Pulmonary embolism is a common clinical problem in patients with immobilization, cancer, indwelling central venous catheter and surgery. However, although rare, it may occur in patients with inherited thrombophilia. Protein S deficiency is known to increase the risk of venous thrombosis and pulmonary embolism. There are many reports of venous thrombosis with protein S deficiency, but there are few reports of arterial thrombosis, especially recurrent acute pulmonary embolism. Here, we report a case of recurrent pulmonary embolism associated with type II protein S deficiency.
Blood Coagulation Disorders, Inherited ; Central Venous Catheters ; Humans ; Immobilization ; Protein S ; Protein S Deficiency ; Pulmonary Embolism ; Thrombophilia ; Thrombosis ; Venous Thrombosis

The percutaneous endoscopic gastrostomy is used for nutritional support in patients requiring prolonged tubal feeding. Unfortunately, numerous complications, such as infection, stomal leak, fever, local pain, ileus and tube occlusion, have been reported since its introduction. The buried bumper syndrome is a rare but well-recognized long-term complication. The tight anchorage between the internal and external bumpers leads to gastric mucosal erosion and embedding of the internal bumper into the gastric wall, obstructing feeding. Our case involves an elderly patient with a buried bumper syndrome complicated by an abdominal wall abscess. A similar case has not been reported in Korea before. This article reports our findings and management with a review of the literature.
Abdominal Wall ; Abscess ; Aged ; Fever ; Gastrostomy ; Humans ; Ileus ; Korea ; Nutritional Support

BACKGROUND: Age-related hearing loss is a common degenerative disorder among older individuals that warrants attention in a society with an aging population. The objectives of this study were to investigate age-related hearing loss and to estimate the prevalence of age-related hearing loss in Korea using a healthcare center-based study. METHODS: Persons older than 50 years of age visiting a selected health promotion center were recruited (n=10,118). Pure tone audiometry was performed on the subjects, and the average hearing thresholds were obtained using 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz for the six-dimension method. RESULTS: The prevalences of age-related hearing loss for subjects older than 65 years were 36.8% at a cutoff of > or =26 dBHL and 10.1% at a cutoff of > or =41 dBHL. When age and gender were corrected for, the estimated prevalences of age related hearing loss for those subjects greater than 65 years in the general population were 45.8% at a cutoff value of > or =26 dBHL and 14.8% at a cutoff value of > or =41 dBHL. CONCLUSION: Our study provides important information concerning age-related hearing loss in Korea. The estimated prevalence of age-related hearing loss in the general population in Korea was high.
Aging ; Audiometry ; Delivery of Health Care ; Health Promotion ; Hearing ; Hearing Loss ; Humans ; Korea ; Prevalence

BACKGROUND: Because patients with idiopathic Parkinson's disease (PD) may exhibit patterns of cognitive impairment, it is difficult to distinguish from patients with Parkinson's disease dementia (PDD). Recently, cardiac 123I-metaiodobenzylguanidine (MIBG) scinti-graphy has been used to help distinguish PD from atypical Parkinsonism. This study investigated the relations between cardiac 123I-MIBG scintigraphy and these diseases. METHODS: Cardiac 123I-MIBG scintigraphy was conducted on 18 patients with PD, 18 patients with PDD and 13 normal controls matched for age, disease duration and severity of symptoms. The heart to mediastinum (H/M) ratio was calculated. RESULTS: The mean values of H/M ratio were significantly lower for PDD and PD than for normal controls but there was no difference between the disease groups. CONCLUSION: Unfortunately, cardiac 123I-MIBG scintigraphy did not distinguish PDD from PD in our study. We suggest further research with larger study populations be done to clarify the use of cardiac 123I-MIBG scintigraphy in differentiating other Lewy body diseases from dementia with PD features.
Dementia ; Heart ; Humans ; Lewy Bodies ; Mediastinum ; Parkinson Disease ; Parkinsonian Disorders

