OBJECTIVES: The sensitivity and accuracy of thermistor airflow signal has been debated. The purposes of this study were to compare apnea-hypopnea index(AHI) detected from a conventional thermistor signal and a nasal pressure transducer of airflow(NPT), to evaluate the value of NPT for the diagnosis of upper airway resistance syndrome (UARS), and to measure airway pressure fluctuations which produced respiratory arousals in UARS by naso-oro-esophageal manometer catheter. The subjects were 30 patients with obstructive sleep apnea syndrome [mild(540), 10), and 6 UARS patients. Airway resistance arousal in this study was defined as arousals which were not associated with apnea or hypopnea of thermistor signal, but showed significant decrease of nasal airflow pressure just before arousal and a prompt recovery of nasal airflow pressure after arousal, The airway pressure fluctuations were measured during 260 airway resistance arousals observed in 10 patients with OSAS, 2 with UARS. RESULTS: Mean AHIs of patients with OSAS were 33.4 by thermistor and 48.4 by NPT. The AHIs of mild, moderate and severe OSAS group were 10.2, 32.1, 65.4 respectively by thermistor and 23.1, 45.9, 76.4 by NPT. The mean AHI of patients with UARS was 3.2 by tehrmistor and 108 by NPT. The mean AHI of patients with nonspecific arousals was 2.7 by thermistor and 4.4 by NPT. The mean airway pressure changes during resiratory arousals of different groups were 8.7 cmH2O in mild OSAS, 11.4 cmH2O in moderate OSAS, 24.7 cmH2O in severs OSAS and 6.6 cmH2O in UARS. CONCLUSION: The nasal pressure transducer of airflow was more sensitive and accurate for assessing respiratory disturbances of patients with OSAS and was extremely helpful for the diagnosis of UARS without esophageal pressure monitoring. From the results, we would like to propose carefully the NPT diagnostic criteria for sleep disordered breathing as follows : NPT-AHI 5-15->UARS, 15-35->mild OSAS, 35-55->moderate OSAS and >55 ->severe OSAS.
Airway Resistance* ; Apnea ; Arousal ; Catheters ; Diagnosis ; Humans ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive* ; Transducers, Pressure

BACKGROUND: Combined spinal epidural anesthesia (CSE) is used for obtaining adventages of both spinal and epidural anesthesia. But it might be suspected that epidural volume load affect spinal sensory blockade level during CSE. METHODS: Eighty patients undergoing lower abdominal and lower extremity operation were involved in our study. Subarachnoid block with 12mg of tetracaine was established in all patients. Four groups were studied. Group 1 (n=20), the control, received only spinal anesthesia. Group 2 (n=20), group 3 (n=20) and group 4 (n=20) received 10, 15 and 20 ml of epidural saline immediately after spinal anesthetic administration. Sensory blockade level was checked by pinprick test at 5, 10, 15, 20, 25, 30, 40, 60 and 90 minutes. Blood pressure, heart rate and incidence of complications such as hypotension, bradycardia, nausea and high block were measured. RESULTS: The sensory blockade level of groups 3 and 4 was higher than group 1 (p<0.05). Blood pressure and heart rate were not different compared with each other. The incidence of complications, except that higher block above T4 in group 4 was more than in group 1 (p<0.05), were not different when compared with each other. CONCLUSIONS: Epidural saline above 15 ml may affect sensory blockade level of spinal anesthesia during CSE.
Anesthesia, Epidural* ; Anesthesia, Spinal ; Blood Pressure ; Bradycardia ; Heart Rate ; Humans ; Hypotension ; Incidence ; Lower Extremity ; Nausea ; Tetracaine

No abstract available.
Activities of Daily Living* ; Humans ; Stroke*

The present study was designed to identify the sequential electrophysiological findings ant to determine the prognostic values of electrophysiological and clinical pararneters in patients with Guillain-Barre syndrome (GBS). Severely affected 42 subjects (Grade D,E). Who fulfilled the diagnostic criteria of GBS were selected. Twentynine patients were followed up at least 6 months (range 6-24 months) from the onset of neurologic syrnptorns. We analyzed 83 electrodiagnostic studies from 42 subjects. The sequential electrophysiological abnorrnalities were most marked at 3-4 weeks after the onset. At that time the most significant change was a decrease of CMAP amplitude. By stepwise discriminant analysis of several electrophysiological parameters, the three variables, of CMAP amplitude, distal conduction velocity; and F-wave latency were deterrnined to be significant pararneters. The accuracy of predicting the prognosis at 6 months was 82. 8%, when the classification functions were applied. Nlerefore the findings of early electrophysiological studies would be irnportant in understanding the serial pathophysiological changes and assessing the clinical outcorne of Guillain-Barre syndrorne.
Ants ; Classification ; Guillain-Barre Syndrome* ; Humans ; Prognosis

