OBJECTIVES: The aim of this study was to know differences of characteristics between presenile and senile patients who were consulted to the department of psychiatry during medical-surgical admission. METHODS: The demographic and clinical data obtained from the medical records of psychiatric consultation in the presenile inpatients with age 50 to 64 years(N=162) and those of the senile inpatients with age over 65 years(N=171) were reviewed and compared. RESULTS: 1) The most common chief complaints for psychiatric consultation in presenile patients were somatic symptoms, anxiety and sleep disturbance in order, while cognitive decline, clouded consciousness and depressed mood were most common in senile patients with statistical significance. 2) The most frequent psychiatric diagnoses after consultation in presenile patients were delirium, mood disorder and substance use disorder in order, while delirium, mood disorder and major neurocognitive disorder were most frequent in senile patients with statistical significance. 3) There were no significant difference in numbers of physical illnesses, while numbers of therapeutic drugs for them were more in senile patients. CONCLUSIONS: Our study found significant differences between presenile and senile patients on psychiatric symptoms and diagnoses in geropsychiatric consultation. Therefore, more subdivided age-specific approach seems to be needed for the geropsychiatric consultation activities.
Anxiety ; Consciousness ; Delirium ; Diagnosis ; Humans ; Inpatients* ; Medical Records ; Mood Disorders ; Substance-Related Disorders

Scapholunate advanced collapse (SLAC) deformity most often occurs with chronic rotary scaphoid instability from scaphoiunate ligament tear and scaphoid fracture. Prior to 1984 when Watson HK reported his concept on SLAC wrist deformity, the most popular procedure for this pathology was scaphoid implant arthroplasty with or without midcarpal fusion. We have reviewed 15 cases of SLAC deformity treated with scaphoid excision and midcarpal fusion from 1984 to 1993. Among them, scaphoid implants made of silicone were inserted in 4 cases. Scaphoid implant arthroplsty without carpal fusion has been excluded. The mean period of follow-up was 8.8 years and the mean age of patients was 47.5 years. Males and right wrists were predominant. Wrist motion was 56% and grip power was 71% of the normal opposite side. On the average overall, 8 patients had no pain and 7 patients had mild pain. The grade of pain was minimal, 0.5 in grade (Rating system: no pain-0, mild- 1, moderate-2, severe-3). However, all of the 4 cases of limited carpal fusion with a scaphoid implant developed silicone particulate induced synovitis and pain. The procedure appears to be effective in maintaining function of the hand with minimal pain up to 5.8 years. However, silicone scaphoid implant appears not to be necessary and is not recommended with a limited carpal fusion for this pathology.
Arthroplasty ; Congenital Abnormalities ; Follow-Up Studies ; Hand ; Hand Strength ; Humans ; Ligaments ; Male ; Pathology ; Silicones ; Synovitis ; Wrist

Young radish (Raphanus sativus L), a member of the mustard family (Cruciferae), is a common ingredient of Kimchi. Although few reports have described anaphylaxis to cruciferous vegetables, we report the case of anaphylaxis induced by contact with young radish. A 46-year-old female with a history of contact allergy to metal presented to our emergency room (ER) with dizziness, generalized eruption and gastrointestinal upset. Her symptoms developed after re-exposure to young radish while chopping it. Hypotensive blood pressures were noted. Three days prior, the patient had experienced generalized urticaria with pruritus immediately after chopping the fresh young radish, which resolved spontaneously. In the ER, her symptoms improved by the administration of epinephrine (0.3 mL), antihistamine (chlorpheniramine) and isotonic saline hydration. A skin prick test with young radish extract showed positive reactivity. The same skin test was negative in five adult controls. IgE-mediated hypersensitivity could be an important immunologic mechanism in the development of young radish-induced anaphylaxis.
Adult ; Anaphylaxis* ; Dizziness ; Emergency Service, Hospital ; Epinephrine ; Female ; Food Hypersensitivity ; Humans ; Hypersensitivity ; Hypersensitivity, Immediate ; Middle Aged ; Mustard Plant ; Pruritus ; Raphanus* ; Skin ; Skin Tests ; Urticaria ; Vegetables

BACKGROUND: For most patients, recovery from anesthesia is a smooth uneventful. But for some, recovery can be life threatening. To prevent this, adequate and prompt evaluation of patients on recovery state is essential. Activity, respiration, circulation, awareness, and color are comprehensively assessed by PAR score. So we performed this clinical study to compare ongoing changes in PAR score and the effects of age, physical status, operation site and operation time on PAR score were evaluated. METHODS: Two hundred and fifty-four patients (ASA 1, 2) undergoing elective surgery under general anesthesia were evaluated in our recovery room. They were anesthetized with enflurane or isoflurane, and nitrous oxide, and were transferred to the recovery room when SpO2 was more than 97% and there was no supplemental oxygen during transport. Once there, O2 5 l/min was administered via a face mask to all the patients. Assessment of each patient's PAR score was made at ten-minute intervals by the same anesthesiologist. RESULTS: Emergence from anesthesia was significantly dependent on patient's age, preoperative physical status but not on operation site and time. PAR score was significantly increased according to PAR-stay time regardless of age, physical status, operation site or time. CONCLUSION: In evaluating the postanesthetic recovery state, it seems to be important to consider patient's age and physical status.
Anesthesia* ; Anesthesia, General ; Enflurane ; Humans ; Isoflurane ; Masks ; Nitrous Oxide ; Oxygen ; Recovery Room ; Respiration

