This review-article is aimed at shedding a light upon the nature of age-associated changes in the human skeletal system. When the anatomical, physiological and biochemical consequences of bone aging are considered together with the hardening, drying and the diminished repair capabilities of the elderly, it can be seen that fractures assume greater importance as a clinical problem in the geriatric population. Older people start out with a deficit of cortical bone, making them more fracture prone and once fractures occur, the necessary treatments (immobilization, use of casts, etc.) accelerate the rate of bone loss. In addition, aged individuals stand a higher risk for complications of the hospital and enforced bed rest that may ensue. The problems resulting from bone loss in the elderly may be partially alleviated by providing adequate health service support which should include consideration of the following points : 1. Age, sex and general health status ; 2. Habits and inclinations towards physical activities ; 3. Nutritional and endocrine background ; 4. Presence of any specific bone diseases, including osteoporosis, osteoarthritis, osteomalacia and ankylosis ; 5. Psychosocial adaptability and other behavioral elements.
Aged ; Aging ; Ankylosis ; Bed Rest ; Biology* ; Bone Diseases ; Health Services ; Humans* ; Motor Activity ; Osteoarthritis ; Osteomalacia ; Osteoporosis

BACKGROUND: We evaluated the current status of diabetes management and the predictors for poor glycemic control in an urban area. METHODS: This study included 1,138 community-dwelling adults (> or =50 years) with diabetes, of which 584 participated in the diabetes care survey. Logistic regression was used to identify the factors predicting poor glycemic control (hemoglobin A1c[HbA1c]> or =7%) in the total sample and to evaluate the relationship between the history of diabetes management checkup and poor glycemic control in the diabetes care survey sample. RESULTS: Of the 1,138 patients, 53.2% had blood pressure less than 130/80 mmHg, 41.7% had fasting glucose between 70 and 130 mg/dL, 48.6% had HbA1c below 7.0%, 60.1% had triglycerides below 150 mg/dL, 41.4% had low density lipoprotein cholesterol below 100 mg/dL, and 59.1% had normoalbuminuria (urine albumin-to-creatinine ratio <30 mg/g creatinine). Of the 584 patients completing the diabetes care survey, 63.9% had one or more lipid tests, 32.0% had one or more HbA1c tests, 43.8% had one or more microalbuminuria tests, and 42.5% had one or more fundoscopic examinations annually. Female gender (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.23-2.36), duration of diabetes (OR, 1.07; 95% CI, 1.06-1.09), and alcohol use (OR, 1.40; 95% CI, 1.06-1.85) were associated with an increased risk for poor glycemic control while age (OR, 0.97; 95% CI, 0.96-0.99) and antihypertensive medication (OR, 0.64; 95% CI, 0.50-0.83) were associated with a decreased risk. CONCLUSIONS: This study shows that glycemic control is likely to be poor in urban areas. We need to develop appropriate community-based strategies to achieve optimal glycemic control and prevent diabetes complications.
Adult ; Blood Pressure ; Cholesterol ; Cholesterol, LDL ; Diabetes Complications ; Diabetes Mellitus ; Fasting ; Female ; Glucose ; Hemoglobin A, Glycosylated ; Humans ; Lipoproteins ; Logistic Models ; Triglycerides

The origin of osteoclast-like giant cell tumor (OGCT) of the salivary gland has been debated because the prototypic cells of osteoclast-like cells and mononuclear stromal cells are largely unexplained in this gland. Bone marrow-derived CD14+ and CD45+ monocyte-derived multipotential cells (CD14+/CD45+ MOMC) may be one of the possible origins of OGCTs of salivary glands, which have never been explored in salivary OGCTs. We present a case of OGCT accompanied with carcinoma ex pleomorphic adenoma in the parotid gland of a 67-year-old Korean female. The tumor presented as a rapidly growing cervical mass comprising a central area of carcinoma ex pleomorphic adenoma and a peripheral circumferential area of OGCT. The immunohistochemical staining pattern was phenotypically consistent with bone marrow-derived CD14+/CD45+ MOMC. This case is the first report of a salivary OGCT in Korea.
Adenoma, Pleomorphic ; Aged ; Cytosine ; Female ; Giant Cell Tumors ; Giant Cells ; Humans ; Korea ; Mixed Tumor, Malignant ; Monocytes ; Osteoclasts ; Parotid Gland ; Salivary Glands ; Stromal Cells

