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

The reference values of motor unit action potentials(MUAP) of first dorsal interosseous and tibialis anterior muscles were measured in 50 healthy subjects. The MUAPs were recorded with a concentric needle electrode and extracted with a decomposition method. Sixty six patients with neuropathy were also studied in the same way with a count of outliers and measurement of mean values. The mean values of amplitude, area, duration and thickness were 667.74+/-204.34 V, 992.26+/-253.18 Vms, 9.75+/-1.95 ms and 1.49+/-0.26 ms, respectively in the first dorsal interosseous muscles, and 612.88+/-140.13 V, 1172.84+/-199.21 Vms, 11.41+/-2.48 ms and 1.93+/-0.34 ms respectively in the tibialis anterior muscles. There was no significant difference in age and gender of normal subjects. The amplitude was the most sensitive parameter to detect abnormality in a count of outliers and measurement of mean values. The outliers count in duration showed a higher sensitivity than the measurement of mean values(p<0.05), but not in amplitude, area or thickness. Based on the results of this study, the count of outliers was more sensitive than the measurement of mean values in the diagnosis of patients with neuropathy. Further more, less numbers of MUAPs were needed for the evaluation of the outliers count. Through this method we could save the evaluation time and the patients felt more comfortable.
Diagnosis ; Electrodes ; Humans ; Muscles ; Needles ; Reference Values

BACKGROUND: Automated external defibrillator(AED) represent a major breakdown to permit more widespread application of the principle of early defibrillation. Many recent efforts to improve emergency medical services(EMS) and increase survival rates are simply efforts to get defibrillation to patients as rapidly as possible. AED is major innovation for the prehospital care of ventricular fibrillation cardiac arrest patients. The purpose of this study is to evaluate the course of initial training to three different groups(nurses, firefighters, and EMT trainee) to use AED. METHOD: We studies the efficacy of education of AED to 33 nurses, 15 EMT trainee, and 16 firefighters. Training lasted 75 mins and included 45 mins an overview of defibrillation, protocols for using the AED, and operation of the AED(Laerdal Heartstart 3000),15 mins demonstraion.4 check list was used to grade the performance of cardiopulmonary resuscitation, operation of the AED, and the time required to deliver the first three defibrillations. RESULT: There were no statistically significant differences in performance and time required to deliver an electrical countershock among the groups(p=0.4). To the second test 92fo of all group completed all steps successfully. The step most often foiled was the preparing of the AED for defibrillation. CONCLUSION: In nurses, EMT trainee, and firefighters, it is both feasible and effective to train AED use irrespective of the degree of the trainee.
Cardiopulmonary Resuscitation ; Defibrillators* ; Education ; Emergencies* ; Firefighters* ; Heart Arrest ; Humans ; Survival Rate ; Ventricular Fibrillation

PURPOSE: We assessed the usefulness of magnetic resonance angiography(MRA) and its techniques for differential diagnosis of hemorrhagic causes in patients with non-traumatic intracranial hemorrhagic disease. MATERIALS AND METHODS: We retrospectively reviewed 74 patients with non-traumatic intracranial hemorrhagic diseases, which were confirmed by radiological examinations(36 cases) and operations(38 cases). We compared the usefulness of magnetic resonance imaging(MRI) alone from MRI with MRA in evaluation of hemorrhagic causes. MRA was obtained by Time-of-Flight(TOF) and Phase Contrast(PC) technique. We investigated the usefulness of TOF and PC technique. RESULTS: MRI with MRA for detection of hemorrhagic causes(89%, 66 cases) was better than MRI only (64%, 47 cases). PC was better than TOF for evaluation of arteriovenous malformation and aneurysm due to subtraction of background noise(hemorrhage). CONCLUSION: MRI with MRA in more useful than MRI alone for evaluation of non-traumatic intracranial hemorrhagic causes.
Aneurysm ; Angiography* ; Arteriovenous Malformations ; Diagnosis, Differential ; Humans ; Magnetic Resonance Imaging ; Retrospective Studies

PURPOSE: The purpose of this study was to evaluate the utility of the CT cholangiography by using helical CT with multiplanar reformation in patients with extrahepatic biliary obstruction. MATERIALS AND METHODS: Helical CT was performed in 36 patients of extrahepatic biliary obstruction confirmed by operation or invasive cholangiography(percutaneous transhepatic cholangiography or endoscopic retrograde cholagiopancreatography). The cause of obstructions were 18 benign diseases(11 common bile duct stones, four choledochal cysts, three pancreatitis) and 18 malignant diseases(seven common bile duct carcinomas, seven pancreatic head carcinomas, three ampullary carcinomas, one periampullary duodenal carcinoma). After helical scanning through the extrahepatic bile duct, retrospective reconstruction of the helical data was performed. And then, CT cholagiogram was obtained with multiplanar reformation. We evaluated the technical success rate and the accuracy in determinating the level and the cause of the obstruction. We compared findings of the CT cholangiogram with that of operation or invasive cholangiography. RESULTS: In 100%(36/36) of cases, CT cholangiography could be obtained successfully. The accuracy of the CT cholangiography in determinating the level of the obstruction was 100%(11 cases of suprapancreatic duct, 13 cases of intrapancreatic duct, 13 cases of infrapancreatic duct and ampulla), and the accuracy in determinating the cause of the obstruction was 91.7%(all cases of 18 benign diseases, and 15 cases of 18 malignant diseases). CONCLUSION: In evaluating the obstruction of extrahepatic bile ducts, the CT cholangiography by using helical CT with multiplanar reformation is an useful noninvasive method in determinating the level.and the cause of biliary obstruction and therefore could replace t~e invasive cholangiography.
Bile Ducts, Extrahepatic ; Cholangiography* ; Choledochal Cyst ; Common Bile Duct ; Head ; Humans ; Retrospective Studies ; Tomography, Spiral Computed*

