Rectus sheath hematoma, caused by rupture of epigastric vessel or muscle tear, is most frequently encountered in association with anticoagulation therapy, trauma, operation, and hematologic disorder. It rarely occurs spontaneously. Rectus sheath hematoma related to subcutaneous injection of insulin is very rare. We report a case of percutaneous catheterbased coil embolization for treatment of rectus sheath hematoma caused by subcutaneous injection of insulin on abdomen during anticoagulation and antiplatelet therapy in an 83-year-old thin woman with diabetes.
Abdomen ; Aged, 80 and over ; Embolization, Therapeutic ; Epigastric Arteries* ; Female ; Hematoma* ; Humans ; Injections, Subcutaneous ; Insulin* ; Rectus Abdominis ; Rupture

A 73-year-old woman who presented with chest discomfort visited the emergency room. The 12-lead electrocardiography showed ST-segment elevation in II, III, and lead augmented vector foot. Emergent coronary angiography revealed a thrombus in the distal right coronary artery. Percutaneous coronary angioplasty with a stent was performed. After the procedure, persistent dyspnea occurred. Her chest computed tomography (CT) showed occlusion of the bilateral pulmonary artery. We could not find a source for the embolization or a hypercoagulable state. We started a course of dual antiplatelets with oral anticoagulants. Pulmonary embolism was resolved at follow-up chest CT scan. Aspirin, clopidogrel and warfarin were given for 6 months. The patient is doing well now 1 year after the episode.
Aged* ; Angioplasty ; Anticoagulants ; Aspirin ; Coronary Angiography ; Coronary Vessels ; Dyspnea ; Electrocardiography ; Emergency Service, Hospital ; Female ; Fibrinolytic Agents ; Follow-Up Studies ; Foot ; Humans ; Myocardial Infarction* ; Percutaneous Coronary Intervention ; Pulmonary Artery ; Pulmonary Embolism* ; Stents ; Thorax ; Thrombosis ; Tomography, X-Ray Computed ; Warfarin

BACKGROUND: Although several investigators have been studying EMG activity in projected movment, a complete and satisfactory understanding of the EMG patterns is still lacking. This present study is an attempt to define these patterns for certain stereotyped movement in a normal population, and to investigate the electrophysiologic mechanisms of abnormal movements in extrapyramidal disorders. METHODS: 5 Patients with Parkinson's disease and 5 patients with cerebellar disease performed several different stereotyped elbow flexion tasks, and the EMG patterns from biceps and triceps were compared with control group. RESULTS: In patients with Parkinson's disease characterized, EMG pattern during a smooth felxion task was almost always abnormal and was chracterised by alternating activity in biceps and triceps. The EMG patterns during a fast flexion task were also usually abnormal although they were always composed of bursts of EMG activity of normal duration appearing alternately in the agonist and antagonist muscles. So, This study demonstrates that both slow and fast movement are clearly abnormal in these patients with diesase of the basal ganglia. In a task designed to investigate antagonist inhibition before agonist activity, a majority of the patients performed normally. CONCLUSIONS: This study suggest that, contrary to previous claims, slowness of movement is not due either to failure to relax or to rigidity of agtagonist muscles. In patients with cerebellar disease, EMG pattern during a fast flexion task showed prolongation of the initial biceps and/or triceps components, and it is suggested that this abnormality might be an elemental featrure of dysmetria. 3 of 5 patients showed the normal pattern of smooth felxion indicating that, with cerebellar deficits, smooth movements are better preserved than fast movements. The timing of the cessation of triceps activity before the initiation of biceps activity in an alternating movement was abnormal in 4 of 5 patients; this abnormality might be an elemental feature of dysdiadochokinesia.
Basal Ganglia Diseases ; Basal Ganglia* ; Cerebellar Ataxia ; Cerebellar Diseases ; Cerebellum ; Dyskinesias ; Elbow ; Humans ; Muscles ; Parkinson Disease ; Research Personnel

