Brown-Séquard syndrome: a rare manifestation of decompression sickness.

Neurological decompression sickness (DCS) is a rare condition that commonly leads to spinal cord injury. We report the case of a 30-year-old man who developed left-sided weakness and numbness after diving to a maximum depth of 15 m with a total dive time of 205min (10 repetitive dives). To the best of our knowledge, only six cases diagnosed as Brown-Séquard syndrome caused by DCS have been reported in the literature. Divers should be aware of the risk factors of DCS before diving and clinicians should make the diagnosis of spinal cord DCS based primarily on clinical symptoms, not on magnetic resonance imaging findings.

Mental health in Asia: social improvements and challenges.

Remarkable improvements in economic conditions and a considerable upgrade in the quality of life have been observed in many parts of Asia during the past several decades. At the same time, many mental health challenges face the people of Asia. Various social mental health indexes are reviewed here, with available data from China, Japan, Korea, Singapore, Malaysia, and other Asian societies. The data are compared with data from the United States, Australia in the Pacific Rim, and some other Western countries to examine patterns of similarity or difference between East and West in the process of modernization. Common trends in mental health issues associated with rapid sociocultural change observed in different Asian societies are discussed, as well as the relative shortage of mental health personnel available in many Asian societies. It is emphasized that, in addition to expanding psychiatric services, there is an even more urgent need to promote mental health knowledge and concern through education in the general population. Mental health needs to be cultivated and maintained by social forces and cultural strengths. It is stressed that there is a challenge for Asian people to advance mental health beyond economic development in the 21st century.

Longitudinal analysis of development among single and nonsingle children in Nanjing, China: ten-year follow-up study.

In order to examine the impact of "one-child-per-couple" family planning policy on child development, a longitudinal study of a group of children in Nanjing, China, was carried out between 1984 and 1995. The same cohort of children was examined at four stages of development: preschool, early school, preadolescence, and adolescence. Achenbach's Child Behavior Checklist was used to measure the child's behavior. A total of 274 children were surveyed in all four stages. The total behavior problem scores obtained at different stages of development were compared among boys and girls. The results showed that the total score declined significantly in association with the time. As the child grew older, the problems score decreased significantly. This maturation effect was seen for both boys and girls. On average, boys' scores dropped from 21 to 11, whereas girls' scores went from 19.5 to 12. In comparing single with nonsingle boys, there were no significant differences throughout the four stages of development. However, girls who were single children, in contrast to girls with siblings, had significantly higher scores of total behavior problems at each stage of development. These findings illustrate that the longitudinal effect of being a "single-child" is similar to other studies, indicating a minimal impact of family policy. However, the effects were more prominent among girls. This phenomenon can be explained by parents' different attitude toward single-children because of gender difference.

Acute life-threatening injuries in facial fracture patients: a review of 1,025 patients.

BACKGROUND: The literature on facial fractures has emphasized obstruction of the airway as the most common associated life-threatening problem. Other life-threatening injuries associated with facial fractures are not as well documented. For this reason, we conducted a retrospective study involving 1,025 patients with facial fractures admitted to the trauma center at Chang Gung Memorial Hospital in Taiwan from January 1995 through December 1998. METHODS: This study identifies the incidence of facial fractures and establishes a management plan. Life-threatening injuries associated with facial fractures were those that warranted immediate invasive rescue procedures. RESULTS: Sixty-four (6.2%) of the patients with facial fractures required life-saving intervention; 21 patients had cerebral trauma prompting craniotomy, 19 had hemorrhagic shock, 17 had airway compromise, and 7 had pulmonary injury grave enough to necessitate tube thoracostomy. There were five mortalities, three due to cerebral trauma and two credited to hemorrhagic shock not identified until long after admission. CONCLUSION: These findings illustrate the need for prompt identification and proper management of the associated life-threatening injuries in facial fracture patients. Clinical assessment should begin with evaluation of cerebral trauma, followed by hemorrhagic shock, airway compromise, and hemopneumothorax. Proper management may require a multidisciplinary and coordinated team approach.

Microsurgical combined scapular/parascapular flap for reconstruction of severe neck contracture: case report and literature review.

OBJECTIVE: The reconstruction for severe neck contracture is difficult, because it may include not only the necessity the use of a large flap but also the ability for three-dimensional movement of the neck. METHODS: A 41-year-old woman sustained a severe neck contracture with retraction of the lower lip and limited range of neck motion after a chemical burn. We used the combined scapular/parascapular flap to reconstruct the soft-tissue defect in the neck after excision of hypertrophic scar and release of contracture. The scapular portion was transferred to cover the defect vertically, and the parascapular portion was transferred to cover the transverse portion of the neck. This kind of design would allow the patient to move her neck more easily. RESULTS: Postoperatively, the range of motion of the neck was full in the vertical and horizontal directions after 6 months of rehabilitation. Also, the patient was satisfied with the final aesthetic results. CONCLUSION: The microsurgical combined scapular/parascapular flap, providing a large area of tissue for coverage in three dimensions with a reliable blood supply by only one pedicle anastomosis during surgery, is a good option for reconstruction of the severe neck contracture. We classify the inset of the combined scapular/parascapular flap into three types with six subtypes, according to the location of defects and the relation of the parascapular flap to the scapular flap.

