After various anesthetic inductions, the effects of tracheal intubation on mean arterial preasure(MAP) and intraocular pressure(IOP) were studied in 88 random patients who did not have any cardiovascular and ocular diseases properatively. IOP and MAP were measured with a Perkins hand held applanation-tonometer and a Cardi- 8- mini syhygmomanometer respectively. The results were as follows: 1) Both the MAP and IOP were increased in succinylcholine and pancuronium anesthetic induction groups after endotracheal intubation. 2) Rises in,both the MAP and IOP were inhibited in induced hypotensive anesthetic induction with halothane and trimethaphan. 3) The IOP was inhibited in the propranolol group. These results show the superiority of induced hypotensive anesthetic induction with halothane, trimethaphan and propranolol prior to administration for inhibition of raising intraocular pressure.
Halothane ; Hand ; Humans ; Intraocular Pressure* ; Intubation ; Intubation, Intratracheal* ; Pancuronium ; Propranolol ; Succinylcholine ; Trimethaphan

We report a case of 53-year-old woman with personification following right middle cerebral artery territory infarction. Although she knew that her paralyzed left limbs belonged to her, she behaved as if it is a separate person. Verbalization of hatred toward her left arm was frequently observed. She attributed her neurologic deficit to the left arm instead of herself, frequently complaining in a fashion that 'I(a person except for the left arm) am all right but he/she(left arm) is wrong'. This delusional beliefs were mainly confined to her paralysed left limb, and were accompanied by left spatial neglect, transient anosognosia for hemiplegia and right-left disorientation.
Agnosia ; Arm ; Delusions ; Extremities* ; Female ; Hemiplegia ; Humans ; Infarction ; Middle Aged ; Middle Cerebral Artery ; Neurologic Manifestations ; Stroke*

No abstract available.
Neck*

BACKGROUND & PURPOSE: Ideomotor apraxia is a gestural deficit which is not due to primary sensory or motor deficit, poor auditory comprehension or incooperation. Previous studies on apraxia in AD patients include advanced AD patients who exhibited marked impairment in auditory comprehension, This might have confounded the results of the studies. The purpose of this study is to observe the frequencies and patterns of gestural errors in the early stage of AD. METHOD: Eighteen patients with AD (M : F = 4 : 14, age 62.6 + 7.2) and eighteen age- and sex- matched controls participated in this research. Patients who scored below 80 % of Western Aphasia Battery comprehension subtest and showed marked cognitive impairments were excluded (MMSE; 19.9 + 4.4, CDR 1.1+/- 0.5). Gestures. In response to commands were videotaped and analyzed by 2 neurologists and 1 speech-language pathologist. Test items included 3 types of movements ; 10 limb intrasitive, 15 transitive, and 10 buccofacial. RESULTS: Limb transitive movements were the most affected while buccofacial was the least. The error patterns most frequently observed were body-part-as-objects (BPO, 20%), external configuration orientation (ECO, 16%), and movement error(M, 9%). In comparision, BPO, ECO, M errors in normal control were 2%, 3%, and 4% respectively. In addition, apraxia item, which are to detecting AD were identified. CONCLUSION: It is suggested that the apraxia is commonly associated with AD even in the early stage of the disease and an accurate anaIysis of errors may contribute to establishing an early diagnosis of AD.
Alzheimer Disease* ; Aphasia ; Apraxia, Ideomotor* ; Apraxias ; Comprehension ; Early Diagnosis ; Extremities ; Gestures ; Humans