BACKGROUND: Glycemic profile has traditionally been with the use of HbAlc over a 2 to 4 month period. Recently, serum fructosamine is highly sensitive to acute metabolic deterioration(period 2 to 3 weeks), and is suitable for automation, allowing multiple assays with minimal effort. In some report, despite evidence suggesting a reduction in serum albumin level with increasing age, serum fructosamine was strongly correlated with HbAlc in elderly diabetic patients. This study was conducted to define the correlation between fructosamine and other parameters in elderly diabetic patients. METHODS: The study group consisted of 56 elderly patients(age range : 66-85 years, group A) and 58 adult patients(age range: 18-64 years, group B), who were stable over recent 2 months in fasting glucose values and serum albumin levels. Fructosamine was measured in 114 diabetic patients. The measured levels were related to HbAlc and fructosamine/albumin index(FAI). RESULTS: 1) There was significant correlation between HbAlc and fructosamine in all diabetic patients(r=0.705, p=0.0001). The correlation between HbAlc and fructosamine was stronger in group A than in group B [group A: r=0.831, group B: r=0.367, p=0.0001](p<0.05). 2) The correlation between HbAlc and FAI was significantly stronger compared to that between HbAlc and fructosamine in elderly diabetic patients(p<0.05). 3) Glycation ratio provides a vector-like insight into the recent trend of glycemia, and Glycation ratio was stable in all diabetic patients. CONCLUSIONS: Our study suggests that correlation between HbAlc and fructosamine in elderly daibetic patients was significantly lower in adult diabetic patients. Further studies are needed to determine the ultimate values of this test in the clinical management of elderly patient with diabetes.
Adult ; Aged* ; Automation ; Fasting ; Fructosamine* ; Glucose ; Humans ; Serum Albumin

OBJECTIVE: Author hypothesized that the presence of a chronic disease burden would change patients' use of health services. METHODS: This research used 4,020,172 medical payment requests(corrected for duplication) and a subset of 1,342,845 payment requests for chronic disease to analyze the pattern of health services utilization among the aged in Korea in 1991. Chronic disease was defined by ICD-9 codes as used in the US Health Services Interview Survey. Author traced the utilization of primary, secondary and tertiary facilities by diagnoses of patients. Thereafter author compared the utilization of health service by age groups, sex, and patterns of care in the chronically disabled. RESULTS: Our data showed that younger seniors are more likely to self refer to tertiary health care. Men are more likely to use tertiary care. On the other hand, women tend to use more primary care. Inpatient tertiary level service is strongly preferred over secondary or primary health services. Patients with chronically disabled had increased use of tertiary care facilities and more self-referrals for care. Secondary health service appeared to be under used. CONCLUSIONS: Comparing the results of utilization pathway of elder clients showed chronically disabled patients overutilize the health service and pursuit the multi-pathways. Especially, overused tertiary care by the elderly may play a part in overstraining of tertiary medical resources in Korea. Thus, there is a strong necessity to introduce long term care systems for the chronically disabled elderly in Korea.
Aged ; Chronic Disease ; Delivery of Health Care ; Diagnosis ; Female ; Hand ; Health Services* ; Humans ; Inpatients ; International Classification of Diseases ; Korea* ; Long-Term Care ; Male ; Primary Health Care ; Tertiary Healthcare

BACKGROUND: Vascular smooth muscle cells(VS-MCs) from diabetic animals proliferate more than that from non-diabetic ones. The proliferative ability of cultured VSMCs is changed by the kind of experimental animals, experimental technique and so on. In this study, I used VSMCs from streptozotocin-induced insulin dependent diabetic Sprague Dawley rats and examined the characteristics of aortic VSMCs proliferation from these rats. METHODS: Using enzyme method I cultured aortic VSMCs. I compared the proliferation between normal rat VSMCS and diabetic ones. I studied the cell growth of VSMCs from diabetic rats as a function of period after streptozotocin injection. I also examined the effects of hyperglycemia and insulin treatment on the proliferation of cultured VSMCs. RESULTS: Diabetic rats VSMCs proliferated more than non-diabetic ones in streptozotocin-induced insulin dependent diabetic rats. The proliferation of VSMCs was enhanced from 2 weeks after streptozotocin injection. Hyperglycemia enhanced the proliferation and insulin treatment lowered that. CONCLUSIONS: The proliferation of VSMCs was increased in streptozotocin-induced diabetic rats.
Animals ; Aorta* ; Hyperglycemia ; Insulin* ; Muscle, Smooth, Vascular* ; Rats* ; Rats, Sprague-Dawley ; Streptozocin

