Recurrent Kaposi Varicelliform Eruption: Investigation of Clinical Characteristics and Predisposing Factors / 대한피부과학회지

BACKGROUND: Kaposi varicelliform eruption (KVE) is a disseminated viral infection primarily caused by the herpes simplex virus in the setting of an underlying chronic skin disease. Few studies have reported the clinical characteristics and predisposing factors for recurrent KVE.OBJECTIVES: To characterize the clinical features and predisposing factors for recurrent KVE.METHODS: This retrospective comparative study of recurrent vs. single-episode KVE was performed at the Pusan National University Hospital between 2004 and 2017.RESULTS: A total of 84 episodes occurred in 60 patients, and of these, 13 patients developed recurrence (21.7%). No statistically significant intergroup difference was observed in the mean age and sex distribution. The face was the most common site of involvement in both groups, followed by the trunk and the upper and lower extremities. Atopic dermatitis was the most common pre-existing disease in both groups; however, Darier's disease was more common in the recurrent KVE group, and this difference was statistically significant. Most patients with KVE (66.7%) showed aggravation of the underlying skin disease within 3 months of KVE onset. This finding was more prominent in patients with recurrent episodes (91.7%) than in those with single-episode KVE (58.3%), (p=0.040).CONCLUSION: This study can contribute to a better understanding of recurrent KVE and guide clinicians in treating patients with conditions predisposing to KVE.

Síndrome de Stevens-Johnson en edad pediátrica / Stevens Johnson Syndrome of a Pediatric Age Case

El síndrome de Stevens-Johnson (SSJ) es una enfermedad inflamatoria aguda, originada por una reacción de hipersensibilidad, secundaria a ingesta de medicamentos o infecciones, que afecta a la piel y las membranas mucosas produciendo lesiones características del síndrome, causadas por apoptosis y posterior necrosis de los queratinocitos; su forma más severa es la necrolisis epidérmica tóxica, que constituye junto al SSJ un espectro de la misma enfermedad, compartiendo aspectos etiológicos, patogenéticos, histológicos y terapéuticos que ponen en peligro la vida del paciente. La afección se caracteriza por una súbita erupción morfológicamente variable, acompañada de estomatitis y oftalmia.En el presente trabajo se presenta el caso de un niño de 8 años de edad,con diagnóstico clínico de síndrome de Stevens-Johnson, con manifestaciones cutáneas, oculares y de la mucosa oral, que iniciaron posterior a ingesta de ibuprofeno, se mantuvo con un protocolo de cuidados que incluyeron soporte de oxígeno, antibioticoterapia, analgesia, corticoides, nebulizaciones, limpieza de lesiones con solución salina, sin debridación y lubricante oftálmico; tras 8 días dehospitalización el paciente evoluciona satisfactoriamente sin complicaciones durante su estancia hospitalaria.

The Stevens-Johnson syndrome (SJS) is an acute inflammatory disease caused by a hypersensitivity reaction, secondary to medication intake or infections, that affects skin and mucous membranes producing characteristic wounds of the syndrome, caused by apoptosis and subsequent necrosis of keratinocytes; the major form of this disease, is toxic epidermal necrolysis, wich together with SJS is a spectrum of the same disease, sharing etiological pathogenetic, histological and therapeutic aspects, that endanger the patient's life. The affection is characterized by a sudden morphologically varying rash, accompanied bystomatitis and ophthalmic injure. In this work we show an 8 year old patient with a clinical diagnosis of Stevens-Johnson syndrome, involving skin, eye and oral mucosa manifestations, which began after the intake of ibuprofen , it was mantained with a protocol care based on oxygen support, antibiotic therapy, analgesia, corticosteroids, sprays, cleansing wounds with saline solution without debridement and ophthalmic lubricant, after 8 days of hospitalization, our patient has a satisfactory evolution without acute complications during their time at the hospital.

