A fifty-eight years old male patient was given general anesthesia for the clipping of aneurysm on the posterior communicating artery. The respiration of the patient was controlled with Ohmeda 7000 anesthesia ventilator. During the surgery there appeared curare cleft on the capnogram which did not disappear after the administration of neuromuscular blocker, but disappeared after the change of the anesthesia ventilator with another one. After that another curare cleft was made by the transient obstruction of the outlet of the excess patient circuit gas of the new anesthesia ventilator. It may be said that inappropriately functioning pop-off valve of the anesthesia ventilator can be one of the causes of curare cleft on the capnogram.
Anesthesia ; Anesthesia, General ; Aneurysm ; Arteries ; Curare* ; Humans ; Male ; Neuromuscular Blockade ; Respiration ; Ventilators, Mechanical

Systemic lupus erythematosus is a connective tissue disease which can affect every organ system. Neurologic abnormalities are common, occuring in approximately half of all patients at some time during the course of their illness. But symptoms of nervous system as the sole presenting symptoms occur in less than 1% of lupus patients. In patients initially presenting with neurologic symptoms and signs, differential diagnosis is difficult and sometimes it may be misdiagnosed. Therefore extensive laboratory investigations should be carried out in all patients with unusual neurological symptoms, since early diagnosis of lupus can help in providing effective treatment. We report a patient with systemic lupus erythematosus who presented with dysarthria and dysphagia resembling multiple sclerosis.
Connective Tissue Diseases ; Deglutition Disorders ; Diagnosis, Differential ; Dysarthria ; Early Diagnosis ; Humans ; Lupus Erythematosus, Systemic* ; Multiple Sclerosis* ; Nervous System ; Neurologic Manifestations

OBJECTIVES: This study was performed to investigate the relationship between age of onset in late-life depression and T2 hyperintensities observed in the brain MRI, we tried to see part of pathophysiology of late-life depression. METHOD: The subjects consisted of 18 patients whose first depressive episode occurred before age 50, and 20 patients whose first depressive episode occurred after age 50 years, and 20 agematched controls. Depressive patients were diagnosed according to DSM-IV. Established hyperintensity rating systems were used to analyse the T2 weighted images and blood pressure, cholesterol level, DM, EKG were measured to compare the relationships. RESULTS: 1) Signal hyperintensities on T2 weighted image were more severe in late-life depressive patients whose first depressive episode after age 50 (p<0.05) and there is no significant difference between patients whose first episode before age 50 and age-matched control subjects. 2) Mild signal hyperintensities were observed in all elderly depressed patients and control subjects, but severe hyperintensities were observed in late-onset depression. 3) Signal hyperintensities were related to age, hypertension, blood cholesterol level (p<0.05). CONCLUSION: The late onset depressive patients had more white matter hyperintensities on T2 weighted image than early onset depressive patients. this results support previous hypothesis that white matter change is the important biological factor of late-onset elderly depression and old age, hypertension, hypercholesterolemia may be associated with signal hyperintensities.
Age of Onset ; Aged ; Biological Factors ; Blood Pressure ; Brain* ; Cholesterol ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Electrocardiography ; Humans ; Hypercholesterolemia ; Hypertension ; Magnetic Resonance Imaging*

