We report a case of a 73-year-old patient with a 17 year-history of well-controlled primary hypertension with a single antihypertensive drug, which became uncontrolled since 9 months ago when he started on oral carbamazepine (CBZ) therapy for syringomyelia. On admission, the patient had a blood pressure of 200-215/95-104mmHg despite an antihypertensive combination therapy with five different drugs. Further investigations ruled out secondary hypertension such as primary aldosteronism, pheochromocytoma and renal artery stenosis. After the discontinuation of CBZ, the blood pressure profile became significantly improved. The rechallenge with CBZ aggravated his blood pressure profile. Therefore, we considered that resistant hypertension was induced by the oral CBZ therapy.
Aged ; Antidepressive Agents, Tricyclic ; Blood Pressure ; Carbamazepine ; Humans ; Hyperaldosteronism ; Hypertension ; Pheochromocytoma ; Quaternary Ammonium Compounds ; Renal Artery Obstruction ; Syringomyelia

Here, we report a case of newly diagnosed diabetes, with concurrent pancreatic cancer manifested as hyperglycemic crisis, and aggravated by urinary tract infection. We summarize the initial clinical manifestations and pertinent laboratory, radiologic, and clinical findings in an elderly patient with hyperglycemic emergency. A review of the documents involving pancreatic tumors and hyperglycemic hyperosmolar state, which is an acute complication of diabetes mellitus, is presented. In the absence of other identifiable conditions, it is reasonable to speculate that some factor (or factors) produced by the tumor had a role in the metabolic decompensation. In addition, this discussion should be more carefully considered in the aged people group.
Aged ; Diabetes Mellitus ; Emergencies ; Humans ; Pancreatic Neoplasms ; Urinary Tract Infections

Aortic stenosis is the most frequent type of valvular heart disease in adult. Approximately 2-7% of the population over the age of 65 suffer from aortic valve stenosis. Due to the increasing average life expectancy in Korea, degenerative aortic stenosis is increasing and becoming a troublesome health problem in older population. Because older patients with severe degenerative aortic stenosis have many other medical conditions so they are not suitable candidate for surgery. Recently, transcatheter aortic-valve implantation (TAVI) has been suggested as a less invasive treatment for patients with high perioperative risk. We report a successful TAVI case in severe aortic stenosis patient with high perioperative risk.
Adult ; Aortic Valve Stenosis ; Heart Valve Diseases ; Humans ; Korea ; Life Expectancy

Subclinical thyroid dysfunction, including both subclinical hyperthyroidism and subclinical hypothyroidism is biochemically defined as an abnormal thyroid-stimulating hormone (TSH) level and thyroid hormone level within its reference range. The prevalence of this condition varies according to the reference range for TSH and geographic or demographic factors, but is common in the elderly and in women. Subclinical thyroid dysfunction has various causes. Thus, careful clinical assessment is needed. Subclinical thyroid dysfunction can be likely to progress to overt thyroid disease and be associated with various health outcomes. However, to date, supporting data are lacking and levels of evidence for the associations are different. Although the management of subclinical thyroid dysfunction is controversial, recommendations are based on the degree to which TSH levels have deviated from normal, age, symptoms, and underlying comorbidities. Further studies are needed to inform how to best care for the elderly with subclinical thyroid dysfunction.
Aged* ; Comorbidity ; Demography ; Female ; Humans ; Hyperthyroidism ; Hypothyroidism ; Prevalence ; Reference Values ; Thyroid Diseases ; Thyroid Gland* ; Thyrotropin

