Atrial fibrillation(AF) diagnosed by fibrillatory waves of atrial activity and an irregular ventricular response on ECG is a common arrhythmia associated with increased cardiovascular morbidity and mor- tality. The incidence of AF increases markedly with advancing age and the presence of congestive heart failure. Most patients with AF can be attributed to organic heart disease such as rheumatic, atherosclerotic and hypertensive heart disease. But there is an increasing awareness of so-called lone AF which has no underlying cardiac or metabolic abnormality. We report a case of paroxysmal AF developed just before the induction of anesthesia in a 73-year-old patient who had no history of cardiovascular disease.
Aged* ; Anesthesia ; Anesthesia, General* ; Arrhythmias, Cardiac ; Atrial Fibrillation* ; Cardiovascular Diseases ; Electrocardiography ; Heart Diseases ; Heart Failure ; Humans ; Incidence

BACKGROUND: This study was designed to investigate the relationship between psychiatric disease and systemic Internal Medical disease in psychiatric inpatients who were consulted to department of Internal Medicine and was directed to assess the physical problems and possible ways to resolve them in a closed psychiatric unit. METHOD: Through evaluation of medical records of 1549 inpatients who had consulted in department of internal medicine in Seoul National(mental) Hospital from January 1, 2002 to December 31, 2002. We classified the Physical illness according to ICD-9-CM and psychiatric disease according to DSM-IV RESULTS: The results were as follows: 1) In age and sex distribution, male was 64.4% and 45.9% of the subject was 4th and 5th decades. 2) The most systemic diagnosis were disease of respiratory system, disease of digestive system and endocrine system. 3) schizophrenia showed the highest rate in respiratory disease. Rate of digestive disease was the highest in alcohol use disorder. Disease of respiratory system and disease of digestive system were the most frequent in mood disorder 4) In 1st decade, Digestive system digease was the most frequent, others were respiratory system disease. 5) onset age of psychiatric disease was the oldest in circulatory disease. In genitourinary system disease, duration of psychiatric disease was the longest CONCLUSION: The clinical characteristics of psychiatric disease influenced to get systemic disease in psychiatric patients.
Age of Onset ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Digestive System ; Endocrine System ; Humans ; Inpatients* ; Internal Medicine ; International Classification of Diseases ; Male ; Medical Records ; Mood Disorders ; Respiratory System ; Schizophrenia ; Seoul ; Sex Distribution ; Urogenital System

BACKGROUND: Cerebral white matter lesions(WMLs), such as leukoaraiosis, may be related to damage from cerebral ischemia and may also be associated with the degenerative process. The apolipoprotein E (APOE) 4 allele is a risk factor for degenerative diseases, such as Alzheimer`s disease, and ischemic brain damage through acceleration of atherosclerosis. No study has been performed regarding WMLs and APOE genotype in Korea. We investigated the association between WMLs and APOE among Koreans. METHODS: Brain MRI was performed in 225 subjects(ages 61 to 85 years) without neuropsychiatric disease randomly selected from the Ansan Health Cohort Study. WMLs observed on 225 MRI scans were rated in terms of severity by 2 raters. All study subjects underwent APOE genotyping. RESULTS: WMLs were observed in 109(48.4%) of subjects. In the subjects with WMLs, the distribution of APOE genotypes was 0.9% for epsilon 2/epsilon 2, 11.0% for epsilon2/epsilon3, 1.8% for epsilon2/epsilon4, 61.5% for epsilon3/epsilon3, 22.9% for epsilon3/epsilon4, and 1.8% for epsilon4/epsilon4, respectively. The distribution of APOE genotypes did not differ between subjects with and without WMLs. CONCLUSION: These data suggest that there is no association between WMLs and APOE genotypes in Koreans.
Acceleration ; Alleles ; Apolipoproteins E ; Apolipoproteins* ; Atherosclerosis ; Brain ; Brain Ischemia ; Cohort Studies ; Genotype ; Gyeonggi-do ; Korea ; Leukoaraiosis ; Magnetic Resonance Imaging ; Risk Factors

BACKGROUNDS: Peripheral neuropathy secondary to diabetes mellitus is believed to cause postural insta- bility which is associated with an increased risk of falling. Posturography enables early detection of postural control failure. This study is to evaluate the relationship between postural sway assessed by a computerized dynamic posturography and peripheral neuropathy in diabetic patients who have not develo- ped clinical symptom of unsteadiness. METHODS: Computerized dynamic posturography and electrophysiological tests were performed in the following age-matched subjects: 40 type 2 diabetic patients without peripheral neuropathy, 30 type 2 dia- betic patients with peripheral neuropathy, and 30 healthy control subjects. Patients had no symptoms or clinical evidence of postural instability. RESULTS: Sensory organization test showed significant dysfunction of somatosensory function of type 2 diabetic patients with peripheral neuropathy. Posturographic parameters were all significantly impaired in the patients with peripheral neuropathy. There were no significant differences in posturographic parameters between diabetic patients without neuropathy and the healthy control subjects. Posturographic parameters showed a direct relationship with some parameters of peripheral nerve conduction. CONCLUSION: Computerized dynamic posturography showed that Type 2 diabetic patients with peripheral neuropathy have greater postural instability than those without neuropathy. A strong correlation of insta- bility with peripheral neuropathy is present in diabetic patients. This result implies that peripheral neuro- pathy plays an essential role in the instability in type 2 diabetic patients. Posturographic study allows a disclosure of the failure of postural control even in the absence of clinical evidence of postural instability.
Diabetes Mellitus ; Diabetic Neuropathies ; Disclosure ; Humans ; Peripheral Nerves ; Peripheral Nervous System Diseases*

