BACKGROUND: We reviewed retrospectively the clinical features and contrast material-enhanced computed tomography(CT) after blunt abdominal trauma demonstrated a characteristic hypoperfusion complex. Our purpose were to evaluate the hypothesis that children with this 'hypoperfusion complex' CT finding were associated with a tenuous hemodynamic state, severe injury and a poor outcome. METHODS: Between January 1996 and December 1999, 39 consecutive children who sustained blunt trauma and were suspected clinically of having intraabdominal injury underwent CT. Demographic data, blood pressure, indication for CT, pediatric trauma score(PTS) and Glasgow coma score(GCS) were recorded at the time of the initial examination. RESULTS: Three of the 39 children(8%) demonstrated a characteristic finding at CT which was described as the hypoperfusion complex. The 'hypoperfusion complex' was present in the 3 of the 39 traumatized children(8%), but was the main radiographic finding in the 3 of the 14 children with a severe pediatric trauma score(PTS<8) and in the 3 of the 6 children with a Glasgow coma score(GCS<8) who were examined with CT. CONCLUSION: The CT finding in all children with the hypoperfusion complex by definition included marked, diffuse dilatation of the intestine with fluid; abnormally intense contrast enhancement of the bowel wall, mesentery, kidney and/or pancreas; decreased caliber of the abdominal aorta and inferior vena cava(IVC); and moderate to large peritoneal fluid collection. This 'hypoperfusion complex' is a relatively rarely observed in injured children but appears to be associated with severe injury and a poor outcome. The pediatric trauma score provides a useful profile of injury severity in children. Prompt diagnosis of hypovolemic shock is important so that supportive therapy can be instituted to prevent further metabolic abnormalities and their potential cardiotoxic effects. In summary, the intense multiorgan enhancement pattern seen in the hypoperfusion complex indicates tenuous hemodynamic stability and is associated with a poor outcome.
Aorta, Abdominal ; Ascitic Fluid ; Blood Pressure ; Child* ; Coma ; Diagnosis ; Dilatation ; Hemodynamics ; Humans ; Hypovolemia* ; Intestines ; Kidney ; Mesentery ; Pancreas ; Retrospective Studies ; Shock* ; Tomography, X-Ray Computed*

Korea is becoming aging society and the number of the aged who need long-term care service is increasing. Korean Elderly Long-Term Care Insurance System will be newly adopted soon and to make the system work successfully, comprehensive evaluation and management by professionals with have knowledge of geriatrics is necessary. In addition, long-term care hospitals should play their role between medical services and nursing care facilities as central organizations and form mutual system. The new insurance system only focuses on nursing care without regards of above facts. Other problems of it will be discussed in this study.
Aged ; Aging ; Geriatrics ; Humans ; Insurance ; Insurance, Long-Term Care ; Long-Term Care ; Nursing Care

BACKGROUND: Recent studies have shown that vascular risk factors may involved in Alzheimer's disease as well as vascular dementia. The main purpose of our study is to review the clinical characteristics of dementia inpatients and to investigate how much vascular risk factors influence the cognition of dementia inpatients for 1 year. METHODS: Between July and August in 2004, 69 dementia inpatients meeting DSM-IV criteria were examined with reviewing their charts carefully and inteviewing them directly. MMSE-K(Mini-Mental State Examination-Korean version) was used to evaluate the cognitive function of dementia inpatients. Vascular risk factors included in this study were DM, hypertension, cholesterol, homocysteine, Apolipoprotein E. RESULTS: Of the 69 dementia inpatients, 33 cases were Alzheimer's disease, 18 cases vascular dementia, 7 cases mixed dementia, 5 cases alcoholic dementia, 5 cases dementia due to brain trauma and 1 case parkinson's disease with dementia, respectively. The mean MMSE-K scores of dementia inpatients were 10.7 points at the time of admission and 9.4 points after about 1 year. Average annual rate of decline in the MMSE-K was 2.2 points in dementia inpatients with Alzheimer Disease. In comparison between dementia inpatients with vascular risk factors(DM, hypertension, cholesterol, homocysteine, APOE epsilon4 genotype) and those without vascular risk factors, there were no differences in average annual rates of decline in the MMSE-K between two groups at each vascular risk factor. According to the presence of APOE epsilon4 genotype, in spite of no difference in age, there was significant difference in the mean MMSE-K scores between two groups at the time of admission. CONCLUSION: These results suggest that Vascular risk factors(DM, hypertension, cholesterol, homocysteine, APOE epsilon4 genotype) do not influence the rates of decline in cognition of dementia inpatients significantly.
Alcoholics ; Alzheimer Disease ; Apolipoproteins ; Apolipoproteins E ; Brain Injuries ; Cholesterol ; Cognition ; Dementia* ; Dementia, Vascular ; Diagnostic and Statistical Manual of Mental Disorders ; Genotype ; Homocysteine ; Humans ; Hypertension ; Inpatients* ; Parkinson Disease ; Risk Factors*

