BACKGROUND: In geriatric patients, cardiovascular disease is common and a main cause of perioperative morbidity and mortality. Therefore preoperative evaluation of cardiac function is important. The purpose of this study is to evaluate preoperative echocardiography in geriatric patients for understanding aging heart changes and proper selection of patients. METHODS: In the 381 geriatric patients, authors evaluated chamber size, wall thickness, wall motion, valve abnormalities and ejection fraction. In addition, in patients who had left ventricular dysfunction (ejection fraction < OR = 55%), authors evaluated past medical histories and electrocardiographic (ECG) findings. RESULTS: Left atrial enlargement was present in 16%, left ventricular enlargement in 3%, right ventricular enlargement in 6%, ascending aorta dilatation in 13% and left ventricular hypertrophy (LVH) in 28%. Aortic regurgitation (AR) was present in 44%, mitral regurgitation (MR) in 42%, aortic valve calcification in 21% and hypokinesia of the left ventricular wall in 4%. Left ventricular dysfunction was present in 18 patients and their past medical histories showed hypertension in 39%, myocardial ischemia in 33%, congestive heart failure in 28% and diabetus mellitus in 28%. Also their ECG findings showed LVH in 45%, atrial fibrillation in 30% and ventricular premature contraction in 15%. Among the 18 patients with left ventricular dysfunction, 16 patients (89%) had dyspnea or heart disease histories such as myocardial ischemia, myocardial infarction, congestive heart failure, premature ventricular contraction and atrial fibrillation. CONCLUSIONS: 16% of the patients showed a normal echocardiograpy. Abnormal findings of the echocardiography were, in order of frequency, AR (44%), MR (42%) and LVH (28%). Dyspnea or cardiac disease histories were present in 89% of the left ventricular dysfunction patients.
Aging ; Aorta ; Aortic Valve ; Aortic Valve Insufficiency ; Atrial Fibrillation ; Cardiovascular Diseases ; Dilatation ; Dyspnea ; Echocardiography* ; Electrocardiography ; Heart ; Heart Diseases ; Heart Failure ; Humans ; Hypertension ; Hypertrophy, Left Ventricular ; Hypokinesia ; Mitral Valve Insufficiency ; Mortality ; Myocardial Infarction ; Myocardial Ischemia ; Ventricular Dysfunction, Left ; Ventricular Premature Complexes

Prostate specific antigen (PSA) has become established as the most useful serological marker for monitoring patients with prostate cancer. However, the benefits of serum PSA values are controversial in screening procedures for prostate cancer due to the rather low specificity of PSA test. To determine if different assays yield comparable results, we compared the IMx PSA enzyme immunoassay and the ELSA PSA monoclonal immunoradiometric assay. We analyzed 72 serum specimens from 68 patients with prostatic disease (12 patients with cancer, 47 benign hyperplasia and 9 prostatitis) and 13 from normal controls by both assays. Results from the assays revealed close linear correlation but the ELSA PSA assay yielded values 1.5 times those of the IMx PSA assay In 13 patients with histologically diagnosed benign prostatic hyperplasia, number of patient with PSA value over l0 ng/ml measured by IMx and ELSA assay were 2(15% ) and 4(31%), respectively. We conclude that the proportional bias between assays demonstrates a need for improved standardization of PSA assays.
Bias (Epidemiology) ; Humans ; Hyperplasia ; Immunoenzyme Techniques* ; Immunoradiometric Assay* ; Mass Screening ; Prostate-Specific Antigen ; Prostatic Diseases ; Prostatic Hyperplasia ; Prostatic Neoplasms ; Sensitivity and Specificity

Recently the change in medical informatics enabled us to use medical information whenever we want and wherever we are. There are many homepages on the web, which provide hospital information, medical counseling. Our multimedia center began its service as a internet Hospital in MIDAS Dongailbo, one of the major daily newspaper in Korea, on March 25th, 1997. The aim of this study is to examine the content and purpose of medical counseling on the web. The subjects consisted of 1,000 counsellings which were called 'Dongailbo Internet Hospital' for March, 25th, 1997 through October 30th, 1997. Many questioners wanted to know treatment principles, to make a diagnosis, and to know specific medical knowledges. The most common questions are as follows: general and unspecified, musculoskeletal, skin, digestive, respiratory, neurological problems.
Computer Communication Networks ; Counseling* ; Diagnosis ; Internet ; Korea ; Medical Informatics ; Multimedia ; Periodicals* ; Skin

