표본 t검정, 일원배치 분산분석법 등으로 결과치를 비교 분석하였다. 총 65명 중 남자는 44명(64.6%), 여자는 21명(35.4%)이었으며, 평균 연령은 57.5 ± 13.90세였다. 이들 중 영구 장루를 가진 환자는 23명(35.4%)이었고, 임시 장루를 가진 환자는 42명(64.6%)이었다. 전체 환자의 신체상 척도의 평균값은 63.3 ± 15.45점이었고, 이는 연령, 경제적 수준, 학력 수준, 진단명 및 수술명과 유의한 관계를 보이지 않았다. 자아 존중감 척도의 평균값은 28.7 ± 4.12점이었고, 배우자가 없는 환자들(미혼, 이혼, 사별 등)에서 더 낮은 경향을 보였으나 뚜렷한 통계학적 연관성은 없었다. 마지막으로 우울증 척도의 평균값은 13.7 ± 8.76점으로 장루를 가진 환자들은 우울 척도 점수가 높았고, 특히 경제적 수준이 낮을수록 환자들의 우울증 척도 점수는 증가하는 양상을 보였다(p=0.031). 자신들의 신체상에 대하여 여자 환자들보다 남자 환자들에서 ‘남성성’이 저하되고 약해지고 무거워졌다고 응답하는 경향이 있었으며 우울증 척도의 몇 가지 문항들에서도 자신을 ‘실패자’라고 생각하거나 일상생활에 만족하지 못한다고 대답하여 남자에서 장루 순응도가 더 낮은 경향을 보였다. 영구 장루를 가진 환자들과 임시 장루를 가진 환자들에서 신체상 척도, 자아 존중감 척도, 우울증 척도를 분석한 결과, 영구 장루를 가진 환자들에서 스스로 ‘죄책감’을 느끼는 경향이 더 강하거나 수술 후 ‘성’에 대한 관심이 감소하고 중등도의 우울증을 나타내는 등 설문지 항목별로 차이를 보였다. 그러나 예상과 달리 임시 장루를 가진 환자들의 설문 척도의 분석 결과는 영구 장루를 가진 환자들과 차이가 없었다. 임시 장루가 일정 기간 후 복원이 가능하다고 할지라도 장루로 인하여 환자들이 받는 정신적 스트레스는 영구 장루를 가진 환자들만큼 크다는 것을 알 수 있었다. 따라서 외과 의사들은 반드시 필요하다고 판단되는 환자들에서만 장루술을 시행하여야 할 것이며, 장루가 환자들에게 미치는 정신적 영향에 대해 충분히 이해하여 영구 장루를 가진 환자들은 물론이거니와 임시 장루를 가진 환자들에게도 올바른 장루 교육과 함께 올바른 정서적 평가를 통한 적절한 지지요법을 시행하여야 할 것이다.;Background and Objectives : In recent years, the psychological problems of patients with stoma have been addressed in a number of studies. But there have been few studies approaching on objective measure for comparing self-appraisal of patients with permanent stoma and patient with temporary stoma. The aim of this study is to compare psychological attitude between patient with permanent and temporary stoma and to find out the appropriate psychological supportive care. Subjects and Methods : This study was performed on 65 patients who received a stoma during the primary operation between Jan 2009 and Mar 2012, prospectively. Patients were classified into two groups with either permanent or temporary stoma. We made a questionnaire with the help of a psychiatrist and scored the scale of psychological attitude to self-appraisal. Patients responded to the questionnaire 4 weeks after operation and we compared the answers of each group. Results : Out of 65 patients, 42 (64.6%) received temporary stoma and 23 (35.4%) received permanent stoma. The questionnaire was categorized into three parts, body image scale, self-esteem scale, and depression scale. First, body image scale was composed of 15 items and the total scores of these items were distributed from 15 to 105 points. The mean of total score was 63.3 ± 15.45 points and there was no significant difference between permanent and temporary stoma patients(62.2 ± 16.93 vs. 63.8 ± 14.76 points, p=0.694). Second, self-esteem scale was composed of 10 items and the total scores of these items were distributed from 0 to 30 points. The mean of total score was 28.9 ± 0.54 points and there was no significant difference between permanent and temporary stoma patients(28.4 ± 4.28 vs. 28.9 ± 4.13 points, p=0.682). Third, depression scale was composed of 21 items and the total scores of these items were distributed from 0 to 63 points. The mean of total score was 13.7 ± 8.76 points and there was no significant difference between permanent and temporary stoma patients(15.3 ± 9.89 vs. 12.8 ± 8.07 points, p=0.276). Patients with permanent stoma were tended to feel ‘guilty’ and had ‘moderate’ depressive mood(p=0.017 and p=0.010). Comparing self-appraisal of male and female, males considered themselves unimportant(p=0.006), humble(p=0.016), incapable(p=0.023), and lesser masculine(p=0.042). Also males were tended to feel guilty(p=0.000) and not to be content with daily-life(p=0.002), and they thought they were heavenly punished(p=0.016). Conclusion : There was no meaningful difference according to types of stoma on total score of questionnaire. But the patients with a permanent stoma tended to have worse body image and lower self-esteem on some specific items and total scores of questionnaire were low overall. It suggested that patients with stoma had negative attitude to themselves and males were frail toward the stoma. Therefore surgeons should concern about the postoperative psychological supports for the patients with stoma.I. 서론 1 II. 연구 대상 및 방법 4 A. 연구 대상 4 B. 연구 방법 4 1. 임상시험심사위원회 4 2. 설문지 4 가. 신체상 척도 5 나. 자아 존중감 척도 5 다. 한국판 벡의 우울증 척도 5 3. 추적 관찰 6 4. 통계 분석 6 III. 결과 7 IV. 고찰 20 V. 결론 25 참고문헌 26 부록 1 29 부록 2 30 부록 3 32 Abstract 3