OBJECTIVE: The purpose of this study is to evaluate effect of patient age amenorrhea duration, motivation, purpose, regimen, side effect on compliance to hormonal replacement therapy(HRT). METHODS: Compliance to HRT was assessed in 86 postmenopausal women who began HRT in the Shin ob & gyn clinic. Fifty six women who had intact uterus received continuous combined therapy with 2 mg of Estradiol hemihydrate and 1mg of Norethinsterone acetate. Thirty women who were hysterectomized received only 0.625mg of conjugated equaine estrogen(premarin) RESULT: A total of 34(39.9%) women reported that they continued HRT at least for one year. Continuation of HRT was significantly more common among women who started HRT because of reconmendation by gyneocologist after hystectomy for improvement sexual function(p<0.05), A greater percentage of women who received only premarin without uterus continuous combined therapy(p<0.05) Duration of amenorrhea, reason for taking HRT and side effect such as irregular bleeding or breast tenderness were not related to the continuation of HRT. CONCLUSION: Education of menopausal women about the improvement of sexual function/ risk and side effect of HRT may be critical in improving compliance.
Amenorrhea ; Breast ; Compliance* ; Education ; Estradiol ; Estrogens, Conjugated (USP) ; Female ; Hemorrhage ; Hormone Replacement Therapy ; Humans ; Motivation ; Postmenopause* ; Uterus

Most patients experiencing an osteoporotic vertebral compression fracture remain asymptomatic or minimally symptomatic. However, a notable number of these patients do experience significant pain at some time resulting in disability and decreased quality of life. A 77-year-old man was admitted to a hospital with severe thoracolumbar pain and functional disabilities even though, 12 months ago, he had received inpatient treatment for 6 months in another hospital with the diagnosis of T12 vertebral compression fracture. Although initial outside spine MRI revealed a stable T12 com pression fracture with a 27.6% compression rate, delayed subsequent re-fracture of the same vertebrae was found on simple X-ray and thoracolumbar CT scan with an 86.5% compression rate and retropulsion to the central spinal canal. He continued to have severe spinal pain and functional disabilities in spite of undergoing a first anterolateral fusion one year ago and a subsequent posterior fusion. We emphasize a proper clinical and radiologic examination at one-year follow-up after successful conservative treatment of vertebral compression fractures.
Aged ; Follow-Up Studies ; Fractures, Compression ; Humans ; Inpatients ; Quality of Life ; Spinal Canal ; Spine

Primary cricopharyngeal dysfunction is a rare, idiopathic, functional disorder of the upper esophageal sphincter (UES) characterized by dysphagia, frequent aspiration, and functional narrowing at the level of UES. It is caused by failure or partial relaxation of the sphincter, lack of pharyngoesophageal coordination, or reduced compliance of the muscular of the UES. We saw a 62-year-old man who presented with dysphagia and UES narrowing on videofluoroscopy swallowing study (VFSS). Physical, neurologic, and laboratory evaluations revealed no abnormal findings. Radiologic evaluation looking for any abnormalities that might provoke dysphagia was within normal limits. VFSS showed laryngeal aspiration, residue in vallecular and pyriform sinuses, and cricopharyngeal narrowing. Balloon catheter dilatation under endoscopic guidance was performed twice, after which, the dysphagia improved. Here, we describe the results of treatment with balloon dilatation in a patient with primary cricopharyngeal dysfunction.
Catheters ; Compliance ; Deglutition ; Deglutition Disorders ; Dilatation ; Esophageal Sphincter, Upper ; Humans ; Middle Aged ; Pyriform Sinus ; Relaxation

BACKGROUND: As the elderly population increases, elderly patients visiting emergency departments (ED) with acute abdominal pain will also likely increase. The underlying causative diseases in these older patients are different from younger patients, usually more serious. Thus, correct diagnosis is very important, but difficult. There needs to be a better understanding of the characteristics of the elderly patient with acute abdominal pain seen in the ED. METHODS: We retrospectively reviewed the medical records of 98 elderly patients (>or=65 years) and 109 adult controls (<65 years) visiting an ED at one general hospital looking at the final diagnoses, characteristics of abdominal pain, admissions, and surgeries. RESULTS: Hepatobiliary tract diseases and bowel obstruction were more common in the elderly patients. The elderly had more admissions and surgeries than younger patients. In addition, they were more likely to have a fatal disease such as myocardial infarction. CONCLUSION: There is a difference in the underlying diseases causing acute abdominal pain in the elderly patients versus younger patients. In terms of frequency of admission and surgery, the elderly present with more serious and fatal diseases. We must consider these features when seeing an elderly patient with acute abdominal pain in an ED.
Abdominal Pain ; Adult ; Aged ; Emergencies ; Hospitals, General ; Humans ; Medical Records ; Myocardial Infarction ; Retrospective Studies

