BACKGROUND: Alzhiemeranjx disease (AD) and vascular dementia (VD) are common types of dementia. As a result of the development of new specific agents for AD, and because vascular dementia is a potentially preventable dementia, differentiating these diseases is of great importance. The role of EEG spectral analysis in the differential diagnosis between Alzheimer type and vascular dementia is still controversial. Since there have been few studies concerning the differential diagnosis of dementia by EEG, the present study has focused on this aspect. Usefulness of EEG in differen-tial diagnosis of dementia will be elucidated by clarifying relationship between type of dementia and spectral profile of EEG. METHODS: We analyzed the power spectra taken from 16 derivations and spectral profile was constructed by averaging twenty 2 sec epochs in three study groups (normal controls, AD and VD). Spectral profile was divided into three groups; (I) type A, showing a dominant 6.5-12 Hz peak (ii) type B, lacking a dominant peak in the 6.5-12 Hz (iii) type C, corresponding to a flat, low voltage, spectrum. To elucidate the relationship between spectral profile and other factors including diagnosis, statistical test was done. RESULTS: (1) In AD, type C profile was statistically more prevalent than in VD and type A profile was reversed. (2) In AD, Mini-Mental State Examination (MMSE) score was statistically lower in type C profile. (3) Spectral profile was not associated with age, age of symptom onset, and symptom duration. CONCLUSIONS: This study suggested that spectral profile is a useful tool for the differential diagnosis of dementia (AD and VD) and correlated with the severity of disease in AD.
Dementia ; Dementia, Vascular* ; Diagnosis ; Diagnosis, Differential* ; Electroencephalography*

The first case report of granular cell tumor was by Abrikossoff in 1926, the tumor has been named with more than 20 different synonyms. It is found usually in the tongue, oral cavity, and the skin. It occurs rarely in the esophagus. Esophageal granular cell tumor is a benign lesion which can be diagnosed by endoscopic biopsy. Large symptomatic lesion can be removed by polypectomy. A 29-year-old female visited our hospital for intermittent epigastric pain and anterior chest discomfort. Endoscopy showed a 0.6 *0.4 cm whitish yellow nodule in the mid-esophagus, 25 cm from the incisor teeth. Endoscopic polypectomy was performed with "O"-type rubber band for endoscopic variceal ligation(EVL). A case of esophageal granular cell tumor conformed by S-100 protein stain is reported with the review of literature.
Adult ; Biopsy ; Endoscopy ; Esophagus* ; Female ; Granular Cell Tumor* ; Humans ; Incisor ; Mouth ; Rubber ; S100 Proteins ; Skin ; Thorax ; Tongue ; Tooth

BACKGROUND: It has been postulated that the derangement of gut perfusion is a factor of the development of multi-organ dysfunction and increasing postoperative morbidity. Gastric mucosal pH (pHim) correlates with splanchnic perfusion and the persistent gastric mucosal acidosis has been supposed to be a predictor of complications after cardiac surgery. The purpose of this study is to measure the change of pHim induced by hypothermic cardiopulmonary bypass (CPB). METHODS: Twelve patients undergoing cardiac surgery were anesthetized with fentanyl and isoflurane. Gastric mucosal PCO2 (PrCO2) and pHim were measured by Tonocap. Temperature was maintained about 28oC during CPB and arterial blood gas tension was managed by alpha-stat mode. Measurement was made at: (1) baseline, after induction of anesthesia, (2) 30 minutes after starting CPB, (3) 60 minutes after starting CPB, (4) at the end of CPB, (5) at the end of operation and (6) at 24 hours after CPB. Statistical analysis was performed using one-way ANOVA and Student t test. RESULTS: The PrCO2 and the CO2 gap (PrCO2 - PaCO2) increased at the end of CPB and maintained the increased state for 24 hours after CPB. The pHim decreased during CPB and maintained the decreased state for 24 hours after CPB. The difference between pHim and pHa increased significantly after CPB. CONCLUSION: We conclude that the hypothermic CPB induces gastric mucosal acidosis and it did not recover for 24 hours after CPB.
Acidosis ; Anesthesia ; Cardiopulmonary Bypass* ; Fentanyl ; Humans ; Hydrogen-Ion Concentration* ; Isoflurane ; Perfusion ; Thoracic Surgery

