Search

Objective This study examined the growth trajectory of fear of cancer recurrence (FCR) and its predictors, and the association of that trajectory with the beliefs and rates of medication adherence in patients with breast cancer. Methods 210 patients with breast cancer undergoing adjuvant endocrine therapy in a university hospital in Seoul, Korea, were followed up five times over 18 months following surgery, and data from the final 162 patients were analyzed. Results Latent class growth analysis identified three classes. Classes 1 (38.31%) and 2 (39.89%) showed low and moderate FCR levels, respectively, with a decreasing trend over time. Class 3 (21.80%) showed a high FCR level with an initially decreasing but increasing trend afterwards. Lower education and unemployed status were associated with the high FCR class. Higher depression was more associated with the moderate FCR class than the low FCR class. Higher emotional representation was more associated with the high FCR class than with low FCR class, and greater illness comprehension was more associated with the moderate FCR class than with the high FCR class. Both necessity and concerns about medication were the highest in the high FCR class. However, self-reported medication adherence rates did not significantly differ between the classes. Conclusions A high level of FCR appear to persist over time, and given its association with greater concerns about medication, monitoring and management of FCR throughout the cancer trajectory. This article is protected by copyright. All rights reserved.

Objective Patients with breast cancer receiving neoadjuvant chemotherapy are at increased risk of poor health-related quality of life (HRQOL). This study examined clinical caseness on depression and anxiety mediate the relationship between resilience and HRQOL in patients with breast cancer. Methods A total of 193 patients with breast cancer undergoing neoadjuvant chemotherapy completed questionnaires including the Connor-Davidson Resilience Scale, Hospital Anxiety and Depression Scale (HADS), and Functional Assessment of Cancer Therapy-Breast before the first session (T0), before the start of the last session (T1), and 6 months after the end (T2) of chemotherapy. Mediation analyses using a bootstrapping method was performed. Results The indirect effect (IE) through T1 depression was significant (IE through depression = 0.043, 95% confidence interval [CI] [0.002-0.090]), while IE through T1 anxiety was not significant (IE through anxiety = 0.037, 95% CI [-0.010-0.097]) in the association between T0 resilience and T2 HRQOL. Conclusions Clinical caseness on HADS depression subscale during chemotherapy was a mediating factor of the relationship between resilience before chemotherapy and HRQOL after chemotherapy in patients with breast cancer receiving neoadjuvant chemotherapy. Depression during chemotherapy in patients with breast cancer may be a target symptom of screening and intervention to maintain the HRQOL after chemotherapy. Also, patients with low resilience are more likely to develop depression during chemotherapy, and clinicians should carefully monitor whether depression occurs in these patients with low resilience.

본 연구는 성인애착(애착불안, 애착회피)과 관계만족의 관계에서 대인관계문제(지배, 복종, 적대, 친밀)의 매개효과를 확인해 보고자 하였다. 이를 위하여 남녀 성인을 대상으로 성인애착, 대인관계문제 및 관계만족에 대한 설문을 실시하였고, 수집된 자료 중 260명의 자료를 분석에 사용하였다. 회귀분석을 통해 성인애착과 관계만족의 관계를 확인하였으며, 경로분석을 활용하여 성인애착이 관계만족에 미치는 직접효과와 성인애착이 대인관계문제를 매개하여 관계만족에 영향을 미치는 간접효과를 검증하였다. 더불어 Sobel’s test를 통해 지배, 복종, 적대 및 친밀의 개별매개효과를 검증하였다. 본 연구의 주요결과를 요약하면 다음과 같다. 첫째, 애착불안과 애착회피가 높을수록 관계만족이 낮았다. 둘째, 애착불안이 높을수록 지배, 복종, 적대, 친밀 문제가 많았고, 애착회피가 높을수록 지배, 복종, 적대 문제가 많았다. 셋째, 지배 문제와 관계만족은 유의한 관련이 없었고, 복종과 적대의 문제는 많을수록 관계만족이 낮았으며, 친밀 문제는 많을수록 관계만족이 높았다. 마지막으로, 대인관계 문제 중 복종 문제와 적대 문제는 성인애착(애착불안, 애착회피)과 관계만족의 관계를 부적으로 매개하였고, 친밀문제는 애착불안과 관계만족의 관계를 정적으로 매개하는 것으로 나타났다. 이러한 연구결과를 바탕으로 시사점과 제한점을 논의하였다.

To examine whether depression, anxiety disorder, and their co-occurrence would increase the risk of mortality in patients with breast cancer, and whether antidepressant treatment would reduce the same. Data were retrieved from the database of the Korean National Health Insurance Service. Of 145,251 patients diagnosed with breast cancer between 2007 and 2014, 20,870 patients diagnosed with depression or anxiety disorder one year before breast cancer diagnosis were excluded. Thus, data of 124,381 patients were included in this study. Depression and anxiety disorder were associated with an increased risk of mortality [Hazard Ratio (HR) 1.26, 95% CI 1.18–1.36; HR 1.14, 95% CI 1.08–1.22, respectively] and their co-occurrence further increased the risk (HR = 1.38, 95% CI 1.24–1.54). Antidepressant treatment was related to a reduced risk of mortality. Compared to patients without any psychiatric comorbidity with no antidepressant treatment, the mortality risk increased in patients with either psychiatric comorbidity or both, but the risk seemed to attenuate with antidepressant treatments. The current findings suggest that psychiatric comorbidities are markers of increased mortality risk in patients with breast cancer, and antidepressant treatment may attenuate the risk. This underscores the need for screening and treating depression and anxiety disorders to improve survival in patients with breast cancer.

Delirium is a common neurocognitive complication in cancer. Despite this, the studies examining the trajectory of the severity of delirium symptoms and its impact on health outcome in gastric cancer is rather limited. This study examined the trajectory of delirium symptom severity (DSS) following resection surgery for gastric cancer and its prospective association with cognitive function. A three-wave prospective observational study was conducted with 242 gastric cancer patients admitted for resection surgery at a teaching hospital in South Korea from May 2016 to November 2017. DSS was assessed by the clinical staff before and 1, 2, 3, and 7 days after surgery using the Delirium Rating Scale-Revised-98. A survey including the Functional Assessment of Cancer Therapy-Cognitive Scale (FACT-Cog) and Mini-Mental State Examination (MMSE) was administered before surgery (T0), 7 days after (T1), and 3 to 6 months after surgery (T2). Out of 242 participants, 48.8% (118) completed the survey at all three time points, 43.4% (105) did so for two time points, and 7.9% (19) for one time point. No cases of full delirium were observed over four postoperative time points. Latent growth curve modeling analyses indicated that DSS declined over 3 days after surgery. Age and anesthesia time were positively associated with the initial level of DSS. A medication history for memory complaints was related to a slower recovery from delirium symptoms. While the use of propofol as an anesthetic agent was associated with lower initial DSS, it predicted a slower recovery from DSS. A higher initial DSS predicted a lower T1 MMSE score. Severity of postoperative delirium symptoms predicts a short-term and objective cognitive function post-surgery. Monitoring and timely treatment of postoperative delirium symptoms is needed to diminish cognitive consequences in gastric cancer patients.

