Succinylcholine-induced prolonged neuromuscular blockade may occur in patients with either a low level of plasma cholinesterase activity or genotypically abnormal form of that enzyme. We experienced a case of succinylcholine-induced prolonged apnea due to a low level of plasma cholinesterase activity. A 31-year-old woman, full term primigravida, underwent cesarean section for breech presentation under general anesthesia. Familial and past medical history were nonspecific and preoperative physical and laboratory findings were within normal range. After operation, delayed apnea was detected and lasted for about one hour. We performed controlled and assisted ventilation for two and half hours. Plasma cholinesterase activity measured 30.00 IU/L (colorimetric method, normal value: 1130~1960 IU/L) at the first postoperative day. She was discharged on 7th postoperative day without any sequelae. From follow-up study after six months, it measured 1.02 U/ml (EIA, normal value: 7~9 U/ml).
Adult ; Anesthesia, General ; Apnea* ; Breech Presentation ; Cesarean Section* ; Cholinesterases* ; Female ; Follow-Up Studies ; Humans ; Neuromuscular Blockade ; Plasma* ; Pregnancy ; Reference Values ; Ventilation

BACKGROUNDS: As the elderly population in-creases the health problem, especially dementia, becomes the clinically important problem. So in the part of primary care medicine it becomes so important that family physician make a focus on the detection, evaluation, and management of demented patient. Until nowadays there is few cohort study about the dementia and few nursing home in Korea. So author performed the MMSE-K in the elderly who are over 65 to get the cognitive function for early diagnosis, management and rehabilitation of psychosocial problem. METHODS: One hundred three persons who included in community society in Seoul and nursing home of Kyunggido were tested. The survey was done twice on september 1997 and September 1998. Author used the MMSE-K to the elderly by same doctors. The analysis was done by SAS 6.12 and t-test, one-way ANOVA and two-way ANOVA with linear trend test. RESULTS: The mean of first MMSE-K score in the community is 26.1 and in the nursing home is 24.4. And the mean of second MMSE-K score in the community is 25.5 and in the nursing home is 22.0. The MMSE-K score is elevated with male and longer duration of education and is decreased with the advanced age in two groups. According to the classification by MMSE-K score the number of people who have normal cognitive function is 45(43.7%), mild impaired cognitive function is 45(43.7%), moderately impaired cognitive function is 13(12.6%) and none has severely impaired cognitive function in both groups. The follow up MMSE-K score shows that the difference of two MMSE-K scores increases as the age increases. CONCLUSION: Until todays there is few study that designed in the form of cohort study about the elderly cognitive function in Korea. So family physicians must perform the prospective cohort study with the consistent concern and effort to get the research data about the dementia for earthy detection, management and rehabilitation for elderly.
Aged* ; Classification ; Cohort Studies ; Dementia ; Early Diagnosis ; Education ; Follow-Up Studies* ; Gyeonggi-do ; Humans ; Korea ; Male ; Nursing Homes ; Physicians, Family ; Primary Health Care ; Rehabilitation ; Seoul

Authors present a case of traumatic nonfistulous intracavernous aneurysm who presented with massive epistaxis 3 1/2 months after head injury. Because of the high mortality and morbidity associated with traumatic intracavernous aneurysmal rupture, patient with severe cranial injury require recognition that late deterioration and epistaxis, visual disturbance may be due to and intracavernous aneurysm for early diagnosis and adequate treatment.
Aneurysm* ; Carotid Artery, Internal* ; Craniocerebral Trauma ; Early Diagnosis ; Epistaxis* ; Humans ; Mortality ; Rupture

No abstract available.

No abstract available.

Schwannomas arising from the cranial nerves of the jugular foramen are rare, only 50 cases including 15 glossopharyngeal schwannomas have been reported. They may be confused with the far more common acoustic schwannoma because of the presenting symptom of hearing loss. With the symptoms and signs of the lower cranial nerve involvement, the characteristic radiographic findings of enlarged jugular foramen and normal internal acoustic meatus can make the diagnosis. The authors review the literature and present a unique case of glossopharyngeal schwannoma which had intra-and extracranial growth with intrapetrosal extension.
Acoustics ; Cranial Nerves ; Diagnosis ; Hearing Loss ; Neurilemmoma* ; Neuroma, Acoustic

The intrauterine fetal death(IUFD) is the death of the fetus prior to complete expulsion or extraction from its mother when the fetus is over 20 weeks gestation or weights more than 500 gm. This is a clinical study of 262 cases of IUFD and 262 control cases among 18542 deli-veries at Chung Goo Sung Sim Hospital during 10 years from 1987 to 1996. The results obtain-ed were as follows: 1. The incidence of IUFD was 1.41%. 2. The risk of IUFD was high in women older. 3. The risk of IUFD was high in women with parity of three or more, there was a previous history of IUFD in 11.2% of the IUFD cases and in 6.3% of the control cases, but there was no difference between the two groups of women in history of spontaneous abortion. 4. The sex ratio of male versus female was 1.24:1 in the IUFD cases, 1.11:1 in the control cases. 5. The low birth weight and preterm infants were much more frequent in the IUFD cases. 6. The mode of delivery IUFD was induced labor(77.5%), laparotomy(12.2%), spontaneo- us delivery(10.3%). The indications for laparotomy were placental abruption, placenta previa, transverse lie, previous cesarean section status, cephalopelvic disproportion and uterine rupture. 7. The most common cause of IUFD was unexplained causes(45.1%). 8. There were 67 cases(25.6%) of maternal complication, and the most common complica- tion was fever(35.8%). 9. In the incidence of abnormal coagulation test, the low platelet count(<100,000/mm3) was 8.0%, the prolonged prothrombin time(>14 seconds) was 7.2%, the prolonged partial thr- omboplastin time was 1.0%, the hypofibrinogenemia(<150mg/dl) was 7.2% and the elevated fibrinogen degradation products(>40 ug/ml) was 8.4%. 10. The risk of IUFD was lowered as the number of antenatal care was increased.
Abortion, Spontaneous ; Abruptio Placentae ; Blood Platelets ; Cephalopelvic Disproportion ; Cesarean Section ; Female ; Fetal Death* ; Fetus ; Fibrinogen ; Humans ; Incidence ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Laparotomy ; Male ; Mothers ; Parity ; Placenta Previa ; Pregnancy ; Prothrombin ; Sex Ratio ; Uterine Rupture ; Weights and Measures

