Electrical stimulation is recently rising as a treatment protocol of dysphagia. The mechanism is known to induce the pharyngeal reflex to stimulate the sensory nerve around the neck. However, elevation of the hyoid and pharynx to stimulate the suprahyoid muscles (esp. mylohyoid muscle) is thought to be more beneficial. We presented 3 cases to improve the dysphagia after stimulation of the suprahyoid muscles to elevate the hyoid and pharynx similar to the normal swallowing during 4 weeks.
Clinical Protocols ; Deglutition ; Deglutition Disorders* ; Electric Stimulation ; Gagging ; Humans ; Muscles ; Neck ; Pharynx

Thrombotic thrombocytopenic purpura (TTP) is frequently associated with small cortical and subcortical infarcts. However, major intracranial artery occlusion is rare. We report a case of progressive middle cerebral artery (MCA) infarction in a patient with TTP. A 76-year-old woman with hypertension was admitted due to right hemiparesis and transcortical motor aphasia. On laboratory findings, she had microangiopathic hemolytic anemia and thrombocytopenia. Brain MRI showed left subcortical multiple infarction, and MR angiogram revealed severe stenosis of left MCA main stem. She was treated with heparin and steroid but a few days later, there was neurologic deterioration attributed to progressive occlusive stroke in the left MCA territory. Follow-up brain CT demonstrated left malignant MCA infarction. TTP may be associated with progressive occlusion of large cerebral artery.
Aged ; Anemia, Hemolytic ; Aphasia, Broca ; Arteries ; Brain ; Cerebral Arteries ; Constriction, Pathologic ; Female ; Follow-Up Studies ; Heparin ; Humans ; Hypertension ; Infarction ; Infarction, Middle Cerebral Artery* ; Magnetic Resonance Imaging ; Middle Cerebral Artery* ; Paresis ; Purpura, Thrombotic Thrombocytopenic* ; Stroke ; Thrombocytopenia

Pulmonary paragonimiasis is a food-borne zoonosis, which is acquired from eating the raw or undercooked freshwater crabs or crayfish (crustaceans). It was highly endemic in Korea the late 1960's. However, human paragonimiasis is still sporadically occuring because of pupularization of Korean traditional crab dishes and is one of the lung disease which needs differential diagnosis. Recently, we experienced a case of pulmonary paragonimiasis in a 55 years man with dyspnea, dry cough and abdominal pain. The patient had hypereosinophilia and pulmonary infiltrates with pleural effusion, which did not improve on antibiotics. Diagnosis was confirmed by sputum with Paragonimus westermani ova, which was treated with praziquantel for two days at a daily dosage of 75 mg/kg. The patient was readmitted to the hospital 1 month following first treatment with recurrence of symptoms and he was cured by a second course of praziquantel.
Abdominal Pain ; Anti-Bacterial Agents ; Astacoidea ; Cough ; Diagnosis ; Diagnosis, Differential ; Dyspnea ; Eating ; Fresh Water ; Humans ; Korea ; Lung Diseases ; Ovum ; Paragonimiasis* ; Paragonimus westermani ; Pleural Effusion ; Praziquantel ; Recurrence ; Sputum

We describe a patient with hyponatremia induced by the use of angiotensin-converting enzyme (ACE) inhibitor; imidapril HCl. Although the mechanism of severe hyponatremia due to ACE inhibitor is not clear, it is conceivable that ACE inhibitor therapy may complicate the syndrome of inappropriate secretion of antidiuretic hormone and induce hyponatremia. In addition, the possibility should be considered that hyponatremia in our patient is a presumptive interaction between oxcarbazepine and imidapril HCl.
Angiotensins* ; Humans ; Hyponatremia* ; Peptidyl-Dipeptidase A*

Transient global amnesia(TGA) is not a rare event in the elderly, which is characterized by transient inability to form the new memory traces plus retrograde amnesia with benign prognosis. The etiology is unknown, but suggested causes have included transient ischemic attack, migraine, epilepsy, brain tumor, drug intoxication, other toxic/metabolic disturbances, or hysteria. Especially, TGA associated with ischemic stroke is important on the elderly patients and necessary to be differentiated with other causes, for stroke prevention. As far as we know, the case of TGA due to cerebral infarction confirmed by brain imaging study is extremely rare in the literature. We report the case of 67 year-old female patient with typical TGA showing ischemic lesion on the right temporal area on MRI and discussed its significance as one of the cause of TGA.
Aged ; Amnesia, Retrograde ; Amnesia, Transient Global* ; Brain Neoplasms ; Cerebral Infarction ; Epilepsy ; Female ; Humans ; Hysteria ; Infarction* ; Ischemic Attack, Transient ; Magnetic Resonance Imaging ; Memory ; Migraine Disorders ; Neuroimaging ; Prognosis ; Stroke

No abstract available.
Aging ; Animals ; Cerebral Cortex* ; Neurons* ; Neuropeptide Y* ; Neuropeptides* ; Nitric Oxide Synthase* ; Nitric Oxide* ; Rats*

