Diagnostic peritoneal lavage is a accurate and safe method confirming the intraabdominal injury with head trauma, unstable multiple injuried patients. But the development of imaging technique and the trend in noninvasive diagnostic value is decreasing now. In the emergency room, the emergency physicians are required the rapidity and accuracy' in intial assessment and the decisions for the operation or not. So emergency physicians have been investigating the diagnostic method for intraabdomial injury that is more rapid, safe and accurate. Many diagnostic tools are developed and now accepted and used widely, among them the diagnostic peritoneal lavage is still the best method for unsatble or head injuries patients. But the positive diagnostic criterias are variable by many authors and still remain imperfectly. So our study was reviewed by medical record of patients who were undertaken the diagnostic peritoneal lavage for the diagnosis intraabdominal injury and statistical analyasis was done compared with many criteria of red blood cell and white blood cell for the more actuate way. A retrospective study of diagnostic peritoneal lavage was done of 90 patients with blunt abdominal trauma during 2 years from January, 1996 to December, 1997 and summerized our experience. The results were as follows; 1) There are 73 males and 17 females in sex. The most common type of injury was the traffic accident. 2) With many variable criteria of RBC and WBC, the accuracy and the false positive and false negative were not different in statistical results. The average accuracy was 80.1%. 3) The operations were done in 30(33.3%) cases, and the most frequent injuried organ was the small bowel, 20 cases(66.7%).
Accidents, Traffic ; Craniocerebral Trauma ; Diagnosis ; Emergencies ; Emergency Service, Hospital ; Erythrocytes ; Female ; Humans ; Leukocytes ; Male ; Medical Records ; Peritoneal Lavage* ; Retrospective Studies

Raeder's syndrome, or Raeder's paratrigeminal syndrome, is a painful Horner's syndrome characterized by unilateral head pain, oculosympathetic paralysis (miosis, ptosis) and anhydrosis over the forehead with otherwise normal facial sweating. We report two cases of Raeder's syndrome whose cause had not been found despite of intensive investigation and one case associated with nasopharyngeal tumor. The first case had a headache, miosis, ptosis but had not cranial nerve palsy. The second case had a unilateral facial headache, oculosympathetic paralysis, aoydrosis of forehead and sensory change in the ipsilateral ophthalmic division of the trigeminal nerve. The third case had a headache, miosis, ptosis, anhydrosis of forehead and sensory change in the whole territory of the trigeminal nerve.
Cranial Nerve Diseases ; Forehead ; Headache ; Horner Syndrome ; Miosis ; Paralysis ; Sweat ; Sweating ; Trigeminal Nerve

Aconitum species have been used in western and eastern medicine for centuries. In present, chinese medicine uses the drug to treat weak constitution, poor metabolism, dysuria, cardiac weakness, gout rheumatism in the limbs, neuralgia. Poisoning may occur from intentional or accidental ingestion, and the concentration of the toxic alkaloids - aonitine, mesaconitine, and hypoconitine - varies depending on species, place of origin, time of harvest, and processing procedure. In addition to cardiac arrhythmias, and hypotension, the alkaloids cause GI upset & neurological symptoms, especially numbness of the mouth and parethesia in the extrimities. The alkaloid causes a prolonged sodium current in cardiac muscle with slowed repolarization. The aconitine acts as a agonist of Na-channel receptor. Vaughan-Williams' classification I antiarrhythmic agents which belong to might be the first choice for the therapy of aconitine induced arrhythmias. The modification of the sodium system by aconitine seems to be responsible for the prolongation of the action potential and the appearance of extrasystoles and fibrillation. We experienced a 67-year-old male patient who suffered chest discomfort and palpitation with ventricular tachycardia through to be caused by aconitine. After treatment for 3days he recovered well and discharged. We report this case with literature review.
Aconitine ; Aconitum ; Action Potentials ; Aged ; Alkaloids ; Arrhythmias, Cardiac ; Asian Continental Ancestry Group ; Cardiac Complexes, Premature ; Classification ; Constitution and Bylaws ; Dysuria ; Eating ; Extremities ; Gout ; Humans ; Hypesthesia ; Hypotension ; Male ; Metabolism ; Mouth ; Myocardium ; Neuralgia ; Poisoning ; Rheumatic Diseases ; Sodium ; Tachycardia, Ventricular* ; Thorax

