No abstract available.

The authors reported an anesthetic experience with removal of a pancreas B-cell tumor in a 43 year old man. Thiopental sodium was used for i duction, followed by ether-oxygen supplemented with pancuronium for muscle relaxation. An endotracheal semiclosed circle absorption technique with controlled ventilation was emploged. The patient well tolerated both the anesthesia and surgery but he showed a marked increase of blood glucose level with intermittent administration of 50% glucose solution and ether inhalation.
Absorption ; Anesthesia ; Anesthesia, General* ; B-Lymphocytes ; Blood Glucose ; Ether ; Glucose ; Humans ; Hypoglycemia* ; Inhalation ; Muscle Relaxation ; Pancreas ; Pancuronium ; Thiopental ; Ventilation

No abstract available.

Intramedullary myelitis due to bacterial meningitis associated with cervical epidural abscess is very rare. Its cause and clinical features are non-specific, therefore exact diagnosis is often missed or mistaken for other disease and immediate treatment may be delayed. We report a case of intramedullary myelitis due to epidural abscess presented with prominent symptoms of meningitis and manifestations of acute cerebrovacular accident. A 69 -year-old man was admitted due to right hemicranial headache with pain on right posterior neck and febrile sensation. At first, the patient's headache was improved by conservative therapy. Three weeks later, the patient showed abrupt right hemiparesis (MRC grade 2/5) with drowsy mentality. The CSF findings of the patient were compatible with acute bacterial meningitis. Cervical spine MRI showed cervical epidural abscess and extensive intramedullary myelitis from cervical to lumbar spinal cord. After antibiotic therapy, mentality of the patient became to be alert and right hemiparesis was improved to MRC grade 4/5. Follow up cervical spine MRI after several weeks represented that the lesions of cervical epidural abscess and intramedullary myelitis were significantly diminished.
Diagnosis ; Epidural Abscess* ; Follow-Up Studies ; Headache ; Humans ; Magnetic Resonance Imaging ; Meningitis ; Meningitis, Bacterial* ; Myelitis* ; Neck ; Paresis ; Sensation ; Spinal Cord ; Spine

Background: Charcot-Marie-Tooth disease (CMTD) is a hereditary polyneuropathy associated with a life-threatening risk of pulmonary complications.Case: A 61-year-old male with CMTD for 40 years was admitted for the drainage of an abscess in his left ankle. Total intravenous anesthesia was administered, and an electromyography device was attached to the hand for neuromuscular monitoring; however, the response was not measured. Kinemyography and acceleromyography devices were attached to both hands, and responses were obtained. After neuromuscular blockade (NMB) with rocuronium 0.6 mg/kg, the train-of-four (TOF) response on kinemyography was normally measured, but the post-tetanic count on acceleromyography consistently showed 0 during anesthesia. Sugammadex 200 mg was injected to reverse the NMB. After 5 min, the TOF ratios for kinemyography and acceleromyography exceeded 90%. The patient recovered without any complications. Conclusions For CMTD patients, acceleromyography or kinemyography is superior to electromyography, and sugammadex can be used to reverse NMB successfully.

OBJECTIVES: This study was conducted to compare the characteristics of psychiatric inpatients in mental health related facilities and community mental health services-utilizing patients by diverse factors in Korea. METHODS: Questionnaires were sent via mail to 140 standard mental health centers from October to December of 2008. 64 facilities responded and data of 461 mentally disabled who are registered at and utilize the services of these mental health centers were analyzed. T-test and cross-analysis were performed to determine the differences in the averages of the variables and the discrepancy in ratios, respectively. RESULTS: Differences between long-term psychiatric inpatients and community mental health services-utilizing patients were seen in characteristics such as gender, age, type of medical coverage, family support systems, diagnosis, age of onset, duration of hospitalization, community-dwelling period, and clinical symptoms and functions. It was significantly short in length of stay in facilities in users of community mental health services with comparison to institutionalized patients. CONCLUSION: The results of this study suggest that invigoration of community mental health services is an alternative that can help deter long-term hospitalization.
Age of Onset ; Community Mental Health Services* ; Diagnosis ; Hospitalization ; Humans ; Inpatients ; Korea* ; Length of Stay ; Mental Health* ; Mentally Disabled Persons ; Postal Service ; Surveys and Questionnaires