BACKGROUND: Recent studies have shown that vascular risk factors may involved in Alzheimer's disease as well as vascular dementia. The main purpose of our study is to review the clinical characteristics of dementia inpatients and to investigate how much vascular risk factors influence the cognition of dementia inpatients for 1 year. METHODS: Between July and August in 2004, 69 dementia inpatients meeting DSM-IV criteria were examined with reviewing their charts carefully and inteviewing them directly. MMSE-K(Mini-Mental State Examination-Korean version) was used to evaluate the cognitive function of dementia inpatients. Vascular risk factors included in this study were DM, hypertension, cholesterol, homocysteine, Apolipoprotein E. RESULTS: Of the 69 dementia inpatients, 33 cases were Alzheimer's disease, 18 cases vascular dementia, 7 cases mixed dementia, 5 cases alcoholic dementia, 5 cases dementia due to brain trauma and 1 case parkinson's disease with dementia, respectively. The mean MMSE-K scores of dementia inpatients were 10.7 points at the time of admission and 9.4 points after about 1 year. Average annual rate of decline in the MMSE-K was 2.2 points in dementia inpatients with Alzheimer Disease. In comparison between dementia inpatients with vascular risk factors(DM, hypertension, cholesterol, homocysteine, APOE epsilon4 genotype) and those without vascular risk factors, there were no differences in average annual rates of decline in the MMSE-K between two groups at each vascular risk factor. According to the presence of APOE epsilon4 genotype, in spite of no difference in age, there was significant difference in the mean MMSE-K scores between two groups at the time of admission. CONCLUSION: These results suggest that Vascular risk factors(DM, hypertension, cholesterol, homocysteine, APOE epsilon4 genotype) do not influence the rates of decline in cognition of dementia inpatients significantly.
Alcoholics ; Alzheimer Disease ; Apolipoproteins ; Apolipoproteins E ; Brain Injuries ; Cholesterol ; Cognition ; Dementia* ; Dementia, Vascular ; Diagnostic and Statistical Manual of Mental Disorders ; Genotype ; Homocysteine ; Humans ; Hypertension ; Inpatients* ; Parkinson Disease ; Risk Factors*

Just these days elder abuse receives increasing social attention even though Korea already entered the ageing society with the steep increase of elderly population and this causes many social problems including elderly suicides. We need to develop methods to deal with these severe social problems, but, owing to lack of reliable data and studies, it is even difficult to document actual conditions of elder maltreatment. In a Korean nationwide epidemiological study conducted in 2007, the prevalence rate of elder abuse for last one year was 6.0%. Emotional abuse showed the highest prevalence (5.2%), and followed by neglect (2.3%), physical abuse (0.2%). The purpose of this study is to investigate the current prevalence and condition of elder maltreatment and provide the information about concept, types, risk factors and intervention of elder maltreatment.
Aged ; Elder Abuse ; Epidemiologic Studies ; Humans ; Korea ; Prevalence ; Risk Factors ; Social Problems ; Suicide

Just these days elder abuse receives increasing social attention even though Korea already entered the ageing society with the steep increase of elderly population and this causes many social problems including elderly suicides. We need to develop methods to deal with these severe social problems, but, owing to lack of reliable data and studies, it is even difficult to document actual conditions of elder maltreatment. In a Korean nationwide epidemiological study conducted in 2007, the prevalence rate of elder abuse for last one year was 6.0%. Emotional abuse showed the highest prevalence (5.2%), and followed by neglect (2.3%), physical abuse (0.2%). The purpose of this study is to investigate the current prevalence and condition of elder maltreatment and provide the information about concept, types, risk factors and intervention of elder maltreatment.
Aged ; Elder Abuse ; Epidemiologic Studies ; Humans ; Korea ; Prevalence ; Risk Factors ; Social Problems ; Suicide

