BACKGROUND: Community-acquired pneumonia is one of the main causes of hospitalization and death, especially in elderly patients. There have been many studies on prognosis for community-acquired pneumonia, but few in Korea. We sought to identify characteristics on admission predicting mortality in elderly patients hospitalized with community-acquired pneumonia and to compare mortality rates by PORT score with PORT study's ones. METHODS: We performed a retrospective study of 267 patients aged 65 years and over admitted with community- acquired pneumonia from January 2000 to December 2002. We reviewed demographic, clinical, laboratory, microbiological and radiologic data and identified independent factors associated with the mortality using logistic regression analysis. We classified patients into risk classes by PORT score and calculated the mortality rate. RESULTS: Among of 267 patients, 48 (18.0%) died. We identified six independent predictors of mortality; male (OR, 2,496; 95% CI, 1,012~6,153), lung cancer (OR, 3,409; 95% CI, 1,302~8,920), general weakness (OR, 5.218; 95% CI, 2,140~12,718), unable to walk (OR, 9,232; 95% CI, 2,228~38,257), BUN > or =30 mg/dL (OR, 3,327; 95% CI, 1.072~10.327), albumin <3 g/dL (OR, 3,219; 95% CI, 1,351~7,670) and pleural effusion (OR, 3.135; 95% CI, 1,052~9,342). Mortality rates of risk class II-V by PORT score were 6.7%, 9.5%, 30.4% and 34.4%, respectively. CONCLUSION: There were factors that were associated with mortality in elderly patients hospitalized with community-acquired pneumonia.
Aged* ; Hospitalization ; Humans ; Korea ; Logistic Models ; Lung Neoplasms ; Male ; Mortality* ; Pleural Effusion ; Pneumonia* ; Prognosis ; Retrospective Studies

Objectives: Adverse childhood experiences (ACEs) of mothers may negatively affect the mental health of their offspring. Little is known about the intergenerational effect of maternal ACE on post-traumatic stress disorder (PTSD) in the offspring. This study investigated the impact of maternal ACEs on PTSD in the offspring. Methods: A total of 156 mothers with children aged 13–18 years completed the Diagnostic Interview Schedule for Children (DISC) Predictive Scales to determine the presence of psychiatric disorders in their offspring. The subjects completed the ACE questionnaire and the Early Trauma Inventory Self-Report-Short Form. Multivariable logistic regression was used to analyze the relationship between maternal ACEs and PTSD in the offspring. Results: Of the mothers, 23.7% had at least one ACE, and PTSD was reported in 21.8% of the offspring. The offspring of the mothers in the ACE group had a significantly higher rates of traumatic experiences and PTSD than the offspring of the mothers in the no ACE group. Maternal household dysfunction independently predicted offspring PTSD [odds ratio (OR)=3.008, p=0.05), and three or more maternal ACEs were significantly related to PTSD in the offspring (OR=10.613, p=0.025). Conclusion Maternal ACEs have a significant impact on the risk of traumatic experiences and PTSD in the offspring. These findings suggest the presence of intergenerational transmissions by which maternal ACEs affect the mental health of the offspring.

Objectives: Adverse childhood experiences (ACEs) of mothers may negatively affect the mental health of their offspring. Little is known about the intergenerational effect of maternal ACE on post-traumatic stress disorder (PTSD) in the offspring. This study investigated the impact of maternal ACEs on PTSD in the offspring. Methods: A total of 156 mothers with children aged 13–18 years completed the Diagnostic Interview Schedule for Children (DISC) Predictive Scales to determine the presence of psychiatric disorders in their offspring. The subjects completed the ACE questionnaire and the Early Trauma Inventory Self-Report-Short Form. Multivariable logistic regression was used to analyze the relationship between maternal ACEs and PTSD in the offspring. Results: Of the mothers, 23.7% had at least one ACE, and PTSD was reported in 21.8% of the offspring. The offspring of the mothers in the ACE group had a significantly higher rates of traumatic experiences and PTSD than the offspring of the mothers in the no ACE group. Maternal household dysfunction independently predicted offspring PTSD [odds ratio (OR)=3.008, p=0.05), and three or more maternal ACEs were significantly related to PTSD in the offspring (OR=10.613, p=0.025). Conclusion Maternal ACEs have a significant impact on the risk of traumatic experiences and PTSD in the offspring. These findings suggest the presence of intergenerational transmissions by which maternal ACEs affect the mental health of the offspring.

