Dementia can be defined as an acquired persistent impairment of intellectual func-tion with compromise in at least three of the mental activities such as language, memory, visuospatial skill, emotion or personality, and cognition. The purposes of diagnosing a dementia syndrome are to search systemically for various etiologies, to differentiate reversible or irreversible dementia, cortical or subcortical dementia, and degenerative or nondegenerative dementia, and to apply to patients neurocognitive rehabilitation or other specific trea-tment strategies. The evaluation of dementia includes neuropsychiatric history taking, neuropsychological assessment, neurologic examination, neuroimaging studies, and laboratory studies. It is impossible to evaluate dementic patients only with clinical signs, symptoms, and neuropsychiatric histories. But I will address specific neurologic or neuropsychiatric symptoms and signs of various dementias to und-erstand them as classification.
Classification ; Cognition ; Dementia* ; Humans ; Memory ; Neuroimaging ; Neurologic Examination ; Rehabilitation

BACKGROUND: Vascular dementia is common cause of dementia, second to the dementia of Alzheimer desease. However in Asia and many developing countries, the incidence of vascular dementia exceeds that of Alzheimer's disease. Though many stroke-related factors related the nature of vascular injury, e.g. infarction and hemorrhage, have not assessed yet. Clarifying the difference of electroencephalograpy and clinical prognosis between infarction and hemorrhage, the aim of this study was to elucidate the role of nature of vascular injury. METHODS: to reduce confounding factors, the study population was restricted to the patients of single hemispheric striatocapsular infarction and hemorrhage saving cortex. On admission, we checked the KMMSE and FIM scores and using quantified EEG, we analyzed occipital peak frequency and the relative background alpha, theta and delta spectra power taken from 16 derivations by averaging twenty-2 -sec epoch in infarction, hemorrhage patients and elderly controls. After 6 months follow up, we compare the MMSE, FIM score between infarction and hemorrhage group. RESULTS: 1) Compared with infarction group, hemorrhage groups had a significantly bilateral lower occipital peak freqauency and background bilateral alpha spectra power. 2) In hemorrhage group, there is lower tendency in K-MMSE after 6 month follow up compared to infarction group. CONCLUSION: This study suggests that hemorrhage show more bilateral electrophysiological dysfunction than infarction group and possible grave prognosis for vascular dementia compared to infarction group.
Aged ; Alzheimer Disease ; Asia ; Dementia ; Dementia, Vascular ; Developing Countries ; Electroencephalography* ; Follow-Up Studies ; Hemorrhage* ; Humans ; Incidence ; Infarction* ; Prognosis* ; Vascular System Injuries

There are about sixty to seventy diseases which develop dementia until now. These include degenerative disease, vascular disease, infectious disease, hydrocephalus, toxic condition, head trauma, tumor , metabolic disease, and demyelinating disease etc. 20% of dementing illness is reversible to treatment. Treatment strategies of dementia can be classified as disease-specific treatment, pharmacotherapy with neurocognitive activators or psychopharmacologic agents, and nonpharmacologic intervention such as neurocognitive rehabilitation, reminiscence therapy, occupational or physical therapy, and psychosocial approach. But medical approach is necessary to prevent disability stemming from pneumonia, dehydration, malnutrition, decubitus ulcer, and other complication. These treatment strategies must be administered comprehensibly due to characteristics of the dementia patients.
Alzheimer Disease* ; Communicable Diseases ; Craniocerebral Trauma ; Dehydration ; Dementia ; Demyelinating Diseases ; Drug Therapy ; Humans ; Hydrocephalus ; Malnutrition ; Metabolic Diseases ; Occupational Therapy ; Pneumonia ; Pressure Ulcer ; Rehabilitation ; Vascular Diseases

