No abstract available.
Embolism, Air*

A 34-year-old woman was admitted because of severe orthostatic headache. On CSF examination, the opening pressure was below 30 mmH2O. A spine MRI showed a large collection of extradural fluid indicating that CSF leaked into the extradural space. The headache was resolved by an epidural blood patch. We present a patient with a syndrome of CSF hypovolemia, whose spine MRI showed a large amount of leaked CSF in the epidural space of the spine.
Adult ; Blood Patch, Epidural ; Cerebrospinal Fluid ; Epidural Space ; Female ; Headache ; Humans ; Hypovolemia* ; Magnetic Resonance Imaging* ; Spine*

No abstract available.
Breast* ; Hepatolenticular Degeneration* ; Humans ; Penicillamine*

There is an evidence that onset time and potency of the non-depolarizing neuromuscular blocking agents are related. However the relationship between onset time and the recovery has not been investigated yet. In this experiment, the onset times of six neuromuscular blocking agents have been compared with their recovery times. The neuromuscular transmission of mivacurium 0.15 mg/kg, atracurium 0.4 mg/kg, vecuronium 0.08 mg/kg, pipecuronium 0.08 mg/kg, pancuronium 0.1 mg/kg and succinylcholine 1 mg/kg were studied in 58 adult healthy patient (ASA I and II) during O2-N2O-isoflurane anesthesia using train-of-four stimulation with Relaxograph. It has been demonstrated that there is a close relationship between onset time and recovery in depolarizing neuromuscular blocking agent but not in non-depolarizing agents. Consequently, it is proposed that the relationships between the onset time and the recovery may hardly expected in clinical practice following systemic administration of non-depolarizing neuromuscular blocking agents.
Adult ; Anesthesia ; Atracurium ; Humans ; Neuromuscular Blockade* ; Neuromuscular Blocking Agents ; Pancuronium ; Pipecuronium ; Succinylcholine ; Vecuronium Bromide

BACKGROUND: Caring for patients with Parkinson's disease (PD) is a burden to caregivers since currently available treatment modalities for PD depend on symptomatic treatments. However, there have only been a few studies regarding the caregivers of PD patients. The authors investigated the burden, depression, and anxiety of the caregivers of PD patients. METHODS: Fifty-three main caregivers of PD patients were included. The burden, anxiety, and depression of the caregivers were evaluated using the Zarit Burden Inventory (ZBI), the Spielberger State-trait Anxiety Inventory, and the Beck Depression Inventory. RESULTS: Twenty-one male and 32 female patients had a mean age 61.4 years and a mean disease duration of 7.5 years. The caregivers included 29 men and 24 women with a mean age of 55.8 years. The sex of the patients (male) and caregivers (female), the relation to the patient (daughter-in-law), and frequency of hospital visits were all significantly associated with the caregiver's burden. Among the disease characteristics, the duration, severity of PD, presence of motor fluctuation, and levodopa-associated confusion/hallucination affected the caregivers' burden significantly. The level of depression and anxiety was positively correlated with the level of burden. On a stepwise regression analysis, the significant predictors of the caregivers' burden were ADL, UPDRS IV, and state anxiety in order of strength. CONCLUSIONS: The caregivers' burden in PD was affected by various demographic and disease characteristics, which also correlated with the level of depression and anxiety. We suggest that comprehensive treatment strategies for PD should be developed for the caregivers as well as the patients.
Activities of Daily Living ; Anxiety ; Caregivers ; Depression ; Female ; Humans ; Male ; Parkinson Disease* ; Regression Analysis

BACKGROUND: The goal of therapeutic interventions for Parkinson's Disease (PD) is to improve the symptoms and mitigate the effect on the Quality of Life (QOL) in the individual patient. The purpose of this study was to investigate QOL and related factors in PD patients in Korea. METHODS: Between January 1, 2004 and July 15, 2004, eighty-one PD patients were included. The patients were assessed using Parkinson's Disease Quality of Life (PDQL), Modified Beck Depression Inventory (BDI), and K-MMSE. RESULTS: Twenty-five male and 56 female patients were included in the study. The mean age was 60.7 years and the mean disease duration was 7 years. The male patients (p=0.07) and young age at onset (p=0.07) showed borderline correlation with PDQL score. Medical cost for PD showed significant correlation with PDQL score (p<0.001). The patients working in the daytime or spending the daytime with their spouse showed significantly higher PDQL score than those who did not (p=0.01). Among the disease characteristics, the disease duration, levodopa dosage, UPDRS score, ADL, Hoehn and Yahr stage, the presence of motor fluctuation and dyskinesia, showed that depression had a strong correlation with the PDQL score (p<0.001). On the stepwise regression analysis, the most important factor was presence of depression, disease duration and the UPDRS total score in order of strength. CONCLUSIONS: The QOL in PD patients was strongly associated with depression, disease duration, and the severity of PD. We suggest that the assessment and proper management of depression as well as other PD symptoms is necessary to improve QOL of the PD patients.
Activities of Daily Living ; Depression ; Dyskinesias ; Female ; Humans ; Korea ; Levodopa ; Male ; Parkinson Disease* ; Quality of Life* ; Regression Analysis ; Spouses

