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Acute hydrocephalus is a rare manifestation of posterior circulation strokes. Clinical worsening and coma may occur in addition to these symptoms of cerebellar dysfunction. Timely and careful approach will certainly prove to be life saving when deciding for a shunt procedure in a patient developing obstructive hydrocephalus following cerebellar infarct. The case presented here is a reminder for both this rare complication, and the treatment approach. We present a patient with cerebellar infarct and secondary obstructive hydrocephalus. Forty three year old male patient was brought to the emergency room in our hospital with unconsciousness, before that patient with suddenly developing dizziness, loss of balance and vomiting. His neurological examination showed that he was coma. The patient's brain computed tomography scan showed severe third and lateral ventricular dilation suggestive of obstructive hydrocephalus. Following shunt placement and suboccipital decompression, the patient recovered and was able to walk without assistance. Cerebellar infarcts may cause death as a result of pressure increase in the posterior fossa and pressure on the brain stem due to edema. Moreover, the aquaductus or the fourth ventricle may close because of edema and cause obstructive hydrocephalus and acute intracranial pressure increase. Temporary external ventricular drainage or permanent shunt systems and surgical decompression of the posterior fossa may be considered to prevent progressive neurologic worsening. In conclusion, we wished to point out that a timely surgical procedure in a cerebellar infarct case where acute hydrocephalus developed could be life saving.
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<p><b>Introduction: </b>We retrospectively examined the grounds for judging the consciousness level as 1 on the Japan Coma Scale (JCS) made by emergency life-saving technicians (ELSTs).</p><p><b>Methods: </b>The survey involved the sick and injured who were transferred to the hospital by ambulance during the 25-month period from July 1st, 2011, and who were able to respond to questions asked by hospital staff to make records after ELSTs had judged their consciousness level as 1 on the JCS.</p><p><b>Result: </b>A survey involving 105 cases was conducted to examine grounds for judgment of consciousness level of the sick and injured as 1 on the JCS. "Vacant or blank expression", "delay in reactions" or "delay in responses" were cited as the grounds by 61.0 and 47.6%, respectively.</p><p><b>Conclusion: </b>When ELSTs judged the consciousness level of the sick and injured as 1 on the JCS, they made the above observations of the patients. Although these factors are useful for evaluating the status of consciousness, they are not certain. In some cases, ELSTs may have judged the consciousness level as 1 when it should have been judged as 2 or 3 on the JCS. Therefore, it is suspected that some ELSTs may not recognize disorientation appropriately.</p>
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Objective:To introduce the Australian Life Saving Drugs Program ( LSDP) and provide references for medical assistance system for the rare diseases in China. Methods:The main content and characteristics of LSDP were analyzed and compared with the Chinese status quo valuation. Results:Through the orphan drug designation and cost-effectiveness evaluation, eligible drugs are included in LSDP and funded to the rare disease patients. LSDP stip-ulated the strict funding criteria and conditions, established the Guidelines and Disease Advisory Committees, and processed the post-market reviews program in order to guarantee the medication requirements of the patients. Conclu-sions:The Australian experience is worth learning and China should implement a country-led management system for the rare disease and orphan drugs, and explore a medical assisstance system in line with the Chinese national condi-tion based on the catastrophic medical insurances.