진로탐색 프로그램이 여자중학생의 진로성숙과 자기효능감에 미치는 영향

학위논문(석사)--아주대학교 교육대학원 :상담심리전공,2001Maste

DROSHA-Dependent AIM2 Inflammasome Activation Contributes to Lung Inflammation during Idiopathic Pulmonary Fibrosis

Idiopathic pulmonary fibrosis (IPF) has been linked to chronic lung inflammation. Drosha ribonuclease III (DROSHA), a class 2 ribonuclease III enzyme, plays a key role in microRNA (miRNA) biogenesis. However, the mechanisms by which DROSHA affects the lung inflammation during idiopathic pulmonary fibrosis (IPF) remain unclear. Here, we demonstrate that DROSHA regulates the absent in melanoma 2 (AIM2) inflammasome activation during idiopathic pulmonary fibrosis (IPF). Both DROSHA and AIM2 protein expression were elevated in alveolar macrophages of patients with IPF. We also found that DROSHA and AIM2 protein expression were increased in alveolar macrophages of lung tissues in a mouse model of bleomycin-induced pulmonary fibrosis. DROSHA deficiency suppressed AIM2 inflammasome-dependent caspase-1 activation and interleukin (IL)-1 beta and IL-18 secretion in primary mouse alveolar macrophages and bone marrow-derived macrophages (BMDMs). Transduction of microRNA (miRNA) increased the formation of the adaptor apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC) specks, which is required for AIM2 inflammasome activation in BMDMs. Our results suggest that DROSHA promotes AIM2 inflammasome activation-dependent lung inflammation during IPF

A comparison of transumbilical single-port laparoscopic appendectomy and conventional three-port laparoscopic appendectomy: From the diagnosis to the hospital cost

