No abstract available.
Silver*

BACKGROUND: It has been documented that certain prognostic factors may affect the outcomes of the old aged victims by trauma. Considering that trauma is the sixth most common cause of death in people over the age of 65 years and there is a rapid growth of elderly population, it is paramount to understand the prognostic factors when dealing with geriatric trauma patients. Hypothesis and Goals : It can be hypothesized that the prognostic factors should be determined independently between populations being consisted of different races, countries, socio-economic states, cultures, or so on. Thus, study was designed to evaluate the factors affecting the outcomes of elderly Korean trauma patients. METHODS: One hundred forty six patients aged over 65 years were retrospectively reviewed, who visited the Emergency Canter of Korea University from January, 1997 to June, 1998. Of 146 patients, 7 were excluded due to discharge against advice or transfer to the other hospitals. Parameters analysed were age, sex, mechanism of injuries, body region injured, Injury Severity Score (ISS), previous medical illness, hospital morbidity, duration of hospital stay, and cost. Each patient was classified into improved or not-improved groups depending on the outcomes, and young-old or old-old group depending on the age. The factors affecting the hospital stay in improved patients were analyzed in the parameters of previous medical illness, hospital morbidity, multiple injuries, ISS, and age. All statistical tests were conducted with two-tailed levels of 0.05. RESULTS: Of 139 patients, the mean age was 74+/-7.1 years, mean ISS 9.3+/-7.26, mean hospital stay 27+/-27.1 days. Most commonly injured body region was the extremities due to fall from a level surface. Rate of previous illness showed 0.94 medical diseases per person and were aggravated after trauma in 39 patients (60.9%). Hospital morbidity rate was 0.46 incidents per person. There were no differences in age and duration of hospital stay between the improved and the not-improved group. Substantial differences were noted in affected body region, incidence of previous illness, and hospital morbidity between the groups (p=NS). Not-improved group had higher ISS (p<0.05). ISS, previous illness and hospital morbidity affected the duration of hospital stay in the improved group. Hospital stay was 40+/-25.1 days in patients with ISS over 6 while 6+/-8.6 days in those with ISS 5 (p<0.05). Hospital stay in the improved was 26+/-26.9 days while 31+/- 24.8 days in the improved old-old group (P=NS). Hospital stay in the young-old minor trauma (ISS5) patients with previous illness and hospital morbidity was 26+/-10.1 days while 4+/-7.3 days in those without previous illness and hospital morbidity (p<0.05). CONCLUSION: Previous medical illness and hospital morbidity, not age, are predictive of outcomes of geriatric trauma patients with respect to hospital stay. As most of the hospital morbidity was a trauma-induced aggravation of previous medical illness and hospital morbidity contributing poor outcomes can be potentially avoidable, routine aggressive care far the geriatric trauma patients with previous medical illnesses is needed.
Aged ; Body Regions ; Cause of Death ; Continental Population Groups ; Emergencies ; Extremities ; Humans ; Incidence ; Injury Severity Score ; Korea ; Length of Stay ; Multiple Trauma ; Retrospective Studies

PURPOSE: To evaluate the clinical aspects of severe endogenous endophthalmitis requiring evisceration,particularly underlying disease, causative microorganisms, and infection focus, and to assess the outcome of evisceration. METHODS: The records of 13 patients who were diagnosed with endogenous endophthalmitis requiring evisceration and treated at Yeungnam University Hospital from July 1994 to April 2007 were retrospectively reviewed. RESULTS: Of the 13 patients, all patients had diabetes mellitus, five had advanced liver disease, and one had aplastic anemia. Infection foci were pyelonephritis, pneumonia, and liver abscess. Five cases were confirmed with positive culture of lebsiella pneumoniae. Ten cases underwent evisceration with hydroxyapatite implantation, and three cases were treated conservatively because the patient was in poor systemic condition. Of the 10 patients who underwent evisceration, ocular implants were exposed in five cases. CONCLUSIONS: This study suggests that evisceration with primary orbital implant insertion for endogenous endophthalmitis involves the risk of implant exposure, but after secondary repair, all patients have stable clinical courses.
Anemia, Aplastic ; Diabetes Mellitus ; Durapatite ; Endophthalmitis ; Humans ; Liver Abscess ; Liver Diseases ; Orbital Implants ; Pneumonia ; Pyelonephritis ; Retrospective Studies

No abstract available.
Tomography, Optical Coherence*

OBJECTIVE: Chronic subdural hematoma (CSDH) is known to have a significant recurrence rate. There are different criteria defining the recurrence of CSDH. We evaluated the postoperative course of CSDH and tried to propose the reasonable criteria of recurrence. METHODS: We retrospectively examined the medical records and pre- and postoperative CT scans of 149 consecutive patients who underwent surgery from January 2005 to December 2009. Diagnosis was confirmed by CT scanning or MRI. The postoperative courses were either resolved or recurrent. The resolved CSDH was one of the three types; early resolution, delayed resolution, or late resolution. The recurrent CSDH was one of the four types; recurrence without resolution, early recurrence after resolution, late recurrence after resolution, or recurrent-and-resolved type. RESULTS: The CSDH was resolved within 30 days after surgery in 58 (39%) patients, between 1 to 3 months in 62 (42%), and after 3 months in 11 (7%) patients. The CSDH was recurred in 18 (12%) patients. Late resolution or recurrence was more common in the aged. The recurrent hematoma was seen on the same side in 11 patients, on the different side in 7 patients. Recurrence was significantly more common in the thick hematomas. CONCLUSION: For a working criteria of the recurrence of CSDH, we propose the early recurrence as return of symptoms or reaccumulation of the hematoma after a surgery within 3 months regardless of the location, amount or repeated operations. The late recurrence can be defined as reappearance or enlargement of a liquefied hematoma within the cranial cavity surrounded by the membranes or persistent CSDH beyond 3 months after surgery.
Aged ; Craniocerebral Trauma ; Hematoma ; Hematoma, Subdural, Chronic ; Humans ; Medical Records ; Membranes ; Recurrence ; Retrospective Studies ; Risk Factors