Rhabdomyolysis after the free fibular flap operation for mandibular reconstruction: a case report / 대한악안면성형재건외과학회지

BACKGROUND: Free fibular flap is one of the most useful methods in the hard tissue reconstruction of the maxilla-mandible. Free fibular flap presents some advantages in which the reconstruction of both soft and hard tissues can be done at the same time. It also provides a safe and successful bone graft for the reconstruction, along with a low rate of complications. Despite these advantages and the rarity of a postoperative complication, particularly in oral and maxillofacial surgery procedures, a prolonged operation might exhibit some complications related with rhabdomyolysis. We experienced the rare event of rhabdomyolysis after oral cancer surgery. CASE PRESENTATION: In this article, we report the case of a patient who developed rhabdomyolysis after undergoing free fibular flap surgery. CONCLUSIONS: Despite the advantages of the free fibular flap operation, clinicians must be aware of the risk of complications because there are multiple factors that could result in rhabdomyolysis, such as duration of operation, position of the subject, and pre-existing conditions of diabetes and hypertension. Once the diagnosis of rhabdomyolysis is confirmed, a prompt treatment plan should be made and applied as soon as possible. This will increase the chance of a full recovery for the patient who is exhibiting symptoms of rhabdomyolysis.

Polyarteritis Nodosa Associated with Interstitial Pulmonary Fibrosis / 대한피부과학회지

Classic polyarteritis nodosa (PAN) involves small-to-medium-sized muscular arteries in multiple organ systems. It presents in combination with skin diseases, myalgia, hypertension, abdominal pain, or neuropathy. Although PAN involves the muscles, kidneys, nerves, and gastrointestinal tract, lung involvement presenting as an interstitial pulmonary fibrosis has rarely been reported. A 71-year-old man presented to our clinic complaining of weakness in his lower legs and painful subcutaneous nodules that began to develop a fortnight before he visited the clinic. He had been diagnosed with mononeuritis multiplex, interstitial pulmonary fibrosis, and a cerebral infarction in 2006. All of the preexisting diseases had become aggravated when his lower leg pain began. Laboratory tests for cytoplasmic antineutrophil cytoplasmic antibodies (ANCA), perinuclear-ANCA, and other autoimmune markers were within the normal limits. A biopsy showed mononuclear infiltrations with fibrinoid necrosis involving the medium-sized arteries. Computed tomographic scanning of the chest revealed an increase in parenchymal ground-glass opacity. The histological findings, laboratory tests, and the clinical history were consistent with PAN that was associated with interstitial pulmonary fibrosis. We report this rare case of PAN associated with interstitial pulmonary fibrosis.

Technical Approach for the Postmortem Examination of SCUBA Diving Fatality / 대한법의학회지

Recreational diving is an exciting and adventurous sport, but is also potentially hazardous. Despite its inherent hazards, an increasing number of people enjoy SCUBA (self-contained underwater breathing apparatus) diving; the number of diving-related accidents is therefore also likely to increase. Divers might face physical or psychological stresses from the unfamiliar or hostile underwater environment, which can lead to fatal accidents. To investigate deaths related to SCUBA diving, a forensic pathologist should understand the types and mechanisms of injuries and illnesses unique to SCUBA diving. Postmortem examination of diving fatalities is therefore a formidable task for most forensic pathologists because cases are sparse and the process requires an understanding of diving physiology, diving equipment, and the underwater environment. The primary aim of autopsies in SCUBA diving fatalities is to detect evidence of pulmonary barotrauma, intravascular gas, or pre-existing illnesses. Standard autopsy protocol for SCUBA diving-related deaths should include methods to detect intravascular gas and gas accumulation in the tissue or body cavity through plain radiographs or Computerized Tomography (CT) scans. Analysis of the gas components is also helpful for determining the origin of the gas. Here, the author proposes a practical method for performing an autopsy on a person who died while SCUBA diving.

Charcot Arthropathy of the Lumbosacral Spine Mimicking a Vertebral Tumor after Spinal Cord Injury

Charcot spinal arthropathy is a rare, progressive type of vertebral joint degeneration that occurs in the setting of any preexisting condition characterized by decreased afferent innervation to the extent that normal protective joint sensation in the vertebral column is impaired. The authors report on a case of Charcot arthropathy of the lower lumbar spine mimicking a spinal tumor following cervical cord injury.