BACKGROUND AND METHODS: To evaluate the role of specific antibodies to corn dust (CD) and their relationship to respiratory dysfunction, we detected serum specific IgE(slgE) and IgG4(slgG4) antibodies by ELISA in 42 employees working in the animal feed industry and 27 unexposed controls. RESULTS: Our survey revealed that 15 (34.9%) subjects had work-related respiratory dysfunction associated with or without nasal symptoms. Among these subjects, eight had airway hyper-responsiveness to methacholine. Significant differences were noted in slgE and slgG4 between exposed and unexposed groups (p = 0.04, p = 0.00 respectively), but no difference was noted in slgG (p = 0.1). Although there was no significant differences in the prevalence of specific IgE antibody between symptomatic (29%) and asymptomatic groups (19%, p = 0.55), the specific IgE levels were significantly higher in symptomatic workers than in asymptomatic workers (p = 0.03). Specific IgG antibody was detected in 1 (6%) symptomatic and 4 (15%) asymptomatic workers (p = 0.46). Specific IgG4 antibody was detected in 11 (73%) of symptomatic and 21 (78%) of asymptomatic workers (p = 0.90). The higher prevalence of slgG4 antibody was noted in workers with slgE antibody (p = 0.001). The correlation between slgG and exposure duration was significant (r = 0.36, p = 0.02). There was no association between the prevalence of slgE, slgG, and slgG4 to exposure intensity, smoking or atopic status. CONCLUSION: These results suggested that the existence of slgG and slgG4 might represent a response to CD exposure, and that some unexposed subjects had slgG to CD. Specific IgE might play a role in the development of respiratory symptoms.
Analysis of Variance ; Antibodies, Anti-Idiotypic/analysis* ; Asthma/immunology* ; Asthma/epidemiology ; Chi-Square Distribution ; Comparative Study ; Corn/adverse effects* ; Dust/adverse effects* ; Enzyme-Linked Immunosorbent Assay ; Human ; IgE/analysis* ; IgG/analysis* ; Male ; Occupational Diseases/immunology* ; Occupational Diseases/epidemiology ; Occupational Exposure/adverse effects ; Reference Values ; Respiratory Hypersensitivity/immunology* ; Skin Tests ; Smoking/immunology ; Substances: IgE ; Substances: IgG ; Substances: Antibodies, Anti-Idiotypic

The authors present a case of clival chordoma in a year-old girl who presented with gradual onset of headache, diplopia and eyeball pain. On plain skull X-rays, there was mild bony erosion at the dorsum sella and clivus without calcification. CT scan revealed low density lesion without contrast enhancement. Angiography showed round posterior displacement of vertebral and basilar arteries, which is compatible with clival mass, without tumor staining.
Angiography ; Basilar Artery ; Chordoma* ; Cranial Fossa, Posterior ; Diplopia ; Female ; Headache ; Humans ; Skull ; Tomography, X-Ray Computed

919 consecutive brain tumor cases and 665 consecutive spontaneous intracranial hemorrhage cases were reviewed for the analysis of cases in which spontaneous intracranial hemorrhage caused by brain tumor was confirmed with gross operative findings. Authors analyzed their incidence, patients' demography, tumor histology, clinical symptoms and signs, predisposing factor, tumor vascularity, type of hemorrhage, relations between the clinical symptoms and signs and the type of hemorrhage, relations between the location of tumor and the type of hemorrhage and the outcome of treatment. The conclusions are as follow; 1) The proportion of the hemorrhage caused by brain tumor to the total spontaneous intracranial hemorrhage was 5.1%(34/665). 2) The proportion of the spontaneous intracranial hemorrhage caused by brain tumor to the total brain tumor was 3.7%(34/919) and the proportion of that excluding pituitary adenoma was 2.5%(18/729). 3) Compared with the other brain tumors, oligodendroglioma and pituitary adenoma had significant tendency of hemorrhage(p<0.05, p<0.01, respectively) and meningioma had a significantly low incidence of hemorrhage(p<0.05). 4) The hemorrhage brought about major symptoms in 13 cases(72%), minor symptoms in 2 cases(11%). These cases showed no symptoms related to the hemorrhage. 5) Among the 18 cases of spontaneous intracranial hemorrhage caused by brain tumor, one case with the major attack died of postoperative pneumonia. There were additional 2 motalities which were not related to the preoperative hemorrhage. And most of the symptoms associated with the preoperative hemorrhage stabilized or improved with operative treatment.
Brain Neoplasms* ; Brain* ; Causality ; Demography ; Hemorrhage ; Incidence ; Intracranial Hemorrhages* ; Meningioma ; Oligodendroglioma ; Pituitary Neoplasms ; Pneumonia