Purpose: Recently many cases of appendectomy have been conducted by singleincision laparoscopic technique. The aim of this study is to figure out the benefits of transumbilical single-port laparoscopic appendectomy (TULA) compared with conventional three-port laparoscopic appendectomy (CTLA). Methods: From 2010 to 2012, 89 patients who were diagnosed as acute appendicitis and then underwent laparoscopic appendectomy a single surgeon were enrolled in this study and with their medical records were reviewed retrospectively. Cases of complicated appendicitis confirmed on imaging tools and patients over 3 points on the American Society of Anesthesia score were excluded. Results: Among the total of 89 patients, there were 51 patients in the TULA group and 38 patients in the CTLA group. The visual analogue scale (VAS) of postoperative day (POD) #1 was higher in the TULA group than in the CTLA group (P = 0.048). The operative time and other variables had no statistical significances (P > 0.05). Conclusion: Despite the insufficiency of instruments and the difficulty of handling, TULA was not worse in operative time, VAS after POD #2, and the total operative cost than CTLA. And, if there are no disadvantages of TULA, TULA may be suitable in substituting three-port laparoscopic surgery and could be considered as one field of natural orifice transluminal endoscopic surgery with the improvement and development of the instruments and revised studies. Copyright © 2013, the Korean Surgical Society

Proposed safe apnea test using positive end-expiratory pressure valve and short-term blood gas analysis Observational study

The apnea test is an essential examination for the determination of brain death; however, hypotension, hypoxemia, and other complications during the apnea test can affect the stability of brain-dead patients, as well as organ function for recipients. Therefore, it is necessary to establish standard guidelines for apnea testing. The modified apnea test (MAT) comprises delivery of 100% oxygen through the endotracheal tube connected to manual resuscitator (Ambu bag) with the positive end-expiratory pressure (PEEP) valve after disconnection of the mechanical ventilator for maintenance of PEEP. Forty-nine instances of the conventional apnea test (CAT) were performed in 25 brain-dead patients; 77 instances of the MAT were performed in 39 brain-dead patients. The mean duration of the apnea test was 3.5 +/- 1.4 minutes in the CAT group and 3.0 +/- 1.2 minutes in the MAT group. There were no significant changes in PaCO2, PaO2, or pH between the CAT and MAT groups (P=.341, .593, and .503, respectively). In overweight patients (body mass index >= 23kg/m(2)), MAT prevented dramatic reductions in PaO2 and SaO(2) (P<.05 for both). In the patients who had hypoxic brain injury due to hanging, differences in PaO2 and SaO(2) in the MAT group were significantly smaller than in the CAT group (P<.05). Although MAT, which was invented to maintain PEEP, was not efficient for all brain-dead patients, it could be helpful in selected patient groups, such as overweight patients or those who had hypoxic injury due to hanging. And clinicians should consider short-term apnea test to avoid unnecessarily prolonged hypoxemia

Prognostic factors and treatment outcomes for patients with Fournier's gangrene: a retrospective study

Fournier's gangrene is a gas-forming, necrotising soft tissue infection affecting the perineum. It spreads rapidly along the deep fascial planes and is associated with a high mortality rate. With a growing elderly population with comorbidities, the frequency of severe cases of Fournier's gangrene is expected to increase. We retrospectively reviewed 20 patients diagnosed with Fournier's gangrene at our institution from 2003 to 2014 and analysed data. Thirteen patients had diabetes mellitus, two had been diagnosed with liver cirrhosis, and four were chronic alcoholics. Of 15 patients admitted to an intensive care unit, 11 underwent colostomy, and 4 required skin grafts for wound healing. The wide wounds of two patients were healed using vacuum-assisted closure (VAC®) dressing without additional surgery. The mortality rate was 25%, and the patients whose Fournier's gangrene severity index (FGSI) score was higher than 9 points or whose blood urea nitrogen (BUN) level was higher than 50 mg/dl had a poor prognosis. In order to treat Fournier's gangrene, aggressive surgical treatment, including wide debridement and stoma creation, should be considered as soon as possible to improve survival rates. Additionally, VAC dressing is helpful in healing the wide debridement wound without additional reconstructive surgery. © 2017 Medicalhelplines.com Inc and John Wiley & Sons Lt

