OBJECTIVE: Alterations in the immune system occur with aging, and these contribute to an increased risk of infection and malignancy. The age-associated changes in T cell immunity range from single cell function to the maintenance of cell populations. We investigated the kinetics of CD4+ T cell activation and proliferation in young and elderly subjects after stimulating their peripheral blood mononuclear cells with anti-CD3 and anti-CD28 antibodies (Abs). METHODS: The expressions of the activation markers CD69, CD40L and CD25 on the CD4+ T cells from young (n=14) and elderly (n=19) were analyzed at 6, 24 and 48 hours (hrs) of T cell receptor (TCR) stimulation by using flow cytometry. In the same individuals, the CD4+ T cell proliferation was determined at 48 and 96 hrs of TCR stimulation by using the CFSE dilution method. RESULTS: The elderly had decreased CD69 and CD40L expressions on the CD4+ T cells at 6 hrs of stimulation, as compared to that of the young patients. The elderly also had a decreased CD25 expression on the CD4+ T cells at 24 hrs of stimulation. However, the two groups had similar levels of the CD25, CD69 and CD40L expressions at 48 hrs of stimulation. The elderly had decreased CD4+ T cell proliferation at 96 hrs of stimulation, as compared to that of the young, although both groups had similar levels of CD4+ T cell proliferation at 48 hrs of stimulation. CONCLUSION: Our findings suggest that the elderly have altered kinetics of CD4+ T cell activation and proliferation in response to anti-CD3 and -CD28 Ab stimulation, and that such an altered response is governed by the duration of stimulation.
Aged ; Aging ; Antibodies ; CD40 Ligand ; Cell Proliferation ; Flow Cytometry ; Fluoresceins ; Humans ; Immune System ; Kinetics ; Receptors, Antigen, T-Cell ; Succinimides ; T-Lymphocytes

PURPOSE: The population of end-stage renal failure patients dependent on hemodialysis continues to expand with an increasing number of patients having an unsuitable cephalic vein or failed radio- and brachio-cephalic fistula. In these patients, the transposed basilic vein to brachial artery arteriovenous fistula (BaVT) provides autologous choice for hemodialysis. The results of basilic vein transposition arteriovenous fistula were assessed. MATERIALS AND METHODS: Three hundred cases of BaVT performed at a single center during the period of January 2005 to December 2011 were reviewed retrospectively. Data including demographics and postoperative complications were collected. Primary and secondary patency rates were determined by using Kaplan-Meier methods. RESULTS: The median age of patients was 57.4±13.1 years, and 154 patients were male. Renal failure was associated with hypertension in 88.7%, and with diabetes in 34.0%. The mean follow-up was 27.4±20.0 (12 to 72) months. There was no operation-related death. Eighteen patients required prosthetic graft interposition because of short vein. Thirty-five postoperative complications developed in 41 patients (148 cases), including thrombosis, stenosis, hematoma, seroma, arm swelling, steal syndrome, infection and aneurysm formation. Primary patency of BaVT was 69%, 60%, 53%, 52%, 44%, and 22% at 1, 2, 3, 4, 5, and 6 years, respectively. Secondary patency was 99%, 97%, 97%, 97%, 95%, and 95%, respectively. CONCLUSION: Chronic renal failure patients with hemodialysis may benefit from BaVT, because of high patency, less radiologic procedure, and less infection rate. The BaVT fistula should be used in preference to polytetrafluoroethylene grafts for secondary access.
Aneurysm ; Arm* ; Arteriovenous Fistula ; Brachial Artery ; Constriction, Pathologic ; Demography ; Fistula ; Follow-Up Studies ; Hematoma ; Humans ; Hypertension ; Kidney Failure, Chronic ; Male ; Ocimum basilicum* ; Polytetrafluoroethylene ; Postoperative Complications ; Renal Dialysis* ; Renal Insufficiency ; Retrospective Studies ; Seroma ; Thrombosis ; Transplants ; Veins*

