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

Extracorporeal shockwave therapy (ESWT) has been reported to be a safe and effective method for decreasing pain and relieving range of motion (ROM) limitations caused by neurogenic heterotopic ossification (NHO), though there has been no report that it might cause hematoma if applied to NHO. We hereby report a case of massive hematoma after ESWT, specifically the radial shockwave therapy (RSWT) device at both hips in a 49-year-old female patient with NHO. She had developed NHO after extensive subarachnoid hemorrhage. We had applied RSWT according to the previous report. The pain and the ROM limitations were gradually improved. Six weeks later, she reported pain and ROM limitations on the right hip. From a medial aspect, swelling and bruising of the right thigh could be seen. Magnetic resonance imaging and ultrasonography suggested a large hematoma between right hip adductor muscles. The symptoms disappeared after conservative treatment for one month, and subsequent follow-up imaging studies demonstrated resolution of the hematoma.
Female ; Follow-Up Studies ; Hematoma* ; Hip ; Humans ; Magnetic Resonance Imaging ; Methods ; Middle Aged ; Muscles ; Ossification, Heterotopic* ; Range of Motion, Articular ; Subarachnoid Hemorrhage ; Thigh ; Ultrasonography

A pressure sore, such as quadriplegia, is developed in patients who have been idle in bed for a long time, particularly in the spinal cord. The treatment is particularly difficult in cases of multiple recurrent sores, osteomyelitis with pathologic fractures, other underlying conditions such as diabetes mellitus, immuno-suppression, or radiotherapy. Over the last 20 years, the development and popularization of rectus abdominis flap have significantly increased for reconstruction of a wide variety of difficult clinical problems. From March 2000 to Dec 2001, 6 neurologically impaired patients underwent reconstruction of chronic pressure sores utilizing an inferiorly based rectus abdominis musculocutaneous flap. Postoperative follow-up ranged from 6 to 15 months. The average thickness of rectus abdominis muscle in quadriplegic patient is less than half of that in healthy patient. In most cases, mild venous congestions are developed, but these were resolved by medical treatment. All wounds have healed without any significant complications such as flap loss, infection, hernia, and sepsis. In conclusion, rectus abdominis muscle for these reconstructions provides a simple, reliable solution to often difficult reconstructive problem. We recommended this highly viable, versatile and reliable flap as one to be considered in planning the reconstruction of the quadriplegia patient with pressure sores when other local and regional flaps are unavailable.
Diabetes Mellitus ; Estrogens, Conjugated (USP) ; Follow-Up Studies ; Fractures, Spontaneous ; Hernia ; Humans ; Myocutaneous Flap ; Osteomyelitis ; Pressure Ulcer* ; Quadriplegia* ; Radiotherapy ; Rectus Abdominis* ; Sepsis ; Spinal Cord ; Wounds and Injuries

Congenital macrostomia is a result of defective union between the mandibular and maxillary processes and it is a rare deformity seen in every 100 to 300 facial clefts. Ohnizuka1`classified macrostomia into two groups as congenital and posttraumatic. We experienced two cases of acquired macrostomia due to NOMA sequelae(58/F:Lt & 51/F:Rt) and one case of congenital macrostomia (3 months/M:Rt). Many plastic surgeons have developed surgical procedures for repair of this congenital macrostomia. Among them, McCarthy6,11 described the classic commissuroplasty. We could repaired 1 case of congenital macrostomia and two cases of acquired macrostomia due to NOMA sequelae using modified technique of McCarthy,s classic commissuroplasty. McCarthy described new oral commissure 2-3mm laterally for prevention of postoperative contraction, orbicularis oris muscle transposition to restore labial function and a z- plasty cutaneous closure. But some author raise an objection to new oral commissure 2-3mm laterally, and they made new oral commissure at same distance of opposite side normal commissure. And so, we designed the new oral commissure moved 1mm laterally comparing to original commissuroplasty in a congenital case for the prevention of displacement. In cases of acquired macrostomia due to NOMA sequelae, we reconstructed new oral commissure like congenital case, moved 1mm laterally. Orbicularis oris muscle transposition could not be possible because of destruction of muscle, adhesion and atrophy. And so we dissected muscle and just sutured side by side. Acquired macrostomia following NOMA sequelae manifsted facial deformity variably, and reconstruction of the facial deformity is difficult by using simple approach. Other variable reconstructive procedures were needed with commissuroplasty as like Washio flap, rotation advancement flap, bone graft and free radial forarm flap, etc. Postoperative results were relatively good. We propose that macrostomia due to NOMA sequelae must add to Ohnizuka classification of acquired macrostomia.
Atrophy ; Classification ; Congenital Abnormalities ; Macrostomia* ; Noma ; Transplants