OBJECTIVES: The purpose of this study is to find out how the Mental Health Act(MHA) which was enacted in 1995 has been practiced in reality since it was enforced. This study focuses on the following provisions of this law; admission procedures in relation to the protection of patients' rights, discharge procedures in view of the human rights, and the conditions of the restriction of the patients' rights in hospital. METHODS: The questionnaire on "the current state of the application of the MHA" was designed by the authors and was distributed by mail to 213 psychiatric hospitals and general hospitals which operate psychiatric closed wards as of 1999. RESULTS: One hundred ten hospitals responded to the survey(51.6%) and 92.5% of the total admission to the closed ward were by 'admission by agreement of guardian'(article 24 of MHA). It was reported that a written agreement paper of guardian was filed in 98% and the official document(for the article 14 of rule for enforcement of MHA) for legal guardianship was filed in 85 % of these ad-missions respectively. However, the rate of filling the official document is actually below 85% accor-ding to the direct telephone confirmation. Other kind of admissions such as 'admission by the order of head of prefecture(article 25 of MHA) and 'emergency admission'(article 26 of MHA) were not performed except in several psychiatric hospitals. There cases no report regarding the patient's or guardian's appeal for the improvement of patient's right and better treatment and/or disagreement to involuntary admission. Sixty three percent of hospitals reported that the patients were free to use telephone, and 18.1% reported that the official forms to appeal human right violation of the institute were accessible to patients. However, the actual rates are suspected to be lower than the reports by the institutes. Petition for extension of hospital stay requested by the doctor in charge(article 24-3 of MHA) was submitted mostly by psychiatric hospitals, and its rejection rate was 3.7%. CONCLUSION: In case of 'admissions by agreement of guardian', the required qualification for guardianship and the accompanying document to prove the legal guardianship should be amended to make it more realistic. For other kinds of admissions, such as 'emergency admission' and 'admission by order of head of prefecture', admission procedure should be modified to make it more efficient and practical. The rules and regulations for the human rights of psychiatric patients are not observed properly, which needs much improvement. As this study was done by a survey, it has limitation in understanding how the MHA is actually applied and therefore msufficient as data for the use of revising the Act. However, it appears that MHA is not properly observed with problems in applying MHA in practice. The information obtained from this study suggests that extensive study on national level should be done to find out how the MHA is practiced in reality with much discussion on improving the MHA on the basis of its finding.
Academies and Institutes ; Head ; Hospitals, General ; Hospitals, Psychiatric ; Human Rights ; Humans ; Jurisprudence ; Length of Stay ; Mental Health* ; Patient Rights ; Postal Service ; Surveys and Questionnaires ; Social Control, Formal ; Telephone

Cholesteatoma of the middle ear and mastoid sometimes destroys the posterior wall of the external auditory canal(EAC), and this phenomenon is termed as "automastoidectomy". During the past two years the authors reviewed the CT features of automastoidectomy in eight patients with middle ear cholesteatoma. There was a variable amount of the cholesteatomatous mass or debris within the mastoid cavity in all patients, of whom air collection was found in four. Interestingly, the site and pattern of the erosion of the EAC were nearly, identical between patients with air in the mastoid cavity and those without it . Air in the mastiod cavity was the only clue of the expulsion of the cholesteatoma. So, we think that the expulsion of the cholesteatoma might be predicted when the erosion of the EAC is present in patients with cholesteatoma in the mastoid cavity. CT clearly depicted associated complications caused by the cholesteatoma, such as ossicular destruction (n=8), the eroion of the facial nerve canal (n=2), the erosion of the lateral semicircular canal (n=2), the erosion of the tegmen (n=1), the erosion of the sigmoid sinus plate(n=1), the erosion of the superior esmicircular canal (n=1), and the erosion of the vestibule (n=1). Although much of the natural history of the middle ear cholesteatoma still remains to be determined, we think that careful evaluation of one type of possible progression of the disease will help us understand its clinical course. Moreover, our findings strongly support the use of CT for evaluation of "automustetomy" seen in many cases of cholesteatoma.es of cholesteatoma.
Cholesteatoma ; Cholesteatoma, Middle Ear ; Colon, Sigmoid ; Ear, Middle ; Facial Nerve ; Humans ; Mastoid ; Natural History ; Semicircular Canals

Gastric neurofibroma is rare and its exact incidence is unknown. We experienced a case of solitary gastric neurofibroma. A 49-year-old woman was admitted because of hematemesis and melena. Neither cafe-au-lait spots in skin nor superficial tumor were found. Gastrofibroscopic examination and UGI series showed a 3 * 4 cm sized luminal protruding mass with adjacent bridging mucosal fold and cental ulceration on the anterior wall of lower body. Mass excision was performed. Grossly, the mass was 4.5 * 3.0 * 2.0 cm sized, well circumscribed submucosal tumor with homogenous cut surface, Microscopically, each of the tumor cells had oval shaped nucleus and spindle shaped cytoplasm. Nuclear atypism and frequent mitosis were not observed. We report a rare case of solitary gastric neurofibroma with review of the literatures.
Cafe-au-Lait Spots ; Cytoplasm ; Female ; Hematemesis* ; Humans ; Incidence ; Melena* ; Middle Aged ; Mitosis ; Neurofibroma* ; Phenobarbital ; Skin ; Stomach ; Ulcer