Cerebral palsy is a non-progressive disorder resulting from central nervous system damage caused by multiple factors. Almost all cerebral palsy patients have a movement disorder that makes dental treatment difficult. Oral hygiene management is difficult and the risks for periodontitis, dental caries and loss of multiple teeth are high. Placement of dental implants for multiple missing teeth in cerebral palsy patients needs multiple rounds of general anesthesia, and the prognosis is poor despite the expense. Therefore, making the decision to perform multiple dental implant treatments on cerebral palsy patients is difficult. A 33-year-old female patient with cerebral palsy and mental retardation was scheduled for multiple implant treatments. She underwent computed tomography (CT) under sedation and the operation of nine dental implants under general anesthesia. Implant-supported fixed prosthesis treatment was completed. During follow-up, she had the anterior incisors extracted and underwent the surgery of 3 additional dental implants, completing the prosthetic treatment. Although oral parafunctions existed due to cerebral palsy, no implant failure was observed 9 years after the first implant surgery.
Adult ; Anesthesia, General* ; Central Nervous System ; Cerebral Palsy* ; Dental Caries ; Dental Implants* ; Disabled Persons ; Female ; Follow-Up Studies ; Humans ; Incisor ; Intellectual Disability* ; Movement Disorders ; Oral Hygiene ; Periodontitis ; Prognosis* ; Prostheses and Implants ; Tooth

Popliteal artery injury in blunt trauma of knee joint is not common but poses high rate of amputation due to anatomical characteristics or delayed diagnosis and treatment. The aim of the present study is to review the authors' experiences with this condition and identify factors contributing to disability. We reviewed 7 cases of popliteal artery injury in trauma around knee. Injury mechanism, type of vessel damage, associated injuries, mangled extremity severity scores (MESS), ischemic time and additional treatments were analyzed. Tibial fracture, distal femoral fracture and serious soft tissue defect were combined. Mean MESS was 9.9 point and mean time of revascularization was 7.1 hours. Transfemoral amputation was performed in 2 cases due to vascular insufficiency and devastating infection, and 4 patients were able to walk without any support at the last follow up. Age, the severity of soft tissue injury, ischemic time and MESS are thought to be related to prognosis, and young patients with short ischemic time show best results, but authors experienced one exceptional case. We have to consider multiple factors related to the prognosis in popliteal artery injury with fractures around knee, and careful decision is needed regarding to early amputation.
Amputation ; Delayed Diagnosis ; Extremities ; Femoral Fractures ; Follow-Up Studies ; Glycosaminoglycans ; Humans ; Knee ; Knee Joint ; Popliteal Artery ; Prognosis ; Soft Tissue Injuries ; Tibial Fractures

Though diagnosis of myelopathy can be easily made by history and neurological examination, modern technologies, such as MRI and evoked potential study (EPS), have played an important role in making the anatomical and pathological diagnosis of myelopathy. To assess the accuracy of clinical diagnosis and the role of the laboratory studies, we prospectively studied 26 patients with myelopathy, admitted to S.N.U.H. We tried to decide, by clinical history and examination, the anatomical location and the pathological diagnosis, and compared them with final diagnosis. 1. The final diagnosis could be made in 23 out of 26 patients. 2. Of 17 patients with the initial clinical diagnosis of intramedullary lesion (IML), two patients turned out to have extramedullary lesions (EML). Final diagnosis could not be made in three patients, and imaging studies and EPS didn't reveal definite local lesions. In another group of nine patients with the initial clinical diagnosis of EML, three patients had IML. 3. The clinically suspected levels of lesions were shown to be accurate within one level in 20 out of 26 patients after MRI. 4. Clinical diagnosis was accurate in 18 out of 26 patients. 5. Among the laboratory tests, MRI helped localize the lesions and make the final diagnosis. EPS was most helpful in making a diagnosis of multiple sclerosis by finding out asymptomatic second lesions. Even with thorough work-up the etiologies of myelopathy in three patients could not be elucidated. 6. Review of wrong diagnosis showed that diagnostic errors were attributed to incomplete history taking or examination, misinterpretation of clinical data, and unusual presentations or unsuspected rare diseases. Therefore, the authors conclude that the physician's clinical examinations in the diagnosis of neurologic diseases are still valuable despite the technology of the laboratory studies is developing further in present days.
Diagnosis ; Diagnostic Errors ; Evoked Potentials ; Humans ; Magnetic Resonance Imaging ; Multiple Sclerosis ; Neurologic Examination* ; Prospective Studies ; Rare Diseases ; Spinal Cord Diseases