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

Comparing with the simple general anesthesia, the combined thoracic epidural and general anesthesia generally provide with more improved regional endocardial perfusion, reduced myocardial oxygen consumption, eventually reduced postoperative morbidity and mortality. Patients undergoing thoracotomy have severe pain and related cardio-respiratory impairment postoperatively, so large amount of the analgesics are usually administered systemically. Recently, the method using epidural injection of the local anesthetics and/or analgesics is prefered during and after the operation because of its excellent analgesic action and advantage of lowering the need for anesthetics and systemic analgesics but has remaining problems such as eardiopulmonary and CNS depression and reduced motor function and so on. So, in an attempt to reduce the untoward effects of epidural injection, we planned to evaluate the validity of the mixing local anesthetic, bupivacaine, and narcotic analgesic, fentanyl, in a given concentration and infusion rate and randomized 70 patients undergoing thoracotomy into 4 groups. Group A(n=20): Intermittent intramuscular injection of nalbuphine hydrochloride in a dose of 0.2 mg/kg Group B(n=15): Continuous epidural infusion of fentanyl citrate, 2-5 ml/hr of 5 mcg/ml solution Group C(n=15): Continuous epidural infusion of bupivacaine hydrochloride, 2-5 ml/hr of 0.15% solution Group D(n=20): Continuous epidural infusion of mixtures of fentanyl and bupivacaine, 2-5 ml/hr of same concentrations We observed the visual analogue pain scale perioperatively and measured the hemodynamic parameters such as cardiac output, cardiac index, systemic vascular resistance, stroke volume, mean arterial pressure and heart rate. The results were as follows: I) The postoperative analgesic outcome was best in group D as compared with other groups. 2) The cardiac output decreased postoperatively in group A, B and C while group D showed an increase but there was no statistical significance. 3) The cardiac index decreased significantly in group B and sbowed a trend of decreasing in group C, increasing in group D, and no change in group A. 4) The stroke volume decreased postoperatively in group A and B but the significance was only in group A. 5) The systemic vascular resistance showed significant postoperative increase in group B. 6) The mean arterial pressure decreased in group D and increased in other groups. 7) The heart rate increased during and immediate after the operation in group B.
Analgesics ; Anesthesia, General* ; Anesthetics ; Anesthetics, Local ; Arterial Pressure ; Bupivacaine ; Cardiac Output ; Catheters* ; Depression ; Fentanyl ; Heart Rate ; Hemodynamics ; Humans ; Injections, Epidural ; Injections, Intramuscular ; Mortality ; Nalbuphine ; Oxygen Consumption ; Pain Measurement ; Perfusion ; Stroke Volume ; Thoracotomy ; Vascular Resistance

OBJECTIVES: We aimed to investigate the relationship between subjective memory complaints and cognition in the elderly. METHODS: Data obtained from 1,496 subjects (510 men and 986 women) aged above 60 years was analyzed from the Gwangju Dementia and Mild Cognitive Impairment Study (GDEMCIS). All subjects completed the study questionnaire including demographic characteristics, history of current and past illnesses, drug history, Korean version-Mini Mental State Examination (K-MMSE), and Short Form Korean version of Geriatric depression scale (SGDS-K). Subjective memory complaints were defined in two different ways; worse than others (SMC-O) and worse than one's past (SMC-P). RESULTS: On analysis of covariance, there was significant difference of estimated marginal means of K-MMSE score among five SMC-P groups (much improve:18.0, little improve:21.3, not changed:21.2, little worse:21.1, much worse:20.2) after adjusting age, sex, educational level and depression (F=9.63, df=4, p<0.0001, adjusted R2=0.375). There was significant difference of estimated marginal means of K-MMSE score among three SMC-O groups (below peer's average:20.4, peer's average:20.9, above peer's average:21.8) after adjusting age, sex, educational level and depression (F=4.89, df=2, p=0.043, adjusted R2=0.0.361). CONCLUSION: These results suggest that subjective memory complaints may be an indicator of objective cognitive impairment in the elderly.
Aged ; Cognition ; Dementia ; Depression ; Humans ; Male ; Memory ; Mild Cognitive Impairment ; Surveys and Questionnaires

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

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: Proctitis is one of acute complications encountered when radiotherapy was applied to the pelvis. Radiation-induced proctitis represents similar microscopic findings that are observed in inflammatory bowel disease (IBD). Nitric oxide (NO) plays an important role in the inflammatory process and many data suggest a close relationship between NO production and gastrointestinal inflammation. This study was aimed to establish the optimal radiation dose for radiation-induced proctitis in rat and to find a relationship between radiation proctitis and NO production. MATERIALS AND METHODS: Female Wistar rats, weighing from 150 to 220 g, received various doses(10-30 Gy) of radiation to the rectum. On the 5th and 10th day after irradiation, rectal specimens were evaluated grossly and microscopically. In addition, the degree of NO production by irradiation dose was evaluated by study with NOS expression and nitrite production in the irradiated rectal tissue. To evaluate relationship between radiation proctitis and NO, we administered aminoguanidine, iNOS inhibitor and L-arginine, substrate of NOS to rats from 2 days before to 7 days after the irradiation. RESULTS: There were obvious gross and histological changes after 17.5 Gy or higher radiation dose but not with 15 Gy or less radiation dose. Twenty Gy or higher dose of radiation caused Grade 4 damage in most of rectal specimens which were more likely to be related to the late complications such as fibrosis, rectal bleeding and rectal obstruction. A single fraction of 17.5 Gy to the rat rectum is considered to be an optimal dose to produce commonly experienced proctitis in the clinic. The result demonstrated that severity of microscopic damage of rectal mucosa from irradiation significantly correlated with iNOS overexpression. However, administration of iNOS inhibitor or substrate of iNOS did not influence the degree of rectal damage. CONCLUSION: A single fraction of 17.5 Gy irradiation to the rat rectum considered to be an optimal dose for radiation induced proctitis model. These results indicated that an excess production of NO contributes to pathogenesis of radiation-induced proctitis in part but was not the direct cause of rectal damage.
Animals ; Arginine ; Female ; Fibrosis ; Hemorrhage ; Humans ; Inflammation ; Inflammatory Bowel Diseases ; Models, Animal ; Mucous Membrane ; Nitric Oxide Synthase ; Nitric Oxide* ; Pelvis ; Proctitis* ; Radiotherapy ; Rats* ; Rats, Wistar ; Rectum