Results of 'Short-Form Comprehensive Geriatric Assessment' Application to Elderly Outpatients

BACKGROUND: The importance of comprehensive geriatric assessment(CGA) for the frail elderly can not be overemphasized. Recently, with increasing elderly population and patients, there are increasing need for simplified CGA tool for evaluation of general health and functional status during the limited time in outpatient clinic. This study was conducted to estimate the effectiveness of the 'Short-form Comprehensive Geriatric Assessment' for detecting hidden medical problems beside preexisting diseases. METHODS: 78 outpatients aged 65 or more who revisited to outpatient clinic in a Social Welfare Center answered questionnaires and were examined of the 'Short-form Comprehensive Geriatric Assessment. This screening tool included vision, hearing, arm and leg function, urinary incontinence, nutrition, mental status, depression, ADL, IADL and social support. These results were compared with patients' previous medical records. RESULTS: Among the total 78 subjects, visual difficulty was detected in 63(80.8%)(Rt. eye)/67(85.9%)(Lt. eye). Right hearing difficulty was shown in 8(10.3%) subjects and left hearing difficulty was shown in 4(5.1 %) subjects. There were 2(2.6%) upper extremities dysfunctions and 25(32.1%) lower extremities dysfunctions. 24(30.8%) subjects had depression. The geriatric depression and age and number of disease showed positive correlations. These problems found by assessment tool were not identified on previous medical records. CONCLUSION: Using the 'Short-form Comprehensive Geriatric Assessmen', we could find the new medical problems besides preexisting disease. These findings stress effectiveness and importance of routine application of screening 'Short-form Comprehensive Geriatric Assessment' on daily outpatient clinical practice to improve quality of medical care for the elderly patients.

Managing In-flight Medical Emergency

In-flight medical emergencies are likely to increase as air travel continues to grow and as more elderly passengers with preexisting diseases fly long distances. Unscheduled landing for a medical reason is a serious situation for commercial air carriers. The common causes of unscheduled landings are cardiac and neurological problems. Physician passengers might be called upon to help ill or injured passengers at any time. Physicians play an important role in in-flight medical emergencies. Most airlines have installed the emergency medical kits and automated external defibrillator (AED), ambu bag, intubation set, etc. The management of in-flight medical emergences requires the assistance from welltrained crew, adequate medical equipments and medications, availability of physician passengers, and ground medical communications. This article summarizes the in-flight resources available for physician passengers when called upon for medical emergencies while on board.

A Clinicopathological Study of Kaposi's Varicelliform Eruption / 대한피부과학회지

BACKGROUND: Kaposi's varicelliform eruption (KVE) is a viral infection with disseminated skin involvement, superimposed on a pre-existing dermatosis. A monomorphic eruption of dome-shaped blisters and pustules in the eczematous lesions, along with severe systemic illness, leads to clinical diagnosis. However, there is no data on the clinicopathologic study of KVE in Koreans. OBJECTIVE: The purpose of this study was to identify clinicopathologic features of KVE. METHOD: We reviewed the medical records and biopsy slides of 21 patients who had previously been diagnosed as having KVE at the National Medical Center between 1990 and 2004. RESULTS: The study results are summarized as follows: 1. The most common pre-existing disease was atopic dermatitis, followed by seborrheic dermatitis and Darier's disease. 2.Men were more commonly affected than women, and the mean age at diagnosis of eczema herpeticum was 30.8 years. 3.Face involvement was seen in 4 patients, and systemic involvement in 6 patients. 4. Histopathologically, common findings included ballooning degeneration (76.1%), reticular degeneration (47.6%), multinucleated giant cell (57.1%), and inclusion body (28.6%), and leukocytoclastic vasculitis (47.6%). CONCLUSION: KVE is a secondary viral infection that can affect patients who suffer from a primary dermatologic condition. In many instances, the history and clinical findings may be sufficient for diagnosis of KVE. However, the clinicopathologic features can help also diagnose KVE and pre-existing dermatosis.