BACKGROUNDS: A stroke is a disease of the nervous system which is accompanied by important chronic disabilities and emotional disorders. These disabilities causes loss of sensation(diminished basic movement). METHODS: Sensation rehabilitation therapy through Activities of Daily Living(ADL) Training is necessary. Reports show that patients who receive occupational therapy in the early stages have an extremely high rate of recovery in the early stages. It is important for a occupational therapist to provide continued reha- bilitative treatment to, enable the patient to accomplish Activities of Daily Living Training independently by treating everything from sustaining posture in bed to normal movement and improvement in sensory perception. occupational therapy refers to the `use of self` of a occupational therapist to help the patient overcome difficulties and increase abilities of the patients by applying knowledge, skill, care and basic patient merits. RESULTS: A occupational therapist must have the basic knowledge, self-confidence and individual skills for a systematic program of therapy in order to be able to communicate with the patient and increase the effectiveness of the therapy. CONCLUSION: This study showed that therapy for patients who received therapy soon after diagnosis of stroke showed to be greatly effective. A deeper study must be done in order to increase effectiveness of occupational therapy methods such as the NDT(treatment to improve normal movement sensation) and SI method(treatment to increase sensitivity of perceptive movement and to give the ability to position objects according to shape and location).
Activities of Daily Living* ; Adult* ; Diagnosis ; Humans ; Nervous System ; Occupational Therapy ; Posture ; Rehabilitation ; Sensation ; Stroke*

BACKGROUNDS: As Korea has advanced into the aging society, Acute Coronary Syndrome is increased in number, especially elderly age group. The symptoms of acutecoronary syndrome in eldery were presented in atypical feature frequently. We studied the relation of the first symptom and diagnosis of acutecoronary syndrome and distribution of risk factor and coronary angiographic finding in elderly patient of korea society. METHODS: The subjects who were under went coronary angiography between 2002.5 and 2003.8 were dividedunder 65 years old group and over 65 years old group. And each group described diagnosis, risk factor, first symptom and coronary angiographic finding retrospectively. RESULTS: The diagnosis of unstable angina are more higher(46.5% vs. 26.1%, p<0.01) in the over 65 years old group and the first significant symptom of typical chest pain was more higher(57.4% vs. 47.6%, p<0.01) in the under 65 years old group and dyspnea was more higher(22.8% vs. 9.2%, p<0.01) in the over 65 years old group. The number of abnormal vessel were more higher(66.3% vs. 46.9%, p<0.01) in the over 65 years old group. CONCLUSION: Over 65 years old group compared with younger age group were prewented more frequently angina equivalent symptom than typical chest pain. And at the diagnosis of Acute Coronary Syndrome, over 65 years old group showed more severe coronary angiographic finding. Consequently, early stage of diagnostic approach and treatment need scrupulous attention in the elderly patients.
Acute Coronary Syndrome* ; Aged* ; Aging ; Angina, Unstable ; Chest Pain ; Coronary Angiography ; Diagnosis* ; Dyspnea ; Humans ; Korea* ; Retrospective Studies ; Risk Factors

BACKGROUND: Metabolic syndrome, a concurrence of disturbed glucose and insulin metabolism, over- weight and abdominal fat distribution, dyslipidemia and hypertension, is associated with subsequent de- velopment of type 2 diabetes mellitus and cardiovascular disease, especially coronary heart disease. The aim of the study is to assess the relationship between metabolic syndrome and coronary heart disease in elderly greater than 65 years old. METHODS: Eighty two elderly patients greater than 65 years old who underwent coronary angiography were divided into two groups with metabolic syndrome or without metabolic syndrome, and assessed the association with coronary angiographic finding. The metabolic syndrome factors and cardiovascular risk factors of JNC 7 were investigated to assess the relationship with coronary heart disease in elderly. Coronary heart disease was defined as 50% or greater diameter in stenosis of coronary artery in coronary angiography. RESULTS: In elderly patients with metabolic syndrome, coronary angiographically abnormal findings(p<0.05) and multi vessel disease findings(p<0.05) were presented significantly higher than non metabolic syndrome patients. In elderly patients with 3 and more cardiovascular risk factors of JNC 7, coronary angiographically abnormal findings(p<0.05) and multi vessel disease findings(p=0.059) were presented more than the other patients. Diabetes mellitus was related significantly with coronary heart disease(p value 0.044). CONCLUSION: In elderly patients, metabolic syndrome was significantly related with coronary heart disease and diabetes mellitus had strong relationship with coronary heart disease. Metabolic syndrome and cardiovascular risk factors of JNC 7 should be further evaluated to assess the relationship with coronary heart disease in the future.
Abdominal Fat ; Aged* ; Cardiovascular Diseases ; Constriction, Pathologic ; Coronary Angiography ; Coronary Disease* ; Coronary Vessels ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Dyslipidemias ; Glucose ; Heart ; Humans ; Hypertension ; Insulin ; Metabolism ; Risk Factors

