After the spontaneous relief of initial symptoms by traumatic carotid-cavernous fistula (CCF), paradoxical worsening of patient's condition can be followed. We present a case of a 60-yr-old man whose audible bruit from a traumatic CCF had completely disappeared. A few days later, however, the patient had spontaneous intracerebral hematoma with cortical venous drainage. Complete obliteration of the fistula was achieved after embolization. When initial audible bruit in traumatic CCF disappears suddenly, cerebral angiography should be performed to differentiate venous hypertension by the hemodynamic changes of the cavernous sinus channels from spontaneous resolution of CCF.
Brain/pathology ; Carotid Arteries/pathology ; Carotid-Cavernous Sinus Fistula/*complications/*pathology/therapy ; Cerebral Angiography/methods ; Cerebral Hemorrhage, Traumatic/*etiology/therapy ; Humans ; Male ; Middle Aged ; Research Support, Non-U.S. Gov't ; Tomography, X-Ray Computed/methods

A collodion baby is born with a tough, inelastic parchment-like membrane covering the whole body surface. As the meinbrane fissures and peels, a more characteristic ichthyosiform change is evident beneath the collodion membrane. Uncommonly, normal skin is found under it. We herein present two cases af collodion baby, which were confirmed as a sporadic case of lamellar ichthyosis and a case of lamellar exfoliation of the newborn, respectively, after long-term clinical observation. It is necessary that detailed genetical and molecular biological studies should be perforrned in order to elucidate the fur:damental, molecular changes that cause these dramatic cutaneous changes.
Collodion* ; Humans ; Ichthyosis, Lamellar ; Infant, Newborn ; Membranes ; Skin

No abstract available.
Fever* ; Humans

The prediction of possibility which patient will develop vasospasm constitutes a further advance in the management of this complication. So the possible clinical risk factors predicting ischemic complication of subarachnoid hemorrhage were retrospectively investigated in patients with ruptured intracranial aneurysm. A comparative analysis of risk factors contributing to symptomatic vasospasm was carried out between 40 patients with symptomatic vasospasm as DID(Delayed Ischemic Neurologic Deficit) group and 52 patients without symptomatic vasospasm as Non-DID group, those who were selected among 349 cases of ruptured intracranial aneurysm admitted to department of neurosurgery at Presbyterian Medical Center, Jeon Ju for 6 years from August, 1982 to July, 1988. Peripheral WBC count, clinical grade, hematocrit, blood glucose level, EKG findings, age, sex and aneurysm location of admission failed to show a prognostic value as a factor developing delayed ischemic neurologic deficit in the patients. However a statistically significant rise in peripheral WBC count was observed at the beginning of clinical deterioration and also systolic blood pressure at admission were significantly higher in DID than Non-DID group. The results suggest that the increase of peripheral WBC count observed at the time of neurological deterioration of delayed onset and high systolic blood pressure at admission might be a risk factor for developing vasospasm.
Aneurysm* ; Blood Glucose ; Blood Pressure ; Electrocardiography ; Hematocrit ; Humans ; Intracranial Aneurysm ; Jeollabuk-do ; Neurologic Manifestations ; Neurosurgery ; Protestantism ; Retrospective Studies ; Risk Factors* ; Subarachnoid Hemorrhage*

Thirty-four patients with various intracranial lesions underwent the stereotatic surgery using the Pelorus system, which consists of integrated skull set, phantom and Arc adaptor, between September, 1987 and October, 1988.10 of 12 biopsies(83%) were diagnosed as 4 metastatic tumors, 3 glioblastoma multiforme, 1 cerebral infarction and 1 calcification. Fifteen patients with the spontaneous intracerebral hematoma and 2 with the abscess were treated successfully. Two patients with the malignant tumors underwent the stereotatic isotope implantation with I125. Only one case of transient hemiparesis among 34 procedures developed. From the results, the use of a simple interlocking plate system, rather than a bulky frame produce benifits evident during application with capabilities and accuracy of most other stereotactic system. It has offered the advantages of stereotaxis to a currently possible wide range of patients, which it can be used to diagnose and treat.
Abscess ; Cerebral Infarction ; Glioblastoma ; Hematoma ; Humans ; Paresis ; Skull

OBJECTIVE: To categorize the spinal cord injury level and American Spinal Injury Association (ASIA) impairment scale into functional classification of shooting and to give information about shooting sport for the disabled to medical staffs, and to remind importance of sports activities for rehabilitation. METHOD: Seventy nine spinal cord injured players were classified into each functional classes by two international classifier. During the classification process, demographic data such as age, sex, duration, injury type and questions including attitude toward disabled shooting or benefits or difficulties from shooting were collected by interview. RESULTS: Functional classes of players were closely related to injury level and ASIA impairment scale. Average duration of shooting experience of men (8.01 years) was significantly different from that of women (5.29 years)(p<0.05). Self-motivated (39.3%) and disabled friends (21.5%) were leading motive providers followed by medical staff (20.2%), other shooting player or coach (12.7%), family (6.3%). Promoting self confidence (32.5%) was number one benefit from shooting and followed by making friends (22.1%), increasing independence (18.3%), and increasing in social participation (12.7%). CONCLUSION: We report the functional classification result of spinal cord inured player and we found that sports activities promote social activities and help to develop self confidence.
Asia ; Classification* ; Female ; Friends ; Humans ; Male ; Medical Staff ; Rehabilitation ; Social Participation ; Spinal Cord Injuries ; Spinal Cord* ; Spinal Injuries ; Sports

