BACKGROUND/AIMS: Nursing home-acquired pneumonia (NHAP) is included under healthcare-associated pneumonia. However, the optimal treatment strategy for NHAP has been controversial in several studies. We evaluated the clinical features of NHAP compared to community-acquired pneumonia (CAP) in elderly patients admitted with pneumonia. METHODS: This was a retrospective study in elderly patients aged > or = 65 years with NHAP or CAP who were hospitalized at Jeju National University Hospital between January 2012 and April 2013. RESULTS: A total of 209 patients were enrolled, and 58 (27.7%) had NHAP. The patients with NHAP were older, had more frequent central nervous system disorders, and showed worse clinical parameters. Potential drug-resistant pathogens were more frequently detected in the NHAP group (22.4% vs. 9.9%, p = 0.018), and the incidences of Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus were 8.6% and 10.3%, respectively. In-hospital mortality occurred in 13 patients (22.4%) with NHAP and 17 patients (11.2%) with CAP (p = 0.039). In multivariate analyses, only higher pneumonia severity index (PSI) score was associated with increased mortality (p < 0.001), and the PSI score was higher in the NHAP group than that in the CAP group. CONCLUSIONS: Elderly patients admitted with NHAP showed more severe pneumonia at onset, higher rates of potentially drug-resistant pathogens, and worse clinical outcomes than those with CAP. However, higher in-hospital mortality in those with NHAP seemed to be related to the PSI score reflecting host factors and severity of pneumonia rather than the type of pneumonia or the presence of drug-resistant pathogens.
Age Factors ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/*therapeutic use ; Chi-Square Distribution ; Community-Acquired Infections/diagnosis/microbiology/mortality/*therapy ; Cross Infection/diagnosis/microbiology/mortality/*therapy ; Drug Resistance, Bacterial ; Female ; *Homes for the Aged ; Hospital Mortality ; *Hospitals, Teaching ; Humans ; Logistic Models ; Male ; Microbial Sensitivity Tests ; Multivariate Analysis ; *Nursing Homes ; Odds Ratio ; *Patient Admission ; Pneumonia, Bacterial/diagnosis/microbiology/mortality/*therapy ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Treatment Outcome

The incidence of colorectal cancer in Korea has increased dramatically over the past few decades. According to the National Cancer Registry, the age-standardized incidence rates increased from 27.1 to 44.5 per 100,000 for men and from 17.2 to 24.3 per 100,000 for women between 1999 and 2007. The overall incidence of colorectal cancer increased by 7.0% annually in men and 5.3% in women from 1999 to 2007, while the incidence rates of the most common cancers, such as stomach and liver cancers, decreased during the same period. Epidemiologic studies have suggested that higher intakes of red and processed meat, a lack of physical activity, obesity, and alcohol drinking are risk factors for colorectal cancer. During the past few decades, significant socio-economic changes have taken place in Korea with respect to the economy, industrial structure, dietary habits, physical activity, and prevalence of obesity. Changes in dietary habits and lifestyle-related factors are believed to be the reasons for the increase in the incidence of colorectal cancer in Korea.
Alcohol Drinking ; Colonic Neoplasms ; Colorectal Neoplasms ; Epidemiologic Studies ; Female ; Food Habits ; Humans ; Hypogonadism ; Incidence ; Korea ; Life Style ; Liver Neoplasms ; Male ; Meat ; Mitochondrial Diseases ; Motor Activity ; Obesity ; Ophthalmoplegia ; Prevalence ; Risk Factors ; Stomach

Progressive multifocal leukoencephalopathy (PML) is a very rare and often fatal demyelinating disease of central nervous system (CNS), which mostly occurs in patients with immunosuppression such as acquired immunodeficiency syndrome (AIDS) patients, transplant patients and patients receiving chemotherapy. PML usually manifests with acute or subacute neurologic deficit. and its late diagnosis may lead death or significant permanent disability. We report a 33-year old man diagnosed with PML in AIDS, who initially presented with gradual onset of dementia. Most symptoms of PML were progressed rapidly for several months, and characterized by focal neurological symptoms. On the other hand, we were experienced in patients without focal neurological symptoms and ongoing overall cognitive decline slowly. Patients with immunosuppression can be presented in a variety of neurological symptoms, detailed examinations for cognitive functions were needed in early stage of the disease.
Acquired Immunodeficiency Syndrome* ; Adult ; Central Nervous System ; Delayed Diagnosis ; Dementia* ; Demyelinating Diseases ; Drug Therapy ; Hand ; Humans ; Immunosuppression ; Leukoencephalopathy, Progressive Multifocal* ; Neurologic Manifestations

For the physical characterization of neutron beam, dosimetric measurements had been performed to obtain physical data of KCCH cyclotron-produced neutrons for clinical use. The results are presented and compared with the data of other institutions from the literatures. The central aixs percent depth dose, build-up curves and open and wedge isodose curve values are intermediate between that of a 4 and 6 MV X-ray. The build-up level of maximum dose was at 1.35 cm and entrance dose was approximately 40%. Flatness of the beam was 9% at Dmax and less than+/-3% at the depth of 80% isodose line. Penumbra begond the 20% line is wider than corresponding photon beam. The output factors ranged 0.894 for 6 x 6 cm field to 1.187 for 30 x 30 cm field. gamma contamination of neutron beam was 4.9% at 2 cm depth in 10 x10 cm field.
Cyclotrons ; Neutrons*