Many authors have been reported that the abdominal trauma, especially injury of the liver and spleen, is frequently found with lower rib fractures, below the ninth rib fractures and the incidence was about 20 to 30%. In cases of rib fractures, Intra- abdominal organs may be injured in the higher rib fractures than the ninth because the diaphragm is elevated at the level of filth intercostal space in expiration period and the intra-abdominal lesions are often delayed evaluated due to the pain of the fractures and masked by the other injuries of the head and the extremities. So above reasons, we were often questioned what the level of rib fracture we must evaluate the intra-abdominal injury was? So we investigated 452 patients with rib fractures who visited our emergency medical center from 1995, January to 1996, December and divided into two groups according to the prescience of intra-abdominal organ injuries by each the level of rib fractures. The number of patients with intra-abdominal organ injuries were 75(16.6%) and the most frequently damaged organ was the liver(25 cases, 33.3%). We calculated the statistical values of each level of rib fractures by the Chi-Square method and got a result that the level of rib fracture we must evaluate the intra-abdominal injuries was the sixth rib fracture. Therefore, if we will meet the patients with rib fracture below the sixth, we must have attentions to the intra-abdominal injuries and evaluate the abdomen closely with various diagnostic methods.
Abdomen ; Attention ; Diaphragm ; Emergencies ; Extremities ; Head ; Humans ; Incidence ; Liver ; Masks ; Rib Fractures* ; Ribs* ; Spleen

We evaluated the effect of carbamazepine-controlled release (CR) on the cognitive function. By using monotherapy study, we investigated the effects of carbamazepine on cognitive function in 10 epileptic patients and 17 normal controls. The evaluations were conducted before and one and six months after therapy using neuropsychological batteries(BUSCHKE SELECTIVE REMINDING TEST BSRT, REY OSTERRIETH COMPLEX FIGURE TEST ROCFT, CONCENTRATION ENDURANCE TEST d2 test, REY VISUAL DESIGN LEARNING TEST RVDLT, FINGER TAPPING TEST). In the patients treated with carbamazepine-CR monotherapy, follow up studies were made in one and six months later, respectively. It was found that the cognitive function determined in the three tests(consistent long-term retrieval : one item of BSRT, d2 test, and ROCFT : P 0.05). The mean anticonvulsant blood levels on the day of cognitive function tests were 6.48mg/ml (SD=l. 87) and 6.53mg /ml (SD=l.97) in one and six months respectively. This study showed carbamazepine-CR monotherapy had an adverse effect on the cognitive function.
Carbamazepine ; Fingers ; Follow-Up Studies ; Humans ; Learning

OBJECTIVE : We investigated the relationship between the severity of the disease and the abnormality of some ocular movements in parkinson's disease. BACKGROUND: Disorders of eye movements have been described in diseases of the basal ganglia for over a century and ocular motor deficits of the saccadic and pursuit system have been reported in parkinsonian patients. METHOD : We studied the electro-oculography of the eye tracking and saccadic movement in 26 patients (11 males, 15 females) with Parkinson's disease. The severity of the disease was divided into two groups by Hoehn & Yahr(H-Y) staging, H-Y stage 1, 2(group A) and H-Y stage 3, 4 (Group B). Some patients antiparkinsonian drugs of L-dopa, dopamine agonist and anticholinergics. RESULT : The velocity of smooth pursuit and the velocity and latency of saccade were calculated and compared between two groups. Eye tracking test revealed decreased pursuit velocity leading to catch-up saccades, but normal phase relationship between eye and target movement, while saccadic eye movement had increased latency. These results showed more profound severity in more advanced stages of the disease. CONCLUSION : We suggest that ocular movement be often chosen as a simple but relevant example of general motor function, as well as criteria for staging of Parkinson's disease and basal ganglia play significant role in ocular movement.
Basal Ganglia ; Cholinergic Antagonists ; Dopamine Agonists ; Eye Movements ; Humans ; Levodopa ; Male ; Parkinson Disease* ; Pursuit, Smooth ; Saccades

Lacune is small infarct located in the deeper part of the brain and developed by occlusion of small branch of the large cerebral arteries. It occupies 10-30% of infarction in western countries but 53.1% in our study. We investigated 181 cases of lacunar infarction confirmed by clinical features and neuroimaging study. We analyzed lacunar stroke into 13 groups of symdrome based on the clinical features. The frequent lacunar syndromes were pure motor stroke (35.4%), sensori-motor stroke (26.5%), ataxic hemiparesis (11.6%), and pure sensory stroke (6.1%). The frequent sites for lacune were pons (25.4%), corona radiata (24.9%), and thalamus (18.2%). The major contributing risk factors were hypertension (65.8%) and diabetes (19.3%). The incidence of multiple lacune was 67.4%. The determining factor for clinical presentation of lacune was not the size of lesion but the location of lesion.
Brain ; Cerebral Arteries ; Hypertension ; Incidence ; Infarction ; Neuroimaging ; Paresis ; Pons ; Risk Factors ; Stroke ; Stroke, Lacunar* ; Thalamus