A comparative study of various fixation methods for mandibular fracture.

BACKGROUND: Internal rigid fixation for mandibular fractures has been recognized as a reliable method for obtaining osteosynthesis. It may allow for early active physiotherapy and resumption of normal function. However, few studies have compared the various fixation methods. METHODS: From January 1993 through December 1997, 101 patients with mandibular fractures, who were selected for study, received treatment using various fixation methods at the Craniofacial Center, Chang Gung Memorial Hospital. The fixation methods included plate fixation in 44 patients, lag screw fixation in 30, combined plate and lag screw fixation in 15, and wire fixation in 12. Clinical data assessment was performed by reviewing hospital records. For assessment of the long-term surgical results, the patients were asked to complete a questionnaire including questions which specifically targeted history regarding occlusion, mastication, facial asymmetry, width of mouth opening, and general appearance. RESULTS: The outcome assessment showed statistically different results among the groups. The wire group required intermaxillary fixation more often and for a longer duration compared to the groups using plates and/or lag screws. The plate, lag screw, and combined plate and lag screw fixation groups had better total outcome scores, in particular for long-term dental occlusion and mastication function. CONCLUSION: This study shows that for mandible fractures, the more rigid types of fixation methods, i.e., plates and screws or lag screws, can offer better short and long-term outcomes.

Acute hydrocephalus after iotrolan lumbar myelography.

A 33-year-old woman with cryoglobulinaemia developed acute hydrocephalus 20 h after lumbar myelography using the water-soluble contrast medium iotrolan. After a ventricular drainage, she was free of symptoms and the hydrocephalus resolved. The development of acute hydrocephalus after myelography has not been reported previously.

Haemodynamic effects of enalaprilat on portal hypertension in patients with HBsAg-positive cirrhosis.

It has been suggested that enalaprilat inhibits the renin-angiotensin-aldosterone system in plasma and tissue; it may therefore reduce portal vascular pressure owing to secondary hyperaldosteronism in patients with liver cirrhosis. In order to evaluate this concept, 20 patients with hepatitis B surface antigen (HBsAg)-positive liver cirrhosis and portal hypertension received an intravenous infusion of 2.5 mg of enalaprilat. Wedged hepatic venous pressure, free hepatic venous pressure and cardiac index were measured before, immediately after, and then 15 min, 30 min and 1 h after intravenous enalaprilat infusion. The mean pressure gradient between wedged hepatic venous pressure and free hepatic venous pressure was significantly decreased, by 13% immediately after, 18% at 15 min, 23% at 30 min and 13% at 1 h after infusion of enalaprilat. Thirteen patients experienced a decrease of hepatic venous pressure gradient (HVPG) greater than 5 mmHg, another three 3-5 mmHg and the remaining four patients exhibited no significant change in HVPG. Systemic haemodynamic indices, including pulmonary arterial pressure, pulmonary capillary wedge pressure and central venous pressure, decreased significantly at 15 and 30 min after enalaprilat infusion (P < 0.01). Liver function, renal function and blood routine before and after enalaprilat infusion showed no significant change. There were no adverse effects during or after enalaprilat infusion. We conclude that enalaprilat infusion can quickly and safely reduce the hepatic venous pressure gradient in patients with HBsAg-positive cirrhosis.

Psychiatric complications of family reunion after four decades of separation.

OBJECTIVE: After four decades of separation due to civil war, many people who had migrated to Taiwan from mainland China had the unexpected opportunity to briefly visit their families in mainland China. A study was conducted to examine psychiatric complications associated with these family reunions following long involuntary separation. METHOD: Eighty subjects who made the journey were given semistructured interviews investigating their psychological experiences relating to the family reunion. The variables investigated were sociodemographic characteristics, the subject's previsit emotional condition, factors related to the family reunion experience, and stress encountered during the visit. RESULTS: The survey indicated that more than one-fifth of the subjects (22.5%) developed psychiatric complications, mainly depression, immediately after the visit. Determinants found to contribute significantly to the occurrence of emotional disorders were previous ways of expressing homesickness, family members seen during the reunion, family misfortunes that the subjects discovered, family conflict encountered at the reunion, and tactics for coping with such stressors. CONCLUSIONS: The study results suggest that family reunions after long-term separation can be trauma-repairing experiences for some but for others can lead to trauma reexperiencing and psychiatric complications requiring mental health intervention.