In order to survey the reality of anxiety and depression among the Koreans residing in china, a study was conducted between January and March of 1991, on the residents of Yun-Kil city, with subjects of 472 Koreans and 479 Chinese. The evaluation was based on the questionnaires, named Combined self-rating anxiety depression scale (CADS), distributed among the subjects. ANOVA and t-test were applied for data processing. The results were as follows: There was not significant difference in the mean of total scores between the two groups. The scores of Koreans were 29.70±7.03, while those of Chinese were 29.45±9.01. The score of the CADS above 50 (clinically significant level) was seen in 12 (2.54%) Koreans and 21 (4.38%) Chinese. The anxiety-depression scores relating to the items of indigestion and decreased appetite, sleep disturbance, apprehension, decreased libido were relatively high among the Koreans. The items appeared low in scores among the Koreans were faintness, fear, suicidal rumination, hopelessness, paresthesias. The highs among the Chinese were facial flushing, anxiousness, dissatisfaction, suicidal rumination. The items appeared low among the Chinese were fear, faintness, paresthesias, weight loss, suicidal rumination. In the compatison of evaluation by items between the two groups, the items placing the Koreans significantly higher over the Chinese are indigestion & decreased appetite, sleep disturbance, apprehension, decreased libldo. The Chinese marked significantly higher in facial flushing, anxiousness, dissastisfaction, suicidal rumination. Those in the case of female (p<0.01 respectively), less than twenty years old (p<0.01 respectively), dissatisfied with family relationship (p<0.01 respectively), with past history of psychiatric hospitalization (Koreans p<0.01, Chinese p<0.05), pessimistic toward future, present, past self image (p<0.01 respectively) had significantly higher scores in both groups. In religion, neither group showed significant difference. In religion, neither group showed significant difference. In marital status, the Koreans showed a higher degree of divorce and separation and the Chinese in singleness (p<0.01 respectively). The Korean were higher in illiteracy and the Chinese had more college education (p<0.01 respectively). In place of growth, The Koreans showed not much difference in the areas while more Chinese grew up un large cities (p<0.01). More Koreans lived in the dormitory while the Chinese were engaged more in self-cooking (p<0.01 respectively), In pocket money per mouth, more Koreans were less than 1 dollar while the Chinese were between 7 and 10 dollars (p<0.01 respectively). There were no significant difference between two groups about religion.
Anxiety* ; Appetite ; Asian Continental Ancestry Group ; China* ; Depression* ; Divorce ; Dyspepsia ; Education ; Ethnopsychology ; Family Relations ; Female ; Flushing ; Hospitalization ; Humans ; Libido ; Literacy ; Marital Status ; Mouth ; Paresthesia ; United Nations ; Weight Loss

Severe limitation of knee motion is a complication of operative procedures or trauma about the knee. Physical therapy and occasionally manipulation of knee with anesthesia may improve results when performed soon after the onset of motion limitation. When performed later, these have been proven less useful. This is a review of 15 patients who had severe limitation of knee motion following open operative procedures or trauma about knee and were treated by percutaneous release of adhesions under arthroscopic control. There were eleven males and four females, ranging in age from 23-67years(mean 38 years). The interval between the last open operative procedure or trauma and arthroscopic adhesiolysis ranged from three and half months to four years(mean 11.5 months). The interval between arthroscopic adhesiolysis and final follow-up evaluation ranged from 6 months to 3 years(mean 1.5 years). Average preoperative knee motion was 38.2 degrees. After arthroscopic adhesiolysis, maximum knee motion under anesthesia was 120.3 degrees and average final motion at follow-up was 101.2 degrees. The results of treatment of treatment of Tbc knee sequalae with secondary osteoarthritis and pyogenic arthritis were less favorable for motion improvement. Arthroscopic adhesiolysis seems to be a useful method of treatment in knee ankylosis. Morbidity was low, complications were few and the duration of hospital stay was short.
Anesthesia ; Ankylosis ; Arthritis ; Arthroscopy ; Female ; Follow-Up Studies ; Humans ; Knee ; Length of Stay ; Male ; Methods ; Osteoarthritis ; Surgical Procedures, Operative

