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

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

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

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*

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

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

PURPOSE: The prognosis of non-Hodgkin's lymphoma (NHL) is disappointing for patients who experience primary treatment failure or relapse after an initial response. Patients in relapse may respond again to chemotherapy, however the time to disease progression becomes shorter and eventually the disease becomes resistant. The aim of this study was to evaluate the efficacy and safety of the MINE regimen in the treatment of patients with relapsed or refractory NHL. Material and Methods: Forty-three pretreated patients with a median age of 56 years were enrolled into the study between October 1995 and June 2000. Most patients (60.5%) had a performance status of 0 to 1, and a diffuse large cell subtype (55.8%). Seventy-four percent of patients had stage III or IV disease at the start of MINE treatment. Eighteen (41.9%) patients had complete response, 5 (11.6%) had partial response, and 20 (46.5%) had failed to respond to prior therapy. Ifosfamide 4 g/m2 was divided over 3 days and administered IV over a 1 hour period. Mitoxantrone 8 mg/m2 was administered as a short IV infusion on day 1. Etoposide (65 mg/m2/day) was infused over 1 hour on days 1 to 3. A total of 144 cycles was administered, with a mean of 3.34 cycles per patient (range, 1-8). The mean relative dose intensity was 87.4%. RESULTS: 1) Nine patients achieved a complete response and nine patients achieved a partial response, resulting in an overall response rate of 43.8% of the 41 assessable patients. 2) The median survival time was 6 months (95% CI, 4 to 8 months), and the median time to failure was 5 months (95% CI, 3 to 7 months). 3) A statistically significant association with complete response rates was found for complete response to prior therapy (p=0.049). The significant factors for overall survival were a complete response after MINE chemotherapy and serum 2-microglobulin (p=0.003, p=0.012, respectively). The significant factors for time to treatment failure were a complete response after MINE chemotherapy and serum 2-microglobulin (p=0.003, p=0.044, respectively). 4) The main result of toxicity of MINE was bone marrow suppression. CONCLUSION: The response to MINE chemotherapy and serum 2-microglobulin were both independent prognostic factors for overall survival and time to treatment failure. As the median time to treatment failure for complete responses was 14 months, the best use of this regimen could be in a strategy that includes prompt consolidation of a complete response with intense chemotherapy, with or without hematopoietic stem cell rescue.
Bone Marrow ; Disease Progression ; Drug Therapy* ; Drug Therapy, Combination ; Etoposide ; Hematopoietic Stem Cells ; Humans ; Ifosfamide* ; Lymphoma ; Lymphoma, Non-Hodgkin* ; Mitoxantrone* ; Prognosis ; Recurrence ; Time-to-Treatment ; Treatment Failure

Esophageal perforation is a rare disease, which require emergent diagnosis and therapeutic procedure. In this paper, we present one case of esophageal perforation by traction of toothbrush which was swallowed during pharyngeal irritation. After the toothbrush was inserted to stomach by gastroscope, gastrostomy was performed for removal of toothbrush and the esophageal perforation was repaired by operation.
Diagnosis ; Esophageal Perforation* ; Gastroscopes ; Gastrostomy ; Rare Diseases ; Stomach ; Traction

Because of various complicatins it's a trend to use non-depolarizing N-M blocker for the intubation, but oneset of action is delayed. So inhalation anesthetics are administered by mask until the onset time of action of N-M blocker which may cause pollution in operating room and it is possible for operating room personnel to bring up serious health problems. So, we used midazolam as adjuvant to induce general anesthesia and compared it with inhalation anesthetics for cardiovascular responses. Group E was given pentothal sodium 5mg/kg and inhaled 2% enflurane, group MP given midazolam O.lmg/kg and pentothal sodium 3mg/kg, and group M given only midazolam 0.3 mg/kg. As a N-M blocker O.lmg/kg of vecuronium bromide was given to all groups for endotracheal intubation. The results were as follows. 1. There was no significant difference in blood pressure and heart rate in each group. 2. Recovery time of consciousness at the end of anesthesia was longer in groups given midazolam. 3. The ratio of the patients who became asleep after the administration of O.lmg/kg of midazolam was 20% and 100% of patients became asleep with 0.3mg/kg of midazolam.
Anesthesia ; Anesthesia, General ; Anesthetics, Inhalation ; Blood Pressure ; Consciousness ; Enflurane ; Heart Rate ; Humans ; Inhalation* ; Intubation* ; Intubation, Intratracheal ; Masks ; Midazolam* ; Operating Rooms ; Sodium ; Thiopental ; Vecuronium Bromide

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