Background This study examined phenomenological manifestations of delirium in advanced cancer patients by examining the factor structure of the Delirium Rating Scale-Revised-98 (DRS-R-98) and profiles of delirium symptoms. Methods Ninety-three patients with advanced cancer admitted to inpatient palliative care units in South Korea were examined by psychiatrists using the DRS-R-98 and the Confusion Assessment Method (CAM). The factor structure of the DRS-R-98 was examined by exploratory structural equation modelling analysis (ESEM) and profiles of delirium were examined by latent profile analysis (LPA). Results CAM-defined delirium was present in 66.6% (n = 62) of patients. Results from the ESEM analysis confirmed applicability of the core and noncore symptom factors of the DRS-R-98 to advanced cancer patients. LPA identified three distinct profiles of delirium characterizing the overall severity of delirium and its core and noncore symptoms. Class 1 (n = 55, 59.1%) showed low levels of all delirium symptoms. Class 2 (n = 17, 18.3%) showed high levels of core symptoms only, whereas Class 3 (n = 21, 22.6%) showed high levels of both core and noncore symptoms except motor retardation. Conclusions Clinical care for delirium in advanced cancer patients may benefit from consideration of the core and noncore symptom factor structure and the three distinct phenomenological profiles of delirium observed in the present study.

We assessed the prevalence/comorbidities of attention deficit hyperactivity disorder (ADHD) in Korean servicemen using the Epidemiological Survey of Mental Health in Military Service in Korea. A total of 3,441 participants were assessed for adult ADHD, depression, social anxiety, generalized anxiety, somatization, insomnia, suicidality, cigarette dependence, and alcohol dependence using a self-report scale. Participants were also asked to rank their perception of their career prospects, health status, and quality of life on a Likert scale. Participants were classified as ADHD according to the WHO A-ADHD self-report scale. Firth multiple logistic regression and Cochran-Armitage trend tests were used to identify the risks of comorbidities and trends of self-perception between the two groups. ADHD (prevalence: 2.8%) was significantly associated with social anxiety (OR, 40.52; 95% CI 25.14-65.74), generalized anxiety (OR, 28.21; 95% CI 17.37-45.69), depression (OR, 16.36; 95% CI 10.50-25.52), somatization (OR, 14.47; 95% CI 9.21-22.76), suicidality (OR, 11.03; 95% CI 6.67-17.86), and insomnia (OR, 5.92; 95% CI 3.68-9.35). Servicemen with ADHD had negative perceptions (p0.001) of their career prospects, health status, and quality of life compared to servicemen without ADHD. It is essential to revise the enlistment criteria for individuals with ADHD or to develop management programs for servicemen with ADHD.

The aim of this study was to develop a screening questionnaire that could distinguish individuals at high risk of smartphone overuse from casual users. The reliability, validity, and diagnostic ability of the Smartphone Overuse Screening Questionnaire (SOS-Q) were evaluated. Preliminary items were assessed by 50 addiction experts on-line, and 28 questions were selected. A total of 158 subjects recruited from six community centers for internet addiction participated in this study. The SOS-Q, Young's internet addiction scale, Korean scale for internet addiction, and Smartphone Scale for Smartphone Addiction (S-Scale) were used to assess the concurrent validity. Construct validity was supported by a six-factor model using an exploratory factor analysis. The internal consistency and the item-total correlations were favorable (α = 0.95, r = 0.35-0.81). The test-retest reliability was moderate (r = 0.70). The SOS-Q showed superior concurrent validity with the highest correlation between the S-Scale (r = 0.76). Receiver operating characteristic curve analysis revealed an area under the curve of 0.877. A cut-off point of 49 effectively categorized addiction high-risk group with a sensitivity of 0.81 and specificity of 0.86. Overall, the current study supports the use of SOS-Q as both a primary and supplementary measurement tool in a variety of settings.

Little research has examined the role of pain catastrophizing (PC) in predicting suicide among patients with rheumatic disease or the mechanisms through which it works. This study examines whether depression, perceived social support (PSS), and perceived burdensomeness (PB) mediate the relationship between PC and suicide risk. It also examines the relative importance of sociodemographic, clinical, and psychological factors in predicting suicide risk. Three hundred sixty patients from a rheumatology clinic in Korea completed measures of pain catastrophizing, social support, depression, and perceived burdensomeness. In hierarchical multiple regression analysis, the PC magnification, PB, physical disability, and PSS were significantly related to suicide risk. Results of the serial multiple mediation analysis indicated that the total indirect effect of PC magnification on suicide risk was significant while the direct effect was not. Four specific indirect effects of PC magnification were found to be statistically significant. First of all, PC magnification was associated with suicide risk through PB and through depression and PB. PC magnification was also associated with suicide risk through depression and PSS. Lastly, PC magnification was associated with suicide risk through depression, PSS, and PB. The identified pathways through which PC affects suicide risk suggest the importance of depression, PSS, and PB. Evaluation and intervention targeted at physical disability and the psychological factors of PC magnification, depression, PSS, and PB may be integrated into the management of suicide risk in patients with rheumatic disease.

To examine factors in the fear-avoidance model, such as pain, pain catastrophizing, fear-avoidance beliefs, physical disability, and depression and their relationships with physical and psychological quality of life in patients with rheumatic diseases.The data were obtained from 360 patients with rheumatic diseases who completed self-report measures assessing study variables. Structural equation modeling was used to examine the hypothesized relationships among factors specified in the fear-avoidance model predicting physical and psychological quality of life.Final models fit the data well, explaining 96% and 82% of the variance in physical and psychological quality of life, respectively. Higher pain catastrophizing was related to stronger fear-avoidance beliefs that had a direct negative association with physical disability and depression, which, in turn, negatively affected physical quality of life. Pain severity was also directly related to physical disability. Physical disability also affected physical quality of life indirectly through depression. The hypothesized relationships specified in the model were also confirmed for psychological quality of life. However, physical disability had an indirect association with psychological quality of life via depression.The current results underscore the significant role of cognitive, affective, and behavioral factors in perceived physical disability and their mediated detrimental effect on physical and psychological quality of life in patients with rheumatic diseases. Implications for rehabilitation The fear-avoidance model is applicable to the prediction of quality of life in patients with rheumatic diseases. As pain-catastrophizing and fear-avoidance beliefs are important factors linked to physical disability and depression, intervening these cognitive factors is necessary to improve physical function and depression in patients with rheumatic diseases. Considering the strong association between depression and physical and psychological quality of life, the assessment and treatment of the former should be included in the rehabilitation of patients with rheumatic diseases. Interventions targeting physical function and depression are likely to be effective in terms of improving physical and psychological quality of life in patients with rheumatic diseases.