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Since microhistory's approach to the past is based on an understanding of and a sympathy for the concrete details of human lives, its area of interests overlaps with the history of medicine and medical humanities, which examine illness and health. If we put a specific region and society in a specific period under a microscope and increase the magnifying power, we can understand the numerous network connections among the body, illness management, and medicine and how multilayered were the knowledge and power applied to them. And this approach of using microhistory to illuminate medical history can be more effective than any other historical approach. This article focuses on Yi Mun-gon's extensive volumes of Mukchaeilgi (Mukchae's diary) in approaching medical history from the perspective of microhistory. Simply defined, this work is a Confucian scholar-doctor's diary. Its author, Yi Mun-gon, played the role of a Confucian doctor, although not professionally, during his 23-year exile, after serving in a high governmental office on the senior grade of the third court rank. Thanks to this extensive and detailed diary, we can now get adetailed andthorough picture of his medical practice in the Songju region, 270 kilometers southeast of Seoul, where he was exiled. This article aims to understand the state of medical practice in the Songju region in the 16thcentury through the"zoom-in" method adopted by microhistory. In particular, I will focus on the following three aspects: 1)Yi Mun-gon's motivation for and method of medical study, 2)the character of Yi Mun-gon'spatient treatment as hwarin (the act of life-saving), and 3) the plural existence of various illness management methods, including pyongjom (divination of illness), sutra-chanting, exorcism, and ch'oje (ritual toward Heaven). All three aspects are closely related to Confucianism. First, Yi Mun-gon decided to acquire professional-level medical knowledge in order to practice the Confucian virtue of filial piety. He sharpened his medical knowledge during the process of caring for his ill mother. In Confucian Choson society, a patient was encouraged to be deeply involved in the process of his or her medical treatment and the space of clinical treatment was not an exclusive domain for the doctor, but for public discussion, where both doctor and patient participated in making the best medical choices. In this atmosphere, a patient's family members would also naturally learn the clinical process, not unlike today's interns learning from renowned doctors. Second, after studying medicine up to a professional level, Yi Mun-gon administered the "life-saving" medicine to many people, yet he did not open his doors to all individuals. His medicine was practiced within his social network of blood, regional, and intellectual relations, where priority was established according to the level of closeness to himself, according to Confucian ideology. Nevertheless, because he did partially accept patients outside of these networks, his practice setin motion the symbolic system of Confucian ideal of universal "life-saving." Third, in the Songju region during the 16thcentury, various methods of treating illnesses-such as medicine, divination, sutra-chanting, exorcism, and kumyongsisik (life-saving, food-offering ritual)-co-existed and were selected according to individual conditions. Confucianism did not want to either acknowledge or outright reject most of these methods, except for officially acknowledged medicine, at that time. In fact, this co-existence was inevitable because there was not one entirely effective means of curing illness at that time. Also, the system of Confucian ideology was not powerful enough to enforce what it championed. On the contrary, behind the outer austerity of Confucian society, people sought out unorthodox methods, such as exorcism, Buddhism, and Taoism-ironically, in order to practice the important Confucian values of filial piety and patrilineage in the face of their parents' or sons'illnesses. It was only after the emergence of modern ideology and methodology of hygiene, which had the ability to control epidemics and prioritize the preservation of the life of individuals and the population, following the opening of the port in the late 19th century, that this pluralistic culture for illness management became much less prevalent.
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China , Confucianism/history , Historiography , History, 16th Century , Korea , Physician-Patient Relations , Physicians/historyABSTRACT
Objective To carry out quantitative investigation on application of emulational trunk dummy (ETD) in evaluating the opening shock of life saving parachute and provide a more reliable test method for further development. Method ETD equipped with parachute was tested in the impact experiment, where a 63.4 kg impact block was dropped from the height of 0.20 m，0.40 m，0.60 m，0.80 m respectively to simulate different opening shocks. The opening shocks were deducted by measured forces on harness and acceleration loads at the center of dummy's thorax. For comparison, 5 rigid trunk dummies (RTD) were tested under the equivalent impacts. As the contrast test, 24 male healthy subjects were also exposed under such impacts with standing and sitting posture respectively. Results Under the same impact, the peak impact value on harness exhibited maximum on RTD, minimum on subjects with sitting posture, and medium on ETD. There were significant differences between each experimental group (P<0.01). With different impact loads, the peak impact value on ETD was 2 795，3 873，4 816 and 5 736 N respectively, which was correspondingly close to that of subjects with standing posture(2 541，3 042，3 720 and 4250 N). Conclusions The result of opening shock gathered from ETD is closer to that from RTD due to ETD’s viscoelasticity, which shall certainly influence the measured opening shock. Therefore, ETD is suggested to be used in the development of live saving parachute.
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The rapid pervasion of AIDS makes it an urgent social issue to achieve the right for acquiring life-saving medication,which is gradually classified into part of human rights by most nations and international organizations.The right for acquiring life-saving medication is also defined as part of human rights comprised by International Convention on Human Rights,being included in life right or right of health.The right for acquiring life-saving medication is a specific social right,thus needs to be applied under government protection and definite legislation.