Recently the change in medical informatics enabled us to use medical information whenever we want and wherever we are. There are many homepages on the web, which provide hospital information, medical counseling. Our multimedia center began its service as a internet Hospital in MIDAS Dongailbo, one of the major daily newspaper in Korea, on March 25th, 1997. The aim of this study is to examine the content and purpose of medical counseling on the web. The subjects consisted of 1,000 counsellings which were called 'Dongailbo Internet Hospital' for March, 25th, 1997 through October 30th, 1997. Many questioners wanted to know treatment principles, to make a diagnosis, and to know specific medical knowledges. The most common questions are as follows: general and unspecified, musculoskeletal, skin, digestive, respiratory, neurological problems.
Computer Communication Networks ; Counseling* ; Diagnosis ; Internet ; Korea ; Medical Informatics ; Multimedia ; Periodicals* ; Skin

Adult onset Still's disease (AOSD) is a systemic autoinflammatory disorder that presents with recurrent fever, extreme fatigue, and joint pain. Pulmonary involvement is not uncommon and, although rare, severe pneumonitis can progress to respiratory failure. Still's disease-associated pneumonitis is generally treated with immunosuppressive agents, but improvement in our understanding of systemic inflammatory processes led us to explore alternative agents. Anakinra is an interleukin-1 receptor antagonist used to treat autoinflammatory disorders resistant to immunosuppressive therapy. Several case reports have demonstrated efficacy of anakinra in treating AOSD, but its relevance in cases complicated with severe pneumonitis has not been examined. Our patient's disease activity was not controlled with systemic steroids and cyclophosphamide. Treatment with anakinra led to a dramatic clinical response. This is the first reported case of AOSD with severe pneumonitis refractory to conventional therapy successfully treated with anakinra.
Arthralgia ; Cyclophosphamide ; Fatigue ; Fever ; Immunosuppressive Agents ; Interleukin 1 Receptor Antagonist Protein* ; Interleukin-1 ; Pneumonia* ; Respiratory Insufficiency ; Steroids ; Still's Disease, Adult-Onset*

Theoretically one might suggest the abdominoplasty can cause respiratory decompensation resulting from musculofascial plication, which reduces the respiratory reserve by decreasing intra-abdominal volume and diaphragmatic excursion. This prospective study was perfomed to evaluate the effect of abdominoplasty and the change of intraoperative Paw on the pulmonary function of 20 consecutive otherwise healthy subjects. The pulmonary function test was performed preoperatively, and repeated 2 months after the operation. Additionally, we monitored intraoperative Paw. Comparison of the pulmonary function test showed a significant decrease(p<0.001) in the mean forced vital capacity(FVC) and the mean forced expiratory volume in one second(FEV1) throughout the study period. Postoperatively, the mean FVC decreased by 11.65% and the mean FEV1 decreased by 16.15%. The mean Paw increased by 6.6cmH2O(3-12cmH2O) by musculofascial plication. And we found that the decrease in FVC and FEV1 was significantly correlated with intraoperative changing of Paw in abdominoplasty(p<0.001). FVC and FEV1 could be decreased by abdominoplasty due to decreasing intra-abdominal volume and diaphragmatic excursion, but there was no respiratory symptom clinically in all patients 2 months after the operation. In conclusion, We found that the decrease in FVC and FEV1 after 2 months of abdominoplasty was significantly correlated with intraoperative Paw change during operation. The intraoperative Paw was increased to 12 cmH2O without any respiratory symptom in this study. We suggested that the increase in intraoperative Paw less than about 10cmH2O can not affect on respiratory function clinically.
Abdominoplasty* ; Forced Expiratory Volume ; Humans ; Prospective Studies ; Respiratory Function Tests

