In patient with renal failure, hypoglycemia may develop because of decreased caloric intake, diminished renal insulin degradation and clearance, reduced renal gluconeogenesis and hepatic glucose production, impaired release of counter-regulatory hormone such as glucagon and epinephrine. We report here on a 80-year-old female patient with hypoglycemia due to endogenous hyperinsulinemia with acute kidney injury. She had chronic kidney disease and had no history of diabetes mellitus or insulin use. She had experienced recurrent hypoglycemia despite of intravenous dextrose injection and eventually generalized tonic clonic seizure occurred as a result of hypoglycemia. As serum creatinine level decreases, serum insulin and C-peptide level decreased and hypoglycemia was not occurred. We present this case along with a review of the literature.
Acute Kidney Injury ; Aged, 80 and over ; C-Peptide ; Creatinine ; Diabetes Mellitus ; Energy Intake ; Epinephrine ; Female ; Glucagon ; Gluconeogenesis ; Glucose ; Humans ; Hyperinsulinism ; Hypoglycemia* ; Insulin ; Renal Insufficiency ; Renal Insufficiency, Chronic ; Seizures

BACKGROUND: There are two variations in the attention subitem of the Mini-Mental State Exam (MMSE): 'serial 7's subtraction and "sam-chun-ri-gang-san" backward. At a scale of one to five, they can be used interchangeably, which inevitably brings a considerable difference in results. Thus, we compared the scores of the 'serial 7's subtraction' and the "sam-chun-ri-gang-san" backward and analyzed the influence of sociodemographic factors on the differences. METHODS: We administered the Korean MMSE including the two types of attention item: serial 7's and "sam-chun-rigang-san" backward to 239 community-dwelling elderly people aged 65 or older in Kyung Hee University Medical Center and four Seoul senior centers and analyzed the difference from June 2012 to July 2012. RESULTS: The score for "sam-chun-ri-gang-san" backward (2.5+/-2.1) was lower than that of the serial 7's (3.4+/-1.7) by a mean point of 0.9+/-1.9. The score of "sam-chun-ri-gang-san" backward was zero in 31.4% of the subjects. However, only 9.6% scored zero on the serial 7's. The ratio of the same scores between two tasks was 36.0%. Education was the primary source of variance on difference score, followed by the number of family. There was no significant effect of age or gender when the score of difference was analyzed by multiple regression. CONCLUSION: In this study, subjects tended to outperform the serial 7's in general. Upon administering "sam-chun-rigang-san" backward instead of serial 7's due to the preference of the patient, we should take into account that the score of "sam-chun-ri-gang-san" backward was 0.9 point (mean value) lower than serial 7's to ensure appropriate interpretation of MMSE score.
Academic Medical Centers ; Aged ; Education ; Humans ; Senior Centers ; Seoul

BACKGROUND: In this study, we identified the cutoff value for the percentage in body fat related to metabolic syndrome in elderly people with normal body mass index (BMI). We also found the correlation between body fat percentage and metabolic syndrome. METHODS: We used data from the Korean National Health and Nutrition Examination Survey conducted from 2008 to 2011. Our subjects were elderly people aged 65 or above, with BMI less than 23.0 kg/m2. We determined the cutoff value for body fat percentage through receiver operating characteristic analysis. RESULTS: The cutoff value for percentage body fat related to metabolic syndrome was 19.5% for men (sensitivity 68.0%, specificity 62.9%) and 30.0% for women (sensitivity 55.1%, specificity 62.0%). Based on the cutoff value, 43.3% in men and 43.1% in women were classified into the high body fat percentage group. After adjusting for age, smoking status, alcohol consumption, and exercise status, the men with higher than normal body fat percentage had an odds ratio of 3.61 (95% confidence interval [CI], 2.10-6.22; p<0.001) for developing metabolic syndrome, whereas women had an odds ratio of 1.95 (95% CI, 1.30-2.92; p<0.001). CONCLUSION: The cutoff value for body fat percentage related to metabolic syndrome was lower in elderly. In the elderly with normal body mass index, high percentage of body fat percentage was associated with a high risk of metabolic syndrome.
Adipose Tissue* ; Aged* ; Alcohol Drinking ; Body Mass Index ; Female ; Humans ; Ideal Body Weight* ; Male ; Nutrition Surveys ; Obesity ; Odds Ratio ; ROC Curve ; Sensitivity and Specificity ; Smoke ; Smoking