This study was performed to investigate the knowledge and attitude of workers in small scale industries on health management, and to provide the basic data for more effective service by the group occupational health service system. The knowledge and attitude of 247 workers and 46 health personnel in the industries scattered around Incheon were investigated from December 1992 to February 1993. The results were summarized as follows; 1. There were significant differences between the workers and the health personnel by age, sex, marriage status, job-position and education level. 2. The recognition level of the workers to contract work related disease was significantly higher than that of health personnel, and recognition level of the workers on environmental hazards and on the utility of measuring hazards were lower than that of health personnel. 3. The recognition level on the content of the group occupational health service system was significantly different between workers and health personnel, 72.6% of the responses from the workers answered that they did not know what the group occupational health service system was, but 82.2% of the responses from the health personnel answered that they knew well what it was. And 79.0% of all respondents thought it was necessary for worker's health. 4. seventy three percent of the respondents from the workers indicated that they had never taken health education. However, 93.0% of all respondents answered positively for the need of health education to promote their health. 5. current health service system was judged to be insufficient for the demand of workers for better health. Most of the respondents prefered a formal but flexible health service system and they wanted the periodic health examination to be followed up. It was revealed that despite of poor knowledge, the demand of workers for health service was higher than the current supply. Therefore, this study suggests that educating both health personnel and workers to obtain correct knowledge on the hazards to work environment and health management is needed for effective occupational health service.
Surveys and Questionnaires ; Education ; Health Education ; Health Personnel* ; Health Services ; Humans ; Incheon ; Marriage ; Occupational Health Services

To evaluate the surgical results, the author made a clinical analysis on 70 patients of postmeningitic hydrocephalus who had been treated surgically. And the results were summarized as follows. 1) The tuberculous meningitis was the most common type causing the postmeningitic hydrocephalus(72.9%). 2) Among 70 patients, 51 were male and 19 were female. About 40% of cases were under 5 years old. 3) The most common clinical symptom was vomiting(67%). Headache, fever and generalized seizure were symptoms in order of frequency. Neurological sings represented neck stiffness, cranial nerve palsy and motor weakness. 4) The most common clinical condition on admission was stage 3 (advanced cases with unconciousness and severe neurological deficits). 5) The spinal fluid analysis showed more abnormal findings comparing to the ventricular fluid. But ventricular pressure was higher than spinal fluid pressure. 6) Plain skull x-rays, carotid angiograms were useful diagnostic methods but CT brain scan was though to be the most accurate, noninvasive method which showed size of ventricle and effectiveness of shunting procedures with Evans'ratio. In enhanced CT brain scans, the basal cistern enhancement was the most common finding beside ventricular enlargement (64.1%). 7) Ventriculoperitoneal shunting was the most common procedure in this series. 8) The initial revision rate was 12/70(19%) and the most of the revision was performed within 6 months after the initial shunting. 9) The revision rate in relation to shunting system and cerebrospinal fluid finding was not statistically significant. 10) The most common cause of the shunt malfuntion was obstruction of the ventricular catheter. 11) Forty one patients(58.6%) showed favorable outcome. The motality rate was 14/70(20%) and they were all belong to the stage 3. About half of the patients in stage 2 and stage 3 showed dramatic improvement after early shunting procedures. So the timing of operation was the most important factor influencing their outcome.
Brain ; Catheters ; Cerebrospinal Fluid ; Cerebrospinal Fluid Pressure ; Child, Preschool ; Cranial Nerve Diseases ; Female ; Fever ; Headache ; Humans ; Hydrocephalus* ; Male ; Neck ; Seizures ; Skull ; Tuberculosis, Meningeal ; Ventricular Pressure ; Ventriculoperitoneal Shunt

The changes in heart rate, systolic, mean and diastolic arterial blood pressure, and the plasma concentration of epinephrine and norepinephrine were measured before and thmughout the induction periods of anesthesia in 60 elective surgical patients in a randomized, double-blind manner to evaluate the effects of continuous intravenous infusion of esmolol for 1 minute at 500 ug/kg/min as a loading dose and for 4 minutes at 100 ug/kg/min as a maintenance dose. The control group (n=30) was given the continuous infusion of normal saline at the same volume-rate. During the study, anesthesia was maintained with N2O-O2-enflurane-vecuronium and controlled ventilation. In the esmolol group, statisticaUy, the heart rate at 1 minute after the intubation was less increased and systolic and diastolic pressure after 11 minutes were more decreased than the control group. And plasma norepinephrine concentration was elevated more than the control group at 3 minutes after the intubation. We concluded that the used infusion rate of esmolol blunted the hemodynamic changes following the laryngoscopy and endotracheal intubation but it is still needed to find the dosage for complete blocking the adrenergic response.
Anesthesia ; Arterial Pressure ; Blood Pressure ; Epinephrine ; Heart Rate ; Hemodynamics* ; Humans ; Infusions, Intravenous* ; Intubation ; Intubation, Intratracheal* ; Laryngoscopy ; Norepinephrine ; Plasma ; Ventilation