No abstract available.
Pregnancy*

A coronary artery aneurysm is an uncommon anomalous disease, defined as a coronary dilatation that exceeds the diameter of normal adjacent segments or the diameter of the patient's largest coronary vessel by 1.5 times. They are usually asymptomatic and diagnosed incidentally by coronary angiography. However, they may also cause angina, myocardial infarction, sudden cardiac death due to thrombosis, embolization or rupture. This report describes one case of a huge coronary artery aneurysm with total occlusion of the left anterior descending artery, resulting in a non ST elevation myocardial infarction, which was treated with bypass graft surgery and excision of the coronary artery aneurysm.
Aneurysm* ; Arteries ; Coronary Aneurysm ; Coronary Angiography ; Coronary Vessels* ; Death, Sudden, Cardiac ; Dilatation ; Myocardial Infarction* ; Rupture ; Thrombosis ; Transplants

Leukemic infiltration of the penis is an extremely rare entity. A case involving the penile shaft is described, and the relevant evaluation and treatment are discussed. Only 3 other documented cases of penile leukemia have been found in the literature. The identification and treatment of the underlying etiology are important aspects with this unusual disease entity.
Leukemia ; Leukemic Infiltration* ; Male ; Penis*

BACKGROUND: Liver ischemia-reperfusion injury is one of the major problems in liver transplantation and radical liver surgery. Ischemia-reperfusion injury is known to be induced by oxygen free radicals and the cell damages used to result in cell necrosis. However, apoptosis, another type of cell death, may be also related to the ischemia-reperfusion injury and hepatic dysfunction after ischemia-reperfusion injury may also be associated with the apoptosis. We examined the correlation between ischemiareperfusion injury and apoptosis in rat liver by apoptosis morphological study. METHODS: Male Sprague-Dawley rats were used. For each rats, 60 minutes partial clamp was applied to the hepatic artery and portal vein. Then, 5 groups which had 4 rats each were divided on the base of reperfusion injury duration of 0, 1, 3, 6, 24 hour (total numbers of rat were 20). For each rat, the central lobe which was given ischemic injury (ischemic groups) and the lateral lobe which was not given ischemic injury (control groups) were sampled after 60 minutes ischemia time. Apoptosis was examined by the method of TdT-mediated dUTP-biotin nick end labeling (TUNEL) assay. Counter staining was H&E staining and under the light microscopy with x60 and x300 magnification, apoptotic cell were examined. RESULTS: The groups of apoptotic cells were observed in 24hr reperfusion group. In 24 hr groups, besides conglomeration of apoptotic cells destructed hepatocyte cytoplasms were also observed. In all of the non-ischemic control group, no apoptosis was observed. Although the early reperfusion groups had not so much apoptotic cells as 24 hour group, the number of apoptotic cells in 0, 1, 3, 6 was significantly increased compared with the control groups. CONCLUSION: Apoptosis activity may be increased during reperfusion period with the maximum in 24 hour. This meant that apoptosis in ischemia-reperfusion injury might be associated with the chronic damage to hepatocyte and it might be the one of the causes of fibrosis or cirrhosis mechanism.
Animals ; Apoptosis* ; Cell Death ; Cytoplasm ; Fibrosis ; Free Radicals ; Hepatic Artery ; Hepatocytes ; Humans ; Ischemia ; Liver Transplantation ; Liver* ; Male ; Microscopy ; Necrosis ; Oxygen ; Portal Vein ; Rats* ; Rats, Sprague-Dawley ; Reperfusion ; Reperfusion Injury*

Sinus of Valsalva aneurysm is postulated to arise from a developmental weakness in the distal bulbar septum by Abbott in 1919. Additionally, properly shaped sinuses will allow stress sharing with the leaflets. The sinus of Valsalva aneurysm is combined with valvular aneurysm is very rare. This anomaly is a very rare and can be confirmed by echocardiography, angiography and operative finding. Clinically, patients complain with the symptom, but surgical approach including aneurysmectomy with patch repain for the tissue defect is recommend to abolish fatal outcome due to intracardiac or extracardiac rupture of aneurysm and fatal deterioration of valvular heart disease. A 48-year-old man presented mild dyspnea and was diagnosed of having a noncoronary cusp and sinus of Valsalva aneurysm by echocardiography. He underwent prosthetic aortic valve replacement and vessel repair with patch of pericardial membrane.
Aneurysm* ; Angiography ; Aortic Valve* ; Dyspnea ; Echocardiography ; Fatal Outcome ; Heart Valve Diseases ; Humans ; Membranes ; Middle Aged ; Rupture ; Sinus of Valsalva*