Diagnostic patterns of social phobia. Comparison in Tokyo and Hawaii.

A comparison was made of the diagnosis of social phobia by Japanese psychiatrists in Tokyo and American psychiatrists in Hawaii. A brief segment of videotaped interviews and written case histories of four Japanese patients from Tokyo and two Japanese-American patients from Hawaii, who were clinically diagnosed with social phobia, were presented to the clinicians for their diagnosis. Japanese psychiatrists tended to diagnose social phobia congruently for the Japanese cases but not for the Japanese-American cases. American psychiatrists tended to diagnose various categories including anxiety disorder and avoidant personality disorder, in addition to social phobia, disregarding the ethnic background of the patients. This illustrates that the diagnostic pattern for social phobia varied considerably between psychiatrists of these two countries. The reasons considered are the patient's cardinal symptom manifestation, style of problems presentation, as well as the clinician's professional orientation and familiarity to this particular disorder.

Koro epidemics in Guangdong, China. A questionnaire survey.

Koro epidemics, characterized by panic due to fear of genital retraction, involving more than 2000 victims, mainly young men, occurred in Hainan Island and Leizhou Peninsula of Guangdong Province, China, in 1984-85 and 1987. A questionnaire survey of 214 victims of these epidemics was conducted in 1988. The survey focused on symptom manifestation, personality profile, life problems, and folk belief. The results of the "koro" group were compared with those of a "clinic" group with minor psychiatric disorder and a "control" group from the non-clinical, non-koro episode population in the epidemic area. The results revealed that the victims of the koro epidemics were characterized by low intellectual endowment and strong acceptance of koro-related folk beliefs. The results support the hypotheses that: a) a koro attack is a psychologically induced anxiety-panic condition; b) the presence of an intensive belief in the culturally related concept of koro makes the subject vulnerable to the attack; and c) social crisis or tension serves as a trigger for the occurrence of the epidemic.

Transethnic adoption and personality traits: a lesson from Japanese orphans returned from China to Japan.

The authors interviewed 25 Japanese who had been left as orphans in China at the end of World War II and who had recently returned to Japan with their Chinese spouses after almost four decades. It was found that even though they had been raised as Chinese culturally for almost their entire lives, most of these subjects had retained certain Japanese personality traits and social behavior from early childhood, and these characteristics distinguished them from their Chinese counterparts.

Multi-cultural study of minor psychiatric disorders in Asia: symptom manifestations.

Patients with minor psychiatric disorders, including neuroses, situational adjustment reaction or acute emotional reaction, were investigated using symptom questionnaires at five research sites in Asia including: Chiang-Mai, Thailand; Bali, Indonesia; Kao-Hsiung, Taiwan, China; Shanghai, China; and Tokyo, Japan. The results revealed that the symptom profiles differ significantly among groups of different settings indicating that sociocultural background does contribute to the manifestation of neurotic symptomatology. It was also found that numerous and various subtypes of somatic scales were identified through factor analysis of symptoms for these Asian populations. It demonstrates that the spectrum of neurotic symptoms has a different focus for subjects in different sociocultural settings.

A sociocultural study of koro epidemics in Guangdong, China.

Koro, a culture-related psychiatric disorder characterized by panic due to fear of genital retraction, occurred as the rare phenomenon of koro epidemics in a remote region of Guangdong, China, in 1984-1985 and 1987. The sociocultural and historical backgrounds of the area are described. The life pattern and attitudes toward supernatural beings and the commonly shared folk belief of evil-induced genital retraction were considered grounds for the panic, while the community's anxious reaction and hysterical atmosphere facilitated the intensification and recurrence of the episodes. Geographic seclusion associated with localism in folk beliefs and practices may have kept the epidemics confined to the region.

Family planning and child mental health in China: the Nanjing Survey.

The authors studied the impact of China's one-child-per-couple family planning policy on child development in 697 preschool children in the city of Nanjing and in two rural areas surrounding Nanjing. A home-visit questionnaire survey including a Chinese version of Achenbach's Child Behavior Checklist was used. The behavior problem profiles of children who were their parents' only children and those who had siblings were compared, revealing a significant difference between girls who were only children and those who had siblings. Girls who were only children tended to have slightly higher scores on the factors of depression, moody, and temper.