BACKGROUND: The role of family caregivers is becoming more important for the recovery of patients with stroke, as the prevalence of stroke is increasing. Consequently, the burden of caregiving can affect both patients' and caregiver's functional health. The purpose of this study was to make a novel caregiving burden scale and evaluate factors that influence the burden of the family caregiver. METHODS: The caregiver burden scale consists of four aspects: psycho-emotional, financial, physical and isolation from social activities. The questionnaire was administrated to the family care-givers of 118 patients with stroke who consented to be interviewed. Among 118 caregivers, we analyzed 106 caregivers who answered the questionnaire completely. We evaluated the construct validity and internal reliability of the burden scale and applied multiple regression analysis for the factors that influence caregiver's burden. RESULTS:1) Construct validity by factor analysis and Internal reliability was high 2) Among 106 caregivers, 40 (37.7%) approached subjective depression on the Beck Depression Inventory (BDI). There was a statistically significant difference(p<0.01) in the strength of burden between the groups with and without depression. 3)Of the variables, including patient's age, caregiver's age, duration of caregiving, education level of caregiver, and socio-economic status of family, only the BDI scores of caregivers and the Barthel Index scores of patients were correlated to the degree of caregiving burden. CONCLUSIONS: This caregiving burden scale can be a useful tool for the evaluation of caregiver's burden with stroke. We believe that thoughtful consideration and realistic support for family caregivers can be very important in the long-term management of patients with stroke. (J Korean Neurol Assoc 19(3):213~218, 2001)
Caregivers ; Depression ; Education ; Humans ; Prevalence ; Surveys and Questionnaires ; Stroke*

To evaluate the safety and effectiveness of the intraoperative phlebotomy with acute hemodilution and autologous transfusion as an approach to blood conservation during cardiac operation, 126 patients were grouped into autologous transfusion group(Group I, n=54), prospective control group(Group II, n=22), and retrospective control group(Group III, n=50). Intraoperative hemodilution was practiced in autologous transfusion group before extracorporeal circulation. After an extracorporeal circulation, the units of blood phlebotomized were transfused. Hematocrit, platelet count, PT(prothrombin time), PTT(partialthromboplastin time), MAP(mean arterial pressure), and amount of homologous transfusion were measured immediately after induction, during bypass, and at the intensive care unit. Blood loss was measured at 12 hours and 24 hours after arrival at intensive care unit. Incidence of hemologous transfusion was 62% in group I, 86.4% in group II, and 100% in group III. Patients received 2.2+/-0.4 units in group I, 4.1+/-0.8 units in group II and 6.7+/-0.5 units in group III. Coagulation studies showed no significant improvement in autologous transfusion group who received fresh autologous blood. There was no difference in blood loss postoperatively among 3 groupes. In conclusion, our data suggest that the use of autologous transfusion with hemodilution reduces usage of homologous blood in all cardiac surgery procedures.
Extracorporeal Circulation ; Heart* ; Hematocrit ; Hemodilution* ; Humans ; Incidence ; Intensive Care Units ; Phlebotomy ; Platelet Count ; Prospective Studies ; Retrospective Studies ; Thoracic Surgery*

A choledochocele is an expanded sac of the duodenal side of the distal common bile duct (CBD), and is categorized as a type III choledochal cyst. Unlike other choledochal cysts, it can be easily overlooked because of its very low prevalence, non-specific clinical symptoms, and lack of distinctive radiological findings. However, a patient having a repeated pancreaticobiliary disorder with an unknown origin, frequent abdominal pain after cholecystectomy, or repeated non-specific gastrointestinal symptoms can be suspected as having a choledochocele, and a more accurate diagnosis can be achieved via endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound. Because it rarely becomes malignant, a choledochocele can be treated via endoscopic sphincterotomy (EST) and surgical treatment. The authors were able to diagnose choledochocele accompanied by a stone in a patient admitted to the authors' hospital due to cholangitis and pancreatitis. The patient's condition was suspected to have been caused by a distal CBD stone detected via multiple detector computed tomography and ERCP, and was successfully treated via EST.
Abdominal Pain ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Cholecystectomy ; Choledochal Cyst* ; Common Bile Duct* ; Diagnosis ; Gallstones ; Humans ; Pancreatitis ; Prevalence ; Sphincterotomy, Endoscopic ; Ultrasonography

Hyperplastic gastric polyps (HPPs) are the most common type of gastric polyps. They are assumed to be caused by chronic inflammation and regenerative proliferation, although this has not been clearly investigated yet. Many studies suggested the development of fundic gland polyps and carcinoid during long-term proton pump inhibitor (PPI) therapy, but the relationship between PPIs and HPPs is still unclear. We encountered a patient who showed aggravation of HPPs after long-term use of PPIs. A 58-year-old male patient with liver cirrhosis visited our hospital because of hematemesis. We started PPI medication after confirming esophageal variceal bleeding and duodenal ulcer with blood clot in its base via emergency endoscopy. He took PPIs for three years because of an intractable duodenal ulcer. There was a marked increase in the size of the pre-existing polyps and in the development of new polyps. We presumed that the PPIs caused the aggravation of the HPPs, so we stopped their administration. After five months, the HPPs shrank and the polyps were partially degraded. More prospective studies are needed to investigate the relationship between HPPs and PPIs.
Carcinoid Tumor ; Duodenal Ulcer ; Emergencies ; Endoscopy ; Esophageal and Gastric Varices ; Hematemesis ; Humans ; Inflammation ; Liver Cirrhosis ; Male ; Middle Aged ; Polyps* ; Proton Pump Inhibitors* ; Proton Pumps* ; Protons*