PURPOSE: The aim of this study was to investigate the change of nutritional status and the incidence of dumping syndrome after gastrectomy for gastric cancer. METHODS: From January 2013 to May 2014, 36 patients who underwent gastrectomy for gastric cancer were prospectively investigated in terms of nutritional status by body weight, anthropometric measurements, biochemical data, and Patient-Generated Subjective Global Assessment (PG-SGA). Dumping syndrome was assessed using a newly developed questionnaire based on the Japanese Society of Gastroenterological Surgery survey and Sigstad's scoring system. RESULTS: Body weight losses were 4.6%, 8.1%, and 6.9% at discharge, six months, and one year after discharge, respectively. Triceps skinfold thickness had no significance, however, mid-arm muscle circumference showed significant loss after gastrectomy. A part of the biochemical data showed significant change after gastrectomy, but almost indicated a restoring tendency within two months after discharge. In terms of PG-SGA, 33 patients (91.7%) were classified as A (well-nourished) before surgery, however, the number of well-nourished patients showed a sharp decrease to 1 (2.8%) at two weeks after discharge, and then gradually increased to 25 (69.4%) at one year. The main obstacles against diet intake were reported as 'early satiety' and 'anxiety'. The number of patients who had experience in at least one dumping syndrome related symptom was 21 (58.3%) at discharge, 26 (72.2%) at two months after discharge, and 11 (30.6%) at one year after discharge. CONCLUSION: Nutritional deficit as well as dumping syndrome is encountered in a large number of gastric cancer patients after gastrectomy. Postoperative nutritional support and personalized education seem to be very important during the postoperative period.
Asian Continental Ancestry Group ; Body Weight ; Diet ; Dumping Syndrome* ; Education ; Gastrectomy* ; Humans ; Incidence* ; Nutritional Status* ; Nutritional Support ; Observational Study* ; Postoperative Period ; Prospective Studies* ; Skinfold Thickness ; Stomach Neoplasms ; Surveys and Questionnaires

Matrix metalloproteinases (MMPs) have been implicated in tissue development and re-modeling. Dynamic morphological changes of tooth germs reflect involvement of these enzymes during odontogenesis. The present study was performed to investigate expression and localization of MMP-2 and MMP-9, which have been known to have type IV collagenase activities, in rat tooth germs at different developmental stages. MMP-2 expression was increased gradually in the tooth germs from cap to crown staged germs at both transcription and translation levels. The localization of this molecule was detected in secretory ameloblasts and preameloblasts. The strong immunoreactivities were occasionally seen along the basement membrane between ameloblasts (or preameloblasts) and odontoblasts (preodontoblasts). However, weak reactivity was detected in odontoblasts and reduced enamel epithelium. The level of MMP-9 expression in the tooth germs was higher in cap stage than in crown staged germs at both transcription and translation levels. They were strongly expressed in both ameloblasts and odontoblasts. Even though reduced enamel epithelium after enamel formation and inner enamel epithelium at the cap stage exhibited weak reactivity, strong reactivity was detected in dental follicles and perifollicular tissues surrounding cap staged germs. These results suggested that MMP-2 may involve degradation of the basement membrane during hard tissue formation, whereas MMP-9 might be involved in remodeling of follicular tissues.
Ameloblasts ; Animals ; Basement Membrane ; Collagenases ; Crowns ; Dental Enamel ; Dental Sac ; Epithelium ; Matrix Metalloproteinases ; Molar ; Odontoblasts ; Odontogenesis ; Rats ; Tooth Germ

Teeth develop via a reciprocal induction between the ectomesenchyme originating from the neural crest and the ectodermal epithelium. During complete formation of the tooth morphology and structure, many cells proliferate, differentiate, and can be replaced with other structures. Apoptosis is a type of genetically-controlled cell death and a biological process arising at the cellular level during development. To determine if apoptosis is an effective mechanism for eliminating cells during tooth development, this process was examined in the rat mandible including the developing molar teeth using the transferase-mediated dUTP-biotin nick labeling (TUNEL) method. The tooth germ of the mandibular first molar in the postnatal rat showed a variety of morphological appearances from the bell stage to the crown stage. Strong TUNEL-positive reactivity was observed in the ameloblasts and cells of the stellate reticulum. Odontoblasts near the prospective cusp area also showed a TUNEL positive reaction and several cells in the dental papilla, which are the forming pulp, were also stained intensively in this assay. Our results thus show that apoptosis may take place not only in epithelial-derived dental organs but also in the mesenchyme-derived dental papilla. Hence, apoptosis may be an essential biological process in tooth development.
Ameloblasts ; Animals ; Apoptosis ; Biological Processes ; Cell Death ; Crowns ; Dental Papilla ; Ectoderm ; Epithelium ; Hypogonadism ; In Situ Nick-End Labeling ; Mandible ; Mitochondrial Diseases ; Molar ; Neural Crest ; Odontoblasts ; Ophthalmoplegia ; Rats ; Reticulum ; Tooth ; Tooth Germ

