L. S. Lin

A nationwide epidemiological study of spinal cord injury in geriatric patients in Taiwan

This prospective epidemiological survey of spinal cord injury (SCI) in Taiwan was carried out among patients attended by physicians from various medical centers and general hospitals all over Taiwan from July 1992 to June 1996. In all, 1,586 new cases of SCI were registered, representing about 70% of all possible SCI cases in Taiwan. The observed average annual incidence of SCI in Taiwan was 18.8 per million people, whereas it was 47.5 for the geriatric section. The mean age was 46.1 years with a plateau distribution after 20 years and older. Geriatric victims (297 cases, 18.7%, group II) formed a major section of SCI cases in Taiwan. Another group of younger SCI patients (15-64 years old, 1,232 cases, group I) was selected for comparison. The results showed that the male-to-female ratio, pattern of neurological deficits, and causes of injury and death of geriatric SCI patients differed significantly from those of the younger SCI group. Elderly women were exposed to a higher risk of SCI than younger women (M/F ratio 1.7:1). Falls were the leading cause of geriatric SCI, and two thirds of them occurred on level ground. Traffic accidents accounted for a third of SCI cases, half of which involved motorcycle accidents, a fifth of them pedestrians. Quadriplegia and quadriparesis occurred more frequently among elderly cases of SCI than in the younger group and a higher proportion of them died of SCI complications. Two thirds of elderly SCI patients recovered well enough after comprehensive treatment to be able to take care of themselves at home. The government should initiate programs of prevention to reduce the prevalence of geriatric SCI in Taiwan.

Epidemiological study of moyamoya disease in Taiwan.

From January 1978 to December 1995, 92 cases of Moyamoya disease were collected from seven major medical centers in Taiwan. The data gave an annual incidence rate of 0.048 per 100,000 population. There were 40 males and 52 females and the ages ranged from 2 to 62 years with the peak incidence in the 31-40 year age group (23 cases). Cerebral infarction occurred in 20 out of 24 juvenile patients (83%), and in 24 out of 68 adult patients (35%). The difference was statistically significant. Haemorrhagic stroke was more frequent in adult patients. Computed tomographic scans following stroke showed cerebral infarction in 44 cases, ventricular haemorrhage in 26 cases, intracerebral haemorrhage in 14 cases and pure subarachnoid haemorrhage in eight. The most frequent initial symptom was motor disturbance (59%), followed by headache (49%) and impaired consciousness (35%). This survey showed an incidence rate much lower than that in Japan, but comparable with those in other Oriental countries and higher than those in Western countries. The male-to-female ratio once differed considerably from that of the Japanese series, but from the present study is now quite similar.

A nationwide epidemiological study of spinal cord injuries in Taiwan from July 1992 to June 1996

This prospective epidemiological survey of spinal cord injury (SCI) in Taiwan was carried out by recruiting patients attended by physicians from various medical centers and general hospitals all over Taiwan from July 1992 to June 1996. A total of 6,410 cases of traumatic spinal fracture were registered among which were 1,586 new cases of SCI. The results represented 70% of the scope of SCI in Taiwan. The observed average annual incidence of SCI in Taiwan was 18.8 per million population. The mean age was 46.1 years-old with a plateau distribution for over 20 years and older. Geriatric victims are a major group of SCI in Taiwan. The male to female ratio was 3 to 1. The leading causes of SCI were traffic accidents and accidental falls. Motorcycle collisions accounted for 62% of the traffic accidents, and as most of the motorcycle riders were not helmet users, head injury became the major associated injury of SCI in Taiwan. The effectiveness of the comprehensive care system for SCI patients in Taiwan is relatively good, as reflected by the low rates of complications of SCI, the low mortality rate (6.6%) and the high percentage (67.4%) of SCI patients achieving self-care ultimately at home after rehabilitation. The analysis of person days healthy life loss and quality adjusted survival time revealed that SCI patients in Taiwan required 4 years to cope with the morbidity, and on average, could return to the main stream of life for another 30 years.

Head injury in urban and rural populations in a developing country

Abstract A population based comparative study of head injury in Taiwan was conducted from January to December 1993. Taipei City was selected to represent an urban population and Hualien County its rural counterpart. A total of 4955 cases of head injury in Taipei and 1069 cases in Hualien were studied. The head injury incidence rate in Hualien is about two times that of Taipei. Traffic accident related head injuries, especially motorcycle accidents, accounted for a larger percentage of cases in Hualien than in Taipei. In terms of mortality rate, the injuries tended to be more fatal in Hualien. The preliminary data clearly show that there exist major geographical differences of head injury patterns in urban and rural areas in a developing country. Preventative measures, specifically focusing on motorcycle accident related head injury, need to be adopted to deal with this serious problem.

Involvement of both opiate and catecholaminergic receptors of ventromedial hypothalamus in the locomotor stimulant action of thyrotropin-releasing hormone

To explore the mode of the locomotor stimulant action of thyrotropin-releasing hormone (TRH), rats with or without administration of opiate or catecholaminergic receptor antagonists were infused with TRH through previously implanted hypothalamic cannula. Administration of TRH, but not the normal saline or TSH, into the ventromedial hypothalamus caused an enhancement in both the gross movements (including stimulation of forward locomotion, head and body rearing) and fine movements (including increased grooming and head swaying). The locomotor stimulant action provoked by TRH was antagonized by pretreatment of ventromedial hypothalamus with either an alpha-adrenergic receptor antagonist (yohimbine), a dopaminergic receptor antagonist (haloperidol) or an opiate receptor antagonist (naloxone), but not with a beta-adrenergic receptor antagonist (propranolol). The results indicate that all the adrenergic, dopaminergic and opiate receptors in the ventromedial hypothalamus are involved in the TRH-induced hyperactivity in the rat.