BACKGROUND: The development of postdural puncture headache is related to a patient's age, size, pregnancy, sex, type of dural puncture needle and direction of the needle bevel. We studied the effect of the needle size and type of dural puncture on postdural puncture headache after spinal anesthesia in the 40 patients. METHODS: Forty patients, belonging to ASA classes 1 and 2, were divided into 2 groups, one using the lumbar paramedian approach (n = 20, Group 1) on L4-5 interspinous space with a 24 G spinal needle and the the other using Taylor's approach (n = 20, Group 2) through S2 foramen with a 22G spinal needle. All patients received an infusion of lactated Ringer's solution (1,000 ml). After spinal anesthesia, we measured the incidence, onset, duration and severity of postdural puncture headache in the 40 patients. RESULTS: The incidence of postdural puncture headache is lower in Group 2 (0%) than in Group 1 (15%). The onset of postdural puncture headache occured within 24 hours in 100% of the patients in Group 1 and the duration of postdural puncture headache occured within 48 hours in 66.7% of the patients in Group 1. The severity of postdural puncture headache was mild and moderate in 3 cases of all the 3 cases with postdural puncture headache of Group 1. The location of postdural puncture headache was frontal in 2 cases and occipital in 1 case. CONCLUSIONS: The incidence of postdural puncture headache is zero in Taylor's approach group in 20 patients. Therefore we think that spinal anesthesia using Taylor's approach is safer than spinal anesthesia with the lumar approach for postdural puncture headache.
Anesthesia, Spinal* ; Humans ; Incidence* ; Needles ; Post-Dural Puncture Headache* ; Pregnancy ; Punctures

The aberrant or ectopic thyroid in lateral neck is a rare developmental anomaly. Furthermore, the primary thyroid carcinoma arising in ectopic thyroid is extremely rare, only a few cases have been reported so far in English literature. We report a 64-year-old male with left transglottic cancer and primary papillary carcinoma from lateral aberrant thyroid in left lateral neck. Preoperatively, we diagnosed as transglottic cancer with ipsilateral neck metastasis. The patient underwent total laryngectomy, left selective neck dissection and left thyroidectomy. Finally, the patient was diagnosed as left transglottic cancer and papillary carcinoma from lateral aberrant thyroid. Surgeons should take into account a primary ectopic thyroid carcinoma arising in lateral neck may co-exist with another type of head and neck tumor.
Carcinoma, Papillary ; Head ; Humans ; Laryngeal Neoplasms* ; Laryngectomy ; Larynx* ; Male ; Middle Aged ; Neck ; Neck Dissection ; Neoplasm Metastasis* ; Thyroid Dysgenesis ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

Immunoglobulin G4-related sclerosing disease (IgG4-RD) is histologically a chronic inflammatory disorder characterized by infiltration of lymphoplasmacytes, sclerosis, and an elevated serum level of IgG4 and IgG4 positive plasmocytes. IgG4-RD is associated with autoimmune pancreatitis, sclerosing cholangitis, sialalithiasis, retroperitoneal diseases, inflammatory arotitis and Mikulicz's disease, typically including the lacrimal glands, salivary glands, pancreas, thyroid gland, lungs and kidneys. It is important to distinguish IgG4-RD from neoplastic disease as it responses well to steroid. Because consensus for nomenclature of IgG4-RD is recently made, reports of IgG4-RD in the Head and Neck area are still rare. In the first case, a 68-year-old man presented with a recurring submandibular gland mass from 7 years ago; he underwent submandibular gland resection and was diagnosed as IgG4-RD. In the second case, a 69-year-old mass presented with a relapsing right neck mass on level Ib. He underwent an exsional biopsy and was diagnosed with the same disease entity. We experienced two cases of IgG4-RD, and so report them with a brief literature review.
Aged ; Biopsy ; Cholangitis, Sclerosing ; Consensus ; Head ; Humans ; Immunoglobulin G ; Immunoglobulins* ; Kidney ; Lacrimal Apparatus ; Lung ; Neck ; Pancreas ; Pancreatitis ; Salivary Glands ; Sclerosis ; Submandibular Gland ; Thyroid Gland

The Tapia's syndrome means symptom complex that result from unilateral vago-hypoglossal nerve paralysis. This syndrome is rare disease entity, bilateral attack is extremely rare. Only three cases have been reported in English literature. A-66-year-old man received the coronary artery bypass graft in our hospital. After the operation, he complained of severe dyspnea, voice change and drooling. The laryngoscopic findings showed the bilateral vocal cord palsy. He could not move the tongue toward any directions. We diagnosed as bilateral Tapia's syndrome. Usually, unilateral Tapia's syndrome is related to the complications of anesthesia and position of the patient's head during surgery. Otherwise, our case may be associated with the complications of operation and anesthesia. The patient's recovered three months later, but the right vocal cord palsy is persistent. We report the very unique disease entity with literature review.
Anesthesia ; Coronary Artery Bypass ; Coronary Vessels ; Dyspnea ; Head ; Paralysis ; Rare Diseases ; Sialorrhea ; Tongue ; Transplants ; Vocal Cord Paralysis ; Voice