BACKGROUND: In this article, authors determine whether rectangularization of survival curve occurred in Korea in the period 1966-1995. Rectangularization is defined as a trend toward a more rectangular shape of the survival curve due to increased survival and concentration of deaths around the mean age of death. Authors distinguish between absolute and relative rectangularization, depending on whether an increase in life expectancy is accompanied by concentration of deaths into a smaller age interval or into a smaller proportion of total life expectancy. METHODS: In this study, the authors intended to demonstrate the survival curve according to the year 1966 and 1970 to 1995. For these purpose, the authors used the annual mortality data published by the National Statistical Office from 1966 to 1995 in Korea. Authors used measures of variability based on Keyfitz' H and the standard deviation, both life table-based. Our results show that absolute and relative rectangularization of the entire survival curve occured except mortality data of 1966 which has little reliability over the complete period. RESULTS: In this study, authors observed relative and absolute rectangularization and the survival curves of 1970 to 1995 shows the convergence between mid-60s and mid-80s. All the Keyfitz' H, NH, SD and CV decreased while the life expectancy increased in the period of 1970 to 1995. This result is similar to the mortality curve suggested by Fries according to his compression of morbidity hypothesis. CONCLUSIONS: According to Keyfitz theory, rectangularization happens to survival curve in Korea. The implications of the recent rectangularization at older ages for achieving compression of morbidity have to be exactly understood. So, the authors suggest that health policy and research must be directed to the preventive health service and health promotion to reduce morbidity, postpone infirmity and to warrant the quality of life for senior people.
Health Policy ; Health Promotion ; Korea* ; Life Expectancy ; Mortality ; Preventive Health Services ; Quality of Life

BACKGROUND: Most stroke-related deaths occur shortly after the onset of symptoms. Analysis of early deaths after stroke is important, since some deaths may be preventable. It also helps to improve the quality of stroke management. We investigated the early mortality and the causes of death in acute ischemic stroke patients. METHODS: We reviewed the medical records of six hundred fifty-one consecutive acute ischemic stroke patients who admitted to HLMC (Hallym University Medical Center) between January 1993 and December 1996. The 30-day mortality rate and the cause of death in each case were assessed. RESULTS: Fifty patients (mean age, 67.7 years, male : female=1 : 1.3) of total 651 patients (mean age, 65.4 years, male : female=1:0.78) died within 30 days (7.7%). Thirty-three (7%) patients of the 471 patients who had supratentorial lesion and sixteen (10.5%) of the 151 patients who had infratentorial lesion died within 30 days. The 30-day mortality rate according to each stroke subtype were 8.2% in large-artery atherosclerosis (n=21), 26.4% in cardioembolism (n=14), 1.2% in small-vessel occlusion (n=3), 33.3% in strokes with other determined etiology (n=1), 12.1% in strokes with undetermined etiology (n=11). Twenty-eight patients (56%) died due to direct stroke-related causes such as herniation, evolving stroke and massive hemorrhagic transformation. Twenty-two patients (44%) died from indirect stroke-complicated causes such as sepsis (n=7, 14%), heart disease (n=6, 12%), pneumonia (n=5, 10%), massive bleeding at tracheostomy site (n=1, 2%), pulmonary edema (n=1, 2%) and unknown cause (n=2, 4%). Forty patients (80%) died in the first 10 days and the main causes of death were herniation and evolving stroke. After the first 10 days, ten patients (20%) died of relative immobility (pneumonia, sepsis, pulmonary embolism). CONCLUSION: To reduce the early mortality within the first 10 days after the onset, aggressive control of IICP with the amelioration of brain edema must be emphasized. Whilst, to reduce the early mortality after the first 10 days, vigorous efforts to prevent and treat complications, such as pneumonia, pulmonary embolism and sepsis should be done.
Atherosclerosis ; Brain Edema ; Cause of Death* ; Cerebral Infarction ; Heart Diseases ; Hemorrhage ; Humans ; Male ; Medical Records ; Mortality* ; Pneumonia ; Pulmonary Edema ; Pulmonary Embolism ; Sepsis ; Stroke* ; Tracheostomy

