OBJECTIVES: Depression, sleep complaints and cognitive impairments are commonly observed in the elderly. Elderly subjects with depressive symptoms have been found to show both poor cognitive performances and sleep disturbances. However, the relationship between sleep complaints and cognitive dysfunction in elderly depression is not clear. The aim of this study is to identify the association between sleep disturbances and cognitive decline in late-life depression. METHODS: A total of 282 elderly people who underwent nocturnal polysomnography in a sleep laboratory were enrolled in the study. The Korean version of the Neuropsychological Assessment Battery developed by the Consortium to Establish a Registry for Alzheimer's Disease (CERAD-K) was applied to evaluate cognitive function. Depressive symptoms were assessed with the geriatric depression scale (GDS) and subjective sleep quality was measured using the Pittsburg sleep quality index (PSQI). RESULTS: The control group (GDS< or =9) when compared with mild (10< or =GDS< or =16) and severe (17< or =GDS) depression groups, had significantly different scores in the Trail making test part B (TMT-B), Benton visual retention test part A (BVRT-A), and Stroop color and word test (SCWT)(all tests p<0.05). The PSQI score, REM sleep duration, apnea-hypopnea index and oxygen desaturation index were significantly different across the three groups (all indices, p<0.05). A stepwise multiple regression model showed that educational level, age and GDS score were predictive for both TMT-B time (adjusted R2=35.6%, p<0.001) and BVRT-A score (adjusted R2=28.3%, p<0.001). SCWT score was predicted by educational level, age, apnea-hypopnea index (AHI) and GDS score (adjusted R2=20.6%, p<0.001). Poor sleep quality and sleep structure alterations observed in depression did not have any significant effects on cognitive deterioration. CONCLUSION: Older adults with depressive symptoms showed mild sleep alterations and poor cognitive performances. However, we found no association between sleep disturbances (except sleep apnea) and cognitive difficulties in elderly subjects with depressive symptoms. It is possible that the impact of sleep disruptions on cognitive abilities was hindered by the confounding effect of age, education and depressive symptoms.
Adult* ; Aged ; Alzheimer Disease ; Depression* ; Education ; Humans ; Oxygen ; Polysomnography ; Sleep, REM ; Trail Making Test

After dual plating with a locking compression plate for comminuted intraarticular fractures of the distal humerus, the incidence of ulnar nerve injury after surgery has been reported to be up to 38%. This can be reduced by an anterior transposition of the ulnar nerve but some surgeons believe that extensive handling of the nerve with transposition can increase the risk of an ulnar nerve dysfunction. This paper reports ulnar nerve injuries caused by the incomplete insertion of a screw head in dual plating without an anterior ulnar nerve transposition for AO/OTA type C2 distal humerus fractures. When an anatomical locking plate is applied to a distal humeral fracture, locking screws around the ulnar nerve should be inserted fully without protrusion of the screw because an incompletely inserted screw can cause irritation or injury to the ulnar nerve because the screw head in the locking system usually has a slightly sharp edge because screw head has threads. If the change in insertion angle and resulting protruded head of the screw are unavoidable for firm fixation of fracture, the anterior transposition of the ulnar nerve is recommended over a soft tissue shield.
Head* ; Humeral Fractures ; Humerus* ; Incidence ; Intra-Articular Fractures ; Surgeons ; Ulnar Nerve*

No abstract available.
Female ; Pregnancy ; Pregnancy in Adolescence*

Fractures of the acetabulum are relatively uncommon. But if fractures of the acetubulum are not accurately evaluated, classified, and reduced anatomically, major sequalae and complications are frequently developed. Because of complicated anatomy, difficulty with surgical exposure, severe comminution, and major associated injuries, the treatment of displaced acetabular fractures between conservative and operative methods is still controversial. We reviewed thirty five cases of displaced acetabular fracture treated operaively from January 1984 to December 1991. The prevalent age was the fourth decade. There was twenty seven cases of associated injuries, twenty two dislocations of the hip. According to the Letournel's classification, the most common fracture type was posterior wall and both column type. The fracture was fixed internally with only screws in thirteen cases and with plate and screws in twenty two cases. Among thirty five patients, five patients were lost in the follow up and another five patients had followed up lesser than one year. The mean duration of follow-up afrer the operation was three years (range, one to eight years). Among twenty five patients who had followed up more than one year, the satisfactory results were achieved in nineteen patients (76%) and the poor results were achieved in three patients (8%). The complications were post-traumatic arthritis, avascular necrosis of femoral head, osteomyelitis in iliac bone, skin necrosis, and heterotopic ossification.
Acetabulum ; Arthritis ; Classification ; Dislocations ; Follow-Up Studies ; Head ; Hip ; Humans ; Necrosis ; Ossification, Heterotopic ; Osteomyelitis ; Skin