Objective To report the development and validation of the National Cancer Center Psychological Symptom Inventory (NCC-PSI). Methods Psychometric properties of the NCC-PSI were examined by using multicenter surveys involving 400 patients with cancer in 5 cancer-treatment hospitals throughout Korea. Related measures including the Mini-International Neuropsychiatric Interview were administered. Results Convergent validity was supported by NCC-PSI's significant associations with related measures. Known-group validity was proven with higher scores of helplessness/hopelessness and anxious preoccupation on the Mini-Mental Adjustment to Cancer in the depression and anxiety diagnosis group, defined by the NCC-PSI. Cutoff scores for insomnia, anxiety, and depression were identified. Overall, the screening performance of the NCC-PSI was comparable to that of the distress thermometer and Patient Health Questionnare-2. Conclusions The NCC-PSI represents a meaningful effort to develop a distress screening tool that addresses specific psychological symptoms common in cancer, which are tailored to the local oncology care system with varying degrees of psychosocial care resources.

Purpose To build and validate a decision tree model using classification and regression tree (CART) analysis to distinguish lipoma and lipoma variants from well-differentiated liposarcoma of the extremities and superficial trunk. Methods This retrospective study included patients who underwent surgical resection and preoperative contrast-enhanced MR imaging for lipoma, lipoma variants, and well-differentiated liposarcoma in two tertiary referral centers. Six MRI findings (tumor size, anatomical location, tumor depth, shape, enhancement pattern, and presence of intermingled muscle fibers) and two demographic factors (patient age and sex) were assessed to build a classification tree using CART analysis with minimal error cross-validation pruning based on a complexity parameter. Results The model building cohort consisted of 231 patients (186 lipoma and lipoma variants and 45 well-differentiated liposarcoma) from one center, while the validation cohort consisted of 157 patients (136 lipoma and lipoma variants and 21 well-differentiated liposarcoma) from another center. In the CART analysis, the contrast enhancement pattern (no enhancement or thin septal enhancement versus thick septal, nodular, confluent hazy, or solid enhancement) was the first partitioning predictor, followed by a maximal tumor size of 12.75 cm. The tree model allowed distinction of lipoma and lipoma variants from well-differentiated liposarcoma in both the model building cohort (C-statistics, 0.955; sensitivity 80 %, specificity 94.62 %, accuracy 91.77 %) and the external validation cohort (C-statistics, 0.917; sensitivity 66.67 %, specificity 95.59 %, accuracy 91.72 %). Conclusion The distinction of lipoma and lipoma variants from well-differentiated liposarcoma can be achieved with the simple classification tree model.

This study examined whether somatic symptoms and sleep quality can be indicators of depression and suicide risk in Korean military conscripts. In October and November of 2016, a total of 1,937 conscripts completed a survey that included the patient health questionnaire (PHQ) 9, PHQ15, the Mini International Neuropsychiatric Interview Plus suicidality module, and the Pittsburgh sleep quality index. Four groups were formed by depression and suicide risk status. Results from analyses of covariance indicated that overall, the severity of somatic symptoms and aspects of sleep quality were higher in conscripts with both depression and suicide risk, and greater associations of depression with somatic symptoms and sleep quality. The results of logistic regression analyses indicated that moderate to high levels of somatic symptoms and poorly perceived health were associated with the risk of depression and suicide, respectively. Poor sleep quality was associated with a higher risk of depression, but it was not significantly related to suicide risk after accounting for depression, which showed a greater association with suicide risk. Monitoring somatic and sleep complaints along with perceived health are needed as potential markers of depression and suicide risk among military conscripts.

Few studies have examined the effect of perceived social support (PSS) on chemotherapy-related symptoms (CRS). This study examined the effect of PSS on CRS in 184 patients with breast cancer.Participants were consecutively enrolled from a tertiary general hospital in Seoul, South Korea. CRS were assessed eight times, from before the first neoadjuvant chemotherapy to six months after the end of neoadjuvant chemotherapy, with the MD Anderson Symptom Inventory. PSS was evaluated once, before the first neoadjuvant chemotherapy session, using the Multidimensional Scale of Perceived Social Support (MSPSS). Two groups were formed based on MSPSS scores: the low PSS group (n = 62) and the moderate-to-high PSS group (n = 122). Linear mixed model analyses were used to compare the change in CRS severity between the two groups during chemotherapy.Results indicated a significant group-by-time (low PSS or moderate-to-high PSS; 8 periods of chemotherapy) interaction for pain (p = .005), nausea (p = .033), insomnia (p .001), distress (p = .003), dyspnea (p = .014), memory loss (p = .021), vomiting (p = .016), and numbness (p = .008) in which the moderate-to-high PSS group showed significantly lower levels of increase in those symptoms during chemotherapy. Moreover, the effect of PSS on CRS differed depending on the sources of PSS.Patients with moderate-to-high PSS experience less severe CRS compared with patients with low PSS during chemotherapy. The current findings indicate the potential benefits of providing social support in the management of CRS.

The high disease burden associated with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is linked to the elevated suicide risk in this population. Informed by the interpersonal theory of suicide, this study examined how and under which conditions depression is related to suicide risk in people living with HIV/AIDS. A total of 202 outpatients with HIV/AIDS participated in a cross-sectional and multi-center survey involving four university hospitals in South Korea. This self-reported survey included the Hospital Anxiety and Depression Scale, Interpersonal Needs Questionnaire, and Mini-International Neuropsychiatric Interview suicidality module. Participants’ mean age was 48.6 (SD = 13.4) and the majority was male (89.1%). The proportions of those at high, medium, and low suicide risk were 18.5%, 20%, and 15.4%, respectively. Depression was associated with suicide risk directly and indirectly by increasing perceived burdensomeness (PB) and the indirect effect of depression on suicide risk mediated by PB was contingent on the level of thwarted belongingness (TB). PB was associated with suicide risk even after controlling for depression, suggesting its independent effect on suicide risk. PB and TB are potential mechanisms through which depression is associated with suicide risk, supporting the applicability of the interpersonal theory of suicide to understanding a complex interplay of risk factors in people with HIV/AIDS. Moreover, given the independent association of PB with suicide risk, as well as a protective effect of TB in suicide risk, monitoring and management of these factors should be included in the care of people with HIV/AIDS.