The incidence of cervical pregnancy and the number of combined intrauterine pregnancy and ectopic pregnancy seems to be increasing. So the possibility of heterotopic pregnancy should always be considered by every gynecologist, especially those who treat infertility problem. We experience a case of a heterotopic pregnancy coexisting of an intrauterine pregnancy and a cervical pregnancy after in-vitro fertilization and embryo transfer, and was successfully managed by transcervical evacuation and resulted in a normal intrauterine pregnancy. Here we present the case with review of literatures.
Embryo Transfer ; Female ; Fertilization ; Fertilization in Vitro* ; Incidence ; Infertility ; Pregnancy* ; Pregnancy, Ectopic ; Pregnancy, Heterotopic*

A complete hydatidiform mole coexisting with a fetus is a rare condition, particularly when diagnosed after IVF-ET. In spite of the wide spread use of assisted reproductive technology, there have been, to our knowledge, only few reported cases of molar pregnancy after IVF-ET. At present, there are limited data to guide the antenatal management of a complete hydatidiform mole coexisting with fetuses. A complete mole can coexist with a normal, healthy fetus who can be carried to term, with good outcome. But, patients who desire to continue the pregnancy after such a diagnosis must be cautioned about the potential for severe medical complications and developing persistent gestational trophoblastic tumor. We report here a case of complete hydatidiform mole in a triplet pregnancy coexistent with two live fetuses following in IVF-ET.
Diagnosis ; Embryo Transfer* ; Embryonic Structures* ; Female ; Fertilization in Vitro* ; Fetus ; Humans ; Hydatidiform Mole* ; Pregnancy ; Pregnancy, Triplet* ; Reproductive Techniques, Assisted ; Triplets* ; Trophoblastic Neoplasms

No abstract available.
Apgar Score* ; Humans ; Smoke* ; Smoking*

Takayasu's arteritis is a non-specific inflammatory process that involves the aorta and its main branches, the etiology of which remains unknown. This arteritis occurs predominantly in young Asian women, although there have been many documented cases in males and non-Asians. Criteria for the diagnosis of Takayasu's arteritis were developed by The Subcommittee on Classification of Vasculitis of the American College of Rheumatology in 1990, of which a modified version is shown in Table 1. The presence of three or more of the six criteria shown demonstrated a diagnostic sensitivity of 90.5% and a specificity of 97.8%. Takayasu's arteritis is known as 'pulseless disease,' and this non-specific inflammatory arteriopathy typically produces segmental arterial narrowing and occlusion with resultant end-organ ischemic consequences, including upper extremity digital necrosis, stroke, visceral ischemia and renal failure. Previously reported sites of aneurysm formation include the thoracic and abdominal aorta, as well as the innominate, the carotid and the superior mesenteric arteries, but rarely the subclavian artery. A 26-year-old man presented with a progressively enlarging and tender pulsatile mass at the base of the left neck, intermittent Claudication of the upper limbs in association with a decreased brachial artery pulse and a bruit over the subclavian artery. Computed tomography and aortography demonstrated a 4 cmX5 cm aneurysm of the left subclavian artery. There was no evidence of occlusive disease. An aneurysmectomy with 8 mm hemashield graft interposis was performed . Pathology revealed a chronic, active inflammatory process. Aneurysm formation is an unusual complication of Takayasu's arteritis. Emergency department physicians must carefully observed patiens with symptomatic upper extremity pain and paresthesia and must consider whether those symptoms might be due to the formation of a subclavian artery aneurysm due to Takayasu's arteritis
Adult ; Aneurysm* ; Aorta ; Aorta, Abdominal ; Aortography ; Arteritis ; Asian Continental Ancestry Group ; Brachial Artery ; Classification ; Diagnosis ; Emergency Service, Hospital ; Female ; Humans ; Intermittent Claudication ; Ischemia ; Male ; Mesenteric Artery, Superior ; Neck ; Necrosis ; Paresthesia ; Pathology ; Renal Insufficiency ; Rheumatology ; Sensitivity and Specificity ; Stroke ; Subclavian Artery* ; Takayasu Arteritis* ; Transplants ; Upper Extremity ; Vasculitis