BACKGROUND: The purpose of this study is to assess the prevalence of falls and to correlate if the fear of falling results in avoidance of activities in a rural community elderly population. METHODS: A cross-sectional study was done in 299 rural residents in Korea aged >60 years, between June 19, 2007 and June 21, 2007. Questionnaires about basic demographics, falling events, fear of falling (K-ABC), and limitations of daily activities (K-IADL) were completed. RESULTS: Among the 299 participants, 26.1% had experienced a fall. 197 participants confirmed that they experienced fear of falling (66.9%). This was further broken down to participants who were 'a little concerned'(31.4%), 'much concerned' (20.7%), and 'very much concerned' (13.7%). 183 people (61.2%) had limited daily activities caused by a fear of falling. Fallers experienced higher levels of anxiety and fear of falling than non-fallers (p<0.001). Comparing fear of falling with limited daily activities shows that the greater the fear of falling, the larger the limitation in daily activities and the lower the K-IADL score. After adjusting for falling, multiple linear regression showed that fear of falling and limited daily activities were positively correlated (p<0.001). Among groups with fear of falling, non-fallers, exercise group (p=0.024), and good perceived health group (p=0.022) had no limitations in activities compared with the control groups. CONCLUSION: Modifying drinking habits, diet habits, and social activities associated with perceived health states may improve daily activity levels in the elderly residing in rural communities, even though they have the fear of falling.
Aged ; Anxiety ; Cross-Sectional Studies ; Demography ; Drinking ; Food Habits ; Humans ; Korea ; Linear Models ; Prevalence ; Surveys and Questionnaires ; Rural Population

BACKGROUND: We selected a computerized neuropsychological test, the Cambridge Neuropsychological Test Automated Battery (CANTAB), along with other conventional neuropsychological tests. The aim of this study was to assess CANTAB's usefulness in diagnosing dementia in the elderly and to compare it with conventional neuropsychological assessment kits. METHODS: We recruited 17 dementia patients diagnosed with Alzheimer's disease or vascular dementia for the dementia group and 52 healthy persons who met our criteria for the control group. We administered four CANTAB subtests to assess their cognitive functions along with the conventional Seoul Neuropsychological Screening Battery, which includes the Rey-Osterreith Complex Figure Test (RCFT) to assess visual memory. The four CANTAB subtests chosen were big/little circle (BLC), paired associates learning (PAL), spatial recognition memory (SRM), and spatial span (SSP). RESULTS: The dementia group showed impairment on the PAL and SRM tasks. The results of the other two subtests were not different between the two groups. The mean adjusted total errors on the PAL task was higher in the dementia group (130.88) than in the control group (51.38), which was statistically significant (p<0.01). The percentage of correct response on the SRM task was lower in the dementia group (58.75%) than in the control group (67.25%), also statistically significant (p=0.03). We also compared the correlations of the CANTAB subtests with the RCFT parameters (immediate recall, delayed recall, and recognition). Again, the results showed that the PAL task correlated well with these three parameters (r=-0.59, -0.60, and -0.56, respectively). CONCLUSION: The CANTAB was useful for assessing cognition in the elderly. In particular, the PAL task, which correlated well with the RCFT parameters, can be used to assess visual memory. It showed to be a valuable tool in diagnosing dementia.
Aged ; Alzheimer Disease ; Cognition ; Computer-Assisted Instruction ; Dementia ; Dementia, Vascular ; Humans ; Learning ; Mass Screening ; Memory ; Neuropsychological Tests ; Pilot Projects