BACKGROUND: The number of elderly patients undergoing surgery is steadily growing. Therefore, this study was designed to determine the prevalence and predictors of postoperative complications in patients older than 80 years. METHODS: The medical records of 532 patients above 80 years in age who underwent elective or emergent noncardiac surgery between June 2011 and May 2013 were reviewed retrospectively. Preoperative concomitant disease, operation site, anesthetic technique, and postoperative complications were analyzed. RESULTS: A total of 81.4% of the patients had pre-existing concomitant diseases, while 22.9% had severe systemic diseases. The incidence of severe complications within the first month after operation was 4.1%, and the in-hospital mortality rate was 1.3%. Among the severe postoperative complications, respiratory and cardiovascular complications were commonly observed. In multivariate logistic regression analysis, the predictors of postoperative severe complications included American Society of Anesthesiologists physical status classification of 3 or greater (odds ratio [OR], 5.271; 95% confidence interval [CI], 2.019-13.758; p=0.001), neurosurgery (OR, 23.132; 95% CI, 2.528-211.707; p=0.005) and duration of operation (OR, 1.006; 95% CI, 1.001-1.012; p=0.027). CONCLUSION: Proper preoperative evaluation and appropriate treatment for age-related concomitant diseases are suggested for patients older than 80 years in order to reduce postoperative complications. After operation, the respiratory and cardiovascular systems should be carefully monitored.
Aged ; Anesthesia ; Cardiovascular System ; Classification ; Hospital Mortality ; Humans ; Incidence ; Intraoperative Complications ; Logistic Models ; Medical Records ; Neurosurgery ; Postoperative Complications* ; Prevalence* ; Retrospective Studies

Sarcopenia has been defined as the considerable loss of skeletal muscle mass and strength that results in frailty in the elderly. Because muscle tissue plays diverse important roles in human, sarcopenia presents many negative health-related consequences including impaired energy homeostasis, falls and cardiovascular disease, and subsequently higher mortality. It is becoming evident that sarcopenia has a negative impact on the healthy life of the elderly. The European Working Group on Sarcopenia, the International Working Group on Sarcopenia and the Asian Working Group on Sarcopenia have released position statement regarding sarcopenia, and more recently the Foundation for the National Institutes of Health Sarcopenia Project has provided a new guideline for assessment of sarcopenia. At this time, there have been several data delineating the status of sarcopenia in Korea. This review focuses on largescale cohorts that assessed sarcopenia and highlights the controversies surrounding the clinical definition and prevalence of sarcopenia in Korea.
Aged ; Asian Continental Ancestry Group ; Cardiovascular Diseases ; Cohort Studies ; Homeostasis ; Humans ; Korea ; Mortality ; Muscle, Skeletal ; National Institutes of Health (U.S.) ; Prevalence* ; Sarcopenia*

