Splenic infarcts are comparatively less common lesions. Caused by the occlusion of the major splenic artery or any of its branches, they are almost always due to emboli that arise in the heart. The spleen, along with the kidneys and brain, ranks as one of the most frequent sites of localization of systemic emboli. Infarcts may be small or large, multiple or single, and sometimes involve the entire organ. Usually these infarcts are of the bland anemic type. Septic infarcts are found in vegetative endocarditis of the valves of the left side of the heart. Much less often, infarcts in the spleen are caused by local thromboses, especially in leukemia, myeloproliferative syndrome, sickle cell anemia, polyarteritis nodosa, Hodgkin's disease, and bacteremic diseases. We experienced a rather unusual splenic infarction due to lymphoma in a 80-year-old man.
Aged, 80 and over ; Anemia, Sickle Cell ; Brain ; Endocarditis ; Heart ; Hodgkin Disease ; Humans ; Kidney ; Leukemia ; Lymphoma ; Polyarteritis Nodosa ; Spleen ; Splenic Artery ; Splenic Infarction ; Thrombosis

The etiology and pathogenesis of transient global amnesia (TGA) is still unclear. Several mechanisms have been proposed, including arterial thromboembolic ischemic attacks, epilepsy, and migraine. However, TGA following severe headache has not been reported, to our knowledge. We described a patient presenting with TGA associated with the sudden onset of headache provoked by a subarachnoid hemorrhage. MRI and CT with angiography of the brain showed no abnormal findings. CSF study revealed hemorrhage. Single photon emission computed tomography revealed mild low perfusion at both hippocampal regions.
Amnesia, Transient Global ; Angiography ; Brain ; Epilepsy ; Headache ; Hemorrhage ; Humans ; Migraine Disorders ; Perfusion ; Subarachnoid Hemorrhage ; Tomography, Emission-Computed, Single-Photon

BACKGROUND: Mitochondrial dysfunction plays an important role in Abeta-induced neuronal toxicity in Alzheimer's disease (AD). We measured the membrane potentials of mitochondria (delta psim) and assessed the genetic expressions of A beta(25-35)-induced neurotoxicity in the human neuroblastoma cell line, SK-N-SH cell. METHODS: SK-N-SH cells were incubated with a single dose of 25 micrometer A beta(25-35) for 0-24 hours, and kinetic study was done. delta psim was measured by flow cytometry. Messenger RNA expressions of cytochrome c oxidase (COX), cytochrome c, succinate dehydrogenase (SDH), amyloid-beta alcohol dehydrogenase (ABAD), caspase 9, and Bcl-2 were measured by quantitative real-time reverse transcriptase polymerase chain reaction (real-time RT-PCR). Cell death rate was measured by MTT reduction assay. RESULTS: delta psim was reduced at 24 hours. mRNA expression for COX gradually decreased by about 29% (p<0.05) while-expressions for cytochrome c, SDH, ABAD, and caspase 9 increased (p<0.05) progressively during the 24-hour time period. Bcl-2 expression decreased (p<0.05) gradually; and apoptotic cell death rate was about 24% (p<0.01) by 24 hours. CONCLUSION: Extracellular administration of A beta(25-35) contributes directly to mitochondrial dysfunction in SK-N-SH cells with the enzymatic impairment of the tricarboxylic acid cycle and electron transport chain, and eventually leading to apoptotic cell death.
Alcohol Dehydrogenase ; Alzheimer Disease ; Amyloid beta-Peptides ; Apoptosis ; Caspase 9 ; Cell Death ; Cell Line ; Citric Acid Cycle ; Cytochromes c ; Electron Transport ; Electron Transport Complex IV ; Flow Cytometry ; Gene Expression ; Humans ; Membrane Potentials ; Mitochondria ; Neuroblastoma ; Neurons ; Reverse Transcriptase Polymerase Chain Reaction ; RNA, Messenger ; Succinate Dehydrogenase

BACKGROUND: Hyponatremia in the elderly, one of the most common disorders seen in the emergency room (ER), has been shown to have a poor prognosis if treated improperly. However, it often is a challenge to detect because of its varying symptoms. This study aimed to improve the diagnosis and management of severe hyponatremia in the ER by analyzing clinical characteristics and patterns according to patient age. METHODS: Of the patients who visited the ER at Asan Medical Center in Seoul from May 1 to October 2006, 151 patients whose blood sodium concentration was 120 mEq/L or lower were examined in terms of gender, age, history, major symptoms, history of diuretic uses, and blood tests. RESULTS: The study group included 91 males and 60 females. Of these, 81 (53.6%) were middle-aged and 70 (46.4%) were elderly. For underlying diseases, 58 (38.4%) had liver disease and 79 (52.3%) had cancer. In the elderly group, more patients (21, 30%) visited the ER with neurological disturbances than with gastrointestinal symptoms (13, 18.6%); and more elderly patients (14, 20%) presented with serious hyponatremia (blood sodium concentration 110 or lower) than middle-aged patients (6, 7.4%). CONCLUSION: In the elderly, many patients visiting the ER did not have any underlying disease but were suffering from more severe hyponatremia. The major symptoms observed included neurological disturbances such as impaired consciousness and generalized weakness. The elderly can easily develop serious hyponatremia with accompanying neurologic disturbances. The emergency physician, having a high level of suspicion, should make a quick diagnosis and manage these patients appropriately.
Aged ; Consciousness ; Emergencies ; Female ; Hematologic Tests ; Humans ; Hyponatremia ; Liver Diseases ; Male ; Prognosis ; Sodium ; Stress, Psychological