Oncologic outcomes in rectal cancer with close distal resection margins: A retrospective analysis

Purpose: The assurance of a negative resection margin is significant in rectal cancer as it indicates a reduced risk of local recurrence; thus, sufficient length of the resection margin is strongly required. The purpose of this study was to analyze the relationship between the length of the distal resection margin (DRM) and local recurrence or survival rate and to evaluate the possibility of performing sphincter-conserving surgery. Methods: The medical records of 218 rectal cancer patients were analyzed. Patients were classified into three groups according to the length of the DRM as follows: group 1, DRM < 1 cm; group 2, 1 cm ≤ DRM ≤ 2 cm; and group 3, DRM > 2 cm. Results: Of 218 patients enrolled, 81 were in group 1, 66 in group 2, and 71 in group 3. The 5-year survival rates were 78.2%, 78.2%, and 76.8% for groups 1, 2, and 3, respectively, and there were no statistically significant differences in survival (P = 0.913). Local recurrence was found in 2 patients in group 1, 1 patient in group 2, and 1 patient in group 3; there were no statistically significant differences in local recurrence (P = 0.908). Conclusion: A DRM of < 1 cm did not impair the oncologic outcomes of rectal cancer patients. Our results indicated that surgeons should keep in mind to consider the option of sphincter-conserving surgery with adjuvant chemoradiotherapy even in very low rectal cancer. Copyright © 2015, the Korean Surgical Society

Acute hyperammonemic encephalopathy after 5-fluorouracil based chemotherapy

5-Fluorouracil (5-FU) based chemotherapy has been commonly used to treat metastatic or advanced colon cancer as an adjuvant chemotherapy. Although the side effects of 5-FU such as gastrointestinal problems and neutropenia and thrombocytopenia are common, not many cases of 5-FU related encephalopathy are reported. Hyperammonemic encephalopathy is a rare central nervous system toxicity following 5-FU chemotherapy manifesting as altered mental status with elevated ammonia levels with no radiologic abnormality. We report one case of 5-FU induced hyperammonemic encephalopathy occurring after Folfox4 (oxaliplatin, folinic acid and 5-fluorouracil) chemotherapy in a colon cancer patient who presented with confused mental status soon after the chemotherapy and review the 5-FU related encephalopathy

Korean Journal of Environmental Agriculture 국내 다소비 농산물의 알루미늄 농도 모니터링 및 농산물 섭취로 인한 위해도 평가 Risk Assessment Aluminum Levels of Circulating Agricultural Products in Korea

Abstract BACKGROUND: This study was carried out to collect occurrence data on aluminum in 12 type agricultural products and assess dietary exposure risk to the Korean population health for aluminum concentration in agricultural products. METHODS AND RESULTS: Aluminum analysis samples were performed using microwave device and Inductively Coupled Plasma Optical Emission Spectrometer. The LOD(Limit of Detection) for aluminum was 0.851 μg/kg, while the LOQ(Limit of Quantitation) was 2.838 μg/kg and recovery was 97.6% for aluminum. The average levels of aluminum in mg/kg were 0.526 for rice, 0.546 for Korean cabbage, 1.316 for corn, 6.207 for soybean, 0.549 for sweet potato, 0.257 for potato, 6.963 for spinach, 1.213 for carrot, 0.524 for garlic, 0.950 for radish, 1.015 for leek, and 3.511 for Welsh onion. The dietary exposures of aluminum through usual intake were polished rice 89.31 μg/day, Korean cabbage 33.14 μg/day, corn 0.66 μg/day, soybean 3.72 μg/day, sweet potato 6.86 μg/day, potato 4.96 μg/day