BACKGROUND: Models of attention deficit hyperactivity disorder(ADHD) that have proposed a hypodopaminergic state resulting in hypofunction of the prefrontal circuitry have assumed a unitary dopamine system, which largely ignores the distinct functional differences between mesocortical dopamine system and nigrostriatal dopamine system. PURPOSE: The author's goal was to develop a pathophysiological model for ADHD with greater explanotory power than dopaminergic hypofunction hypothesis in prefronal circuitry. MATERIALS AND METHODS: Published clinical findings on ADHD were integrated with data from genetic, pharmacological, neuroimaging studies in human and animals. RESULTS: Molecular genetic studies suggest that three genes may increase the susceptibility to ADHD. The three candidate genes associated with ADHD are each involved in dopaminergic function, and this consistent with the neurobiologic studies implicating catecholamines in the etiology of ADHD. Pharmacological data also provide compelling support for dopamine and noradrenergic hypothesis of ADHD. Neuroimaging studies lend substantial support for the hypothesis that right-sided abnormalities of prefrontal-basal ganglia circuit would be found in ADHD. CONCLUSIONS: The present hypothesis takes advantage of the major differences between the two pertinent dopamine systems. Mesocortical dopamine system, which largely lacks inhibitory autoreceptors, is ideally positioned to regulate cortical inputs, thus improving the signal-to-noise ratio for biologically valued signals. In this circuit, therapeutic doses of stimulants are hypothesized to increase postsynaptic dopamine effects and enhance executive functions. By contrast, symptoms of hyperactivity/impulsivity in ADHD are hypothesized to be associated with relative overactivity of nigrostriatal circuit. This nigrostriatal circuit is tightly regulated by inhibitory autoreceptoors as well as by long distance feedback from the cortex, and slow diffusion of therapeutic doses of stimulant via oral administration is hypothesized to produce a net inhibition of dopaminergic neurotransmission and improves hyperactivity.
Administration, Oral ; Animals ; Attention Deficit Disorder with Hyperactivity* ; Autoreceptors ; Catecholamines ; Diffusion ; Dopamine ; Dopamine Agents ; Executive Function ; Ganglia ; Humans ; Molecular Biology ; Neuroimaging ; Signal-To-Noise Ratio ; Synaptic Transmission

BACKGROUND: Wheezing which is defined as a continuous sound with a musical quality is commonly auscultated in patients with chronic obstructive airway diseases. The correlation between wheezing and airway obstruction is unclear. OBJECTIVE: This study was designed to evaluate the relationships among wheezing, severity of airway obstruction, and pulmonary function tests. METHOD: Forty-one subjects were examined by the same observer. Wheezing during normal breathing and maximal forced exhalation, was auscultated respectively. Posterior lung bases were auscultated bilaterally with the seated patient taking repeated inspiratory capacity breaths through an open mouth. To quantify wheezing intensity, a regional score was assigned for each area after a minimum of 3 breaths, according to the following scale: zero, no wheezing heard: one, faint or intermittent wheezes: two, moderate wheezing during every expiration: three, loud wheezing during every expiration. The lung function tests by standard pneumotachograph were performed by skilled technicians. RESULTS: Wheezing was auscultated more in forced exhalation than in normal breathing in patients with asthma and COPD [8/9(88%) vs 1/9(11%), p<0.01 ll/15(73%) vs 1/15(6%), p<0.05)]. Forced expiratory wheezes group (n=25) compared to no wheezes group (n=16) had significantly lower FEVl (75+-5.8% vs 95.6+-6.6%, p<0.05). Compared to no wheezes group, the group with forced expiratory wheezes had lower FEV1 and FEV1/FVC (50.4+- 21.3% vs 81.15+-27.7%, 70.4+-22.4% vs 92.5+-19.3%, respectively, p<0.05). Bronchial asthma compared with COPD tended to have higher wheezing scores (Wheeze scores Bronchial asthma 3.5 vs COPD 2.4, p=0.08). Wheezing scores were correlated to FEV1 (normal breathing: r=-0.35, p<0.05: forced exhalation: r=-0.45, p<0.05), but no differences were found in wheezing incidence according to severity of airway obstruction. CONCLUSION: These findings suggest that wheezing on maximal forced exhalation may be a useful physical indicator for evaluating the severity of airway obstruction.
Airway Obstruction ; Asthma ; Exhalation ; Humans ; Incidence ; Inspiratory Capacity ; Lung ; Mouth ; Music ; Pulmonary Disease, Chronic Obstructive* ; Respiration ; Respiratory Function Tests ; Respiratory Sounds*