BACKGROUND: This study was designed to investigate the relationship between psychiatric disease and systemic disease in geriatric psychiatric inpatients who were consulted to department of internal medicine and were above 6th decade, and was directed to assess the physical problems and possible ways to resolve them in a closed psychiatric unit. METHOD: Through evaluation of medical records of 225 inpatients who had consulted in department of internal medicine in Seoul National Mental Hospital from January 1, 1998 to December 31, 1999. We classified the physical illness according to ICD-9-CM and psychiatric disease according to NTA. RESULTS: The result were as follows: 1) In age sex distribution, male was 62.7%, and 81.8% of the subjects was 6th decade. 2) The most common systemic diagnosis were disease of circulatory system, disease of digestive system, and disease of respiratory system. 3) The most systemic disease was disease of circulatory system in 6th and 8th decade. 4) Disease of circulatory system in all psychiatric disease was the most frequent. 5) Rate of circulatory disorder was the highest in organic mental disorder. Disease of digestive system and disease of endocrine system were the most frequent in alcoholics. Disease of respiratory system showed the highest rate in schizophrenea. CONCLUSION: The clinical characteristics of psychiatric diseases influenced to get systemic disease in geriatric patients.
Alcoholics ; Neurocognitive Disorders ; Diagnosis ; Digestive System ; Endocrine System ; Hospitals, Psychiatric ; Humans ; Inpatients* ; Internal Medicine ; International Classification of Diseases ; Male ; Medical Records ; Respiratory System ; Seoul ; Sex Distribution

BACKGROUND: There is a continuing increase in geriatric population. Many workers have reported an increased mortality rate after operation on patients over 65 years of age. The aim of this study is to analyze and to measure the risk factors associated with geriatric surgery. METHODS: We reviewed the medical records of 467 patients over 65 years of age who had been admitted and operated on in the department of General Surgery, Konkuk University Hospital, between January, 1993 and December, 1999. An analysis was done on age and sex distribution, duration of admission, type of anesthesia, duration of general anesthesia, number of benign and malignant disease, number of coexistent disease, number of emergency and elective operation, and then, we analyzed the above factors to know whether they influence mortality rate or not. RESULTS: 1) Overall operative mortality rate was 4.3%, and the factors influencing mortality rate were, malignant disease, coexisting disease, emergency operation and long duration of general anesthesia. 2) Old age in itself did not affect the mortality. CONCLUSION: In order to reduce the operative mortality in geriatric surgery, careful preoperative evaluation and elective surgery rather than emergency operation must be done, and the operation chosen should be the one of less magnitude, not very radical operations to achieve permanent cures.
Anesthesia ; Anesthesia, General ; Emergencies ; Humans ; Medical Records ; Mortality* ; Risk Factors ; Sex Distribution

BACKGROUND: Recently the number of elderly gallstone patients has increased, in Korea. The aim of this study is to analyze and to measure the risk factors associated with operation on elderly gallstone patients. METHODS: We reviewed the medical records of 206 gallstone patients who had been admitted and operated on in the department of general surgery. Konkuk University Hospital, between January, 1993 and December, 1999. The patients were divided into 2 groups, over and under age 65. In each group, analysis was done on sex distribution, the ratio according to location of gallstone, duration of hospital stay, duration of general anesthesia and operative mortality, and then the above factors of each group were compared. RESULTS: 1) The ratio of common bile duct stones in patients over age 65 was two times of that in patients under age 65(48%,24%) 2) The overall operative mortality was 1.9% and has no correlation with old age. 3) Severe coexisting disease may seem the risk factor for operative mortality. CONCLUSION: In the diagnosis and management of gallstones in the elderly, the possibility of common bile duct stone should be suspected. And in order to reduce the operative mortality, careful preoperative evaluation and treatment of coexisting disease should be done.
Aged ; Anesthesia, General ; Common Bile Duct ; Diagnosis ; Gallstones* ; Humans ; Korea ; Length of Stay ; Medical Records ; Mortality ; Risk Factors ; Sex Distribution

BACKGROUND: Vascular smooth muscle cells (VSMCs) proliferation is an important process in the pathogenesis of atherosclerosis. VSMCs proliferation is closedly related to the cytosolic calcium flux via L-type voltage dependent calcium channel. OBJECTIVES: To investigate the role of cytosolic Ca(2+) in the proliferation of VSMCs. METHODS: The proliferation of aortic vascular smooth muscle cells of rats(1% cholesterol diet fed rats and general diet fed ones), acquired by enzymatic method. Cell counting, and calcium agonists(Bay K 8644 10(-6)M) or calcium antagonists(verapamil 10(-6)M). Cytosolic calcium ion was measured with Fura 2 method. Calcium channel gene expresssion was detected with RT-PCR method. RESULTS: Masson Trichrome staining shows more disturbed cell lining, more VSMCs, more degenerated media, more collagen laydown, and more adventitial fat in the aorta of cholesterol-fed rats than in that of general diet-fed ones. VSMCs of cholesterol fed-rats were moreproliferated than those of general diet fed-ones. Bay K 8644 enhanced VSMCs proliferation of both groups. Verapamil blocked the incremental effects induced by Bay K 8644. Expression of calcium channel gene was enhanced by Bay K 8644 and was reversed by verapamil. CONCLUSION: The enhanced proliferation of atherosclerotic VSMCs is associated with the increment in cytosolic calcium, which is accomplshed through the expression of L-type voltage dependent calcium channel.
3-Pyridinecarboxylic acid, 1,4-dihydro-2,6-dimethyl-5-nitro-4-(2-(trifluoromethyl)phenyl)-, Methyl ester ; Animals ; Aorta* ; Atherosclerosis ; Calcium Channels ; Calcium* ; Cell Count ; Cholesterol* ; Collagen ; Cytosol* ; Diet ; Fura-2 ; Muscle, Smooth* ; Muscle, Smooth, Vascular ; Myocytes, Smooth Muscle* ; Rats* ; Verapamil