BACKGROUND AND OBJECTIVES: To measure the accuracy of Embletta X100, a level 2 portable sleep monitoring device, for diagnosis of obstructive sleep apnea and assessment of sleep structure. MATERIALS AND METHOD: We enrolled 200 consecutive patients who had been referred due to habitual snoring or witnessed apnea during sleep and had undergone standard polysomnography (PSG). We created a simulated situation similar to that of the Embletta X100 using only data from PSG and scored the sleep stage and the apnea-hypopnea index (AHI). Thereafter, the results of PSG and simulated Embletta X100 were compared. RESULTS: Sensitivity, specificity, and positive and negative predictive values of simulated Embletta X100 based on PSG were nearly 100% at three different cutoff values of AHI (5, 15, and 30). Intraclass correlation (ICC) of simulated Embletta X100 based on PSG was also excellent (≥0.9) for most of the sleep-related parameters and respiratory index. However, ICC of sleep stage percent was variable according to sleep stage (>0.9 for N1 and N2, 0.664 for N3, and 0.864 for R). CONCLUSION: Although sleep staging is not very precise, Embletta X100 matches well with PSG overall.
Apnea ; Diagnosis* ; Humans ; Methods ; Polysomnography ; Sensitivity and Specificity ; Sleep Apnea, Obstructive* ; Sleep Stages ; Snoring

OBJECTIVE: This study was carried out to evaluate the clinicopathologic significance of hepatocyte growth factor (HGF) and c-met expression as well as tumor angiogenesis in endometrial hyperplasia and adenocarcinoma. METHOD: By means of immunohistochemical staining, HGF, c-met expression, and angiogenesis were investigated in total of 49 patients (19 endometrial hyperplasia, 30 endometrial adenocarcinoma). HGF and c-met were identified with specific corresponding antibodies. To evaluate angiogenesis, the microvessels were highlighted by staining their endothelial cells immunohistochemically for anti-CD31. Areas close to the deepest myometrial invasion or those with the highest grade of endometrial hyperplasia and the highest angiogenic intensity were selected. Three fields of 400 magnification were selected for each slide, and the mean microvessel count was obtained. RESULTS: Diffuse staining for HGF was demonstrated in normal, endometrial hyperplasia and endometrial adenocarcinoma tissue in 45.5, 52.6 and 63.3 percent, respectively, while that for c-met was demonstrated in 9.1, 36.8 and 60.0 percent, respectively. c-Met overexpression was significantly correlated with high surgical stage as well as poor cellular differentiation. There were significant differences in microvessel count among normal, complex endometrial hyperplasia and adenocarcinoma (median 5, 9 vs. 22) and was between simple and complex endometrial hyperplasia (median 6 vs. 9). The microvessel counts were also significantly correlated with high surgical stage, poor cellular differentiation, lymph node involvement and deep myometrial invasion. CONCLUSION: This results suggested that both c-met overexpression and angiogenesis measured by microvessel count could be significantly important prognostic indicators for the prognosis of endometrial adenocarcinoma.
Adenocarcinoma* ; Antibodies ; Endometrial Hyperplasia* ; Endothelial Cells ; Female ; Hepatocyte Growth Factor* ; Hepatocytes* ; Humans ; Lymph Nodes ; Microvessels ; Prognosis

BACKGROUND:Colonic adenocarcinoma usually shows CK7 negativity and CK20 positivity, which helps to differentiate it from cholangiocarcinoma usually showing a reverse immunohistochemical profile. We immunohistochemically investigated the pattern of CK7 and 20 expressions according to the anatomical location of colon cancer to refine the usefulness of CK expression in differential diagnosis. METHODS: Immunohistochemical staining was done on 90 cases of surgically resected colon cancers and 84 cases of cholangiocarcinomas. RESULTS: When the cases of colon cancer were divided into CATD (from the cecum to the descending colon) (32), sigmoid (26), and rectum (32), the positivity of CK7 was 41%, 15% and 28%, respectively, and the negativity of CK20 was 25%, 0 and 9% (p=0.013), respectively. In sigmoid colon cancers, 22 cases (85%) exhibited CK7-/CK20+ immunophenotype. However, the percentage decreased to 63% in the rectum and 47% in CATD. The CK7+/CK20- immunophenotype was found only in cancers in the cecum and ascending colon. The expression of CK7 was related to histologic differentiation (p=0.017). CONCLUSIONS: The aberrant expressions of CKs were frequent in cancers of the rectum and ascending colon which are located in the transition site from the anus and small bowel, respectively. If adenocarcinoma in the liver were CK7+/CK20+ or CK7-/CK20-, the possibility of metastatic adenocarcinoma from CATD and rectum should be considered.
Adenocarcinoma ; Anal Canal ; Cecum ; Cholangiocarcinoma* ; Colon* ; Colon, Ascending ; Colon, Sigmoid ; Colonic Neoplasms* ; Colorectal Neoplasms ; Diagnosis, Differential* ; Immunohistochemistry ; Keratin-7* ; Keratins* ; Liver ; Rectum