Upbeat nystagmus has been described in bilateral lesions of the medulla, the ventral tegmentum, the anterior cerebellar vermis, the adjacent brachium conjunctivum, and the midbrain. Imbalance of the vertical vestibulo- ocular reflex (VOR) favoring the downward VOR activity would therefore result in upbeat nystagmus. We report a patient with transient upbeat nystagmus due to unilateral pontine infarction that may have disrupted bilateral upward VOR pathways running in the ventral tegmental tracts.
Humans ; Infarction* ; Mesencephalon ; Reflex ; Running

Eclampsia and hypertensive encephalopathy share similar pathophysiological mechanisms, which present as vaso-genic edema and vasospasm. In majority of the patients, neurologic manifestations are reversible. A 31-year-old pregnant woman in her 40 weeks of gestation developed repeated attacks of seizure and confused mentality. As consciousness improved, multiple neurologic deficits were detected. Cerebral angiography a showed diffuse vasospasm. Six months later, neurologic manifestations were partially recovered. We report a rare case of eclampsia with irreversible neurologic deficits, in which cerebral vasospasm was confirmed by an angiography. (J Korean Neurol Assoc 19(5):537~540, 2001)
Adult ; Angiography ; Cerebral Angiography ; Consciousness ; Eclampsia* ; Edema ; Female ; Humans ; Hypertensive Encephalopathy ; Neuroimaging* ; Neurologic Manifestations ; Pregnancy ; Pregnant Women ; Seizures ; Vasospasm, Intracranial

BACKGROUND AND PURPOSE: Alzheimer's disease (AD) is the most common form of dementia which typically manifests as loss of memory and cognitive functions. Currently, available treatments for AD provide only symptomatic improvement and the benefit is minimal. Stem cell therapy (SCT) has been considered a promising treatment option for AD. We investigated the caregiver's perception about implementation of SCT in their AD patients, and determined the factors related to SCT. METHODS: A total of 100 caregivers, who cared for their AD patients, were interviewed at two hospitals. Structured open and closed questions about SCT for AD were asked by trained interviewers using the conventional in-person method. In addition, 60 dementia-related physicians were randomly interviewed via an e-mail questionnaire. RESULTS: Of the 100 subjects, 61 caregivers replied that they wanted their AD patients to receive SCT. Approximately 50% of the caregivers expected high improvement in cognitive function, behavioral and psychological symptoms, and activities of daily living, and physical improvements among their AD patients. However, physicians had much lower expectations of improvements in the above parameters. Multi-variate analysis revealed that female gender [odds ratio (OR): 3.747, 95% confidence interval (CI): 1.425–9.851] and familiarity with stem cells (OR: 3.873, 95% CI: 1.290–11.622) were independently associated with caregivers' desire that their AD patients should undergo SCT. The major source of information on SCT was television (76.7%), and the most reliable source of information on SCT was physicians (83.6%). CONCLUSIONS: In this study, many caregivers of AD patients fantasized and overestimated the need for SCT in comparison with physicians' expectation. Therefore, it is necessary for physicians to develop strategies for educating caregivers about the appropriate risks and benefits of SCT.
Activities of Daily Living ; Alzheimer Disease ; Caregivers ; Cognition ; Dementia ; Electronic Mail ; Female ; Humans ; Memory ; Methods ; Recognition (Psychology) ; Risk Assessment ; Stem Cells* ; Television

No abstract available.
Paragonimiasis ; Paragonimus westermani ; Stroke

OBJECTIVE: The aim of this study was to evaluate the relationship between motor evoked potentials (MEPs) or somatosensory evoked potentials (SSEPs) and the recovery of function in acute or subacute stroke patients. METHOD: Twenty one hemiplegic stroke patients were examined with MEPs of extensor carpi radialis, abductor pollicis brevis, tibialis anterior and abductor hallucis and SSEPs of median and tibial nerves. A separate score was defined for upper and lower extremities within the Fugl-Meyer assessment and Korean-modified Barthel index. Motor performances were evaluated simultaneously with the evoked potential assessments and at 2 weeks after the first examination. RESULTS: The second motor function of upper extremity was significantly higher in patients with the presence of MEP or SSEP (p<0.05). The improvement of self care was correlated with the responsiveness in SSEP. Motor function of lower extremity was significantly associated with the responsiveness in MEP or SSEP (p>0.05). MEP in tibialis anterior or tibial SSEP were correlated with the mobility. CONCLUSION: MEP in tibialis anterior is useful in predicting in mobility after stroke. SSEP is predictive for activities in daily living after stroke.
Activities of Daily Living ; Evoked Potentials ; Evoked Potentials, Motor ; Evoked Potentials, Somatosensory ; Humans ; Lower Extremity ; Recovery of Function ; Self Care ; Stroke ; Tibial Nerve ; Upper Extremity

Reversible lesion in the splenium of the corpus callosum can be caused by various conditions. There is no report about the case with first seizure attack. We report a 25-year-old man shown transient isolated splenial lesion of the corpus callosum associated with new onset seizure. Lesion was shown in the splenium of the corpus callosum on MRI. Theses findings were resolved on follow up MRI without specific treatment. This case suggests that the first attack seizure could make a reversible splenial lesion.
Adult ; Corpus Callosum ; Follow-Up Studies ; Humans ; Seizures