Spontaneous subarachnoid hemorrhage(SAH) is a cause of high mortality and morbidity in the emergency department. Rebleeding has been well investigated, and it is now recognized that early operation can prevent rebleeding. However, ultra-early rebleeding, which may occur prior to early operation(within 24 hours after admission), worsens the clinical outcome of patients with SAH. To determine the risk factors of ultra-early rebleeding in patients with spontaneous SAH before early operation, we analyzed the cases of 383 patients admitted within 24 hours after their last attack of SAH between 1994 to 1996. In this analysis, diagnosis of rebleeding before admission was defined only if the patients experienced a definite clinical deterioration once more after an attack suggesting SAH. After admission patients who observed a sudden neurological deterioration were subject to repeat CT scanning and rebleeding was diagnosed only when new hemorrhage was observed on the CT scan in comparison with the previous scan. 45 cases(11.7%) of 383 patients had ultra-early rebleeding. The incidence of ultra-early rebleeding significantly increased in the patients who admitted hospital within 2 hours after attack. The incidence of ultra-early rebleeding also increased in the old-age group(70 years or more), patients with high systolic blood pressure, those who underwent angiography within 6 hours of the last SAH, and patients who had poor neurological condition.
Angiography ; Blood Pressure ; Diagnosis ; Emergency Service, Hospital ; Hemorrhage* ; Humans ; Incidence ; Mortality ; Risk Factors* ; Tomography, X-Ray Computed

BACKGROUND: Care for prehospital cardiac arrest is one of the major concerns of emergency medical services. But, in Korea, prehospital emergency medical service systems are not yet well established. We tried to offer one of the fundamental data for development of these systems. METHODS: After application of exclusion criteria, 183 patients who transferred to emergency center of our hospital after cardiac arrest in consecutive 24 months from Jan,1,1994 to Dec,31,1995 were included in this study. Retrospective review of the hospital charts of these patients was done. For statistical analysis, we divided patients to some categories. t-test or chi-square analysis was used. RESULTS: 24 patients of the 183 patients were secondary visitors(cardiac arrest was occurred during transfer from other hospitals), 159 patients were primary visitors. In the primary visitor group, only one third was ambulance visitors, and there is no statistical differences between arrest time of ambulance visitors and non-ambulance visitors(35+/-27 vs 37+/-24 min, p=NS). No organized bystander CPR was done. After arrival, 131 patients received CPR and 87 patients(66.4%) were not responded, 31 patients(23.1%) experienced transient ROSC, 13 patients(10.0%) survived until discharge, and only 2 patients(1.5%) were returned to their lives. CONCLUSION: We failed to find significant statistical survival differences between ambulance visitors and non-ambulance visitors, between presumed cardiac etiology group and non-cardiac etiology group. Survival rate was high in witnessed arrest group than unwitnessed arrest group(14.5% vs 2.1%, p=0.015).
Ambulances ; Cardiopulmonary Resuscitation ; Emergencies ; Emergency Medical Services ; Heart Arrest* ; Humans ; Korea ; Retrospective Studies ; Survival Rate

Dementia is defined as a syndrome which is characterized by various impairments in cognitive functions, especially memory function, Most of the diagnostic criteria for dementia include memory impairment as no essential feature. Memory decline can be present as a consequence of the aging process, But it does not cause significant distress or impairment in social and occupational functionings while dementiadoes. Depression may also be associated with memory impairment. funcitionings while dementiadoes. Depression may also be associated with memory impairment. However, unlike dementia, depression dose not cause decrease in delayed verbal learning and recognition memory. In dementia, different features of memory impairment may be present depending on the involved area. Memory impairment in cortical dementia is affected by the disturbance of encoding of information and memory consolidation, while memory imparnene in subcrotical denentiy is affected y the disturbance of retrieval in subcortial dementia.
Aging ; Dementia ; Depression ; Humans ; Memory* ; Verbal Learning

Intussusception is most frequent and emergency condition of abdomen in infancy and childhood. But the causation of that is uncertain. In the method of treatment, primary barium reduction was recommended. This is a clinical observation of 51 cases of intussusception from January 1973 to December 1977 at Han-Il Hospital. The result were summarized as follows; 1) In age incidence, 72.55% of the patients were under 1 year of age. The highest morbidity (54.90%) occurred between 6 months to 12 months. 2) Males were affected more often than females ; the ratio was 1.8 : 1. 3) In seasonal incidence, 31.37% of patients occurred in Spring. 4) In artificial fed partients, the incidence was higher than others (54.35%). 5) Among siblings the first baby was most frequently affected (49.02%). 6) In development states(their body weight) 43.14% of them were over 91th precentile. 7) The cardinal symptoms and signs on admission were vomiting (82.35%), mucous bloody stool(78.43%), abdominal pain and irritability(66.67%), and abdominal mass(58.82%). 8) Most common type of intussusception was ileo-colic(50.98%) 9) Etiologically 90.20% of cases were idiopathic, but only 9.80% had organic causes. 10) In 50.98% of cases, bariumm enema was performed successfully, and surgical management with manual reduction and segmental resection was performed in 47.06%. 11) The recurrence rate was 3.92%.
Abdomen ; Abdominal Pain ; Barium ; Child* ; Emergencies ; Enema ; Female ; Humans ; Incidence ; Infant* ; Intussusception* ; Male ; Recurrence ; Seasons ; Siblings ; Vomiting