PURPOSE: The present study explored novel methods in visual field tests that actively induce the gaze of the examinee to the fixation target in the center vision and compared their effectiveness. METHODS: Four gaze induction methods (dot-on, dot-off, number-on, and number-off) were prepared by combining 2 types of fixation targets (dot and number) and 2 conditions of sound presence (on and off). The gaze induction methods were implemented to a PC-based visual field testing system and the 24-2 visual field testing protocol was administered to 14 participants without glaucoma. The performance of the gaze induction method was evaluated in terms of fixation error rate, target detection rate, and subjective satisfaction (7-point scale, 1 for least satisfied and 7 for most satisfied). RESULTS: The fixation error rates of dot-on (5.7%) and number-on (6.4%) were relatively lower than the other methods; the target detection rates of the induction methods were very high (95-96%) without significant differences, and the subjective satisfaction levels of dot-on (5.7) and number-on (5.4) were significantly higher than the other methods. CONCLUSIONS: In the present study we determined number-on as the preferred effective gaze induction method compared to the conventional dot-off method when fixation error rates and subjective satisfaction were considered.
Glaucoma ; Vision, Ocular ; Visual Field Tests ; Visual Fields

The effects of embryo number and incubation volume on the development of mouse embryos were evaluated. The growth rate of two-cell mouse embryos to attached blastocyst stage and the growth rate of blastocysts to early somite stage were assessed after culture in different incubation volumes and embryo densities. Embryos were collected from ICR female mice superovulated with pregnant mare serum gonadotropin and human chorionic gonadotropin and mated by ICR males. In experiment 1, groups of one, five, ten, twenty 2-cell embryos were cultured in 10-, 50-, 500-, 1000-microliter drops of BWW media under mineral oil at 37 degrees C in a humidified atmosphere of 5% CO2 and 95% air. As the incubation volume decreased, significantly (p<0.05) higher rates of embryos reached morular and blastocyst stage on day 3 and 4 culture, respectively In experiment 2, groups of one, five, ten, twenty blastocysts were cultured in 1- and 2-ml volumes of CMRL 1066 media under same condition as in experiment 1. However the reverse was the result. Decreasing the number of embryos incubated per volume from 1 to 20 significantly (p<0.05) increased the number of blastocysts reaching the late egg cylinde. (LEC) and early somite (ES) stage on day 6 and 8 culture, respectively, regardless of incubation volume. Blastocysts cultured in 2ml had higher (p<0.05) development rates to LEC and ES stage on day 6 and 8 culture, respectively, than embryos cultured in 1ml. Our results suggest that the effects of embryo number and incubation volume on the development of mouse embryos are stage specific and the shifting point was between hatching and EEC stage.
Animals ; Atmosphere ; Blastocyst ; Chorionic Gonadotropin ; Embryonic Structures* ; European Union ; Female ; Gonadotropins ; Humans ; Male ; Mice* ; Mineral Oil ; Ovum ; Somites

Mucormycosis is a rare disease caused by fungi. Most commonly involved sites of mucormycosis infection are sinuses, lungs, skin and soft tissues. Systemic risk factors for mucormycosis are diabetes mellitus, neutropenia, corticosteroid use, hematological malignancies, organ transplantation, metabolic acidosis, deferoxamine use and advanced age. Local risk factors are history of trauma, burns, surgery and motor vehicle accidents. We present a case of cutaneous mucormycosis in a patient with diabetes mellitus. A 66-year-old female with uncontrolled diabetes mellitus, admitted with necrotizing lesion after minor abrasions on leg. We took a culture of the lesion and it is diagnosed with mucormycosis. Disease progressed despite administration of systemic amphotericin B. We performed above-knee amputation and changed antifungal agents into liposomal amphotericin B. A tissue biopsy showed nonseptate, irregularly wide fungal hyphae with frequent right-angle branching. Our case report suggests that patients with risk factors should be observed carefully.
Acidosis ; Aged ; Amphotericin B ; Amputation ; Antifungal Agents ; Biopsy ; Burns ; Deferoxamine ; Diabetes Mellitus* ; Female ; Fungi ; Hematologic Neoplasms ; Humans ; Hyphae ; Leg ; Lung ; Motor Vehicles ; Mucormycosis* ; Neutropenia ; Organ Transplantation ; Rare Diseases ; Risk Factors ; Skin ; Transplants