BACKGROUND: Depression is prevalent and a serious disorder in the elderly that interferes with social and physical function. It is associated with significant morbidity and a high mortality rate from suicide. Depression is highly treatable disease, but it remain largely unrecognized and untreated among the elderly. This study evaluate the factors related to depression of elderly, to be used as basic reference for management program in the community. METHODS: The cross-sectional study evaluates the depression of community-living elderly, aged 60 and older, in a Korean rural community. The subject were selected from a two stage cluster sampling. Questionnaire contained demographics, Geriatric Depression Scale (GDS), Mini-Nutritional Assessment (MNA), Mini-Mental Status Exam-Korean (MMSE-K), IADL, Social support network. T-test and multiple stepwise regression were constructed to explore the factors related to depression. RESULTS: Mean age was 71.22+/-7.1 with 101 male subjects and 200 female subjects. The mean GDS score was 6.9+/-3.7 and 56.5% of subjects were suggested depression (above 5 point on GDS). The mean score from the GDS showed significant differences in terms of following factors: gender, age, education, marital status, income, expenditures, type of residency, cognitive function, presence of disease, number of medications, stress, subjective self perception of health, IADL, nutrition, emotional support, social activity support, instrumental support (p<0.05). In the multiple stepwise regression analysis on depression, nutrition, IADL, education, presence of disease were selected as highly correlated variables (p<0.05), and religion, cognitive function, subjective self perception of health, stress were also selected (p>0.05). These variables explained 34.2% of depression. CONCLUSION: Nutritional status, cognitive function, physical state, functional state, social support network demographic characteristics were related to depression in the elderly.
Aged* ; Cross-Sectional Studies ; Demography ; Depression* ; Education ; Female ; Health Expenditures ; Humans ; Internship and Residency ; Male ; Marital Status ; Mortality ; Nutritional Status ; Surveys and Questionnaires ; Rural Population* ; Self Concept ; Suicide

BACKGROUND: As the elderly population grows and increasing average life expectancy, medical needs and utilization by elderly people are rapid increase in recent years. It is thus essential that elderly people are included in clinical studies. There are also needed the standardization of age grouping and guideline of the elderly for the purpose of relative review between studies. And a study must include what age was used as a cut off value. So we set out to discover age grouping, cut off ages and guideline age of the elderly in two major Korean medical journals. METHODS: We examined all original research papers in all the issues of the Korean Journal of Medicine (KJM), and the Journal of The Korean Surgical Society (JKSS) between January 1995 and December 1997. We excluded animal works and papers concerned with special age (children, soldiers). Of the remaining 931 (386 KJM/545 JKSS) papers, we reviewed how many papers included elderly people in them, age grouping and regularity, age group intervals, cut off age, and of the specific to the elderly papers, what age was used as guideline age of the elderly. RESULTS: Of the reviewed 931 papers, included above 60-year were 701 (75.3%), excluded were 166 (17.8%), and no age limit was set in 64 (6.9%) papers. Of the 701 papers that included above 60 years, no age grouping were 349 (49.8%), and 352 (50.2%) had age grouping. Among them, 341 papers used regular intervals, while 11 papers used irregular intervals. Of the 341 regular age interval papers, five year interval were 4, ten year were 322, fifteen year were 2, and twenty year were 13. The cut off age as a specific value were 118, and cut off as a group of ages were 223. Ten papers were specifically about elderly people. Of these papers, the guidelines of the elderly were 60-year in 6, and 65-year in 4 papers. CONCLUSION: Many Korean medical papers included above 60-year people. But near half of them had no age grouping, and no age limit sets were 6.9%. And there were mixed use of 60 and 65 years for guideline of the elderly. So more elderly people should be included in future clinical studies. The standardization of age grouping and guideline of the elderly are also needed.
Aged* ; Animals ; Humans ; Life Expectancy