No abstract available.
Sarcoma, Endometrial Stromal*

The hemodynamic changes during the induction and maintenance of anesthesia, the rapidity of postanesthetic recovery, and side effects were measured and compared in 60 patients receiving either morphine, meperidine, or fentanyl as supplements to balanced anesthesia. Blood pressure, measured through an indwelling arterial catheter, was recorded continuously, as were electrocardiogram and heart rates. The narcotics, made up in equipotent concentration, were given as indicated by hemodynamic and clinical signs. After induction, hemodynamic reponses to laryngoscopy and intubation were more suppressed in patients receiving fentanyl than in patients receiving morphine or meperidine. Meperidine, unilke morphine or fentanyl, significantly increased heart rates. Intraoperatively, mean arterial blood pressure and rate-pressure product were lowest in patients receiving fentanyl. Because of the increase in blood pressure, hart rate, or both to greater than 20% above preanesthetic values, supplementation with a potent inhalatinal agent was necessary, in 25%, 10%, and 10% of the patients given meperidine, morphine, and fentanyl, respectively. Side effects, including histamine release accompanied by tachycardia and hypotension, were most frequent and most severe in patients who received meperidine. Postoperatively, there was more rapid recovery of consciousness with fentanyl than meperidine and morphine and the incidence of postoperative respiratory depression was least with fentanyl. The authors concluded that a moderate dose of fentanyl was a better supplement to balanced anesthesia than morphine or meperidine.
Anesthesia ; Arterial Pressure ; Balanced Anesthesia* ; Blood Pressure ; Catheters ; Consciousness ; Electrocardiography ; Fentanyl* ; Heart Rate ; Hemodynamics ; Histamine Release ; Humans ; Hypotension ; Incidence ; Intubation ; Laryngoscopy ; Meperidine* ; Morphine* ; Narcotics ; Respiratory Insufficiency ; Tachycardia

No abstract available.

No abstract available.
Angiomyoma ; Ear

A 69-year-old man was admitted to the hospital because of flu-like symptoms and fatigue for 2 weeks. Computed tomography revealed ground glass opacity and consolidation in both the lungs as well as pleural effusion. The patient was diagnosed with pneumonia and was hospitalized. At the time of hospitalization, he complained of shortness of breath and coughed-up blood-tinged sputum. Two days after admission, he died suddenly. An autopsy was performed; cardiomegaly was noted, and further examination revealed that the aortic valve had been destroyed by multiple, irregular vegetations. Herein, we report an autopsy case of infective endocarditis with a review of the relevant literatures.
Aged ; Aortic Valve ; Autopsy* ; Cardiomegaly ; Dyspnea ; Endocarditis* ; Fatigue ; Glass ; Hospitalization ; Humans ; Lung ; Pleural Effusion ; Pneumonia ; Sputum

No abstract available.
Cushing Syndrome* ; Glucose* ; Humans ; Metabolism*

Time to antagonism induced by pyridostigmine from different levels of neuromuscular blockade was evaluated in 45 patients anesthetized with nitrous oxide, fentanyl, and vecuronium. Neuromuscular blockade, as monitered by train-of-four count, was antagonized at varing degrees of spontaneous recovery. Train-of-four ratio was used as an index of the ability of the patients to maintain adequate spontaneous ventil'ation, and maximum inspiratory pressure as an index of the ability of the patients to protect their airways against aspiration or obstruction. We measured time from administration of pyridostigmine to train-of-four ratio of 70% indicating the recovery of the ability to maintain adquate spontaneous ventilation, and time to maximum inspiratory pressure of -45 cmH2O indicating the recovery of the ability to protect the patients airways against aspiration or obstruction. For a train-of-four count level of 0-1, reversal time to train-of-four ratio of 70% was 22.73+/-3.00 minutes and that to maximum inspiratory pressure of -45 cmH2O was 30.33+/-2.69 minutes. For a train-of-four count level of 2- 3, reversal time to train-of-four ratio of 70% was 17.33+/-3.18 minutes and that to maximum inspiratory pressure of -45cmH2O was 22.27+/-2.91 minutes. For a train-of-four count level of 4, reversal time to train-of-four ratio of 70% was 8.40+/-3.58 minutes and that to maximum inspiratory pressure of -45 cmH2O was 14.60+/-3.11 minutes. It is concluded that the more shallow is the neuromuscular blockade, the more rapid and the safer is the reversal of neuromuscular blockade, although the dose of reversal drug was determined according to the depth of neuromuscular blockade. Moreover, it should take more than 30 minutes to antagonixe profaund neuromuacular hlock- ade induced by vecuronium to such a degree that not only can the patients maintain adequate spontaneous ventilation, but they can maintain the airways and protect them against aspiration as well.
Fentanyl ; Humans ; Neuromuscular Blockade* ; Nitrous Oxide ; Pyridostigmine Bromide ; Vecuronium Bromide* ; Ventilation

OBJECTIVE: The purpose of this study was to determine the validity and the reliability of the Activity Index to ascertain its value in the functional evaluation of stroke patients. METHOD: The Activity Index consists of sixteen variables divided into three main parts(mental capacity, motor activity, and ADL function) with a total value ranging from 16 to 92 points. A group of 96 stroke patients were included in this study. To determine the validity, kappa statistics between the Functional Independence Measure and the Activity Index were measured. RESULTS: In the validity study, the kappa statistics between the Functional Independence Measure and Activity Index were 0.79 and 0.84 for an initial total score and a discharge total score respectively, indicating a reasonable agreement between the two tests. In the reliability study, the Cronbach's alpha coefficient was 0.97 for the total score indicating a good internal consistency. CONCLUSION: The Activity Index demonstrated an acceptable validity and reliability for the evaluation of functional capacity of stroke patients in clinical practice.
Activities of Daily Living ; Humans ; Motor Activity ; Reproducibility of Results ; Stroke*