Infective endocarditis caused by Pasteurella multocida is a rare disease with a high mortality rate. Most patients have a previous history of animal contact. The most common comorbid condition is a chronic liver disease, which is attributable to the high mortality rate. Over half of the patients who survived the disease had required valve replacement surgery. We report the case of a 70-year-old man diagnosed with prosthetic valve endocarditis caused by Pasteurella multocida and complicated with multiple peripheral arterial embolism. He had neither any underlying immunocompromising diseases nor previous history of animal contact. He was successfully cured after antibiotic therapy for 6 weeks without valve replacement surgery.
Aged ; Animals ; Embolism ; Endocarditis ; Heart Valve Prosthesis ; Humans ; Liver Diseases ; Pasteurella ; Pasteurella multocida ; Rare Diseases

Levodopa treatment in Parkinson's disease (PD) can cause a wide range of non-motor manifestations including poor impulse control and stereotyped behaviors. Punding is a term used to describe complex prolonged, purposeless and repetitive behavior in patients under dopamine replacement therapy. We report a 64-year-old PD patient who, concomitantly with self-increment of levodopa, developed punding behaviors in association with dopamine dysregulation syndrome. Gradual reduction of dopaminergic medication partially alleviated repetitive behavior over time.
Dopamine ; Humans ; Levodopa ; Middle Aged ; Parkinson Disease ; Stereotyped Behavior

BACKGROUND: The purpose of this study is to investigate the incidence and associated factors of postoperative delirium in elderly patients with hip fracture. METHODS: We interviewed 90 patients with hip fracture with the aim of identifying underlying diseases and laboratory data. Cognitive function was measured with Mini Mental Status Exam-K (MMSE-K) before surgery. RESULTS: Delirium developed in 20 patients (22.2%). History of dementia (p=0.041) and mean score of MMSE-K (p<0.001) were significantly related to the incidence of delirium. An MMSE-K score less than 20 was an independent risk factor for postoperative delirium in patients with hip fracture. CONCLUSION: Cognitive impairment was a risk factor of postoperative delirium. MMSE-K is expected to be a simple indicator for predicting postoperative delirium in older patients with hip fracture.
Aged ; Delirium ; Dementia ; Hip ; Humans ; Incidence ; Risk Factors

BACKGROUND: Elderly patients with underlying cardiovascular or respiratory diseases are more susceptible to anesthesiologic risks or serious complications following laparoscopic operations. We evaluated the safety of laparoscopic radical nephrectomy in elderly patients to compensate for the lack of Korean data on the subject in the field of urology. METHODS: From March 2003 and March 2009, 73 patients with localized renal cell cancer underwent laparoscopic radical nephrectomy. They were divided into two groups according to age; 75 years or older (elderly group, n=21) and under 75 years (young group, n=52). Operative parameters as well as oncological outcomes were evaluated. RESULTS: The mean age was 77.7+/-2.5 years for the elderly group and 55.9+/-10.5 years for the young group. No significant differences existed between the groups in terms of mean operative time, intraoperative blood loss, complications, and hospital stay. However, American Society of Anesthesiologists (ASA) score, co-morbidities (p<0.05), and rate of transfusion (p<0.05) were significantly higher in the elderly group. In overall analyses, we conclude that in elderly patients undergoing laparoscopic radical nephrectomy, close monitoring of hemoglobin level as well as intraoperative transfusion for maintenance of hemoglobin level at 10 mg/L or higher is necessary in elderly patients to achieve adequate circulation. CONCLUSION: Laparoscopic radical nephrectomy can be considered a safe and effective procedure for most elderly patients.
Aged ; Carcinoma, Renal Cell ; Hemoglobins ; Humans ; Laparoscopy ; Length of Stay ; Nephrectomy ; Operative Time ; Urology

