BACKGROUND: The recent studies shows that LV relaxation abnormalities are the important factors of heart failure in elders. To determine the association between LV diastolic functions and heart failure, we assessed LV diastolic functions in elderly patients with pulmonary congestion and in asymptomatic elders by using pulsed doppler echocardiography. METHODS: In order to assess LV diastolic function, we performed pulsed doppler echocardiography to elderly patients with pulmonary congestion and asymptomatic elders from Mar.2001 to Sep.2001. The following parameters were used as indices of LV diastolic function; Mitral E wave(E), Mitral A wave(A), Deceleration time(DT), Isovolumic relaxation time(IVRT), Systolic pulmonary venous flow(PVs), Diastolic pulmonary venous flow(PVd). RESULTS: In elderly patients groups, there was significant increase in deceleration time compared with asymptomatic elders(255.83+/-54.41 vs 210.80+/-48.53, p<0.05). There was significant increase in isovolumic relaxation time in elderly patient group compared with asymptomatic elders(123.06+/-25.07 vs 98.78+/-15.12, p<0.01). Although there was no significant difference, decreased E/A ratio and increased PVs/PVd were noted in both groups. CONCLUSIONS: The results shows that the impairments of LV diastolic function were noted in both groups. Especially DT and JVRT were significant increase in elderly patient group with pulmonary congestion. Therefore these parameters, such as DT, IVRT, can be helpful as predictive indices of diastolic heart failure in elders.
Aged* ; Deceleration ; Echocardiography, Doppler, Pulsed ; Estrogens, Conjugated (USP)* ; Heart Failure ; Heart Failure, Diastolic ; Humans ; Relaxation

Severe cough may contribute to serous coplications such as pneumothorax, pneumomediastinum, rib fracture, subconjunctival hemorrhage, subdural hemorrhage and cough syncope. However abdominal wall hematoma is a rare complication. Because it usually presents with abdmoianal pain, abdominal wall hematoma needs to be differentiated from the acute surgical abdomen. A 78-year-old woman was admitted with right lower quadrant abdominal pain and a palpable mass for several days. She experienced abdominal pain after violent coughing associated with an upper respiratory tract in fection. Abdominal computed tomography revealed an approximately 7×4 cm sized, ill-defined, soft tissue density lesion in the right lower posterolateral abdominal wall. An abdominal wall hematoma was diagnosed. After admission, she had persistent right lower abdominal pain and an increasing mass. The mass was surgically removed and she was discharged without complications. In summary, when a patient complains of abdmonial pain after severe coughing, an abdominal wall hematomas as a differential diagnosis must be considered.
Abdomen ; Abdomen, Acute ; Abdominal Pain ; Abdominal Wall* ; Aged ; Cough ; Diagnosis, Differential ; Female ; Hematoma* ; Hematoma, Subdural ; Hemorrhage ; Humans ; Mediastinal Emphysema ; Pneumothorax ; Respiratory System ; Rib Fractures ; Syncope

BACKGROUNDS: Katz index of ADL and Barthel index of ADL have been used to evaluate the function of disabled elderly in Korea. But no ADL scale reflecting Korean's own language expression and culture has been developed and verified yet. METHODS: Descriptions of basic activities which needed others' help were collected from 190 Korean disabled elderly. The collected results were categorized into basic activities of daily living and instrumental activities of daily living, and then in each domain such as bathing, shopping, etc. Preliminary instrument items were selected by the judgement of the expert committee, considering the frequency of the responses and the importance of each item. A preliminary questionnaire was developed based on the selected items. The preliminary questionnaire was pretested twice, and corrected by the results. Finally a scholar on Korean literature verified the questionnaire on the grammar and context. RESULTS: A total of 408 basic activities of daily living and 242 instrumental activities of daily living were collected. The activities were categorized into 7 domains of ADL(dressing, washing face and hand, bathing, eating, transfer, toileting, continence) and 10 domains of IADL(decorating, housework, preparing meals, laundry, outgoing for a short distance, using transportation, shopping, handling money, using telephone, taking medicine) CONCLUSIONS: We developed a Korean Activities of Daily Living(K-ADL) scale and Korean Instrumental Activities of Daily Living(K-IADL) scale reflecting Korean elderly's own language expression and culture.
Activities of Daily Living ; Aged ; Baths ; Eating ; Hand ; Housekeeping ; Humans ; Korea ; Meals ; Surveys and Questionnaires ; Telephone ; Transportation