Chorea is an uncommon clinical manifestation of Sytemic lupus erythematosus (SLE). Its pathogenic mechanism has not been clearly clarified. We report a 54-year-old woman with SLE who presented with generalized chorea as an initial manifestation. Fluorine-18-fluorodeoxyglucose (FDG) PET revealed increased metabolism in the bilateral putamen. Intravenous and oral administration of steroid markedly improved chorea. Hypermetabolism of the bilateral putamen diminished on follow-up FDG-PET after the disappearance of chorea. This study suggests that chorea in SLE is associated with striatal hypermetabolism.
Administration, Oral ; Chorea* ; Female ; Fluorodeoxyglucose F18 ; Follow-Up Studies ; Humans ; Lupus Erythematosus, Systemic* ; Metabolism ; Middle Aged ; Putamen

We report a patient with AIDS, who initially presented with progressive cognitive impairment and gait disturbance. A T2-weighted brain MRI demonstrated multiple hyperintensities in bilateral periventricular white matter, thalami, brainstem, cerebellum, and left temporo-occipital white matter. Enzyme-linked immunosorbent assay and Western blot for HIV were positive. The CD4+ T-cell count was 158 cells/mm3 and the plasma HIV RNA level was 65, 000 copies/mL. Highly active antiretroviral therapy was administered.
Antiretroviral Therapy, Highly Active ; Blotting, Western ; Brain ; Brain Stem ; Cerebellum ; Dementia* ; Enzyme-Linked Immunosorbent Assay ; Gait ; HIV ; Humans ; Magnetic Resonance Imaging ; Plasma ; RNA ; T-Lymphocytes

Neurofibromatosis also referred to as von Recklinghausen`s disease, is an autosomal dominant disease, which is characterized by cutaneous neurofibromas, cafe-au-lait spot, and axillary freckles. Although neruofibromatosis is a congenital disorder, the pulmonary manifestation become evident in adulthood. Approximately 15percent of patients with cutaneous lesions have intrathoracic neurofibromas. In some patients with neurofibromatosis, the lungs are the seat of interstitial fibrosis, leiomyoma, and bullous lesion, meningocele or less commonly lung cancer. The association of neurofibromatosis and lung cancer is rare, A 47-year-old man, who was a heavy smoker, was admitted to our hospital because of hemoptysis. Since cafe-au-lait sopts, diffuse pigmentation and multiple neurofibromatosis were observed on the skin, he was considered to have von Recklinghausen`s disease. Chest X-ray film showd extensive hazy density affecting all of his lung field, and minimal peribronchial infiltratin in his left lower lung field. Chest CT showed that near total consolidative lesions were present of right middle lobe. Also, some patchy infiltration were present in his right lower lobe and some of left lower lobe. Histoathological examination of the percutaneous lung biopsy specimen demonstrated that he had undifferentiated large cell carcinoma. The Authors have experienced a case of neurofibromatosis combined with undifferntiated large cell carcinoma. A brief review of related literature was conducted.
Biopsy ; Blister ; Cafe-au-Lait Spots ; Carcinoma, Large Cell* ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Fibrosis ; Hemoptysis ; Humans ; Leiomyoma ; Lung Neoplasms ; Lung* ; Melanosis ; Meningocele ; Middle Aged ; Neurofibroma ; Neurofibromatoses* ; Pigmentation ; Skin ; Thorax ; Tomography, X-Ray Computed ; X-Ray Film

The neuromuscular blocking and cardiovascular effects of rocuronium (Roc) have been compared with succinylcholine (Scc), mivacurium (Miv) and vecuronium (Vec). Thirty six healthy adult patients were randomly assigned to receive Roc (0.6 mg/kg), Scc (1.0 mg/kg), Miv (0.16 mg/kg) and Vec (0.08 mg/kg) during induction with propofol and fentanyl. The 3M surface electtodes (Red Dot, Ag/AgC1) were applied over the ulnar nerve at the wrist and supramaximal transcutaneous stimulation from a peripheral nerve stimulator (Innervator, Fisher & Paykel, New Zealand) using a 0.2 ms square wave pulses in duration at 0.1 Hz were applied. The twitch response of the thumb adductor was measured mechanomyographically using 2 kg load cell strain gauge (Model No. 505H, RS Component, Ltd, U.K.) with a thumb piece modification. Recordings were made on a Gould TA 240 Easy Graf Thermal Array Recorder with a 6600 series transducer signal. The time from injection of muscle relaxant to complete depression of control twitch height (onset), the time from injection to 25% recovery of control twitch height (clinical duration, CD) and recovery indices (RI, time from 25% to 75% recovery of control twitch height) were measured, and the cardiovascular effects; heart rate (HR) and mean arterial pressure (MAP), were determined before and after injection of muscle relaxants. Onset times for patients, receiving Roc, Scc, Vec and Miv were 65.0+/-13.5 s, 54.0+/-5.2 s, 191.+/-58.0 s and 201.3+/-37.6 s. CDs were 33.6+/-6.6 min, 8.4+/-2.1 min, 21.6+/-4.8 min and 13.0+/-2.2 min. RIs were 12.9+/-4.3 min, 5.5+/-1.2 min, 10.9+/-3.8 min and 6.9+/-1.3 min. There were no significant changes of HR, however MAP were decreased significantly from 2 min after injection of Roc. Consequently, onset time of Roc were faster than that of Miv or Vec and slower than that of Scc but not significant. However, CD and RI of Roc were significantly longer than those of the others, with minimum cardiovascular effects.
Adult ; Anesthesia* ; Arterial Pressure ; Depression ; Fentanyl* ; Heart Rate ; Humans ; Isoflurane* ; Neuromuscular Blockade ; Peripheral Nerves ; Propofol* ; Succinylcholine ; Thumb ; Transducers ; Ulnar Nerve ; Vecuronium Bromide ; Wrist