BACKGROUND: The incidence of colorectal cancer in elderly is on the rise as colorectal cancer is increasing in prevalence. To come up with a proper screening guideline for the elderly, we collected basic data by comparing the clinical characteristics of colorectal cancer of younger patients with those of elderly patients. METHODS: A total of 899 patients diagnosed with primary colorectal cancer at Seoul National University Bundang Hospital between May 2003 and January 2009 were enrolled. Operative and pathologic reports, colonoscopic records, and case notes of each patient were reviewed. Tumors located in cecum, ascending colon and transverse colon were classified as right colon cancer. RESULTS: The median age of the patients was 61.4 years old (range, 27 to 87). Of the 899 enrolled patients, 369 (41.0%) were 65 years old or older (older group). The Colon cancer affected a higher proportion of the older group than the young group (29.0% vs. 21.1%, p=0.007) while mucinous adenocarcinoma was found significantly more often in the young group when compared with the older group (2.2% vs. 5.9%, p=0.007). Hemoglobin level at diagnosis was also lower in the older group compared to the young group (mean+/-SD, 12.2+/-2.45 vs. 13.0+/-2.28, p<0.001). In addition, there was a female predominance in right colon cancer in terms of gender (28.7% vs. 21.5%, p=0.014). CONCLUSION: In overall analyses, right colon cancer was more common in elderly and female patients. Total colonoscopic surveillance should be considered for the early detection of cancerous lesions in elderly and female patients.
Adenocarcinoma, Mucinous ; Aged ; Cecum ; Colon ; Colon, Ascending ; Colon, Transverse ; Colonic Neoplasms ; Colorectal Neoplasms ; Early Detection of Cancer ; Female ; Hemoglobins ; Humans ; Incidence ; Korea ; Mass Screening ; Prevalence

BACKGROUND: The aim of the Long-term Care of Older People via Incheon Nursing Home Network (LOVE) study was to evaluate disease status and its association with physical activity and emotional status among the elderly in nursing homes. METHODS: This retrospective study included 1,379 nursing home residents aged 65 years and older, of which 260 were excluded due to lack of baseline information. Data regarding major diseases from 1,119 people were analyzed to compare prevalence according to age. Data about physical function and emotional status on admission from 497 residents were analyzed looking for contributing factors to limited function and unstable emotion. RESULTS: Hypertension was the most common ailment at 58.6% of the total followed by dementia (50.6%), stroke (28.7%), and diabetes (24.2%). Prevalence of diabetes (p<0.001) and stroke (p<0.001) were relatively low in the older age groups but that of osteoarthritis (p<0.001) and dementia (p=0.001) were relatively high. After adjusting for age and sex, limited physical activity was more frequent in those with strokes (odds ratio [OR], 3.7 [2.1-6.2], p<0.001) and fractures (OR, 2.1 [1.1-4.1], p=0.023). Unstable emotion was more frequent in residents with dementia (OR, 1.9 [1.3-2.8], p=0.001). CONCLUSION: The most common diseases among nursing home residents, in decreasing order, were hypertension, dementia, stroke, and diabetes. Diseases related to the need for physical aids were strokes and fractures. Effective strategies for the management of unstable emotional status in the elderly with dementia are needed.
Aged ; Dementia ; Humans ; Hypertension ; Long-Term Care ; Motor Activity ; Nursing Homes ; Osteoarthritis ; Prevalence ; Retrospective Studies ; Stroke

BACKGROUND: In Alzheimer's disease (AD), cognitive impairment is associated with functional impairment; and neuropsychiatric symptoms are common in AD patients. However, there have been few studies about the relationship between neuropsychiatric symptoms and functional state in AD. The objective of this study is to investigate the effects of neuropsychiatric symptoms on activities of daily living in AD. METHODS: We reviewed the medical records of 60 AD patients meeting the criteria of the Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) for probable AD (mean age, 75.4+/-7.0 years; 13 men, 47 women). The relationships between the Neuropsychiatric Inventory (NPI) and two functional measures, instrumental activities of daily living (IADL) and the Barthel Index, were analysed. RESULTS: The total NPI score was significantly associated with both functional measures (IADL: r=0.543; Barthel Index: r=-0.515), as were the NPI subscale scores of delusion, hallucination, agitation, depression, anxiety, and irritability. Multivariate regression analyses showed that total NPI score and duration of dementia were significant predictive factors for both IADL and the Barthel Index. In addition, the total NPI score still significantly influenced the two functional measures after controlling for age, duration of dementia, and Mini-Mental State Examination. CONCLUSION: The total NPI score was a significant predictive factor for functional status beyond the contribution of cognitive impairment in AD. Neuropsychiatric symptoms are associated with increased functional impairments in AD. Screening and management of neuropsychiatric symptoms during the course of AD would be helpful in improving functional status.
Activities of Daily Living ; Alzheimer Disease ; Anxiety ; Communication Disorders ; Delusions ; Dementia ; Depression ; Dihydroergotamine ; Hallucinations ; Humans ; Male ; Mass Screening ; Medical Records