PIP: The 1 child per family policy was begun in China in 1980 in order to keep the population down to 1.15 billion by year 2000. By 1985, 80-90% of urban families and 50-60% of rural families had only 1 child. This study of 697 children aged 3-6 in urban, suburban-rural, and remote rural areas in and around Nanjing was designed to determine whether only children developed significantly more behavior problems than did children with siblings. The survey used the Child and Family Questionnaire and a Chinese version of the Achenbach Child Behavior Checklist. The age of the parents ranged from 25-40 years, and 99% of the marriages were not arranged. 60% of the families were nuclear, and 40% were stem, i.e., the married couple lived with either the husband's or the wife's parents. Only 1/4 of the families had wanted children for traditional reasons, such as to continue a clan, to provide labor, or to provide old-age security. 29% had wanted only 1 child, 63% preferred 2, and 3% preferred 3 children. The remote rural families wanted the most children. 54% of families indicated no preference for a boy or a girl, and 51.59% of the children were boys, and 48.5% were girls. 71% of the children attended public day care institutions and were thus exposed to socialization even if they were only children. 89% of the children slept in the same bed as their parents, the usual custom in China. Behavior problems included in the questionnaire were immaturity, regression, schizoid behavior, depression, moodiness, neuroses, and aggression. Single factor and multifactor analyses of variance were used to determine the effects of demographic variables and presence or absence of siblings on behavior problems. Boys who were only children and who were cared for by grandparents had more anxious aggression than only children cared for by parents. But boys who had siblings and were cared for by grandparents scored lower for anxious aggression. All boys who were cared for by grandparents had more anxious aggression than boys cared for by parents. Girls who were only children of parents who preferred 2 children scored high for moodiness, but girls who had siblings and whose parents preferred 1 child had highest scores for obsessive-neurotic behavior and aggression. Girls who were only children and lived in rural areas had higher temper scores than did only children girls in the country. But for girls with siblings temper scores were higher in the city. Girls who were only children and lived in nuclear families had higher temper scores than those who lived in stem families, but girls who had siblings and lived in nuclear families had lower temper scores than those who lived in stem families. In general, the behavior patterns of only children were significantly different only for boys. The results of this study indicate that the 1 child per family policy will not result in problem behavior among children.

A comparative study on schizophrenia diagnosed by ICD-9 and DSM-III: course, family history and stability of diagnosis.

Data from the Taipei Center of the International Pilot Study of Schizophrenia were reanalyzed using the ICD-9 and DSM-III diagnoses at 7-year follow-up. Patients diagnosed as schizophrenic according to DSM-III were shown to be a more homogeneous group in terms of their clinical manifestations, social functions and family psychiatric history than those defined as schizophrenic by ICD-9. The discordant cases of ICD-9 schizophrenia and DSM-III affective disorders were found to be different from the concordant schizophrenic group, but similar to the concordant group of affective disorders diagnosed by ICD-9 and DSM-III. Thirty-five per cent of mood-incongruent psychotic major depressive disorders defined by DSM-III at initial evaluation were diagnosed as schizophrenia at 7-year follow-up.

Diagnostic pattern for neuroses in China, Japan, and the United States.

To investigate the diagnostic patterns for neuroses in China, Japan, and the United States, the authors showed videotapes and brief written case histories of six Chinese patients to psychiatrists and psychiatrists-in-training in Beijing, Tokyo, and Honolulu. In cases with a well-distinguished clinical picture the diagnoses were congruent in the three countries. Diagnostic disagreement occurred in cases with symptoms of decline in mental function, which were overwhelmingly diagnosed as neurasthenia by the Chinese clinicians, and cases with situational stress, which were diagnosed as adjustment reaction by the Americans. This illustrates that different professional concepts and classification systems are used in different countries.

Family interaction patterns among Japanese-American and Caucasian families in Hawaii.

The authors compared the family interaction patterns of Japanese-American and Caucasian families in Hawaii by rating videotapes of structured family interactions. There were significant differences between the two groups in many aspects of family interaction, such as power, coalition, closeness, negotiation, clarity of self-disclosure, responsibility, invasiveness, affect, and empathy. The differences in family interaction could be explained by the cultural differences between the two groups and indicate that profiles of healthy families differ between distinct cultures, and there is a need to establish a culturally relevant family interaction profile; otherwise normal interactions in families outside the mainstream could be misinterpreted as pathological.

Reexamining the concept of adolescence: differences between adolescent boys and girls in the context of their families.

As part of a larger study on family functioning, the authors administered a questionnaire on individual attitudes toward family values to 158 Japanese-American and Caucasian families. Differences between the generations on questions of authority and responsibility were predictable; few differences were found between ethnic groups. However, differences were striking between adolescent boys and girls, regardless of ethnicity: Girls valued family affiliation, closeness, and emotional expression significantly more highly than did boys. The authors emphasize the need for families to value girls' needs for closeness and emotional expression as highly as boys' needs for independence and self-differentiation. They suggest that the concept of separation-individuation as the major goal of adolescence be reexamined.