Laryngoscopy and endotracheal intubation are potent stimuli that increase heart rate and blood pressure. These transient stress responses are probably not harmful in healthy individuals. However hypertensive patients are more prone to have significant increase in heart rate and blood pressure whether they have been treated beforehand or not and these responses also can lead to fstal complications. A randomized double-blind study was csrried out on 40 ASA physical status II-III adult elective surgical patients with hypertension to assess the effects of continuous intravenous infusion of esmolol, ultrashortacting cardioselective beta blocker, on hemodynamic responses to laryngoscopy and endotracheal intubation. Patients received a continuous infusion of esmolol(500mcg/kg/min for 1 minute, followed by 200mcg/kg/min for 12minutes) or an equal volume of saline before and throughout the induction periods of anesthesia. Using noninvasive automatic blood pressure monitor, blood pressure( systolic, diastolic and mean arterial pressure) and heart rate were measured at 6 points: 1) as the control value, on arrival to operating room, 2) just after IV loading dose of saline or esmolol, 3) just after IV thiopental, 4) 1 minute after intuhation, 5) 3 minutes after intubation, and 6) 5 minutes after intubation. The rate-pressure product was calculated in each time. During this study, anesthesia was maintained with enflursne-N2O-O2 vecuronium and controlled ventilstion. In patients given esmolol, systolic pressure, diasolic pressure, mean arterial pressure, heart rate, and rate pressure product at 1 minute, 3 minutes, 5 minutes after intubation were less increased than control group. And the heart rste response was more effectively blunted than the blood pressure response. The continuous infusion of esmolol can blunt hemodynamic changes caused by laryngoscopy and endotracheal intubation in hypertensive patients, yet it is needed to find out the optimal dosage of esmolol for complete blocking of the sympathetic response without the adverse effects.
Adult ; Anesthesia ; Arterial Pressure ; Blood Pressure ; Blood Pressure Monitors ; Double-Blind Method ; Heart ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension* ; Infusions, Intravenous ; Intubation ; Intubation, Intratracheal* ; Laryngoscopy ; Operating Rooms ; Thiopental ; Vecuronium Bromide

Azopt (brinzolamide ophthalmic suspension, 1%)is a carbonic anhydrase type II inhibitor,which reduces intraocular pressure by suppression of aque-ous humor production in ciliary process. It was developed as an agent which has little systemic side effect and was adjusted to physiologic ophthalmic environment. We observed the effect of intrao- cular pressure, pulsatile ocular blood flow and side effect to investigate the clinical effectiveness of Azopt in normal Azopt was instilled to 10 eyes of 10 volunteers and artificial tear was instilled to the other 10 eyes of 10 volunteers three times daily, respectively. We measured intraocular pressure by Goldman applanation tonometer at twohours, 8 hours, 1 day and 7 days after instillation. Pulsatile ocular blood flow, pupil diameter, blood pressure and pulse rate were also measured. Decrease of intraocular pressure after instillation of Azopt was statistically significant (p<0.05), compared with the pressure before instillation of Azopt and the decrease of pressure after instillation of artifical tear. No systemic side effect and ophthalmic discomfort was noted except for temporary visual blurring. Therefore we expect that Azopt will have a great effect on glaucoma patients in Korea who must be treated for long duration.
Blood Pressure ; Carbonic Anhydrases ; Glaucoma ; Heart Rate ; Humans ; Intraocular Pressure ; Korea ; Pupil ; Tears ; Volunteers