PURPOSE: recent studies have reported that the expression of Drg-1 is up-regulated by androgen. It has been suggested that Drg-1 gene be used as a molecular marker for prostate cancer therapies like PSA. To de termine the role of Drg-1 gene as a molecular marker during intermittent androgen deprivation(IAD) therapy, we investigated the expression of Drg-1 and compared it with PSA expression in human prostate cancer cell lines treated with dihydrotestosterone (DHT) continuously or intermittently. MATERIALS AND METHODS: Two prostate cancer cells having different status of androgen receptor [LNCaP (androgen dependent) and PC-3 (androgen independent)] were used in this study. To know the change in PSA and Drg-1 expression after DHT treatment the cells were cultured in steroid-free RPMI media for 24 hours. 10(-7) and 10(-8)M of DHT and 10(-7)M bicalutimide was added into the cells and then cultured for 72 hours. And we established in vitro IAD model using LNCaP cells. Northern analyses were performed to determine the expression level of both PSA and Drg-1genes. Also, western analyses were performed to determine the protein level of proliferating cellular nuclear antigen and androgen receptor. RESULTS: Transcripts of Drg-1 were detected in both LNCaP and PC-3 cells but PSA was not expressed in PC-3 cells. The expression of Drg-1gene in LNCaP cells was up-regulated by 10(-8)M of DHT like PSA gene and down-regulated by 10(-7)M bicalutamide. In the treatment of intermittent androgen deprivation, the expression pattern of Drg-1was similar to that of PSA. However, up-regulation of PSA was detected earlier than of Drg-1. CONCLUSIONS: Based on observation, Drg-1 was up-regulated by androgen and down-regulated by anti-androgen. This suggests that Drg-1gene is useful for determining the androgen independency of prostate cancer during IAD.
Cell Line ; Dihydrotestosterone ; Humans ; Prostate* ; Prostatic Neoplasms* ; Receptors, Androgen ; Up-Regulation

Decubitus ulcer is often seen in the skin and underlying tissue of debilitated or immobilized patients as the result of prolonged pressure and impaired circulation. It manifests chiefly as an ulcer over bony prominences, but tumefaction is an extremely unusual presentation. A 53-year old male, a paralytic of the lower extremity for 18 years, developed a recurrent decubital ulcer despite repeated surgical repair, from which a rapidly growing, large fungating mass grew within a month. The last resected mass was bosselated and measured 15x9x3 cm with a major area of cicatrix-like induration, interdigitated with skeletal muscle bundles at the central area. Microscopically, the mass was composed of an upper half of active granulation tissue layer and a deeper half of dense, poorly cellular, fibrocollagenous bundles admixed with florid proliferation of atypical fibroblasts, but the absence of mitosis and the multifocal admixture of active inflammatory process-granulation tissue formation seemed to help exclude genuine fibromatosis, nodular fasciitis or proliferative myositis. We assume that this rapidly growing pseudofibromatosis is an additional manifestation of a prolonged decubitus ulcer, possibly related to the modified reparative process of decubitus ulcer following repeated excisions, for which we propose a term of decubitoma.

Myositis ossificans progressiva is a rare disease characterized by the formation of areas of calcification in the interstitial connective tissue of muscles, tendons, ligaments, fascia, and aponeuroses. There may be exacerbations and remissions of the disease, but the general course is an insidious loss of body motion, affecting especially the neck, spine and upper extremities and, rarely, the hips and lower extremities. It is commonly associated with various congenital anomalies. The cause is unknown and there is no known effective treatment. Myositis ossificans progressiva associated with brachydactyly of both great toes, in a 34 year old femaIe, is presented with a review of the literature. Chief complaints were ankylosis of the left knee and hip of 9 years duration. We performed biopsy of tubular bone which is placed antero-lateral side of the left knee.
Ankylosis ; Biopsy ; Brachydactyly ; Connective Tissue ; Fascia ; Hip ; Knee ; Ligaments ; Lower Extremity ; Muscles ; Myositis Ossificans ; Myositis ; Neck ; Rare Diseases ; Spine ; Tendons ; Toes ; Upper Extremity