Isolation of Nontuberculous Mycobacteria by DNA Probe and Clinical Characteristics of Patients with NTM Pulmonary Disease / 결핵및호흡기질환

BACKGROUND: Nontuberculous mycobacterial (NTM) infections are increasingly being recognized as a cause of chronic pulmonary disease. This study describes the prevalence of NTM species from clinical specimens and the clinical characteristics of NTM pulmonary disease. MATERIAL AND METHODS: The NTM isolated from March 2003 to December 2003 at the Kosin Medical Center were identified using an oligonucleotide chip containing the internal transcribed space (ITS) sequence. The medical records of the patients with the NTM isolates, who fulfilled the 1997 ATS diagnostic criteria for NTM pulmonary disease, were analyzed, retrospectively. RESULTS: Twenty four species (24.2%) of NTM were isolated from 99 cultured AFB specimens. M. avium complex (MAC) (13 isolates), M. szulgai (3), M. kansasii (2), M. malmoense (2), M. abscessus (1), M. chelonae (1), M. scrofulaceum (1), and unclassified (1). Of the 23 patients with isolated NTM, 11 patients were found to be compatible with a NTM pulmonary infection according to the ATS criteria; MAC was found in 6 cases (54.5%), M. szulgai in 2 cases (18.2%), and M. abscessus, M. szulgai, M. kansasii and M. malmoense in 1 case each (9.1%). Ten patients (91%) were male and the median age at diagnosis was 61 years. In the pre-existing diseases, malignant disease was found in 6 cases including 5 patients with lung cancer, and history of old pulmonary tuberculosis was identified in 4 cases. The radiological patterns showed lung destruction lung in 3 cases, a cavitary mass in 3 cases, a nodular pattern in 2 cases, and reticulonodular, consolidation and a bronchiectasis pattern were in 1 case each. CONCLUSION: Various types of NTM pulmonary diseases were`found in a tertiary hospital at Busan, Korea. The NTM pulmonary diseases were caused by MAC, M. szugai, M. kansasii, M. malmoense, M. abscessus, M. chelonae, and M. scrofulaceum in the order of frequency.

The Analysis of 137 Anesthesia-related Adverse Outcome Cases in Korea / 대한마취과학회지

BACKGROUND: 137 anesthesia-related adverse outcome cases were registered by civil courts, criminal courts, police departments, and district health care centers with the Korean Society of Anesthesiologists between November 1994 and October 2002. These cases were analyzed according to type of event causing the adverse outcomes (death, brain damage, disability). METHODS: 137 adverse outcome cases were classified into obstetric and gynecologic, orthopedic, surgical, and other cases. Also, based upon a review of medical records, anesthesia records, autopsy findings, investigation records and the decisions of civil courts and criminal courts, the cases were classified into four categories; e.g. problems due to anesthetic management, preexisting diseases or preoperative patient conditions, anesthetic agents or anesthetic techniques, and operating procedures. RESULTS: 1) 45 cases were associated with problems due to anesthetic management (ventilatory failure, drug overdose, etc). 2) 39 cases were associated with problem due to preexisting diseases (cardiovascular disease, cerebrovascular disease, diabetes mellitus, etc) or preoperative patient conditions. 3) 27 cases were associated with problems due to anesthetic agents or techniques (nerve injury, malignant hyperthermia, etc). 4) 26 cases were associated with problems due to operating procedures (massive bleeding, embolism, etc). CONCLUSIONS: The most common type of damaging event causing an anesthesia-related adverse outcome was connected with anesthetic management. Therefore, it is mandatory to prepare adequate anesthetic monitoring equipment and to monitor patients thoroughly, to ensure safer perioperative anesthetic management.