BACKGROUND: Cardiovascular injury is a potentially fatal complication of blunt chest trauma. The diagnosis of cardiovascular injury in blunt chest trauma is not easy because of concomittent injuries of thoracic cage or lungs and early death from cardiovascular injury. Diagnostic tools such as electrocardiography or cardiac enzyme studies are not specific to cardiovascular injury. Two-demensional echocardiography can visualize anatomic and functional disturbances from cardiovascular injuries in patients with blunt chest trauma. Purpose: This study was designed to evaluate the usefulness of echocardiography in detecting cardiovascular injury of patients with blunt chest trauma. METHODS: We performed echocardiography for detecting cardiovascular injury in 151 patients with significant blunt chest trauma including sternal fracture, multiple rib fractures or pulmonary contusion. Echocardiography was performed within 6 hours since patient arrived emergency department. Electrocardiography was traced on arrival and 24 hours after admission. Serial determinations of cardiac enzymes including MB fraction of creatinine phosphokinase were also performed every 8 hours after admission. RESULTS: 37(25%) patients had echocardiographic evidences of cardiovascular injury. Abnormal echocardiographic findings were 10 pericardial effusion, 9 regional wall motion abnormality(RWMA) outright ventricle, 5 aortic injuries, 4 reduced left ventricular ejection fraction, 3 RWMA of left ventricle, 2 right ventricular dilatation, 2 valve injuries, and 2 other cardiovascular injuries. Electrocardiographic abnormalities were associated with echocardiographic findings. However, CK-MB/CK ratio was not associated with echocardiographic findings. Significant proportion(65%) of patients with abnormal echocardiographic findings needed cardiovascular management during hospital stay. CONCLUSION: Two-dimensional echocardiography is useful for detecting cardiovascular injury. Echocardiographic abnormality in blunt chest trauma is associated with high probability of need of cardiovascular management.
Contusions ; Creatinine ; Diagnosis* ; Dilatation ; Echocardiography* ; Electrocardiography ; Emergency Service, Hospital ; Heart Ventricles ; Humans ; Length of Stay ; Lung ; Pericardial Effusion ; Rib Fractures ; Stroke Volume ; Thorax*

PURPOSE: To evaluate the relationship between endoscopic change in esophagogastric varices and post transjugular intrahepatic portosystemic shunt (TIPS) portal pressure reduction, and to study any difference in post-TIPS endoscopic change between esophageal and gastric varices. MATERIALS AND METHODS: Sixty four patients who had undergone pre- and post- TIPS endoscopic examination were analysed. They were divided into two groups, Group 1 (n = 40) and Group 2 (n = 24), according to whether they had not or had, respectively, undergone post-TIPS residual variceal embolization. The varices were classified as either esophageal (n = 54) or gastric (n = 60). Post TIPS endoscopic change was evaluated as Grade 1 (complete disappearance), Grade 2 (partial disappearance), or Grade 3 (no change). Mean pressure reduction between the pre and post TIPS portosystemic pressure gradient was checked, and statistical correlation between mean portal pressure reduction and endoscopic change in Group 1 and Group 2 was evaluated using the ANOVA test. By means of the x2 test, post-TIPS endoscopic change between esophageal and gastric varices was also evaluated. RESULTS: In Group I, a significant statistical relationship was found between endoscopic change and mean portal pressure reduction (p<0.001), but in Group 2, no such relationship was found (p>0.05). No significant statistical difference was found between endoscopic change in esophageal and in gastric varices (p> 0 . 0 5 ). CONCLUSION: In patients who had not undergone post-TIPS residual variceal embolization, endoscopicf change in gastroesophageal varices correlated significantly with post-TIPS portal pressure reduction. With regard to post-TIPS endoscopic change, these was no significant difference between esophageal and gastric varices.
Endoscopy* ; Esophageal and Gastric Varices ; Humans ; Portal Pressure ; Portasystemic Shunt, Surgical ; Stomach ; Varicose Veins