BACKGROUND: According as old aged people have an increased interest in early detection of disease and health promotion, old aged people who take health examinations are increased. So this study is aimed to survey common problems about geriatric health in community and their frequency by way of investigation on diagnosis in health examination data and to evaluate the effects of health risk factors on each disease patterns. METHODS: The medical records of the clients who have taken health examinations for the first time from March 1995 to February 2000 at a health examination center of a university hospital in Seoul were reviewed. The category and number of judged diagnosis, sociodemographic factors are compared and analyzed. RESULTS: The selected medical records accounted to 22,393. The study subjects consist of 11,544(51.6%) male. Mean age is 52.0+/-10.5 years(range 16~90). 65 years or more old aged people of them are 2,612(11.7%), the number of judged diagnosis per one old person is 4.84+/-2.22(range 0~9) and young people took less diagnosis is 35.7%, functional diagnosis is 7.9%. The common diagnoses are liver disease(7.07%), decreased physical strength(6.68%), hyperlipidemin(6.53%),obesity(5.90%), osteoporosis or postmenopausal syndrome(4.72%), need for immunization against viral hepatitis(4.69%), hypertension(4.20%) functional gastrointestinal disease(3.93%). The number of total diagnosis and organic diagnosis is larger in older age, no exercise, female,smoker, no-spouse, lower education(p<0.05). The number of other diagnosis is larger in no exercise, smoker, female, younger age(p<0.05). CONCLUSION: According to health examination, total diagnosis and organic diagnosis are more in old aged group than in young. Functioinal diagnosis and other diagnosis is less in old aged group than in young.
Diagnosis* ; Early Diagnosis ; Female ; Health Promotion ; Humans ; Immunization ; Liver ; Male ; Medical Records ; Osteoporosis ; Risk Factors ; Seoul

BACKGROUND: The elderly ex-smokers are not free from the effect of previously exposed smoking, and have a tendency to participate in health promoting behavior eagerly. This study was designed to evaluate factors that affect pulmonary function in the elderly ex-smokers. METHODS: The ex-smokers with normal chest radiological findings who visited Seoul National University Hospital Health Promotion Center were analyzed. The effect of various factors including age, height, smoking amount, and duration of smoking cessation on pulmonary function indices were analyzed with bivariate correlation analysis. Multiple regression analysis was performed using factors indentified significant in bivariate correlation tests. RESULTS: Multiple regression analyses were done for the all age group and the elderly group. Factors significantly affecting Forced vital capacity(FVC) were height,age and duration of smoking cessation for both grroups. Smoking amount was not significant. Forced expiratory volume in 1 second(FEV1) was significantly influenced by height, age, duration of smoking cessation, and smoking amount for both group. In the all age group, peak expiratory flow(PEF) was siginificantly influenced by age, regular exercise, and duration of smoking cessation. In the elderly group, PEF was significantly affected by height, age, regular exercise, and duration of smoking cessation. The factors significantly affectiong FEV1/FVC were age, smoking amount in the all age group, and regular exercise, smoking amount in the elderly group. CONCLUSION: Smoking amount was a significant factor decreasing FEV1 in the elderly ex-smoker. Duration of smoking cessation was significant in normalization of pulmonary function indices in both the all age group and the elderly group. It is inferred that smoking cessation is beneficial in reversing the adver sely affected pulmonary function indices even in the elderly.
Aged* ; Forced Expiratory Volume ; Health Promotion ; Humans ; Seoul ; Smoke ; Smoking ; Smoking Cessation ; Thorax

BACKGROUND: To evaluate usefulness of cerebrospinal aspartate aminotransferase(AST) as a biologic marker for differentiation of Alzheimer's disease(AD) and Vascular dementia(VD) METHODS: A consecutive series of patients who met either the criteria of the National Institute of Neurological Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association(NINCDSADRDA) for probable AD or National Institute of Neurological Disorders and Stroke and the Association Internationale pour la Recherche et l'Enseignement en Neurosciences(NINDS-AIREN) criteria for porbable VD were included in the study. Enzymatic determinations in cere brospinal fluid of aspartate aminotransferase in cerebrospinal fluid of aspartate aminotransferase and serologic analysis of apolipoprotein E were performed in 17 patients with AD and in 15 patients with VD. And we compared CSF AST of AD with that of VD. RESULTS: We found no difference of CSF AST concentration between patients with Alzheimer's disease and vascular dementia. Cerebrospinal AST activity also did not correlate with K-MMSE score, serum AST activity, Functional inde-pence measure(FIM) as a ADL(Activity of daily living), and presence of Apolipoprotein E4 allele in AD. Only serum AST of VD shows correlation with CSF AST. CONCLUSION: These findings suggest that cerebrospinal AST concentration is not useful maker for differentiation between AD and VD.
Alleles ; Alzheimer Disease* ; Apolipoprotein E4 ; Apolipoproteins ; Aspartate Aminotransferases* ; Aspartic Acid* ; Biomarkers ; Cerebrospinal Fluid* ; Dementia, Vascular* ; Humans ; National Institute of Neurological Disorders and Stroke