Treatment of Intertrochanteric Fracture of the Femur with Ender Nail in the Elderly Patients with High Risk of Anesthesia

PURPOSE: To evaluate the usefulness of IM Ender nail in treating femoral intertrochanteric fractures with high risks including cardiovascular disease, pulmonary disease, liver cirrhosis, cerebrovascular disease, metastatic cancer, and skin problem at hip joint region. MATERIALS AND METHODS: Thirty-five patients of pre-existing diseases and femoral intertrochanteric fractures treated with Ender nailing, January 1990 to November 1997. Under the c-arm guided, closed reduction and internal fixation were performed using Ender nails, We analized operation time, blood loss, bone union, ambulation time and complications RESULTS: Mean operation time was 55 minutes, mean blood loss was 120 ml, mean radiological bone union was 12 weeks and average of partial weight bearing was 6.9 days. Postoperative complications were gastrointestinal discomfort in 3 cases, superficial wound infection in 1 case, knee pain in 7 cases, inguinal pains in 5 cases, distal migration of nails in 3 cases, varus deformity in 2 cases, proximal migration of nail with nonunion in 1 case. CONCLUSION: The intramedullary ender nail is useful method in treating femoral intertrochanteric fractures in high risk patients of anesthesia and blood loss or skin problem at hip joint region.

Status on Occurrence and Preventive Measures of Disasters in Korea / 한국역학회지

Disasters are emergencies of a severity and magnitude resulting in deaths, injuries, illness and/or property damage that cannot be effectively managed by the application of routine procedures or resources. These events are caused by nature, the result of technological or manmade error. Natural disasters include typhoon, flood, heavy snowfall, drought, famine, and earthquake. Natural disasters are unpreventable and, for the most part, uncontrollable. Technological or manmade disasters include fire, nuclear accidents, bombings, and bioterrorism. The severity of damage caused by natural or technological disasters is affected by population density in disaster-prone areas, local building codes, community preparedness, and the use of public safety announcements and education on how to respond correctly at the first signs of danger. Recovery following a disaster varies according to the public's access to pertinent information, pre-existing conditions that increase or reduce vulnerability, prior experience with stressful situations, and availability of sufficient savings and insurance. Epidemiology can be used to investigate the public health and medical consequences of disasters. The aim of disaster epidemiology is to ascertain strategies for the prevention of both acute and chronic health events. Disaster epidemiology includes rapid needs assessment, disease control strategies, assessment of the availability and use of health services, surveillance systems for both descriptive and analytic investigations of disease and injury, and research on risk factors contributing to disease, injury, or death. With both disasters and the number of people affected by such events on the increase, the importance of disasters as a public health program is now widely recognized in Korea. The epidemiologists must do their best effort for prevention of disasters.

Clinical Characteristics of Geriatric Brain Tumors

OBJECTIVE: The authors analyze the clinical characteristics of the geriatric brain tumors and suggest the treatment modality. METHODS: Patients older than 65years, managed between Jan 1980 and Feb 2002 in our department, were included in this study and the number of patients was 315. Age, sex, medical history, performance scale, treatment modality, morbidity and mortality as well as the incidence of brain tumor in this age group were analyzed. RESULTS: Geriatric brain tumors were comprised of 7.8% of the adult brain tumors. The mean age was 68.7 years and male to female ratio was 1 : 1.3. The most common one was meningioma(114, 36.2%), followed by metastatic tumor(49, 15.6%), high grade glioma(39, 12.4%), schwannoma(38, 12%) and pituitary adenoma(35, 10.5%) in the order of frequency. The incidence of pre-existing disease, such as hypertension(25%), caridiovascular disease(15%), diabetes melitus(12%) was high. Surgical outcome was good with acceptable operative morbidity and mortality rate 26% and 3% respectively. Frequent postoperative surgical complications were tumor bed bleeding and wound infection. During perioperative course, medical complications such as cardiovascular problem, delirium, pneumonia and sepsis were common. CONCLUSION: Incidence of combined medical problem in the geriatric patients was considerablly high. However, in the case of surgically accesible benign tumor or even malignant tumor, surgical treatment should be considered.