BACKGROUND: Glutamate is a well-known central nervous system (CNS) excitatory neurotransmitter that plays a role in memory and learning. However, in excess, it leads to a process called excitotoxicity resulting in cell death. To investigate the mechanism of glutamate cytotoxicity, the apoptosis signaling pathway of primary rat astrocytes was explored in vitro. With this study, we hope to improve the prevention and treatment of ischaemic strokes and various central nervous system disorders. METHODS: To produce a model of cell injury, primary rat astrocytes were treated with glutamate. RESULTS: Treatment with glutamate induced death by apoptosis in primary rat astrocytes. This was evidenced by an increase in sub-G0/G1 fraction of the cell cycle with a loss of cell viability. Glutamate also increased the intracellular accumulation of Ca2+ ions, the expression levels of glucose-regulated protein 78 (Grp78) and C/EBP homologous protein (CHOP) protein, and the phosphorylation of protein kinase r-like endoplasmic reticulum kianse (PERK). However, the expression pattern of activating transcription factor (ATF)4 protein did not change and the 90 kDa ATF6 was cleaved to 50 kDa along with a reduced amount of Bcl-2 protein in a time-dependent manner. Interestingly, pre-treatment with glutathione markedly suppressed the reactive oxygen species (ROS) generation and the sub-G0/G1 fraction. However, the intracellular concentration of Ca2+ did not change. CONCLUSION: Our findings suggest that glutamate injures primary rat astrocytes through the endoplasmic reticulum (ER) stress-mediated apoptotic signaling pathway, as well as, ROS generation. More specifically, through Grp78, PERK, and CHOP, glutamate activates the ER stress-mediated signaling pathway in astrocytes and activates ATF6 to reduce the expression of the Bcl-2 proteins contributing to apoptosis. In addition, the ER stress-mediated signaling pathway is closely related to the transformation of intracellular ROS. This information should be applied to research for the prevention and treatment of strokes and other CNS conditions.
Animals ; Apoptosis ; Astrocytes ; Cell Cycle ; Cell Death ; Cell Survival ; Central Nervous System ; Endoplasmic Reticulum ; Glutamic Acid ; Glutathione ; Ions ; Learning ; Memory ; Neurotransmitter Agents ; Phosphorylation ; Protein Kinases ; Proteins ; Rats ; Reactive Oxygen Species ; Stroke ; Transcription Factors

BACKGROUND: The prevalence of diabetes mellitus (DM) is higher in old age, and diabetic retinopathy is the leading cause of blindness. Appropriate glycemic control is known to reduce the incidence of diabetic retinopathy in diabetic patients. We evaluated the relationship between hemoglobin A1c levels and diabetic retinopathy. METHODS: Our subjects included 654 diabetic patients registered with the public health center. Following an overnight fast, venous blood and urine samples were collected and analyzed. Non-mydriatic fundus photography was done to diagnosis diabetic retinopathy. We calculated the odds ratios of hemoglobin A1c and fasting plasma glucose for diabetic retinopathy using logistic regression. RESULTS: Diabetic retinopathy was seen significantly more often at higher levels of hemoglobin A1c (odds ratio, 3.46; 95 % confidence interval, 1.90-6.30 for <50 percentile vs. >75 percentile). Fasting glucose, however, was not significantly associated with diabetic retinopathy after adjusting for hemoglobin A1c (Hb1cA). The odds ratio for diabetic retinopathy according to HbA1c was higher in those with DM for >10 years than <10 years. CONCLUSION: The HbA1c level was significantly associated with diabetic retinopathy in Koreans with type 2 diabetes.
Blindness ; Diabetes Mellitus ; Diabetic Retinopathy ; Fasting ; Glucose ; Hemoglobins ; Humans ; Incidence ; Odds Ratio ; Photography ; Plasma ; Prevalence ; Public Health

BACKGROUND: Elderly onset rheumatoid arthritis (EORA) affects people older than 60 years of age and is different from younger onset rheumatoid arthritis (YORA) in several aspects. EORA is seen in each sex equally, has more large joint involvement and is associated with a higher erythrocyte sedimentation rate (ESR). In this study, we compared the clinical and laboratory data of these two conditions. METHODS: Our subjects included 230 patients meeting the American College of Rheumatology criteria for rheumatoid arthritis. We compared the clinical manifestation, medication history and laboratory data including rheumatoid factor, anti-nuclear antibody, ESR, C-reactive protein and total sharp score of EORA and YORA. RESULTS: The male to female ratio was 1:2.5 in EORA and 1:5.6 in YORA (p=0.016). The mean age was 74+/-5.3 years in EORA and 47+/-8.9 years in YORA. ESR was higher for EORA (52.8+/-35.6 mm/hr) than for YORA (40.2+/-29.2 mm/hr) (p=0.004). A positive RF was seen more often in EORA (75%) than in YORA (67%) (p=0.027). Shoulder joint pain was more common in EORA (41.0%) than in YORA (21.6%) (p=0.001) as was knee joint pain, 77.1% and 48.8%(p<0.001), respectively. CONCLUSION: EORA showed a relatively higher incidence in males and had more large joint involvement than YORA. The higher abnormal values of ESR and rheumatoid factor seen in EORA might be associated with poor prognosis.
Aged ; Arthritis, Rheumatoid ; Blood Sedimentation ; C-Reactive Protein ; Female ; Humans ; Incidence ; Joints ; Knee Joint ; Male ; Prognosis ; Rheumatoid Factor ; Rheumatology ; Shoulder Joint