To evaluate the cerebral blood flow in feline hydrocephalic brain, this study was designed to measure the regional cerebral blood flow(rCBF ; frontal and periventricular area) by the hydrogen clearance method and to visualize the vascular morphology such as angioarchitecture, diameter and number of vessels using microfil in different stages of the kaolininduced hydrocephalus. There have been several prior reports about intracraial vascular morphology, using various material such as colloida carbon and microcorrosion casts. But there is none about microfil in normal or hydrocephalic cats. The authors made a first cicrofil model to observe the vascular changes in experimental feline hydrocephalus in the literature. The results were as follows : 1) A reduction of rCBF was detected in the left periventricular area at 2 weeks after kaolin injection. A significant reduction of rCBF was revealed at left periventricular area at 4 weeks after kaolin injection. However, the rCBF of the left frontal cortex was significantly decreased at 4 week after kaolin injection. 2) A reduction in diameter of vessels was detected in the left periventricular area at 2 weeks after kaolin injection. The significant reduction of diameter in the left periventricular area was revealed at 4 weeks after kaolin injection. 3) The vessels of the periventricular area in the control cats were dense but loose in hydrocephalic cats. A reduction in number of vessels was found in the a periventricular area at 1 week after kaolin injection. A reduction in number of vessels was found at 2 weeks after kaolin injection also. And a significant reduction in number of vessels was found at 4 weeks after kaolin injection. 4) The number and caliber of vessels in the frontal cortex were similar between the control and hydrocephelic groups. However, cortical vessels of the control group were straight and parallel and showed the typical 'palisade pattern', whereas some of the hydrocephalic group showed distortion of the cortical vessels. In conclusion, ventricular enlargement causes displacement of primary cerebral arteries, followed by both stretching and a decrease in the caliber of the microvasculature, resulting in diminished cerebral blood flow and tissue destruction. The results suggest that vascular changes playa important role in the production of brain damage in hydrocephalus.
Animals ; Brain ; Carbon ; Cats ; Cerebral Arteries ; Hydrocephalus* ; Hydrogen ; Kaolin ; Microvessels ; Silicone Elastomers

Background : There is a substantial body of evidence that intraocular pressure increase with age among western population. However, Japanese study showed that intraocular pressure was inversely related with age. So we investigated whether intraocular pressure is related with age for Koreans. Methods : Between March, 1996 and February, 1997, 6201 subjects underwent comprehensive health examinationinthe Kyung Hee medical screening center in Seoul, Korea. The intraocular pressure was measured with pneumatonograpyh. At the same time blood pressure, body weight, height, serum osmolarity, fasting blood glucose, T3, T4, TSH(thyroid stimulating hormone), hematocrit measurements were performed. We selected 250 case randomly and investigated whether the distribution of C/D ration(cup/disk ratio), smoking status, alcohol drinking amount are uniform by aged group. So we measured C/D ratio by fundusphotograph and investigated smoking and drinking habits by questionnaires. Results : In the randomly sampled 250 cases, the amounts of smoking and alcohol consumption were lower in the elderly group. But, the C/D ration didn't show any difference between young and elderly group. In a multivariable analysis, both right and left intraocular pressure showed significantly inverse correlations with aged and visual acuity. Male had significantly higher intraocular pressure than female. Both right and left intraocular pressure showed significant positive correlations with body mass index, fasting blood glucose, hematocrit and systolic blood pressure. Diastolic blood pressure, serum osmolarity, T3 and T4 were not associated with intraocular pressure. TSH had significant positive correlation with right intraocular pressure, but no correlation with left intraocular pressure. Conclusion : Age was independently and inversely related with intraocular pressure for Koreans.
Aged ; Aging* ; Alcohol Drinking ; Asian Continental Ancestry Group ; Blood Glucose ; Blood Pressure ; Body Mass Index ; Body Weight ; Drinking ; Fasting ; Female ; Hematocrit ; Humans ; Intraocular Pressure* ; Korea ; Male ; Mass Screening ; Osmolar Concentration ; Surveys and Questionnaires ; Seoul ; Smoke ; Smoking ; Visual Acuity