Tuberculous Spondylitis Aggravated by Spinal Manipulative Therapy: A case report

A 43 years old woman had suffered from a lower back pain for 2 months. She experienced pain aggravation after spinal manipulative therapy that was practiced by non-licentiate. Physical examination showed tenderness on L1 and L2 spinous processes. Radionuclide bone scan with 99mTc-MDP showed increased radioactivity of L1, L2 vertebral bodies. The MRI finding showed low signal intensity of L1 and L2 vertebral bodies in T1-weighted image and high signal intensity in T2-weighted image. Needle biopsy finding showed fibrosis and inflammatory cell invasion of bone marrow. We concluded that she had tuberculous spondylitis and non-detection or negligent treatment of a preexisting disease contributed to aggravation of her symptoms. We report one case of tuberculous spondylitis aggravated by spinal manipulative therapy with review of literatures.

Surgical analysis of pulmonary aspergilloma / 대한흉부외과학회지

BACKGROUND: Pulmonary aspergilloma is a potential life-threatening disease resulting from massive hemoptysis. Pulmonary aspergilloma has been treated surgically for many years, however, it has also had higher risk of mortality and complication rate. The purpose of this study is to analyze the operative methods and the types of complications. MATERIAL AND METHOD: Sixty patients who underwent surgical resection for pulmonary their medical reconrds. RESULT: The mean age was 46.3+/-13.4 years(range 20 to 76 years). The most common clinical presentation was hemoptysis which occurred in 48 patients(80%). Pulmonary tuberculosis was the most common pre-existing disease, occurri9ng in 28 patients(46.7%). The other associated lung diseases were bronchiectasis(n=11), silicosis(n=2), and chronic pnumonia(n=1). Operative proceudres wer lobectomy in 35 patients, pneumonectomy in 6, segmentectomy in 5, lobectomy and thoracoplasty in 3, segmentectomy and thoracopasty in 1, and cavernostomy in 10. The operative mortality was 6%(n=3) in lung resection patients but 0% in cavernostomy patients. The most common complications were prolonged air leakage, wound infection and postoperative bleeding. CONCLUSIONS: In most cases of pulmonary aspergilloma surgical resectin remains the only effective therapy. However, cavernostomy may be more effective for pulmonary aspergilloma patients with decreased pulmonary functions and for patients with high risk for lung resection.

Two Cases of Olfactory Reference Syndrome / 신경정신의학

Disease identity of dysmorphophobia and olfactory reference syndrome which used to be manifested by a kind of monosymptomatic somatic delusion is not yet established definitely. So many issues such as whether it be regarded as separate disease, or a spectrum of preexisting diseases such as schizophrenia or obsessive compulsive disorder and whether the monosymptom should be considered as a delusion or not are still on debate and the results are controversial. Consequently few is known about the etiology of the disorder.Obvioulsy, somatic delusion in dysmorphophobia and olfactory reference syndrome is the result of cognitive distortion of body image of the self. It reflects symbolic meaning of unresolved psychological conflict by defense mechanisms such as repression, dissociation, symbolization, projection, and so on. Though psychopharmacological and psychotherapeutic treatment modality has been reported, the treatment efficacy is unclear. Prognosis has been reported unfavorable and one of the leading causes has been thought to be treatment noncompliance. The authors experienced 2 cases of olfactory reference syndrome, so reported with literature review.