Ataxic hemiparesis is a stroke syndrome in which the main features are unusual combination of weakness and cerebellar-like ataxia involving the limb on the same side. We describe an analysis of 17 patients with ataxic hemiparesis who underwent magnetic resonance imaging or computed tomography. Ten patients had lacunar infarction in the contralateral pons. In six, lesions were found in the contralateral thalamus and the posterior limb of internal capsule. In one patient, infarct was located in the contralateral midbrain, They showed different clinical manifestations depending on the sites of lesion. This study may suggest that variable sites of lesion can cause ataxic hemiparesis and different clinical manifestations.
Ataxia ; Extremities ; Humans ; Internal Capsule ; Magnetic Resonance Imaging ; Mesencephalon ; Paresis* ; Pons ; Stroke ; Stroke, Lacunar* ; Thalamus

Experinece in the management of 74 patients with delayed traumatic intracranial hemorrhage(DTICH) of 474 head injury from January 1996 to December 1996 is poresented with emphasis on the incidence, occurring time, risk factors and outcome. The incidence of DTICH was 15.6% of all hospitalized head-injury patients. After an injury, every patient had an immediate computerized tomography(CT) scan to diagnose intracranial pathology and then CT follow-up was carried out according to intial CT finding and reurological deficit. The lesion was almost occurred in patients with initial abnormal CT finding(85.1%). 82.4% of DTICH were noted within 72 hours after injury. The delayed epidural hematoma and intracerebral hemorrhage were almost noted in first 72 hours(>90%), but the delayed subdural hemorrhage was found after a time interval varying from 6 hours to 10 days. So we strongly recommend CT follow-up in 4-8hour, 24-72hour, and then 7th day after head injury, especially in patients with initial abnormal CT findings. The risk factor of the delayed lesion was not hypotension, hypoxia, and consciousness level, but age of patients and the initial CT finding. The development of DTICH was not heralded by neurological deterioration. The prognosis of DTICH was not worse than non-DTICH. The patient with delayed subdural hemorrhage was better than the patient with non-delayed lesion(including hemorrhage and normal CT finding).
Anoxia ; Cerebral Hemorrhage ; Consciousness ; Craniocerebral Trauma* ; Follow-Up Studies ; Head* ; Hematoma ; Hematoma, Subdural ; Hemorrhage ; Humans ; Hypotension ; Incidence ; Intracranial Hemorrhages* ; Pathology ; Prognosis ; Risk Factors

BACKGROUND: Arterial hypoxemia has been noted in patients with liver cirrhosis because of bronchial vessel dilatation. Cabenes et al. reported that bronchial hyperresponsiveness to the metacholine inhalation was observed in patients of left side heart failure, he suggested that one of the mechanism was bronchial vessel dilatation. We hypothesized that patients of liver cirrhosis might have bronchial hyperresponsiveness to metacholine inhalation due to portal hypertension. We evaluate the relationship between bronchial responsiveness and severity of liver cirrhosirs, severity of portal hypertension. METHODS: In the 22 patients of the liver cirrhosis with clinical portal hypertension metacholine provocation test was done and determined PC20 FEV1. We classified lifter cirrhosis according to Pugh- Child classification Esophagogastroscopies were performed for the evaluation of the relationship between bronchial hyperresponsiveness and severity of esophageal varix. RESULTS: In the 22 cases of the liver cirrhosis with clinical portal hypertension. The causes of liver cirrhosis, alcoholic hepatitis was 9 cases. hepatitis B virus was 12 cases, hepatitis C virus was 1 case. and 151 cases (68.18%) of total 22 cases were positive in metacholine provocation test. In positive cases There was no significant relationship between PC20FEV1 and severity of liver cirrhosis which were classified by Pugh-Child classification or severity of esophageal varix(p<0.05). CONCLUSION: we observed that bronchial responsiveness to metacholine increased in the patients of liver cirrhosis and there was no significant relationship between the severity of liver cirrhosis and the severity of esophageal varix.
Anoxia ; Child ; Classification ; Dilatation ; Esophageal and Gastric Varices ; Fibrosis ; Heart Failure ; Hepacivirus ; Hepatitis ; Hepatitis B virus ; Humans ; Hypertension, Portal ; Inhalation ; Liver Cirrhosis* ; Liver Cirrhosis, Alcoholic ; Liver*