OBJECTIVE: The objective of this study was to evaluate the safety and timing of the surgery and fetal outcome of pregnancy complicated by a persistent adnexal mass that was required surgical intervention METHODS: We retrospectively reviewed 171 cases of adnexal masses during pregnancy that were required surgery at Samsung Cheil Hospital and Women's Healthcare Center between 1996 to 2001. We analysed medical records for characteristics of tumor, indication and timing of surgery and the effect of pregnancy outcome. Adverse pregnancy outcome is defined as preterm delivery, spontaneous abortion, intrauterine fetal death and perinatal death. The obtained data were analysed using t-test and Fisher's exact test by SPSS. RESULTS: The incidence of adnexal masses during pregnancy that required surgical management was 1 in 292.3 live births. A malignant tumor or a tumor of low malignant potential was found in 7% of cases. A total of 43 patients underwent surgery under emergency condition, 31 (72%) of which were done due to torsion. There were 14 preterm delivery, 3 spontaneous abortion, 1 intrauterine fetal death, 1 perinatal death and 2 artificial abortion in this study. There was a significant difference in adverse pregnancy outcome between elective and emergency group (7/118 [5.9%] versus 11/43 [25.6%] P=.001), and surgery group that before 20 week's gestation and those of after 20 week's gestation (12/145 [8.3%] versus 6/16 [37.5%] P=.004). CONCLUSION: When necessary and feasible, surgery should be scheduled for the early portion of the second trimester, when organogenesis is complete and most spontaneous abortion have occurred, but before later risks of technical difficulties and premature labor. Also we recommend early diagnostic evaluation and immediate surgical intervention of adnexal masses as problematic adnexal mass diagnosed during pregnancy to prevent the risk of emergency surgery associated with adnexal complication (torsion, rupture and hemorrhage) and the risk of delayed diagnosis of malignancy.
Abortion, Spontaneous ; Delayed Diagnosis ; Delivery of Health Care ; Emergencies ; Female ; Fetal Death ; Humans ; Incidence ; Live Birth ; Medical Records ; Obstetric Labor, Premature ; Organogenesis ; Pregnancy Outcome ; Pregnancy Trimester, Second ; Pregnancy* ; Retrospective Studies ; Rupture

The aim of our study was to determine the impact of vascular access on in-hospital major bleeding (IHMB) in acute coronary syndrome (ACS). We analyzed 995 patients with non-ST elevation myocardial infarction and unstable angina at the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) moderate- to very high-bleeding risk scores in trans-radial intervention (TRI) retrospective registry from 16 centers in Korea. A total of 402 patients received TRI and 593 patients did trans-femoral intervention (TFI). The primary end-point was IHMB as defined in the CRUSADE. There were no significant differences in in-hospital and 1-yr mortality rates between two groups. However, TRI had lower incidences of IHMB and blood transfusion than TFI (6.0% vs 9.4%, P = 0.048; 4.5% vs 9.4%, P = 0.003). The patients suffered from IHMB had higher incidences of in-hospital and 1-yr mortality than those free from IHMB (3.1% vs 15.0%, P < 0.001; 7.2% vs 30.0%, P < 0.001). TRI was an independent negative predictor of IHMB (odds ratio, 0.305; 95% confidence interval, 0.109-0.851; P = 0.003). In conclusions, IHMB is still significantly correlated with in-hospital and 1-yr mortality. Our study suggests that compared to TFI, TRI could reduce IHMB in patients with ACS at moderate- to very high-bleeding risk.
Acute Coronary Syndrome/mortality/*pathology ; Aged ; Female ; Femoral Artery ; *Hemorrhage ; Hospital Mortality ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Odds Ratio ; Percutaneous Coronary Intervention ; Radial Artery ; Retrospective Studies ; Risk Factors ; Stents ; Treatment Outcome