Inter-rater reliability refers to the degree of agreement when a measurement is repeated under identical conditions by different raters. In systematic review, it can be used to evaluate agreement between authors in the process of extracting data. While there have been a variety of methods to measure inter-rater reliability, percent agreement and Cohen's kappa are commonly used in the categorical data. Percent agreement is an amount of actually observed agreement. While the calculation is simple, it has a limitation in that the effect of chance in achieving agreement between raters is not accounted for. Cohen's kappa is a more robust method than percent agreement since it is an adjusted agreement considering the effect of chance. The interpretation of kappa can be misled, because it is sensitive to the distribution of data. Therefore, it is desirable to present both values of percent agreement and kappa in the review. If the value of kappa is too low in spite of high observed agreement, alternative statistics can be pursued.

A clinical survey was made on 15 cases of perinephric abscess who were admitted to the department of urology during 12 years from May, 1972 to April, 1984. We reviewed perinephric abscess, analyzed according to incidence, symptoms, laboratory finding, culture in urine and blood and abscess, sensitivity to antibiotics, associated disease, radiographic finding and treatment. On the abscess culture, the organisms were identified in 12 cases (80.0%) : S. aureus was in 5 cases, E. coli in 5 cases, Hemolytic streptococcus in 1 case and Klebsiella in 1 case. The diagnostic ultrasonographic evaluation in perinephric abscess performed in 6 cases and documented it was very highly valuable method. The treatment was satisfactory with incision and drainage in 9 cases and with nephrectomy in 6 cases. The average duration of hospital stay was 21 days.
Abscess* ; Anti-Bacterial Agents ; Drainage ; Incidence ; Klebsiella ; Length of Stay ; Nephrectomy ; Streptococcus ; Urology

Fine needle aspiration cytology of the salivary lesions was performed on 221 patients at Soonchunhyang University Hospital for 10 years. Of 221 aspirates, 6 aspirates(2.7%) were inadequate, 116 cases(52.5%) were non-neoplastic lesions, 76(34.4%) cases were benign neoplasms and 23 cases(10.4%) were malignant neoplasms. The cytologic diagnoses could be correlated with histologic findings in 58 cases. FNAC correctly discriminated between neoplastic and nonneoplastic lesions in fifty-seven lesions and failed in a case, and overall accuracy, sensitivity, and specificity were 98.3%, 98.0%, and 100.0%. FNAC correctly discriminated malignant neoplasms from benign neoplastic/non- neoplastic lesions in fifty-three cases and failed in five cases, and overall accuracy, sensitivity, and specificity were 91.3%, 72.7%, and 95.7%. Among three false negative cases, two mucoepidermoid carcinomas were misdiagnosed as mucocele and benign neoplasm, and an acinic cell carcinoma were misdiagnosed as Warthin's tumor. Two false positive cases were a Warthin's tumor misdiagnosed as squamous cell carcinoma and a pleomorphic adenoma misinterpretated as suggestive of malignancy. In conclusion, diagnostic accuracy of FNAC of salivary lesions is high, and the possibilities of low grade mucoepidermoid carcinoma and acinic cell carcinoma should be considered on hypocellular smears with mucoid or fluidy background.
Adenoma

The purpose of this study is to estimate the minimum optimal scale(MOS) of the self-employed health insurance associations. Considering the high proportion of operating expenses, the author have selected 254 regional health insurance associations from the 1990 Finance Report of the self-employed health insurance programs. both a quadratic function and a hyperbolic function were chosen for the analysis. The dependent variables are the average maintenance cost per insured person and per household, and the independent variables are the number of insured members and of household. The minimum optimal scale was obtained from the differentiation of the quadratic function. Major findings are summarized as follows: 1. The M.O.S. was calculated as 166,174 members (27,442 households) for the rural self-employed health insurance associations and 258,462 members (75,446 households) for the urban. Providing that both the rural and urban health insurance associations would e integrated, the M.O.S. be found to become 231,687 members (68,101 households) 2. Compared with the optimal minimum scale, the magnitude of the current health insurance association found to be much smaller, less than half of the optimal scale. 3. In order to reduce the operating cost, it is necessary to enlarge the operational scale of self-employed health insurance associations.
Family Characteristics ; Humans ; Insurance ; Insurance, Health* ; Korea* ; Urban Health