OBJECTIVE: To investigate if walking is independently associated with low back pain (LBP) in the general population. METHODS: This cross-sectional study used public data from the Fourth and Fifth Korean National Health and Nutrition Examination Survey. Subjects included 5,982 community-dwelling adults aged ≥50 years. Presence of current LBP was defined as LBP for 1 month or more in the past 3 months. Walking was measured as total walking duration for the past week and subjects were divided into four quartiles. Independent effect of walking on LBP was determined using odds ratios (OR) adjusted for age, sex, osteoporosis, depression or anxiety, and radiographic lumbar spondylosis. RESULTS: Prevalence of LBP was 26.4% in this population. Older people and women had higher prevalence of current LBP. Prevalence of obesity and osteoporosis was higher in subjects with current LBP and quality of life was poorer in subjects with current LBP. Adjusted logistic regression model revealed that older age (OR, 1.655; p=0.018), female sex (OR, 2.578; p<0.001), radiographic lumbar spondylosis (OR, 2.728; p<0.001), depression or anxiety (OR, 5.409; p<0.001), and presence of osteoporosis (OR, 1.467; p=0.002) were positively associated with current LBP. Walking decreased prevalence of current LBP proportionally (2nd quartile OR, 0.795; 3rd quartile OR, 0.770; and 4th quartile OR, 0.686 compared with the 1st quartile of walking). CONCLUSION: Walking was negatively associated with LBP. Further studies are needed to reveal causal relationship of this phenomenon.
Adult ; Anxiety ; Cross-Sectional Studies* ; Depression ; Female ; Humans ; Logistic Models ; Low Back Pain* ; Nutrition Surveys ; Obesity ; Odds Ratio ; Osteoporosis ; Prevalence ; Quality of Life ; Spondylosis ; Walking*

No abstract available.

For many years it has been known that the dosage of thiopental required to induce anesthesia depends on the age of the patient, but this information ha resulted from clinical experience with the drugs rather than from planned study. In our study, to elucidate the influence of age on the size of the sleeping dosage of thiopental, 144 patients who underwent minor orthopedic and gynecological operations were studied. This patients had no evidence of a disease other than that scheduled for operation and were within normal values in hematologic examination, liver function and kidney function. Using a simple "yes" or "no" verbal command response, as sleeping response, to a single bolus of thiopental in mg/kg body weight, we have attemted to minimize uncontroliable factors such as cerebral perfusion, circulation time and plasma protein binding which would alter response to thiopental infusions continued to the end points. The results were as follows: 1) There was no statistical difference in verbal command response to thiopental according to age in age groups below 59 years. 2) Compared with age groups below 59 years, 60~79yrs, group failed to respond to the verbal command in 33% by 2.2mg/kg and 100% by above 2.6mg/kg.(p<0.05) 3) The mean time for loss of verbal command response after thiopental injection was 27.4+/-10.3 seconds and 80.4% of theses patients lost lid reflex with a mean time of 41.7+/-9.1 seconds after thiopental injection. 4) All groups showed statistically non-significant alterations of systolic blood pressure and heart rate after injection of thiopental.
Anesthesia ; Blood Pressure ; Body Weight ; Heart Rate ; Humans ; Kidney ; Liver ; Orthopedics ; Perfusion ; Plasma ; Protein Binding ; Reference Values ; Reflex ; Thiopental*

OBJECTIVE: To assess cough reflex sensitivity using the simplified cough test (SCT) and to evaluate the usefulness of SCT to screen for silent aspiration. METHODS: The healthy control group was divided into two subgroups: the young (n=29, 33.44+/-9.99 years) and the elderly (n=30, 63.66+/-4.37 years). The dysphagic elderly group (n=101, 72.95+/-9.19 years) consisted of patients with dysphagia, who suffered from a disease involving central nervous system (ischemic stroke 47, intracerebral hemorrhage 27, traumatic brain injury 11, encephalitis 5, hypoxic brain damage 3, and Parkinson disease 8). The SCT was performed using the mist of a 1% citric acid from a portable nebulizer. The time from the start of the inhalation to the first cough was measured as the cough latency. All the dysphagic patients underwent the videofluoroscopic swallowing study. RESULTS: The cough latency was more significantly prolonged in the healthy elderly group than in the healthy young group (p<0.001), and in the dysphagic elderly group than in the healthy elderly group (p<0.001). The sensitivity and specificity of SCT were 73.8% and 72.5% for detecting aspiration in the dysphagic patients, and 87.1% and 66.7% for detecting silent aspiration in the aspirated patients. CONCLUSION: Cough latency measured with the SCT reflects the impairment of cough reflex in healthy elderly and dysphasic subjects. The results of this study show that the SCT test can be a valuable method of screening aspiration with or without cough in dysphasic patients.
Aged ; Brain Injuries ; Central Nervous System ; Cerebral Hemorrhage ; Citric Acid ; Cough* ; Deglutition ; Deglutition Disorders ; Diagnosis ; Encephalitis ; Humans ; Hypoxia, Brain ; Inhalation ; Mass Screening* ; Nebulizers and Vaporizers ; Parkinson Disease ; Reflex* ; Respiratory Aspiration of Gastric Contents ; Sensitivity and Specificity ; Stroke