Factors Influencing Mortality in Geriatric Trauma

BACKGROUND: The goal of this study is to identify the factors that predict mortality in elderly trauma patients. METHOD: We reviewed retrospectively the medical record of 144 cases of geriatric trauma admitted to Kyungpook National University Hospital firm January 1998 to December 1998. We evaluated the general characteristics, mechanisms of injury, Revised Trauma Score(RTS), Injury Severity Score(ISS), Probability of survival(Ps) by TRISS(Trauma and Injury Severity Score) method, amount of blood transfused, preexisting disease, complications, length of stay, and mortality. RESULTS: 1. The mean age was 75.39+/-7.89 years old, and male to female ratio was 0.89 : 1. 2. The mechanisms of injury were primarily frills(56.3%) followed by bicycle or motorcycle(13.9%), and pedestrian injuries(13.2%) and motor vehicle accidents(6.9%). 3. The mean Glasgow Coma Scale(GCS), RTS and ISS ate 13.3+/-3.5, 7.2+/-1.4 and 14.2 +/-11.6 respectively. 4. The actual mortality rate was 18.1% (26/144). But by TRISS method, predicted mortality rate was 9.3%(12.5/144), excess mortality rate was 108% and Z score was 3.99 indicating that actual number of death exceed predicted number of death. 5. Between the survivors and nonsurvivors, the insults were significantly different as follows ; systolic blood pressure(141.9+/-28.3 vs. 116.8+/-48.7 mmHg), GCS(14.3+/-2.0 vs. 9.0 +/-5.1), RTS(7.8+/-0.7 vs 5.4+/-2.3), ISS(11.3+/-5.6 vs 27.2+/-20.2), Ps by TRISS(0.97+/-0.06 vs 0.65+/-0.37), preexisting diseases(50.8 vs 69.8%). CONCLUSION: Geriatric patients are more likely to die after trauma than other age groups. The cause of higher actual mortality rate compared to predicted mortality rate was considered as the higher incidence of delayed death due to sepsis or multiple organ failure. In order to reduce the mortality, even with relatively stable initial vile sign, invasive hemodynamic monitoring and intensive treatment are recommended and also, prevention and treatment of nosocomial infection are very important.

New-onset seizure in hospitalized patients

Systemic illnesses and preexisting disorders affecting the brain may decrease the seizure threshold in some conditions. For the non-neurologist, patient with new-onset seizure (NOS) is troublesome problem to manage properly. To verify the characteristics of patients with NOS, we analyzed their clinical features. From Jan. 1991 to Jul. 1995, 47 patients were consulted to the neurological department because of their NOS during the admission. We retrieved the medical records, laboratory data and consultation sheets. The most common cause of the NOS was a metabolic disorder (18 patients, 38.3%) and was followed by a previous cerebrovasular disease (6 patients, 12.8%). Ceneralized tonic-clonic seizure occurred in more than half of the patients (55.3%). Fifteen out of 26 initial EEGs revealed diffuse slowings only, whereas only four patients showed focal epileptiform discharges. Status epileptics occurred in seven patients and five of them died. Six patients out of 17 patients with metabolic causes died, comparing five patients out of 27 patients with other causes. It is suggested that the NOS associated with metabolic causes are most common in hospitalized patients and were associated with poor prognosis.

Clinical Analysis of Aneurysmal Subarachnoid Hemorrhage in Elderly Patients

In order to determine the advisability of surgical intervention, 61 patients aged 66 or over and 481 patients aged 65 or less, who during the five-year period January, 1991 to December, 1995 had undergone surgery for aneurysmal subarachnoid hemorrhge, were retrospectively analysed in terms of clinical characteristics, operative outcome and factors affecting it, and were compared. The overall female to male sex ratio was 1.6: 1 while(1.49: 1 in the younger group and 3.36: 1 in the older group), showing a female preponderance with increasing age. Hunt-Hess admission grades I and II accounted for 61.1% of the younger and 44% of the elderly group. Between the two groups, there was no significant difference in the site of aneurysms, but those measuring 12 to 24mm were more frequently found in the elderly(29.5%) than in the younger group(16%; p<0.05). The incidences of rebleeding and symptomatic vasospasm were not different between the two groups but there was an increased incidence of hydrocephalus in the older group(19.7% versus 8.1% for the younger group)(p<0.05). Favorable outcome, defined according to the Glasgow outcome scale as good recovery or moderately disabled, was 84.2% for the younger group and 72.2% for the elderly group but surgical outcome did not differ according to preoperative grade. The major causes of disability and death were the direct effect of bleed(7%) and rebleeding(7%) in the younger group , and operative complications(14.7%), medical complications(11.5%) in the elderly group. The less favorable outcome among elderly patients was attributed to their poorer admission grades and greater frequency of initial intracerebral hemorrhage. We conclude that for elderly patients presenting with good admission grades and general condition, an aggressive approach with surgical treatment with regard to intraoperative hemodynamic fluctuations and preexisting conditions is indicated.