BACKGROUND: The purpose of this study was to compare clinical aspects of pelvic fractures in an aged group with a non-aged group and to delineate its characteristics to improve prevention and treatment. METHODS: Medical records and radiological examinations of 100 cases were reviewed. Two groups were created, older than 65 years and younger than 65 years. In addition, the following were carefully examined and recorded-gender distribution, cause and types of fractures, associated injuries, Injury Severity Score (ISS), Glasgow Coma Scale, need for intensive care unit admission, duration of hospitalization, and mortality rate. RESULTS: A difference in gender distribution was seen with 12 males and 26 females in the aged group and 35 males and 27 females in the non-aged group (p<0.05). The mechanism of injury for the aged group in decreasing order was pedstrian accidents, falls, and passenger accidents while it was passenger accidents, pedestrian accidents, and falls for the non-aged group (p<0.05). Level of severity was higher in the non-aged group for fracture type, ISS, Glasgow Coma Scale, intensive care unit admission, and hospitalization duration. However, when ISS was greater than 15, this was seen in the aged group with also a higher mortality rate in the same group. CONCLUSION: Education and prevention, particularly about gender distribution and mechanism of injury, of pelvic fractures in the aged population are needed, and because of the potential seriousness of fractures in the elderly, active assessment and treatment are also necessary.
Aged ; Female ; Glasgow Coma Scale ; Hospitalization ; Humans ; Injury Severity Score ; Intensive Care Units ; Male ; Medical Records ; Pelvic Bones

BACKGROUND: To investigate the physical function of elderly people in Korea using quantitative and objective tools and to assess the impact of declined physical function on their quality of life. METHODS: The Korean Longitudinal Study on Health and Aging was designed as a population-based prospective cohort study on the health and aging of the elderly people in Korea aged 65 years and older. Within one city's central metropolitan area, 1,000 subjects including a simple random sample and an oldest-old subpopulation participated in a baseline study for one year. We evaluated the isokinetic peak torque of the knee extensors and flexors, grip force, and Short Physical Performance Battery (SPPB) and surveyed their daily physical activities and quality of life using the 36-Item Short Form Health Survey (SF-36). RESULTS: Overall, 676 subjects completed the evaluations of physical function and activity. The isokinetic torque of the knee extensors and flexors declined with age in both men and women. The women in the old-old (75-84 years) group showed lower SPPB and physical activity than women in the young-old (65-74 years) group, but these measures were maintained till age 85 in the men. SPPB and physical activity were significantly associated with the physical component scale (PCS) of the SF-36 in both men and women, while isokinetic torque was associated with PCS in women only. CONCLUSION: Physical performance and activity declined differently in Korean elderly men and women. Both these measures showed to be the main factors associated with quality of life.
Aged ; Aging ; Cohort Studies ; Female ; Hand Strength ; Health Surveys ; Humans ; Knee ; Korea ; Longitudinal Studies ; Male ; Motor Activity ; Prospective Studies ; Quality of Life ; Torque

BACKGROUND: Propofol, an ultrashort-acting anesthetic agent, is being increasingly used for sedation during regional anesthesia. The goal of this study was to characterize the pharmacodynamic relation between the effect site concentration of propofol and the occurrence of loss of consciousness (LOC) and apnea in elderly patients undergoing regional anesthesia. METHODS: Twenty patients aged 65 years or older presenting for elective surgery requiring regional anesthesia were enrolled. After performing spinal anesthesia, the target effect site concentration of propofol was set at 1.0 microg/mL. Effect site concentration was increased by 0.2 or 0.3 microg/mL until LOC and apnea were observed. LOC was determined by the loss of response to verbal command ("open your eyes") and apnea as the loss of spontaneous breathing for 20 seconds. The pharmacodynamic relation between effect site concentrations of propofol and LOC or apnea was characterized by population analysis using nonlinear mixed effects model. Approximate entropy (ApEn) as a surrogate measure of central nervous effect of propofol was calculated from raw electroencephalogram, retrospectively. The correlation between effect site concentration of propofol and ApEn was tested. RESULTS: The estimates (standard error) of Ce50 for LOC and apnea (the effect site concentration of propofol associated with 50% probability of LOC and apnea) were 1.74 (0.09) and 2.35 (0.11) microg/mL, respectively. The Spearman correlation coefficient between effect site concentration of propofol and ApEn was -0.8164 (p<0.0001). CONCLUSION: These results provide an adequate guidance for sedation in elderly patients for elective surgery under regional anesthesia.
Aged ; Anesthesia, Conduction ; Anesthesia, Spinal ; Apnea ; Electroencephalography ; Entropy ; Humans ; Propofol ; Respiration ; Retrospective Studies ; Unconsciousness