BACKGROUND: Drug-induced Parkinsonism(DIP) is the second commonest cause of Parkinsonism, after idiopathic Parkinson's disease(IPD). DIP is frequently produced by antipsychotic drugs. But the clinical characteristics of DIP did not get attention by neurologist. So we studied the clinical profiles of DIP patients. METHODS: We studied the clinical profiles of thirthone patients who showed parkinsonism after antipsychotic drug treatment. We compared the score of motor part of the Unified Parkinson's Disease Rating Scale(UPDRS) between trihexyphenidyl(n=15) & amantadine(n=16) monotherapy group(initial & 4 week after treatment). RESULTS: The mean age of patients was 45 years. Bradykinesia was the 1st symptom in 26 patients(94%), tremor in 5 patients(6%). In 25 patients(81%), the first symptom appeared within 1 week after sntipsychotic treatment. There was a statistical significant negative correlation between the dosage of antipsychotic drug and the symptom-onset interval following treatment with antipsychotic drugs(simple correlation analysis, p>0.01). Bradykinesia and rigidity were appeared in all DIP patients, symmetric distribution was more common(94%, 87%) Tremor occurred in 27 patients (87%). In patients with tremor, postural or action tremor was dominant in 15 patients(56%) asymmetric distribution was more common(16/27, 59%). There are no statistical difference in motor score of UPDRS between trihexyphenidyl & amantadine monotherapy group(student t-test, p<0.05) CONCLUSIONS: Bradykinesia was the most common 1st symptom in DIP patients. Asymmertrical postural or action tremor was relativelly common in DIP. Amantadine showed the same efficacy in the treatment of DIP compared to anticholinergics.
Amantadine ; Antipsychotic Agents ; Cholinergic Antagonists ; Humans ; Hypokinesia ; Parkinson Disease ; Parkinsonian Disorders* ; Tremor ; Trihexyphenidyl

BACKGROUND: Vascular dementia is common cause of dementia, second to the dementia of Alzheimer desease. However in Asia and many developing countries, the incidence of vascular dementia exceeds that of Alzheimer's disease. Though many stroke-related factors related the nature of vascular injury, e.g. infarction and hemorrhage, have not assessed yet. Clarifying the difference of electroencephalograpy and clinical prognosis between infarction and hemorrhage, the aim of this study was to elucidate the role of nature of vascular injury. METHODS: to reduce confounding factors, the study population was restricted to the patients of single hemispheric striatocapsular infarction and hemorrhage saving cortex. On admission, we checked the KMMSE and FIM scores and using quantified EEG, we analyzed occipital peak frequency and the relative background alpha, theta and delta spectra power taken from 16 derivations by averaging twenty-2 -sec epoch in infarction, hemorrhage patients and elderly controls. After 6 months follow up, we compare the MMSE, FIM score between infarction and hemorrhage group. RESULTS: 1) Compared with infarction group, hemorrhage groups had a significantly bilateral lower occipital peak freqauency and background bilateral alpha spectra power. 2) In hemorrhage group, there is lower tendency in K-MMSE after 6 month follow up compared to infarction group. CONCLUSION: This study suggests that hemorrhage show more bilateral electrophysiological dysfunction than infarction group and possible grave prognosis for vascular dementia compared to infarction group.
Aged ; Alzheimer Disease ; Asia ; Dementia ; Dementia, Vascular ; Developing Countries ; Electroencephalography* ; Follow-Up Studies ; Hemorrhage* ; Humans ; Incidence ; Infarction* ; Prognosis* ; Vascular System Injuries