No abstract available.
Enterotoxigenic Escherichia coli* ; Enterotoxins*

PURPOSE: The ictal perfusion patterns of cerebellum and basal ganglia have not been systematically investigated in patients with temporal lobe epilepsy (TLE). Their ictal perfusion patterns were analyzed in relation with temporal lobe and frontal lobe hyperperfusion during TLE seizures using SPECT subtraction. MATERIALS AND METHODS: Thirty-three TLE patients had interictal and ictal SPECT, video-EEG monitoring, SPGR MRI, and SPECT subtraction with MRI co-registration. RESULTS: The vermian cerebellar hyperperfusion (CH) was observed in 26 patients (78.8%) and hemispheric CH in 25 (75.8%). Compared to the side of epileptogenic temporal lobe, there were seven ipsilateral hemispheric CH (28.0%), fifteen contralateral hemispheric CH (60.0%) and three bilateral hemispheric CH (12.0%). CH was more frequently observed in patients with additional frontal hyperperfusion (14/15, 93.3%) than in patients without frontal hyperperfusion (11/18, 61.1%). The basal ganglia hyperperfusion (BGH) was seen in 11 of the 15 patients with frontotemporal hyperperfusion (73.3%) and 11 of the 18 with temporal hyperperfusion only (61.1%). In 17 patients with unilateral BGH, contralateral CH to the BGH was observed in 14 (82.5%) and ipsilateral CH to BGH in 2 (11.8%) and bilateral CH in 1 (5.9%). CONCLUSION: The cerebellar hyperperfusion and basal ganglia hyperperfusion during seizures of TLE can be contralateral, ipsilateral or bilateral to the seizure focus. The presence of additional frontal or basal ganglia hyperperfusion was more frequently associated with contralateral hemispheric CH to their sides. However, temporal lobe hyperperfusion appears to be related with both ipsilateral and contralateral hemispheric CH.
Basal Ganglia* ; Cerebellum* ; Epilepsy, Temporal Lobe* ; Frontal Lobe ; Humans ; Magnetic Resonance Imaging ; Perfusion ; Seizures ; Temporal Lobe* ; Tomography, Emission-Computed, Single-Photon

BACKGROUND: Neocortical temporal lobe epilepsy (NTLE) appears to have different characteristics in clinical and electrophysiological aspects from mesial temporal lobe epilepsy (MTLE). Many semiological studies on TLE have been performed. We investigated ictal EEG patterns to differentiate NTLE from MTLE. METHODS: One hundred twenty nine scalp ictal EEG recordings came from 27 pathologically proven TLE patients were analyzed by 1) frequency of ictal discharge at EEG seizure onset (alpha, beta, theta & delta), 2) distribution patterns of ictal EEG onset (diffuse, lateralized & regionalized), 3) electrode of maximum amplitude at initial regionalized portion of ictal EEG, and 4) mesial to lateral and anterior to posterior amplitude ratio of ictal discharges in temporal electrodes. RESULTS: One hundred seven seizures came from MTLE (23 patients) and twenty-two seizures from NTLE (4 patients). Ictal EEG onset with delta wave was observed more frequently in MTLE (42.7%) than in NTLE (14.3%), but beta wave onset was noted more frequently in NTLE (14.3%) than MTLE (0%). Initial ictal EEG discharges were lateralized on ipsilateral hemisphere in 22.0% of MTLE and in 28.6% of NTLE, regionalized over ipsilateral temporal region in 36.6% and 23.8% respectively, and showed diffuse nonlateralized onset in 41.5% of MTLE and 47.6% of NTLE. Both TLE groups revealed most often their maximum negativity of ictal EEG onset at sphenoidal electrode (MTLE: 59.3%, NTLE: 42.8%). Mesial to lateral amplitude ratio of ictal EEG was significantly larger in MTLE group than NTLE group. The amplitude ratio of anterior to posterior temporal electrodes was greater in NTLE group than in MTLE group. CONCLUSION: Delta frequency of ictal onset EEG is more suggestive of MTLE while beta frequency may suggest NTLE. Initial ictal EEG patterns with their maximum on sphenoidal electrode do not differentiate MTLE from NTLE. NTLE has wide vertical and narrow horizontal electrical field, but MTLE has wide horizontal and narrow vertical electrical field.
Electrodes ; Electroencephalography* ; Epilepsy, Temporal Lobe* ; Humans ; Scalp ; Seizures ; Temporal Lobe*

PURPOSE: The aim of this study is to compare the shock wave lithotripsy (SWL) with the rigid ureteroscopic stone removal (URS) in order to establish the efficacy in treating upper ureteral stones according to the stone size. MATERIALS AND METHODS: We reviewed 328 patients who have been treated for upper ureteral stones between January 1999 and December 2002. 227 patients were treated with SWL, and 101 patients were treated with URS. We analyzed the success rates of the stone removal, reasons for failure, and complication rates of each procedure. RESULTS: The overall success rate of the URS was 93.1%. In terms of stone size, the success rates were 94.5% (<10mm) and 91.3% (>10mm), respectively. With the SWL treatments, the overall success rates after the first, second, and third sessions were 59%, 78%, and 92.5%, respectively. According to the stone size, the success rates were 96.5% (<10mm) and 85.7% (>10mm) after third sessions, respectively. The success rate was significantly affected by the size of the stone in the SWL group, but this was not the case with the URS group. The associated complication rates of URS and SWL were 11% and 7%, respectively. CONCLUSIONS: In this study, URS was relatively more efficacious than SWL when the stone was larger than 10 mm. The proper selection of patients for in situ SWL or URS would improve the results of the initial treatment.
Humans ; Lithotripsy* ; Shock* ; Ureter* ; Ureteral Calculi ; Ureteroscopy