BackgroundThis meta-analysis aimed to evaluate the association between antiplatelet resistance and the risk of procedure-related complications in neurovascular interventions.MethodsWe identified relevant articles by searching electronic databases and reviewed the reference lists of selected papers. The risk of adverse events between antiplatelet responders and hyporesponders during neurointervention was compared in eligible clinical studies. Risk ratios (RRs) and 95% CIs were pooled using a random-effects meta-analysis.ResultsOf 2134 potentially relevant studies, our search identified 15 studies enrolling a total of 2365 patients. Pooled RRs showed thromboembolic events (TEE) were more frequent in hyporesponders (RR 2.634, 95% CI 1.465 to 4.734). However, hemorrhagic complications did not differ between the two groups (RR 1.236, 95% CI 0.642 to 2.380). In subgroup analysis, hyporesponders showed a higher prevalence of TEE with standard antiplatelet medication, but there was no obvious difference in TEE between the two arms when using a modified antiplatelet medication (RR 3.645, 95% CI 1.537 to 8.646; and RR 1.877, 95% CI 0.749 to 4.751). Studies using stent placement for aneurysms showed a higher TEE rate in hyporesponders (RR 3.221, 95% CI 1.899 to 5.464).ConclusionAntiplatelet resistance was significantly associated with TEE in neurointervention, and this adverse event was associated with individually-intensified antiplatelet medication as well as the type of neurointerventional procedure. Our findings support the use of antiplatelet resistance assays and tailored antiplatelet medications in neurovascular stent placement as a management strategy to reduce thromboembolic risk.

Objective:Our aim was to examine the prevalence, correlates, and association of depressive and anxiety disorders with quality of life (QoL) and such other outcomes as the need for psychosocial services in cancer patients.Method:A total of 400 patients participated in a multicenter survey involving five cancer centers located throughout Korea. The Short-Form Health Survey, the MD Anderson Symptom Inventory, the Mini-Mental Adjustment to Cancer (MINI-MAC), and Mini-International Neuropsychiatric Interview were administered.Results:The prevalence rates for depressive and anxiety disorders were 16 and 17.1%, respectively. Younger age and poor Eastern Cooperative Oncology Group performance status, and all physical symptoms, as well as helplessness/hopelessness, anxious preoccupation (AP), and cognitive avoidance (CA) on the MINI-MAC were found to be significantly related to depressive disorder (DD) in a univariate logistic regression analysis. Metastases, the symptoms of disturbed sleep, dry mouth, and numbness or tingling, as well as AP and CA were significantly correlated with anxiety disorder (AD) in the univariate analysis. In the multivariate analyses, only AP was significant for AD (odds ratio = 2.94,p< 0.001), while none reached statistical significance for DD. Psychiatric comorbidity status had a detrimental effect on various dimensions of QoL. Patients with DD or AD reported a significantly higher need for professional psychosocial services.Significance of results:Given the substantial prevalence and pervasive impact of DD and AD on various aspects of QoL, its assessment and care should be integrated as a regular part of oncological care throughout the cancer continuum.

Background Psycho-oncology in Korea was introduced among the circle of consultation-liaison psychiatrists, in the 1990s. For almost 25 years, the field has been developing at a steady pace as the psychosocial needs of patients with cancer continue to increase. In this study, we review the history of psycho-oncology in Korea, in a chronological order, within the domains of clinical practice, research activity, training, and public policy. Main body Before the 1990s, patients with cancer with psychiatric comorbidities were usually taken care of by consultation-liaison psychiatrists in general hospitals. In 1993, psycho-oncology was first introduced by psychiatrists. Psychologists, nurses, and social workers have also been increasingly involved in providing psychosocial care for patients with cancer. Professionals from various disciplines began to communicate, and agreed to found the Korean Psycho-Oncology Study Group (KPOSG) in 2006, the first academic society in this field. In 2009, National Cancer Center published the “Recommendations for Distress Management in Patients with Cancer”, which are consensus-based guidelines for Korean patients. In 2014, the KPOSG was dissolved and absorbed into a new organization, the Korean Psycho-Oncology Society (KPOS). It functions as a center of development of psycho-oncology, publishing official journals, and hosting annual conferences. There are many challenges, including, low awareness of psycho-oncology, presence of undertreated psychiatric disorders in patients with cancer, shortage of well-trained psycho-oncologists, stigma, and suicide risk. It is important to improve the cancer care system to the extent that psycho-oncology is integrated with mainstream oncology. Considering the socio-cultural characteristics of Korean cancer care, a Korean model of distress management is being prepared by the KPOS. Conclusion This article provides an overview of the development, current issues, and future challenges of psycho-oncology in Korea. Through its long journey to overcome the many barriers and stigmas of cancer and mental illnesses, psycho-oncology is now acknowledged as an essential part of integrated supportive care in cancer. Active research and international cooperation can gradually shape the Korean model of distress management.

Objective Fear of progression (FOP) is a prevalent concern among breast cancer patients that affect their adjustment to disease. This study examined whether self-efficacy moderates the effect of illness perception (IP) on FOP and whether the moderating effect of self-efficacy depends on the level of depressive symptoms. Methods A cross-sectional survey including brief illness perception questionnaire (BIPQ), FOP short form, general self-efficacy scale, and the center for epidemiologic studies depression scale were administered to 245 patients with breast cancer in Korea. Results Self-efficacy moderated the negative impact of the patients' perception of chronic timeline and a greater emotional impact of the illness on FOP. However, the moderating effect of self-efficacy of the BIPQ timeline and emotions on FOP depended on level of depressive symptoms. Conclusions The findings underscore the importance of considering the IP as determinants of FOP, as well as of self-efficacy and depression as the moderating factors in the relationship between IP and FOP, suggesting the need to enhance self-efficacy and depressive symptoms in order to compensate the negative impact of IP on FOP in breast cancer patients.

Many previous studies have revealed that individuals with depression have higher thought of suicide, although not always exhibiting intent. We investigated the associated factors with respect to intent for suicide in the future. A total of 1584 adults were selected through a nationwide multistage probability sampling, randomly one person per household, and through face-to-face interviews (response rate was 63.4%) using the suicidality module of the Mini-International Neuropsychiatric Interview and the Patient Health Questionnaire-9. The group with depression (n = 152) revealed a significantly higher level of future suicide intent (t = 4.65, p

Inflammatory fibroid polyp (IFP) is a rare benign lesion of the gastrointestinal tract. We report a case of computed tomography (CT) imaging finding of a gastric IFP with massive fibrosis. CT scans showed thickening of submucosal layer with overlying mucosal hyperenhancement in the gastric antrum. The submucosal layer showed increased enhancement on delayed phase imaging. An antrectomy with gastroduodenostomy was performed because gastric cancer was suspected, particularly signet ring cell carcinoma. The histopathological diagnosis was an IFP with massive fibrosis. The authors suggest that when the submucosal layer of the gastric wall is markedly thickened with delayed enhancement and preservation of the mucosal layer, an IFP with massive fibrosis should be considered in the differential diagnosis.