Spontaneous spinal epidural hemorrhage(SSEH) represent 0.3%~0.9% of spinal epidural-space-occupying lesions. The therapeutic outcome seems to be determined by the accuracy of the diagnosis and by the time interval between the onset of symptom and surgical decompression. Thus, SSEH is a rare spinal emergency and a diagnostic challenge. We experienced two such cases. In one case, the symptoms were confused with those for a ureter stone, aortic aneurysm, spinal cord infarction. That patient completely recovered spontaneously within 2 hours. In the other case, which was initially diagnosed incorrectly as a cerebral infarction, surgical decompression was performed. That patient recovered completely within 1 month.
Aortic Aneurysm ; Cerebral Infarction ; Decompression, Surgical ; Diagnosis ; Emergencies ; Hematoma, Epidural, Spinal* ; Humans ; Infarction ; Spinal Cord ; Ureter

PURPOSE: Primary tumor of the small bowel is uncommon but as its clinical features are non-specific and diagnosis is difficult, treatment is delayed in many cases and its prognosis is poor. The aim of this study was to investigate the clinical features of small bowel tumor. METHODS: We reviewed 60 patients with primary small bowel tumor who underwent operation from January, 1990 to December, 2000. We retrospectively analyzed the following factors; age, sex, anatomical distribution and histologic features, symptoms and signs, diagnostic method, operation and its complications, morbidity and mortality. RESULTS: The primary sites of benign tumor were the duodenum in 6 cases, jejunum in 6 and ileum in 3. The primary sites of malignant tumor were duodenum in 16 cases, jejunum in 17 and ileum in 12. Leiomyoma was the most common benign tumor and leiomyosarcoma was the most common malignant tumor. The most common symptom and sign were abdominal and palpable mass and anemia. In cases of malignant tumor, curative resection was performed in 30 cases (66.7%), palliative resction in 13 (28.9%) and bypass procedure in 2 (4.4%). In cases of benign tumor, the type of surgery were excision (6 cases), segmental resection (8) and right hemicolectomy (1). CONCLUSION: Because the clinical features of primary tumor of the small bowel are obscure and its diagnosis is difficult, it is important to maintain a high degree of suspicion and recognition for possibility of primary small bowel tumor.
Anemia ; Diagnosis ; Duodenum ; Humans ; Ileum ; Jejunum ; Leiomyoma ; Leiomyosarcoma ; Mortality ; Prognosis ; Retrospective Studies

OBJECTIVES : The authors have evaluated the validity of four currently used screening tools of cognitive function in Korea for dementia and mild cognitive impairment in a community elderly population. METHODS : We screened 5,085 non-randomly sampled elderly over age 60 in the Gwangju city, Gyeonggi Province. Among those, 927 persons were examined further for evidence of dementia and mild cognitive impairment (MCI). A baseline questionnaire on sociodemographic characteristics and four major screening tests (K-MMSE, MMSE-K, MMSE-KC, and K-HDS) were administered. For the evaluation of validity, we have analyzed the ROC curve and calculated the sensitivity and specificity of each test at its optimal cutoff points. RESULTS : ROC analysis of the 3 MMSEs and K-HDS has shown that area under the curve (AUC) was between 0.897 and 0.923 for dementia. Sensitivity and specificity were 0.768 and 0.870, respectively, when the cutoff line was set at 17/18 in K-MMSE. The other two MMSEs had optimal cutoff lines at 16/17 with sensitivity of 0.768 and specificity more than 0.90. K-HDS had its optimal cutoff line at 18/19 with higher sensitivity (0.874) and lower specificity (0.755). Compared with dementia, the four screening tests showed poor validity on MCI. Sensitivity and specificity was in the range of 0.733-0.756 and 0.840-0.855, respectively. CONCLUSION : The validity of the screening tools which are currently being used in Korea to screen for MCI was not significantly different among tests. Because of the difference in the population norm and z-score estimation, use of the common norm is advisable.
Aged ; Alzheimer Disease ; Dementia ; Humans ; Korea ; Mass Screening ; Mild Cognitive Impairment ; Surveys and Questionnaires ; ROC Curve ; Sensitivity and Specificity