OBJECTIVE: To evaluate the effects of the videofluoroscopic swallowing study (VFSS) timing after the nasogastric tube (NGT) removal on swallowing function of the patients with dysphagia. METHODS: This study was conducted on 40 NGT-fed patients with dysphagia. To assess the patients' swallowing function, VFSS was performed twice using a 5-mL 35% diluted barium solution. For the initial examination, VFSS was performed immediately after the NGT removal (VFSS 1). For the second examination, VFSS was performed five hours after the NGT removal (VFSS 2). We used the functional dysphagia scale (FDS) to assess swallowing function. In the FDS, a significant difference in the four items in the oral phase, seven items in the pharyngeal phase, and total scores were assessed (p<0.05). We also used modified penetration-aspiration scale (mPAS) to compare the two examinations (p<0.05). RESULTS: A paired t-test was performed to confirm the statistical significance of the two examinations (p<0.05). The overall swallowing function was assessed as better in VFSS 2 than in VFSS 1. In the FDS, significant differences in the residue in valleculae (p=0.002), the residue in pyriform sinuses (p=0.001), the coating of pharyngeal wall after swallow (p=0.001), and the total scores (p<0.001) were found between the two examinations. Also, in the mPAS that assessed the degree of penetration-aspiration, a significant difference was found between the two examinations (p<0.001). CONCLUSION: The results of this study confirmed that the timing of the VFSS after the NGT removal affects the swallowing function. Thus, to accurately assess the swallowing function, VFSS must be performed in NGT-fed patients after they have rested for a certain period following the removal of their NGT.
Barium ; Deglutition Disorders* ; Deglutition* ; Enteral Nutrition ; Humans ; Pyriform Sinus

The incidence of ovarian metastasis of transitional cell carcinoma is very rare and its prognosis appears to be poor. We have experienced a unique case of ovarian metastasis from transitional cell carcinoma of the bladder in 59 year old female whose complaint was palpable abdominal mass. The patient previously underwent partial cystectomy due to perforation during transurethral resection of the bladder tumor. During the course of evaluation, left distal ureteral tumor was identified with cystic abdominal mass. On exploration, the palpable abdominal mass was confirmed as ovarian mass. She eventually underwent left oophorectomy and distal ureterectomy. The final diagnosis was confirmed as metastatic ovarian transitional cell carcinoma.
Carcinoma, Transitional Cell* ; Cystectomy ; Diagnosis ; Female ; Humans ; Incidence ; Middle Aged ; Neoplasm Metastasis* ; Ovariectomy ; Ovary* ; Prognosis ; Ureter ; Urinary Bladder Neoplasms ; Urinary Bladder*

Congenital earlobe deformity and the presence of the cleft at a site of the earlobe seems to be rare. It is important to well-formed, symmetrically positioned ears as a sign of esthetically pleasing, harmonious facial features. So the patients with cleft earlobe require operative repairs. The surgical techniques for congenital earlobe clefts employed vary from simple closure, Z-plasty, L-plasty, two flap method, triangular flap method, and so on. Among them, Passow-Claus described the classic L-plasty method. We designed the modified method that the L-flap direction faced laterally opposed to that of classic L-plasty and propose to term this method `reverse L-plasty`. Kitayama classified the congenital earlobe cleft into four groups according to the shape of cleft, as longitudinal, transverse, triplelobe or mixed, and defective type. We experienced four cases of congenital earlobe cleft. One patient was a defective type and the others were triplelobe types. There`s no complication in patients. We could obtain the advantages of smooth contour of free border, lack of groove or notching due to scar contracture, and possible in moderate defective type without additional method after long term follow-up. This technique breaks the vertical component of scar contracture, resulting in a smooth lobular border. So we believe that this reverse L-plasty technique offers a better cosmetic result in the repair of the cleft earlobe.
Cicatrix ; Congenital Abnormalities ; Contracture ; Ear ; Follow-Up Studies ; Humans