Background Doctor-patient communication is a crucial aspect of patient care. This study explored the communication experience of patients in a cancer consultation over the course of the cancer continuum. Methods In-depth interviews with seven breast cancer patients were carried out. Results Themes related to communication experiences across the five phases of cancer consultation, from diagnosis to recurrence, were identified. The most salient issue is that patients also perceived cancer as ‘a disease of the mind’, which is not adequately cared for in consultation. This highlights the notion that cancer care providers should provide appropriate care for the psychological dimensions of the cancer experience with an empathic and sincere attitude during consultations. To this end, non-verbal aspects of communication that convey caring, support, and respect seem important. Furthermore, patients perceived that the consultation time was far shorter then they needed and reported that they felt pressured for time. Moreover, the stance taken by patients and the needs and preferences of patients varied across the phases of the cancer trajectory. As patients progressed through the phases of their treatment, they assumed more active roles in the course of their care and the need for more detailed information and questioning increased. Thus, ensuring that patients have opportunities to ask questions in the consultation is important. Conclusion Current findings suggest that the efficacy of communication varies depending on which phase patients are in and that effective communication should be tailored to these evolving needs and preferences of breast cancer patients. Also, patients perceived that the consultation did not adequately address their need for information related to their care or their emotional issues associated with the cancer experience. It is therefore important to address their needs by paying particular attention to non-verbal aspects of communication that convey empathy and respect toward patients, as well as allowing patients to ask questions. Electronic supplementary material The online version of this article (doi:10.1186/s12905-016-0347-x) contains supplementary material, which is available to authorized users.

Background: Little is known about whether exposure to suicide within close social networks is associated with the suicidality in exposed individuals, and potential gender differences regarding this association. Aims: This study examines the effect of exposure to suicide on the suicidality in exposed individuals. Methods: The data were drawn from the 2009 Korean General Social Survey, a nationally representative interview survey. Suicidality was measured by the suicidality module in the Mini International Neuropsychiatric Interview (MINI), with exposure to suicide being determined by asking about the experience of a failed or completed suicide attempt by a closely related person. Results: Exposure to the suicide of someone close was significantly associated with higher suicidality in exposed individuals. While the effect of a failed attempt became non-significant after controlling for psychological factors, that of exposure to a completed act of suicide remained significant. A subsample analysis by gender indicated a significant gender difference: with control for demographic and psychological factors, exposure to a completed suicide had a significant effect on the suicidality of females only. The effect of exposure to a failed attempt became non-significant both in males and females after controlling for other factors. Conclusions: Findings suggest the necessity of screening for prior exposure to suicide in suicide risk assessment and the need for gender-tailored suicide-prevention strategies.

Shared decision making and an integrative approach is expected to result in better outcomes, but might require more time. While ensuring that sufficient consultation time is essential to quality cancer care, it is not clear whether cancer patients feel that the amount of consultation time with their oncologists is sufficient. Data were collected from 2,556 cancer patients on their perceived and preferred consultation time, and included potential predictors, such as socio-demographics, clinical, behavioral, and quality-of-life factors, as well as potential outcomes, including unmet patient needs, trust in doctor, and satisfaction. The feeling of insufficient consultation time was defined as the perception that consultation time is less than the preferred consultation time; multivariate analyses were used for identification of predictors and comparison of outcomes. Overall, 37.1% felt that consultation time was less than preferred. Younger age, female sex, higher education level, having national health insurance, having been diagnosed with less common cancers, and having anxiety/depression were significantly associated with feelings of insufficient consultation time. Subjects with a feeling of insufficient consultation time reported higher current needs for information, physical symptoms, and psychological problems. They also reported less trust in their physician, lower overall satisfaction, and lower intention to continue treatment at the current cancer center. This study illustrated that high-quality cancer care, characterized by shared decision making and an integrative approach, seems to be related to sufficient consultation time that meets the individual’s subjective needs, and measures should be taken to ensure sufficient consultation time.

SHIM E.-J. & HAHM B.-J. (2011) European Journal of Cancer Care20, 395–402 Anxiety, helplessness/hopelessness and ‘desire for hastened death’ in Korean cancer patients Despite a relatively high rate of suicide associated with cancer, this issue has not been explored in Korean patients. This study investigates the prevalence and factors related to ‘the desire for hastened death’ (DHD) in Korean cancer patients. A cross-sectional survey using standardised measures, including the Schedule of Attitudes toward Hastened Death and the Hospital Anxiety and Depression Scale, was performed with 131 patients with different types of cancer. 13.7% of the participants experienced moderate DHD (Schedule of Attitudes toward Hastened Death scores 5–9) and 1.7% experienced high DHD (≥10). Socio-demographic and disease-associated factors of the DHD included age, overall health and shortness of breath. The majority of psychosocial variables such as sadness, distress, ‘helplessness/hopelessness’ and ‘anxious preoccupation’ had a moderate association with DHD. Patients with a clinically significant level of anxiety or depression reported higher levels of DHD. Other significant correlates included ‘meaning/peace’, a sense of burdening family, dignity impairment and suicidal thoughts after diagnosis. Helplessness/hopelessness and anxiety were the strongest predictors of DHD in multivariate analysis. In view of significant role of helplessness/hopelessness and anxiety in the DHD of cancer patients, careful monitoring and management of these factors should be an integral part of cancer care to reduce the occurrence of DHD.

Objectives: Psychological distress is common in cancer patients, and the need to develop a system for assessing and managing distress is widely recognized. This project developed recommendations that are feasible for Korean cancer patients and the Korean healthcare system. Methods: Based on the findings from a series of studies in the context of this project, we developed guidelines following the steps and parameters recommended by the Scottish Intercollegiate Guidelines Network (SIGN). The Development Group consisted of individuals from several professions, including psychiatrists, psychologists, nurses, social workers, a health policy expert, and a methodologist. Opinions from various healthcare providers, patients, and related societies were also reflected in the guidelines. Results: The main recommendations for distress management in cancer patients were the following: (1) a concept of distress in Korean cancer patients, screening tools, management algorithms, and triage approaches was developed and (2) four symptom-specific guidelines with management algorithms were proposed for depression, anxiety, insomnia, and delirium. Conclusion: This is the first effort to develop recommendations for distress management in psycho-oncology in Korea. These guidelines offer standards for psychosocial care for cancer patients in Korea. We have made a significant step toward integrated cancer care that incorporates the psychosocial care of patients as an essential component of patient care in a Korean oncology context. This version will be updated constantly to keep up with emerging evidence from empirical research and clinical experience. Copyright © 2011 John Wiley & Sons, Ltd.