The major causes of small bowel obstruction are postoperative adhesion, hernia, intussusception and malignancies. However, in cases of uncommon causes of small bowel obstruction, surgeons are in a dilemma because the preoperative diagnosis and making a decision to operate are frequently difficult and delayed. Phytobezoars are unusual cause of small bowel obstruction. They are mostly due to ingestion of stringent immature fruits following gastric surgery. They are usually formed in stomach and do not migrate to the other intestinal tract, but can lead to the serious complication of acute small bowel obstruction. We are reporting a case of acute small bowel obstruction due to phytobezoar about 2x2x3 cm3 size in a 90 year old female.
Aged* ; Aged, 80 and over ; Bezoars ; Diagnosis ; Eating ; Female ; Fruit ; Hernia ; Humans ; Intestinal Obstruction* ; Intussusception ; Stomach

INTRODUCTION: Nausea & vomiting are one of the most distressful events after strabismus surgery in pediatric patients. Propofol is known to reduce the incidence of postoperative emesis. The aim of this study was to compare the influence of propofol to that of enflurane on the postoperative nausea & vomiting after pediatric strabismus surgery. METHODS: Forty children scheduled for strabismus surgery were randomly assigned into two groups according to the induction agent and main anesthetics. Propofol group (n=20) received propofol, Enflurane gruop (n=20) thiopental as an induction agent and anesthesia were maintained either propofol- O2-air or enflurane-O2-air. The incidence of postoperative nausea & vomiting was assessed at awakening period, in the recovery room and at the 1st, 2nd day after operation. Operation time, awakening time and the incidence of oculocardiac reflex were evaluated. RESULTS: The operation time was not different between two groups, and the awakening time was shorter in Propofol group than in Enflurane group. Although oculocardiac reflexes were more frequently seen in Propofol group, no cases of postoperative nausea & vomiting were seen in Propofol group. The incidence of postoperative nausea & vomiting was not significantly different between two groups except at the 1st day after operation. At that time, the incidence of nausea was greater in Enflurane group than in Propofol group. CONCLUSION: These findings indicated that propofol resulted in a more rapid recovery and less postoperative nausea & vomiting than enflurane, but more oculocardiac reflexes were seen in propofol.
Anesthesia ; Anesthetics ; Child ; Enflurane* ; Humans ; Incidence ; Nausea ; Postoperative Nausea and Vomiting* ; Propofol* ; Recovery Room ; Reflex, Oculocardiac ; Strabismus* ; Thiopental ; Vomiting*

BACKGROUND: As the size of the elderly population has increased compared to the hole, there has been growing concern over potential health problems and geriatric hospitals for elderly people. However, despite the emerging needs for geriatric hospitals, there is no data on the clinical characteristics of patients being admitted to geriatric hospitals. To analyze the characteristics of elderly patients admitted to a geriatric hospital, we studied the medical records of patients admitted to Yong-in Hyoja Geriatric Hospital during a recent 20 months period. By clarifying the clinical characteristics of elderly patients admitted to a geriatric hospital, the basic data for understanding and treating elderly patients could be made. METHODS: We analyzed the medical records of 345 patients who were admitted to Yong-in Hyoja Geriatric Hospital from November 1997 to July 1999. The diagnosis of patients was largely subgrouped according to the existence of dementia, and subsequent detailed diagnoses were made. RESULTS: (1) The average age of patients was 74.59 years and there were slightly more females than males admitted (ratio, 1.15:1). (2) Most of the patients suffered from dementia (62.1%), of which vascular dementia was the most common(31.6%), followed by Alzheimer dementia(19.15%). (3) Compared to vascular dementia, patients with Alzheimer dementia had more severe cognitive dysfunction, psychosis, and agitation, while patients with vascular dementia had more problems in activities of daily living (ADL) and were more depressed than Alzheimer dementia (4) The average hospitalization duration was 3.54 months and incidence of significant illness after admission was 29.8%. The mortality rate was 10.9%. (5) The most common cause of death was infection (45.2%), followed by cardiovascular problems(16.2%). CONCLUSIONS: In addition to significant illnesses and mortality after admission, most patients admitted to geriatric hospitals have severe cognitive and behavioral problems. Therefore, adequate medical and neurological assessment and treatment for the aged is necessary.
Activities of Daily Living ; Aged ; Cause of Death ; Dementia ; Dementia, Vascular ; Diagnosis ; Dihydroergotamine ; Female ; Geriatrics ; Gyeonggi-do* ; Hospitalization ; Humans ; Incidence ; Male ; Medical Records ; Mortality ; Psychotic Disorders