BACKGROUND: The aim of this study was to investigate sarcopenia and its association with cardiometabolic risk factors in a community-based elderly cohort in Korea. METHODS: We recruited 287 men and 278 women aged 65 years or older and without physical disability. Appendicular skeletal muscle mass (ASM) was measured with dual energy X-ray absorptiometry. We used two definitions for sarcopenia-ASM divided by height2 (kg/m2) or by weight (%) <1 SD below the sex-specific mean for young adults. We compared RBP-4, adiponectin, hsCRP, lipid profiles, and insulin resistance between the sarcopenic and normal groups using ASM/Ht2 and ASM/Wt. RESULTS: The prevalence of sarcopenia was 35.3% in men and 13.4% in women with sarcopenia defined by ASM/Ht2. However, it was 38.3% in men and 62.6% in women by ASM/Wt. In correlation analysis, body mass index was positively correlated with ASM/Ht2 and negatively correlated with ASM/Wt. The sarcopenic group, when defined as ASM/Ht2, showed lower RBP4, fasting plasma glucose, and HOMA-IR and higher adiponectin than the normal group but not significantly different lipid profiles. The sarcopenic group defined by ASM/Wt had higher RBP4, fasting plasma glucose, and HOMA-IR, and lower adiponectin than the normal group in both sexes. Only in the males did the sarcopenic group defined by ASM/Wt reveal higher total cholesterol, triglycerides, and LDL cholesterol, and lower HDL cholesterol than the normal group. CONCLUSION: In conclusion, the sarcopenic group defined by ASM/Wt was more closely associated with cardiometabolic risk factors than the normal group in a community-based elderly cohort.
Absorptiometry, Photon ; Adiponectin ; Aged ; Body Mass Index ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Cohort Studies ; Fasting ; Female ; Glucose ; Humans ; Insulin Resistance ; Korea ; Male ; Muscle, Skeletal ; Plasma ; Prevalence ; Risk Factors ; Sarcopenia ; Triglycerides ; Young Adult

Cytomegalovirus(CMV) infections are common in immune compromised situations such as human immunodeficiency virus infection and organ transplantation. However CMV colitis had been rarely found in immunocompetent individuals. We experienced a case of an 83-year-old female patient, initially immune competent, who developed a massive lower gastrointestinal bleeding caused by CMV colitis. Previously, multiple antibiotics were used for nontuberculous Myco- bacterium and other bacterial infections after total knee arthroplasty. Colonoscopy revealed multiple ulcerations and mucosal congestion with hemorrhage. In spite of ganciclovir therapy, our patient did not recover.
Aged, 80 and over ; Anti-Bacterial Agents ; Arthroplasty ; Bacterial Infections ; Colitis ; Colonoscopy ; Cytomegalovirus ; Estrogens, Conjugated (USP) ; Female ; Ganciclovir ; Hemorrhage ; HIV ; Humans ; Knee ; Mycobacterium Infections, Nontuberculous ; Nontuberculous Mycobacteria ; Organ Transplantation ; Transplants ; Ulcer

BACKGROUND: Abdominal pain is a common complaint seen at emergency centers. Various diseases can cause abdomin al pain making it difficult to make a correct diagnosis. In the elderly, however, the consequences of an incorrect or delayed diagnosis can be more critical. We investigated the accuracy of initial diagnoses in the emergency center and analyzed the associations among medical factors including age. METHODS: We compared the ICD 10 codes of initial diagnoses to the codes of final diagnoses, defined the 'degree of agreement' using a 5 point scale, and classified patients into 'high degree of agreement' or 'low degree of agreement' groups. According to the severity of illness, we classified patients as 'admission' or 'out patient follow up'. According to their illness, we classified them as 'surgical' or 'medical'. According to age, we classified them as 'elderly' or 'adult'. Finally, we analyzed the statistical significance of each association. RESULTS: Overall, admitted patients and surgical diagnoses had higher degrees of agreement. 'Elderly' patients had no significant difference in 'degree of agreement' from 'adult' patients. CONCLUSION: Among patients presenting with acute abdominal pain to the emergency center, the degree of agreement between initial diagnosis and final diagnosis is dependent on the diagnostic characteristics of the disease, and not on the age of the patients. Further studies on the diagnostic accuracy of individual diseases are needed. Additional diagnosis associated variables, for example comorbidity and prognosis, needs to be studied regarding relationship to diagnostic accuracy.
Abdominal Pain ; Aged ; Comorbidity ; Delayed Diagnosis ; Emergencies ; Humans ; Prognosis