BACKGROUND: Recently elderly people have increased in Korea and increased demands of medical service. This study was carried out to identify diseases and health service utilization patterns of geriatric inpatients to provide better understanding and basis planning to meet the needs of expanding geriatric population. METHOD: We use data of `Patient Survey in Korea` in 1999 and analyzed characteristics of disease structure and utilization patterns of health care service of 54,013 cases of discharged patients aged 65 years or more. RESULT: The proportion of the elderly in total discharged patients is 14.7%. Male to female ratio is 1:1.3 and most common age group was between 65 and 69 years old. 84.2% of elderly patients were admitted at secondary or tertiary health care facilities. The most common disease in geriatric inpatients is malig- nancy in male and vascular disease in female. The average duration of hospitalization is 14.2 days. They stay longer than the nation wide average hospital length and stay longest when they are admitted by mental and behavioral disorders. CONCLUSION: Geriatric patients are admitted mostly with chronic degenerative diseases such as neoplasm and vascular disease. Elders prefer to be admitted to tertiary hospitals and oriental hospitals. They stay more in hospital.
Aged ; Delivery of Health Care ; Female ; Health Services* ; Hospitalization ; Humans ; Inpatients* ; Korea ; Male ; Tertiary Care Centers ; Vascular Diseases

PURPOSE: Frailty is a wasting syndrome common in old age and to confer high risk for morbidity and mortality. There is a growing consensus of the definition of frailty, but until now the diagnostic criteria is not clear yet. In the older male patients, almost of studies about testosterone replacement therapy performed to normal healthy population. And also only few studies were performed to the frail elderly patients. So we would like to investigate the effficacy of testosterone supplementation in the frail elderly. METHODS: Since May to Sep 2001, ambulatory elderly patients who were 65 years and over were recruited in the outpatient clinic of Asan Medical Center. All of them showed the typical characteristics of frailty symptom-weight loss, loss of muscle mass, weakness, fatigability, anorexia, inactivity. The patients who have sleep-apnea or previous history of prostate cancer were excluded. All patients were checked the serum PSA, total testosterone level, routine CBC, lipid, liver function test and evaluated prostate status with US or digital rectal examination, and treated with oral formula testosterone unde- canoate 80 mg daily. All patients were surveyed with ADL, IADL before the testosterone therapy and 3month later. RESULTS: A total of 6 male frail patients(mean age: 80+/-8.5) were enrolled. During 3 month Follow-up period, one was expired, 5 were finished the study. Before the testosterone replacement, mean total testos- terone level was 3.0+/-0.5 ng/ml and mean PSA was 1.3+/-0.7 ng/ml. After 3 months, blood hematocrit, cholesterol, total testosterone were not changed significantly and the body weight also showed insig- nificant increase. But after 3 months, all of them reported the increased well-being sensation, improved fatigability, weakness and improved ADL level. There were no significant adverse effects associated with testosterone replacement. CONCLUSION: In male frail elderly patients, the testosterone replacement therapy can be used safely, and can be improve the frailty associated symptom and ADL ability.
Activities of Daily Living ; Aged ; Ambulatory Care Facilities ; Anorexia ; Body Weight ; Cholesterol ; Chungcheongnam-do ; Consensus ; Digital Rectal Examination ; Follow-Up Studies ; Frail Elderly* ; Hematocrit ; Humans ; Liver Function Tests ; Male ; Mortality ; Prostate ; Prostatic Neoplasms ; Sensation ; Testosterone* ; Wasting Syndrome

OBJECTIVES: To develop the Korean version of Disability Assessment for Dementia Scale(DAD-K), an instrument for functional disability for use with proxy-respondents of community-dwelling persons who have Alzheimer`s disease METHOD: Community-dwelling elderly and their caregivers with memory impairment(N=341) participated in this study to evaluate reliabilities and validities of DAD-K. RESULTS: The DAD-K demonstrated a high degree of internal consistency(Cronbach`s alpha=0.88) and excellent interrater(ICC=0.96) and test-retest(ICC=0.96) reliability and good concurrent validity. In addi- tion, it was found not to have age, education and gender bias. CONCLUSION: The DAD-K is valid and reliable instrument in Korean elderly with Alzheimer`s disease, that may help clinicians and caregivers of the population with Alzheimer`s disease make decisions regar- ding the choice of suitable interventions.
Aged ; Caregivers ; Dementia* ; Education ; Humans ; Memory ; Sexism