To evaluate the normal development of the paranasal sinuses in children with CT, authors prospectively studied with brain CT scans of 260 children without known sinus diseases, ranging in age from 7 days to 16 years. Maximal anteroposterior and transverse diameters(mm) and maximal cross-sectional area(mm2) of both sides of the maxillary sinus were measured with the aid of computer device. As to the ethmoidal and sphenoidal sinuses, we simply documented the presence of the aplastic ethmoidal sinus and calculated the age-incidence of the sphenoidal sinus pneumatization, respectively. There noted three phases in the development of the maxillary sinus. The anteroposterior and transverse diameters of the maxillay sinus increased nearly in parallel. The former was always greater than the latter. In no cases was the ethmoidal sinus aplastic and almost all sinuses were pneumatized even in infants as early as 7 days old. CT identified the conchal pattern of sphenoidal sinus pneumatization in infants as early as 11 days old. Sphenoidal sinus pueumatization was seen in 38% of the children under the age of 1 year, 82% of the children between the age of 1 and 2 years, and almost all children older than 2 years. The anteroposterior and transverse diameters of the maxillary sinus seem to reach the adult size by 8 years of age, and the conchal pattern of sphenoidal sinus pneumatization can be recognized earlier with CT than on the plain radiographs.
Adult ; Brain ; Child* ; Humans ; Infant ; Maxillary Sinus ; Paranasal Sinuses* ; Prospective Studies ; Tomography, X-Ray Computed

Background: The lack of data on the solubility of certain crystals has resulted in conflicting findings. Therefore, establishing a standardized solubility test for use in clinical laboratories is essential. Methods: Calcium carbonate, calcium oxalate monohydrate, calcium phosphate dibasic, calcium sulfate, cystine, hippuric acid, leucine, magnesium ammonium phosphate, meglumine diatrizoate, tyrosine, uric acid, uric acid sodium salt, and xanthine were procured from SigmaAldrich Co., USA. These crystals were suspended in 30% acetic acid, 30% hydrochloric acid, 10% potassium hydroxide (KOH), distilled water, ethanol, chloroform, and ether. Their morphology and dissolution characteristics were examined under an inverted microscope. Results: The morphology and solubility of all 13 crystals were examined.Calcium carbonate, calcium oxalate, calcium phosphate, cystine, triple phosphate, tyrosine, and uric acid demonstrated solubility patterns consistent with those reported in existing literature. Meanwhile, the solubility of five crystals that lacked data was newly established. Calcium sulfate exhibited partial dissolution in 10% KOH and in distilled water at 60°C. Hippuric acid, uric acid sodium salt, and xanthine dissolved in 10% KOH, while meglumine diatrizoate dissolved in distilled water and 10% KOH.Notably, the solubility patterns of calcium sulfate, hippuric acid, and leucine differed from those documented in the literature. Conclusions This study confirmed the solubility of five crystals. Notably, the solubility of three crystals differed from that documented in existing literature. Microscopic examination, augmented by polarization, proved invaluable for distinguishing urinary crystals during the solubility test. The study findings are expected to improve the discrimination of crystals in future analyses.

Background: The lack of data on the solubility of certain crystals has resulted in conflicting findings. Therefore, establishing a standardized solubility test for use in clinical laboratories is essential. Methods: Calcium carbonate, calcium oxalate monohydrate, calcium phosphate dibasic, calcium sulfate, cystine, hippuric acid, leucine, magnesium ammonium phosphate, meglumine diatrizoate, tyrosine, uric acid, uric acid sodium salt, and xanthine were procured from SigmaAldrich Co., USA. These crystals were suspended in 30% acetic acid, 30% hydrochloric acid, 10% potassium hydroxide (KOH), distilled water, ethanol, chloroform, and ether. Their morphology and dissolution characteristics were examined under an inverted microscope. Results: The morphology and solubility of all 13 crystals were examined.Calcium carbonate, calcium oxalate, calcium phosphate, cystine, triple phosphate, tyrosine, and uric acid demonstrated solubility patterns consistent with those reported in existing literature. Meanwhile, the solubility of five crystals that lacked data was newly established. Calcium sulfate exhibited partial dissolution in 10% KOH and in distilled water at 60°C. Hippuric acid, uric acid sodium salt, and xanthine dissolved in 10% KOH, while meglumine diatrizoate dissolved in distilled water and 10% KOH.Notably, the solubility patterns of calcium sulfate, hippuric acid, and leucine differed from those documented in the literature. Conclusions This study confirmed the solubility of five crystals. Notably, the solubility of three crystals differed from that documented in existing literature. Microscopic examination, augmented by polarization, proved invaluable for distinguishing urinary crystals during the solubility test. The study findings are expected to improve the discrimination of crystals in future analyses.