Needs assessment is an important step toward quality and patient-centered cancer care, as it identifies patient need, guiding evidence-based cancer care policy, and maximizing care outcome. This study reports on the development and validation of comprehensive needs assessment tool in cancer (CNAT).The CNAT, 59-item needs assessment tool for cancer was developed and validated in a large scale multi-center survey involving 2,661 cancer patients in ten fairly distributed cancer centers throughout Korea.To ensure content validity of the CNAT, items were derived from major needs assessment tools and input from experts and patients. Exploratory factor analysis confirmed its construct validity and identified seven factors: health care staff, psychological problems, physical symptoms, information, social and religious/spiritual support, practical support, and hospital facilities/services. Cronbach's alpha for the scale was 0.97, and for subscales, it varied from 0.80 to 0.97. Convergent validity was demonstrated by its significant association with the EQ5D. Patients with elevated stress, depressive episodes, or suicidal ideation reported a significantly higher level of psychological and overall need. Known-group validity was also supported by its ability to detect significant differences according to age, gender, education, insurance status, months since diagnosis, and non-surgical anticancer treatment. Needs differed according to SEER stage and cancer type: advanced stage and breast and lung cancer were associated with a greater level of need.The CNAT constitutes a meaningful and valid response to the challenges of cancer care, enabling assessment of need in cancer with a comprehensive yet concise and psychometrically sound tool.

Objective: The assessment of a caregiver’s needs is a critical step for determining appropriatesupport services, providing high quality care, and achieving caregiver satisfaction. However,a systematic assessment of family caregiver’s needs is rarely practiced. This study reports thedevelopment and validation of a comprehensive needs assessment tool for cancer caregivers(CNAT-C).Methods: Items of CNAT-C were generated through literature review and refined throughexpert consultation and caregiver interview, and pilot test. Final 41-item needs assessment toolfor cancer was developed and validated in a large-scale multi-center survey involving 600 cancerpatients-family caregiver dyads in 10 cancer centers fairly distributed throughout Korea.Results: The content validity of CNAT-C was established throughout the developmentprocess. Principal component analysis resulted in a seven-factor structure explaining 66.4% ofthe total variance: (1) health and psychological problems (6 items), (2) family/social support(5 items), (3) health-care staff (8 items), (4) information (8 items), (5) religious/spiritualsupport (2 items), (6) hospital facilities and services (6 items), and (7) practical support(6 items). The Cronbach alpha was 0.96 for the total scale, and those for the subscales rangedfrom 0.79 to 0.95. Caregiver needs were not highly correlated with patient needs whencompared domain-by-domain. Known-group validity was also supported by the tool’s ability todetect significant differences according to various patient and caregiver characteristics.Conclusions: The CNAT-C appears to be a valid and reliable measure to assess comprehensiveand multidimensional needs in caregivers of cancer patients.Copyright r 2010 John Wiley & Sons, Ltd.Keywords: caregiver; cancer; needs assessment; validation; oncology

Aims: To assess the relationship between depression and the vision-related quality of life in patients with retinitis pigmentosa (RP). Methods: The study included 144 patients diagnosed as having RP. The mean age of the patients was 38.5 (SD 13.3) years, and 42% of the subjects were women. They answered the National Eye Institute Visual Function Questionnaire (NEI-VFQ) to assess the vision-related quality of life and the Beck Depression Inventory (BDI) to assess depressive symptoms. Patients were classified into groups with and without depression according to the BDI score. The NEI-VFQ composite and subscale scores were compared between groups. The correlations between the BDI and the NEI-VFQ, weighted visual acuity (WVA) and functional vision score (FVS) were investigated. Results: The depressed group had significantly less subjective visual function compared with the non-depressed group. A negative correlation was observed between the BDI and the NEI-VFQ scores, while no correlation was found between the BDI score and WVA or FVS. Conclusion: The RP patients with depression had poorer vision-related functions compared with those patients without depression, which cannot be explained by the visual acuity. Interventions to diagnose and treat depression are necessary to enhance the overall quality of life in RP patients.

Although previous studies have suggested that childhood trauma and parental death are strongly associated with suicidality in adulthood, it is still unclear how these factors interact within the same population. A total of 1396 adults were recruited through nationwide multistage probability sampling in South Korea. Subjects were evaluated through face-to-face interviews using the Suicidality Module of the Mini-International Neuropsychiatric Interview and the Early Trauma Inventory Self Report-Short Form. Among the 1396 adults, the group that experienced both childhood trauma and parental death had the highest current suicidality risks (F = 12.16, p0.0001) and lifetime suicide attempt (χ2 = 35.81, p0.0001) compared with the other groups, which were only childhood trauma, only parental death, and neither. Multivariate logistic regression analyses revealed that middle-to-high current suicidality risk and lifetime suicide attempt were significantly associated with concurrent childhood trauma and parental death (odds ratio, 3.64; 95% confidence interval, 1.99-6.65) as well as with only childhood trauma (odds ratio, 1.95; 95% confidence interval, 1.33-2.87), after adjusting for age, sex, education, marital status, household monthly income, and living area. Emotional abuse was the only type of childhood trauma significantly associated with higher current suicidality scores in those who experienced childhood parental death than in those who did not (F = 3.26, p = 0.041). Current suicidality risk and lifetime suicide attempt are associated with experiencing both parental death and trauma, especially emotional abuse, in childhood, whereas experiencing only childhood parental death is associated with neither.

Objective Scar-related cosmetic outcomes were compared prospectively between conventional three-port and single-port access laparoscopic adnexal gynaecological surgery. Methods Enrolled patients were randomly assigned to a single- or three-port surgery group. Scar-related outcomes were evaluated at 1 month, 6 months and 1 year. Scars were assessed by an independent observer using the modified Vancouver Scar Scale (mVSS). All patients were asked about pain related to the scar and scar satisfaction; results were recorded using a numerical rating scale. Results Seventy-three patients were enrolled between June 2010 and June 2011. Demographic and surgical outcomes did not differ between the groups. mVSS results were similar in the two groups at each follow-up point. The scar satisfaction profile measured at 1 month showed no significant difference between the groups, but the single-port access group had better results than the conventional group at all other follow-up timepoints. Conclusion Cosmetic outcome was better for single-port than for three-port adnexal gynaecological surgery at 6-month and 1-year follow-up.

Background Turner syndrome is due to the absence of all or significant parts of one of the sex chromosomes in females. Turner syndrome is a common cause of ovarian failure, and hypergonadotropic hypogonadism occurs in virtually all affected individuals. One case of a variant Turner syndrome with precocious puberty is presented. Case An eight-year-old girl was referred with complaints of short stature and breast budding. A physical examination revealed a Tanner stage III for breast development and her bone age was 11 years. Chromosome analysis showed a karyotype of 46,X,del(x)(p11.2). Summary and Conclusion To preserve growth potential, careful examinations are recommended for pediatric patients with an unusual growth pattern.