Esophageal small cell carcinoma is a very rare disease. Primary extra-pulmonary small cell carcinoma was reported to account for 4% of primary small cell carcinoma and only 2% of all esophageal malignancy. Because the rate of early distant metastasis is very high, the prognosis is very poor. In Korea, 20 cases were reported. Seventeen cases were located at the mid or lower esophagus and 3 cases were located at the upper esophagus. We have experienced a case of primary upper esophageal small cell cancer, a 65-year-old female with cervical lymph node metastasis, which were diagnosed by endoscopy, open surgical lymph node biopsy and immunohistochemical analysis.
Aged ; Biopsy ; Carcinoma, Small Cell ; Endoscopy ; Esophagus ; Female ; Humans ; Korea ; Lymph Nodes* ; Neoplasm Metastasis* ; Prognosis ; Rare Diseases

PURPOSE: The purpose of this study was to determine the significant factors for risk estimate of aspiration and to evaluate the efficiency of the dysphagia assessment tool. METHODS: A consecutive series of 210 stroke patients with aspiration symptoms such as cough and dysphagia who had soft or regular diet without tube feeding were examined. The dysphagia assessment tool for aspiration was compared with videofluoroscopy using Classification and Regression Tree (CART) analysis. RESULTS: In CART analysis, of 34 factors, the significant factors for estimating risk of aspiration were cough during swallowing, oral stasis, facial symmetry, salivary drooling, and cough after swallowing. The risk estimate error of the revised dysphagia assessment tool was 25.2%, equal to that of videofluoroscopy. CONCLUSION: The results indicate that the dysphagia assessment tool developed and examined in this study was potentially useful in the clinical field and the primary risk estimating factor was cough during swallowing. Oral stasis, facial symmetry, salivary drooling, cough after swallowing were other significant factors, and based on these results, the dysphagia assessment tool for aspiration was revised and complemented.
Adult ; Aged ; Cough ; Deglutition ; Deglutition Disorders/complications/*diagnosis ; Facial Asymmetry ; Female ; Fluoroscopy/methods ; Humans ; Inhalation ; Male ; Middle Aged ; Risk Assessment ; Stroke/*complications/radiography/therapy

Multiple symmetric lipomatosis (MSL) is a rare disease characterized by the presence of diffuse, non-tender, symmetric deposits of adipose tissue on the neck, back and upper part of the trunk. It has been reported that this disease could be associated with various metabolic abnormalities such as impaired glucose tolerance, hyperuricemia, alcohol consumption, type 4 hyperlipidemia, renal tubular acidosis and thyroid disorder. We present a case of type 2 MSL with pulmonary thromboembolism. He suffered sudden dyspnea and decreased urine output. The causes of dyspnea and acute renal failure (ARF) in this case were dehydration and hemodynamic disturbance due to pulmonary thromboembolism. After thrombolytic and fluid therapy, his condition was improved. He was discharged on warfarin medication and has remained asymptomatic for 12 months.
Acidosis, Renal Tubular ; Acute Kidney Injury* ; Adipose Tissue ; Alcohol Drinking ; Dehydration ; Dyspnea ; Fluid Therapy ; Glucose ; Hemodynamics ; Hyperlipidemias ; Hyperuricemia ; Lipomatosis, Multiple Symmetrical* ; Neck ; Pulmonary Embolism* ; Rare Diseases ; Thyroid Gland ; Warfarin

β Blockers such as propranolol and labetalol are known to induce toxic myopathy because of their partial β₂ adrenoceptor agonistic effect. Nebivolol has the highest β1 receptor affinity among β blockers, and it has never been reported to induce rhabdomyolysis until now. We report a patient who developed rhabdomyolysis after changing medication to nebivolol. A 75-year-old woman was admitted to our hospital because of generalized weakness originating 2 weeks before visiting. Approximately 1 month before her admission, her medication was changed from carvedilol 12.5 mg to nebivolol 5 mg. Over this time span, she had no other lifestyle changes causing rhabdomyolysis. Her blood chemistry and whole body bone scan indicated rhabdomyolysis. We considered newly prescribed nebivolol as a causal agent. She was prescribed carvedilol 12.5 mg, which she was previously taking, instead of nebivolol. She was treated by hydration and urine alkalization. She had fully recovered and was discharged.
Aged ; Chemistry ; Female ; Humans ; Labetalol ; Life Style ; Muscular Diseases ; Nebivolol* ; Propranolol ; Rhabdomyolysis*