Background: A minimally invasive procedure for symptomatic pelvic bone metastasis is a feasible option for advanced cancer patients, and bone cement injection plays an essential role. Pulmonary embolism caused by thrombus, fat, or tumor emboli is a major complication related to bone cement injection, and increasing intraosseous pressure is a predisposing factor. This study aimed to quantify the degree of pressure change in the pelvic bone during percutaneous bone cement injection and investigate whether there is a significant decrease in intraosseous pressure when a decompressive route is additionally established. Methods: Bone cement injection into the acetabulum of swine pelvises by simulating the actual surgical procedure in terms of the injection method, bone cement, and surgical instruments was performed while recording the intraosseous pressure. Twenty swine pelvises were used and grouped into a decompression group and a non-decompression group. Bone cement injection and pressure measurement were conducted in the same way in both groups, but an additional decompressive route was established for each pelvis in the decompression group. Continuous variables were compared using the Mann-Whitney test. Results: The mean amount of injected bone cement was 19.8 mL and 20.3 mL and the mean speed of bone cement injection was 0.14 mL/sec and 0.12 mL/sec in the decompression group and the non-decompression group, respectively. The mean peak intraosseous pressures was 10.5 kPa with decompression and 37.8 kPa without decompression, and the difference was statistically significant (p < 0.01). Conclusions Intraosseous pressure during bone cement injection into swine pelvises was similar to that during vertebroplasty or kyphoplasty. When the additional decompression route was established, the intraosseous pressure decreased to one third the level.

OBJECTIVES: We investigated the effectiveness and safety when treated in schizophrenics with paliperidone palmitate, a long acting injectable antipsychotic. METHODS: This was a 24-week open-label study, performed at one center in Korea. The eligible patients with schizophrenia diagnosed by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria were enrolled. Patients received long-acting paliperidone palmitate injection (234 mg, baseline; 156 mg, week 1 ; then once 4 weeks flexible dosing). Effectiveness assessments were measured by the Positive and Negative Syndrome Scale (PANSS), The Clinical Global Impression Severity Scale (CGI-S), The Personal and Social Performance (PSP) at baseline, week 1, every 4 weeks untill 24 weeks or endpoint. Safety assessments were measured by The Extrapyramidal Symptom Rating Scale (ESRS), body weight (BW) and incidence of adverse events. Oral antipsychotics were stopped or tapered off within next 14 days. RESULTS: Of 20 patients recruited, 9 patients (45%) completed the study. Paliperidone palmitate produced a significant improvement in PANSS total score from baseline to endpoint. The response rate was 75% [mean change (+/- SD) -25.9 +/- 14.4, all p < 0.001]. The CGI-S and PSP total scores significantly improved during 24 weeks (All p < 0.001). Eighty percent of patients reported adverse events and most common adverse events (> or = 10%) in paliperidone palmitate were anticholinergic adverse event, extrapyramidal symptoms, weight gain, akathisia, insomnia, headache, agitation, anxiety and GI trouble. ESRS score is not statistically significant, but tends to get better at the end of the study when compared to baseline. CONCLUSIONS: Our study results demonstrated maintained effectiveness and safety of paliperidone palmitate treatment in schizophrenics. And provides both clinicians and patients with a new choice of treatment that can improve the outcome of long term therapy. Their potential effectiveness and safety should be better addressed by future randomized-controlled trials.
Antipsychotic Agents ; Anxiety ; Body Weight ; Diagnostic and Statistical Manual of Mental Disorders ; Dihydroergotamine ; Headache ; Humans ; Incidence ; Korea ; Psychomotor Agitation ; Schizophrenia ; Sleep Initiation and Maintenance Disorders ; Weight Gain ; Paliperidone Palmitate

PURPOSE: To evaluate the usefulness of 3 dimensional-volume MR imaging technique for demonstrating the facial nerves and to describe MR findings in facial palsy patients and evaluate the significance of facial nerve enhancement. MATERIALS AND METHODS: We reviewed the MR images of facial nerves obtained with 3 Dimensional-volume imaging technique before and after intravenous administration of Gadopentetate dimeglumine in 13 cases who had facial paralysis and 33 cases who had no facial palsy. And we analyzed the detectabilty of anatomical segments of intratemporal facial nerves and facial nerve enhancement. RESULTS: When the 3 Dimensional-volume MR images of 46 nerves were analyzed subjectively, the nerve courses of 43(93%) of 46 nerves were effectively demonstrated on 3 Dimensional-volume MR images. Internal acoustic canal portions and geniculate ganglion of facial nerve were well visualized on axial images and tympanic and mastold segments were well depicted on oblique sagittal images. 10 of 13 patients(77%) were visibly enhanced along at least one segment of the facial nerve with swelling or thickening, and nerves of 8 of normal 33 cases(24%) were enhanced without thickening or swelling. CONCLUSION: MR findings of facial nerve paralysis is asymmetrical thickening of facial nerve with contrast enhancement. The 3 Dimensional-volume MR imaging technique should be a useful study for the evaluation of intratemporal facial nerve disease.
Acoustics ; Administration, Intravenous ; Facial Nerve Diseases ; Facial Nerve* ; Facial Paralysis ; Gadolinium DTPA ; Geniculate Ganglion ; Humans ; Magnetic Resonance Imaging* ; Paralysis