BACKGROUND AND OBJECTIVES Patent ductus arteriosus (PDA) is a significant cause of morbidity and mortality in preterm infants. Measurement of plasma B-type natriuretic peptide (BNP) has been reported to be a useful bedside screening tool for the presence of hemodynamically significant PDA (hsPDA) in neonates. This study was conducted to investigate the usefulness of a BNP assay as a biochemical marker for the diagnosis of hsPDA and predictive biomarker of the response to indomethacin in preterm infants. SUBJECTS AND METHODS Preterm infants born at

Background and Objectives Patent foramen ovale (PFO) has been implicated in the pathogenesis of cryptogenic stroke or transient ischemic attack (TIA) due to paradoxical embolism, and in the pathogenesis of migraine. This paper reports the intermediate and long-term results of transcatheter closure of PFO associated with cerebrovascular accidents (CVAs), TIAs and migraine, using the Amplatzer PFO occluder. This paper also reports a case of pulmonary embolism which developed in one patient after PFO closure. Subjects and Methods From January 2003 to May 2010, 16 patients with PFO (seven males and nine females) with a history of at least one episode of cryptogenic stroke/TIA, CVA, or migraine and who underwent percutaneous transcatheter closure of PFO using the Amplatzer occluder. All the procedures were performed under general anesthesia and were assisted by transesophageal echocardiography. Results The device was implanted without any significant complications in all the patients, and the PFOs were effectively closed. At an average follow-up period of 54 months, the 15 patients with TIA/CVA had no recurrence of any thromboembolic event. The symptoms in one patient with migraine subsided after occlusion of the PFO. In this study, pulmonary embolism occurred five months after PFO closure in one patient, but the cause of pulmonary embolism was not identified. However, it is believed that the pulmonary embolism occurred without stroke recurrence because occlusion of the PFO was performed when the patient had a stroke event. Conclusion It can be concluded that according to the intermediate and long-term follow-up results, transcatheter PFO closure is an effective and safe therapeutic modality in the prevention of thromboembolic events, especially in the patients with cryptogenic stroke/TIA, and PFO closure is helpful in the treatment of migraine. However, this study involved a small number of patients and also the follow-up period was not long enough. Hence, randomized, controlled trials are necessary to determine if this approach is preferable to medical therapy for the prevention of recurrent stroke or as primary treatment for patients with migraine headache.

Objective This study investigated the fear of progression (FoP) in cancer patients and the discriminant ability of the Fear of Progression Questionnaire (FoP-Q) against the Hospital Anxiety and Depression Scale (HADS), while also examining relationships between FoP, satisfaction outcomes and supportive needs. Method The FoP-Q and HADS were administered to 112 cancer patients in Korea during June and July 2006. The FoP-Q totals and subscales, and the HADS scores were compared across three groups (patients with recurrence, patients with metastases and controls experiencing neither). Results Comparison of the FoP-Q total score to HADS anxiety (HADS-A) and depression (HADS-D) scores showed higher FoP in the recurrence group compared to the control group (P=.009). Subscale score comparisons revealed a heightened “affective reaction” (P=.003) to cancer progression and fear of “loss of autonomy” (P=.011) in recurrence patients. FoP-Q score showed a moderate association with HADS-A (r=.54, P=.000) and a significant association with treatment satisfaction (r=−.26, P=.007), medical staff and communication (r=−.31, P=.001), and supportive needs (r=.41, P=.000). Conclusion The importance of providing supportive interventions tailored to the specific emotional concerns of cancer patients, assessed via appropriate, disease-specific instruments, and the need to pay special attention to the concerns of recurrence patients are suggested.

Kikuchi-Fujimoto disease is a rare and benign disease, characterized by regional cervical lymphadenopathy with fever of unknown origin, affecting mainly young women. This self-limiting disease of unknown etiology has rarely been reported in children, so it has been frequently confused with malignancies. We describe a case of a child who was initially mistaken for malignant lymphoma because of multiple lymph nodes with 18-fluorodeoxyglucose uptake on positron emission tomography and was finally diagnosed with Kikuchi-Fujimoto disease by excisional biopsy of the affected lymph node.

The distress thermometer (DT), a one-item measure for distress, provides a means for rapidly and effectively screening psychological distress in cancer patients. In this pilot study, a screening efficacy of the DT was investigated in a mixed cohort of 108 Korean cancer patients. Participants completed the DT, the problem list (PL), and the Hospital Anxiety and Depression Scale (HADS), and answered questions regarding supportive needs and their degree of satisfaction with several aspects of care. Receiver operating characteristic (ROC) curve analyses indicated that a DT cutoff score of 4 yielded an area under the ROC curve of 0.75 with a sensitivity of 0.83 and a specificity of 0.59 for HADS-total score defined cases (or =15). HADS--Anxiety and Depression subscale scores explained 27% of the variability in the DT scores, implying that 'distress' is a broader concept that includes anxiety and depressive symptoms but has a more comprehensive meaning that encompasses multiple contributory factors. Regarding the PL, distressed patients (DTor =4) reported significantly more problems (23 of 35) in all categories, suggesting, although degrees differ, that a wide variety of problems contribute to distress in cancer patients. Distress as defined by DT and HADS subscale scores was also significantly associated with higher supportive needs, a poor ECOG performance status (both physician and patient-rated), and a reduced level of satisfaction with treatment, staff, and communications. In conclusion, the DT and the PL were found to be simple yet effective screening instruments for detecting psychosocial distress in Korean cancer patients, and for identifying problems that warrant intervention.

Objective In previous research studies, performance status as determined by cancer patients themselves frequently did not agree with that determined by their oncologists. However, only a few studies have evaluated the reasons for this discrepancy. Methods One hundred eleven cancer patients attending the Comprehensive Cancer Center of Seoul National University Hospital were asked to complete a questionnaire that included questions on sociodemographic and medical status, Eastern Cooperative Oncology Group (ECOG) performance status score and the Hospital Anxiety and Depression Scale (HADS). Medical oncology records were reviewed to obtain information and oncologist-assessed ECOG performance status scores. Results Patients and oncologists agreed in 59 cases (53.2%; weighted κ=0.17). There were no statistically significant gender-, cancer-type- or cancer-stage-related differences in agreement rates. Hierarchical logistic regression analyses showed that HADS depression subscale was the only variable that significantly contributed to patient-assessed performance status scores (β=0.50, P=.0005), whereas cancer stage was the only variable that significantly contributed to oncologist-assessed performance status scores (β=0.34, P=.0004). The mean of HADS depression subscale and the depression rates were highest in patients who rated themselves as most impaired on ECOG performance. Conclusions Depression was found to be significantly associated with patients who rated their performance status as more impaired than with the oncologist-assessed score.