BACKGROUND: To investigate the influence of the initial readings of blood pressure (BP) components on functional outcome in acute ischemic stroke patients stratified by age. METHODS: We reviewed the medical records of 54 first-ever hemiplegic MCA ischemic stroke patients (age 61.6+/-9.6 years; 37men, 17 women). Subjects were stratified by age, and BP was measured six times within the initial 24 hours after stroke onset. The maximal systolic BP (MSBP), minimal diastolic BP (mDBP), and maximal pulse pressure (MPP) were selected for analysis. Functional outcomes were evaluated with the korean-modified Barthel index (K-MBI) and functional independence measure (FIM) at 3 months after stroke onset in all subjects. RESULTS: The amount of MSBP and MPP elevation was significantly higher in patients with diabetes mellitus and smoking history, respectively (p<0.05). In regards to age groups, MPP was inversely correlated with FIM (r= -0.727, p=0.027) in subjects in their 40s. Each of MSBP and MPP were inversely correlated with FIM in the 50s age group (r= -0.666, -0.761; p=0.013, 0.002). MPP was inversely correlated with each of K-MBI and FIM in the 60s age group (r= -0.659, -0.786; p=0.002, 0.000). MPP was inversely correlated with K-MBI, and MSBP was inversely correlated with FIM in the 70s age group (r= -0.787, -0.651; p=0.002, 0.022). CONCLUSION: In elderly patients with ischemic stroke, MPP was significantly correlated with functional outcome. Therefore, the tight control and management of pulse pressure from the acute stage of stroke should be seriously considered.
Aged ; Blood Pressure ; Diabetes Mellitus ; Humans ; Medical Records ; Reading ; Smoke ; Smoking ; Stroke

No abstract available.
Gastrointestinal Neoplasms* ; Mass Screening*

Hepatocellular carcinoma(HCC) of unknown origin presents unusually in the elderly as a huge abdominal mass. Though most commonly associated with viral infections, about 10% of HCC in Korea arise from an unknown cause. HCC of unknown origin has a varying clinical picture and prognosis. It is known to have relatively good reserve liver function and rarely complications with previous cirrhosis or active hepatitis. Its pathogenesis may be not associated with an inflammation-dysplasia-carcinoma sequence. We recently managed an unusual case of moderately differentiated hepatocellular carinoma of unknown origin presenting with a huge abdominal mass. The 82-year-old female patient had no history of viral hepatitis and no other metabolic diseases were diagnosed. She received palliative care.
Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular ; Female ; Fibrosis ; Hepatitis ; Humans ; Korea ; Liver ; Metabolic Diseases ; Neoplasms, Unknown Primary ; Prognosis

Duodenal diverticulum is commonly found at 2nd portion of duodenum undergoing duodenal procedure. It is generally asymptomatic and not harmful. But occasionally it causes massive upper gastrointestinal bleeding. Bleeding from duodenal diverticulum is very difficult to diagnose and manage since vision of the lesion by conventional direct endoscope is limited. Recently, emphasis has been placed on aggressive and careful endos- copic diagnosis and hemostasis with hemoclip or local injection. We report a case of massive duodenal diverti- cular bleeding on a senile patient which was treated successfully by endoscopic hemoclip therapy.
Diverticulum ; Duodenal Diseases ; Duodenum ; Endoscopes ; Gastrointestinal Hemorrhage ; Hemorrhage ; Hemostasis ; Humans ; Vision, Ocular

Pancreatic acinar cell carcinoma is an uncommon malignancy of the exocrine pancreas. Because of a higher recurrence rate and frequent metastases, this tumor, generally, has a poor prognosis. We report a case of pancreatic acinar cell carcinoma in a 60-year-old man. His chief complaint was jaundice. Abdominal CT revealed a heterogeneous enhancing mass in the pancreatic head measuring 8.2x7.5cm. After receiving the Whipple procedure, acinar cell carcinoma was diagnosed by pathological examination. Liver metastasis was found at one year after the curative resection.
Acinar Cells ; Carcinoma, Acinar Cell ; Head ; Humans ; Jaundice ; Liver ; Middle Aged ; Neoplasm Metastasis ; Pancreas ; Pancreas, Exocrine ; Prognosis ; Recurrence

BACKGROUND: Patients who survive CPR are profoundly disabled and live with reduced quality of life. Therefore advanced directives are needed to ensure that life sustaining therapies are provided appropriately. This study compared the attitudes of elderly subjects toward advanced directives for CPR before and after receiving CPR education. METHODS: Between January and July 2007, 99 ambulatory persons aged older than 64 years were recruited from six community welfare facilities for the elderly. A questionnaire was distributed to obtain demographic data and their basic understanding and attitudes toward CPR. After providing information and showing a video clip on CPR, we compared whether having received this information influenced the thoughts of our subjects on CPR. RESULTS: None had had previous education on CPR, including prognostic information. Most overestimated the survival chance after CPR. Most wished to be resuscitated. After providing prognostic information on CPR and showing a short video clip, there was a change in their decision and the knowledge of CPR outcome seemed to influence their thoughts on CPR. In particular, the information on CPR prognosis greatly influenced their decision. CONCLUSION: Elderly people rarely have a chance to receive information regarding CPR. As a result, their decision to receive CPR may not accurately reflect the patient's wishes in emergency circumstances. It is important to pro- vide accurate prognostic information to help the elderly in their life-sustaining treatment decisions.
Advance Directives ; Aged ; Cardiopulmonary Resuscitation ; Dietary Sucrose ; Emergencies ; Humans ; Prognosis ; Quality of Life ; Surveys and Questionnaires