A prospective study had been performed in infants with hydronephrosis due to ureteropelvic junction stenosis to determine adequate management plan. Forty infants (47 renal units) were selected for the study during the period from January 1995 to July 1997 in the Department of Pediatrics, Asan Medical Center. They were diagnosed prenatally or early postnatally (<3 months of age) on the basis of renal ultrasonography and techotium-99m-mercap- toacetyltriglycerine (MAG3) scan. The antero-poste- rior pelvic diameter (APPD) was measured from serial renal ultrasonography and relative renal function and clearance half time (T1/2) were calculated from serial MAG3 scan. Those who had accompanying other urogenital anomalies or vesicoureteral reflux were excluded in this study. Follow-up tests (ultrasonography and MAG3 scan) and surgical corrections, if necessary, were performed according to the predetermined algorithrn. The male to female ratio was 3: 1. Hydronephrosis was involved the left side in 24 renal units, the right side in 9 renal units, and the bilateral sides in 14 renal units. All the hydronephrotic renal units were divided into 2 groups; Group A (19 renal units) those had taken surgical correction, and group B (28 renal units) those revealed spontaneous improvement without surgical correction. The mean follow-up duration was 7.2+/-6.3 months in group A and 14.1+/-12.6 months in group B. The mean APPD in the first postnatal renal ultrasonography was 19.4+6.8 mm in group A and 10.0+/-3.0mm in group B and this was statistically significant (P<0.01). The rela- tive renal function of group A in the first MAG3 scan was under 35% in 7 renal units and over 35M in 12 renal units. In group B, the relative renal function was over 35% in the all 28 renal units. Tl/2 in the first MAG3 scan was longer than 20 minutes in the all 19 renal units in group A. In group B, Tl/2 was shorter than 10 minutes in 15 renal units, between 10 minutes and 20 minutes in 6 renal units, and longer than 20 rninutes in 7 renal units. The mean APPD of the 7 renal units in group B of which Tl/2 was longer than 20 minutes was 12.62.6mm and that of group A was 19.4+/-6.8mrn and this was statistically significant (P<0.01). In conclusion, the renal ultrasonography and MAG3 scan can be used effectively to determine the degree of the stenosis of the ureteropelvic junction in hydronephosis during infancy. When the babies are diagnosed with hydronephrosis due to ureteropelvic junction stenosis in the early infantile period, serial renal ultrasonography and MAG3 scan play an important role in the decision of the management.
Chungcheongnam-do ; Constriction, Pathologic ; Female ; Follow-Up Studies ; Humans ; Hydronephrosis* ; Infant ; Male ; Pediatrics ; Ultrasonography* ; Vesico-Ureteral Reflux

No abstract available.
Cerebrospinal Fluid* ; Immunoglobulin G* ; Meningitis, Aseptic*

No abstract available.
Irritable Bowel Syndrome* ; Mast Cells*

OBJECTIVES: REM sleep behavior disorder (RBD) has received little attention in epidemiologic studies. This study aimed to determine the prevalence of probable REM sleep behavior disorder (pRBD) in the elderly population and its clinical features. METHODS: A random sample of 1,588 was selected from a roster of 14,050 elderly population living in Osan city. The subjects were asked to fill out the REM sleep behavior disorder screening questionnaire (RBDSQ). Subjects whose score were 5 or higher on RBDSQ underwent a diagnostic phase of person-to-person assessment by experts in RBD. RESULTS: Among 1,588 subjects, 886 elderly subjects participated in the screening phase and 123 subjects were assessed in the diagnostic phase. Eleven subjects were diagnosed as having pRBD, so prevalence was 1.5% (95% CI=0.70-2.30%). The frequency of depression and cognitive decline was significantly increased in patients with pRBD compared to subjects without pRBD, and there was no difference in sleep disturbances between two groups. CONCLUSIONS: Probable REM sleep behavior disorder is not rare in the elderly but frequently under-recognized. More attention should be paid to evaluation and treatment of RBD.
Aged ; Depression ; Epidemiologic Studies ; Humans ; Mass Screening ; Prevalence ; Surveys and Questionnaires ; REM Sleep Behavior Disorder ; Sleep, REM

BACKGROUND: Generalized aggressive periodontitis (GAP) is a destructive periodontal disease that can develop in young age. Only a few cases of full mouth rehabilitation, using dental implants, have been reported in a patient with aggressive periodontitis. CASE DESCRIPTION: This clinical report describes the treatment procedures and results of full mouth rehabilitation in a patient with aggressive periodontitis. After all teeth were extracted, 6 implants were placed in the maxilla and mandible, respectively. Fixed detachable implant prostheses were made. The patient was satisfied with the final results. She was followed for 10 months postloading. CLINICAL IMPLICATION: For a long-term success, continuous maintenance care is critical, as the contributing factors of the disease (such as immune factors or periodontal pathogens) may not be controlled adequately.
Aggressive Periodontitis ; Dental Implants ; Humans ; Immunologic Factors ; Mandible ; Maxilla ; Mouth ; Mouth Rehabilitation ; Periodontal Diseases ; Prostheses and Implants ; Tooth

A 49-year-old man had a 5-year history of left proptisis accompanied by headache, ocular pain, ocular motility and visual disturbance. Corrected visual acuity was 1.0 in the right and 0.2 in the left eye. There was 9mm of left proptosis by Hertel exophthalmometry. A hard, nontender mass was palpable in the superotemporal part of the orbit. Lateral and up gaze were impaired in the left eye. On the slit lamp examination of the left eye, there were moderate corneal edema and erosions resulting from lagophthalmos. Computed axial tomgraphy showed a large ill-defined massi with homogenous enhancement in the superior temporal part of the left orbit. The mass was removed by modified Kronlein operation as much as possible and diagnosed as the adenoid cystic carcinoma of the lacrimal gland by the light microscopic examination. The tumor cell already extended to contiguous bone, blood vessel. perineurium and adjacent muscles. One month after the operation, 5040 rad of radiation therapy was given. The mass was remarkably decreased in size after radiation. We are planning further radiation therapy now.
Adenoids* ; Blood Vessels ; Carcinoma, Adenoid Cystic* ; Corneal Edema ; Exophthalmos ; Headache ; Humans ; Lacrimal Apparatus* ; Middle Aged ; Muscles ; Orbit ; Peripheral Nerves ; Visual Acuity