Purpose: Follow-up after primary treatment for breast cancer is an important component of survivor care and various international guidelines exist for the surveillance. However, little is known about current actual practice patterns of physicians whether they adhere to or deviate from recommended guidelines. The aim of this study was to determine how physicians follow-up their patients after primary treatment for breast cancer in Korea. Methods: A questionnaire survey with 34 questions in 4 categories was e-mailed to the members of Korean Breast Cancer Society from November to December 2013. Respondents were asked how they use follow-up modalities after primary treatment of breast cancer and we compared the survey results with present guidelines. Results: Of the 129 respondents, 123 (95.3%) were breast surgeons. The most important consideration in follow-up was tumor stage. History taking, physical examinations, and mammography were conducted in similar frequency recommended by other guidelines while breast ultrasonography was performed more often. The advanced imaging studies such as CT, MRI, and bone scan, which had been recommended to be conducted only if necessary, were also examined more frequently. Regular screenings for secondary malignancy were performed in 38 respondents (29.5%). Five years later after primary treatment, almost the whole respondents (94.6%) themselves monitored their patients. Conclusion: A majority of respondents have been performed more intensive follow-up modalities in comparison with present guidelines and less frequently screenings for secondary malignancy. For optimal follow-up of breast cancer survivors, tailored delivery system should be considered.

Objective To find out the factors affecting medication discontinuation in patients with overactive bladder (OAB) symptoms. Methods The clinical data of 125 patients with OAB symptoms who had taken antimuscarinics and behavioral therapy were retrospectively reviewed. Antimuscarinics related outcomes were evaluated by an independent observer with telephone interview. All patients were asked about duration of medication and reason of continuation or discontinuation of antimuscarinics. To determine pre-treatment factors predicting self-report discontinuation of antimuscarinics, variables of only those with P-values

Despite the fact that more breast cancer survivors are currently enjoying longer lifespans, there remains limited knowledge about the factors and issues that are of greatest significance for these survivors, particularly from their perspectives. This review was based on the concept that the topics addressed should focus on the perspectives of current survivors and should be extended to future modalities, which physicians will be able to use to gain a better understanding of the hidden needs of these patients. We intended to choose and review dimensions other than the pathology and the disease process that could have been overlooked during treatment. The eight topics upon which we focused included: delay of treatment and survival outcome; sexual well-being; concerns about childbearing; tailored follow-up; presence of a family history of breast cancer; diet and physical activity for survivors and their families; qualitative approach toward understanding of breast cancer survivorship, and; mobile health care for breast cancer survivors. Through this review, we aimed to examine the present clinical basis of the central issues noted from the survivors' perspectives and suggest a direction for future survivorship-related research.

We report a very rare case of congenital adrenal agenesis presented with adrenal insuffi­ ciency in a 4­day­old female newborn. She was admitted with darkish skin color and seizure. Her external genitalia was normal. Elevated serum level of adrenocorticotropic hormone and increased plasma renin activity were observed. Plasma cortisol level and aldosterone level were decreased. Pelvic ultrasonography revealed bilateral agenesis of adrenal glands. Six exons of the steroidogenic factor­1 (SF­1, NR5A1) gene and their intronic flanking sequences were normal. Now, she is continuously receiving replacement doses of glucocorticoids and mineralocorticoids under adrenal insufficiency. Her growth and development are completely normal. We propose that when a patient presents with 46, XY disorder of sex development or normal female genitalia with adrenal insuf­ ficiency, SF­1 gene mutation study should be included in the differential diagnosis.

Gastric outlet obstruction (GOO) results from obstructing lesions in the region of the pyloric channel. In neonates, hypertrophic pyloric stenosis (HPS) is the most common cause while peptic ulcer is a rare cause. Neonatal gastric ulcer is relatively frequent in preterm newborn babies or in neonates treated in intensive care units. In healthy neonates, mucosal ulcers are associated with stressful conditions. In gastric ulcer diseases, gastric outlet obstruction is usually caused by a combination of edema, spasm, fibrotic stenosis and gastric atony. We experienced a case of neonatal gastric ulcer with a large hematoma in a 3-day-old infant presenting with repeated vomiting, poor oral intake, and abdominal distension. For the differential diagnosis, we did abdominal ultrasonography. Hematoma was diagnosed by abdominal ultrasonography. Endoscopic examination confirmed the hematoma and the presence of gastric ulcerations. We report this case with a brief review of the literature. (Korean J Pediatr Gastroenterol Nutr 2011; 14: 398∼402)

Purpose:To characterize the pathogens and their antibiotic susceptibilities in more than 24-month-old children with urinary tract infection (UTI) and to study the Escherichia coli antimicrobial susceptibility trend. Methods:We retrospectively reviewed the record of more than 24-month-old children with UTI between January 2003 and December 2008. Positive results for 1 bacterial species with a colony count of ≥10 CFU/mL was considered statistically significant. We analyzed uropathogens and their antibiotic susceptibilities. To investigate E. coli antibiotic susceptibility trend, we compared 2 study periods (group A: 2003-2005 versus group B: 2006-2008) using the chi-square test for trend. Results:In all, 63 bacterial isolates were identified in children with febrile UTI. The most common pathogen was E. coli (77.8%). There was no difference in the resistance patterns of uropathogens during the 2 study periods (P>0.05). Antibiotic susceptibility of the E. coli isolates to aztreonam, cefotetan, cefotaxime, ceftriaxone, cefepime, amikacin, and imipenem was >90% to trimethoprim/sulfamethoxazol, 49% and to ampicillin and ampicillin/sulbactam, 20-25%. Over the 2 study period, the E. coli susceptibilities to most antibiotics did not change: the susceptibility to cefuroxime increased from 74.1% to 95.5% (P=0.046) and that to ciprofloxacin increased from 59.3% to 86.4% (P=0.039). Conclusion:Empirical treatment with trimethoprim/sulfamethoxazole, ampicillin, and ampicillin/sulbactam alone appeared to be insufficient in childhood UTI because of the high resistance of E. coli and other gram-negative uropathogens. Antibiotics for empirical therapy should be selected based on the sensitivity and resistance pattern of uropathogens found in a particular region.

Purpose : We analyzed the clinical features management and outcome of small bowel intussusception in children compared with ileocolic intussusception. Methods : We retrospectively reviewed the records of 210 children with documented intussusception in whom intus- susception was initially diagnosed by ultrasonography during the four-year period of 2002 to 2005. Results : A total of 191 children were diagnosed with ileocolic intussusception and 19 were diagnosed with small bowel intussusception. Children with small bowel intussusception were older than children with ileocolic intussusception (P