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*

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

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

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

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

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

OBJECTIVES: Previous studies of cognitive impairment in schizophrenia suggest that negative syndrome can be characterized by specific impairments in visual information-processing. We examined the possibility of such cognitive impairments as a a trait marker of 'deficit' syndrome group characterized by persistent primary negative symptoms or schizophrenic patients as a whole. METHODS: The subjects were 35 schizophrenic patients in partial or full remission state and the controls were 25 volunteers screened for major mental illnesses in their 2nd degree relatives. The patients were divided into deficit & nondeficit groups based on Schedule for the Deficit Syndrome and they showed positive, depressive or extrapyramidal symptoms of minimal to mild degree. Performance on various cognitive tasks associated with visual information-processing was examined. RESULTS: Deficit and nondeficit groups showed no significant difference in age of onset, duration of illness, the severity of positive and depressive symptoms and dose of antipsychotics. Deficit group performed significantly less well than normal control group on Continuous Attention Test. Significant difference was found between the patients groups and normal control group on Vigilance Test, Signal-Detection Test, and in decision time of Reaction Unit Tests. There were no significant differences among three groups on the tasks of visual immediate memory, visual analysis, motor reaction, and fine motor control. No cognitive variable was correlated to duration of illness, the severity of positive and depressive symptoms, general psychopathology, and dose of antipsychotics. CONCLUSIONS: The results suggest that deficit syndrome might be characterized by the impairment of continuous attention to simple visual stimuli. Impaired vigilance to infrequent visual stimuli, selective auention to visual stimuli and delayed decision time in simple information-processing tasks which were not related to various clinical variables were suggested to be cognitive markers of schizophrenia.
Age of Onset ; Antipsychotic Agents ; Appointments and Schedules ; Depression ; Humans ; Memory, Short-Term ; Psychopathology ; Schizophrenia ; Volunteers

BACKGROUND/AIMS: Anisakiasis is a well known parasitosis resulted from eating raw seafoods and there were many reports of cases. However, its endoscopic and clinical characteristics have not been reviewed well. The aim of this study was to clarify the gastric mucosal changes and influencing factors of upper gastrointestinal (UGI) anisakiasis. METHODS: We analyzed retrospectively the endoscopic and clinical characteristics of 141 cases with UGI anisakiasis diagnosed during UGI endoscopy, based on the review of medical records. The patients' data were collected consecutively from October 1999 through September 2006. RESULTS: In the 141 patients with UGI anisakiasis, the peak age was the 40s (44.7%). The female to male ratio was 1.82:1. The most prevailed season was winter (41.1%). The most frequent symptom was acute epigastric pain and 76.6% of the patients developed symptoms within 12 hours after the ingestion of raw seafoods. The greater curvature of body was the most preferred site of anisakid larvae. The median time from meal to symptom onset was shortest in esophageal location and longest in fundus location (3 vs. 18.7 hours). The various mucosal changes were observed and the most frequent mucosal change was edema (90.8%). Submucosal tumor was also found in 31.9% of the patients. The severity of mucosal change was related inversely with the time interval from meal to endoscopy (p=0.048). CONCLUSIONS: Anisakiasis presented various mucosal changes depending on the time interval from ingestion of raw seafood to endoscopy. Delayed endoscopy may lead chronic mucosal change and cause difficulty in the detection of anisakiasis. Therefore, the prompt endoscopic examination is required for the patients presenting acute gastrointestinal symptoms after taking raw fish.
Adult ; Aged ; Animals ; Anisakiasis/*diagnosis/parasitology ; Edema/etiology ; Esophageal Diseases/*parasitology/pathology ; Female ; Gastric Mucosa/parasitology/*pathology ; Gastroscopy ; Humans ; Male ; Medical Records ; Middle Aged ; Retrospective Studies ; Seafood ; Stomach Diseases/*parasitology/pathology ; Time Factors ; Upper Gastrointestinal Tract/parasitology/*pathology