The origin of osteoclast-like giant cell tumor (OGCT) of the salivary gland has been debated because the prototypic cells of osteoclast-like cells and mononuclear stromal cells are largely unexplained in this gland. Bone marrow-derived CD14+ and CD45+ monocyte-derived multipotential cells (CD14+/CD45+ MOMC) may be one of the possible origins of OGCTs of salivary glands, which have never been explored in salivary OGCTs. We present a case of OGCT accompanied with carcinoma ex pleomorphic adenoma in the parotid gland of a 67-year-old Korean female. The tumor presented as a rapidly growing cervical mass comprising a central area of carcinoma ex pleomorphic adenoma and a peripheral circumferential area of OGCT. The immunohistochemical staining pattern was phenotypically consistent with bone marrow-derived CD14+/CD45+ MOMC. This case is the first report of a salivary OGCT in Korea.
Adenoma, Pleomorphic ; Aged ; Cytosine ; Female ; Giant Cell Tumors ; Giant Cells ; Humans ; Korea ; Mixed Tumor, Malignant ; Monocytes ; Osteoclasts ; Parotid Gland ; Salivary Glands ; Stromal Cells

PURPOSE: We investigated the relationship of vesicoureteral reflux (VUR) and renal scarring in children who were treated surgically due to failure of initial medical management. MATERIALS AND METHODS: Thirty two children (51 renal units), 15 boys and 17 girls, aged 1-8 (median 3.2) years, with VUR were analyzed retrospectively. All children were initially treated with antibiotic prophylaxis for median 15.2 months (10-19 months). In 51 renal units, reflux grade at presentation was grade II in 8, III in 14, IV in 25 and V in 4. Renal scars were evaluated with dimercaptosuccinic acid (DMSA) scan and classified into three grades. We analyzed the incidence and severity of renal scar according to various clinical characteristics and discussed the optimal treatment in vesicoureteral reflux with respect to the development of renal scar. RESULTS: DMSA scan revealed that 69% (35/51) of the renal units had renal scars. Scarring at presentation was grade I in 10, II in 20 and III in 5 renal units. The incidence of renal scar was 86% at ages less than 2 years, 72% at ages 2 to 5 and 27% at ages greater than 5, of which the difference was statistically significant. And the incidence of renal scar according to the reflux grade was 38% in II, 50% in III, 84% in IV and 100% in V, of which the differnce was also statistically significant. However, the sex and laterality did not affect the incidence of renal scar in this study. With respect to the scar grade, the grade of refux was the only statistically significant determining factor. Especially, grade IV reflux resulted in much more severe scarring than grade III reflux. Comparing the result of DMSA scan at presentation with that just before operation in 13 children (18 renal units), only two renal units with grade IV reflux showed increase in renal scar. CONCLUSIONS: The most important factor to affect the development and severity of renal scar was the reflux grade. Considering relatively higher incidence of renal scar and more severe scarring in grade IV reflux than grade III reflux, early surgical management may be a possible option in the treatment of children with grade IV reflux.
Antibiotic Prophylaxis ; Child ; Cicatrix* ; Female ; Humans ; Incidence ; Retrospective Studies ; Succimer ; Vesico-Ureteral Reflux*

No abstract available.
Lipoma*

BACKGROUND: Core hypothermia during the first hour after induction of anesthesia results primarily from a redistribution of body heat. Propofol in low doses provides reliable sedation and is associated with fast recovery. However, propofol-induced peripheral vasodilation is likely to facilitate core-to-peripheral heat redistribution. This study was designed to evaluate the effects of low dose propofol on core and peripheral temperatures during spinal anesthesia. METHODS: Fifty patients of ASA status I or II, aged 20 to 60, undergoing lower extremity surgery under spinal anesthesia were studied. Spinal anesthesia was administered to all patients, who were assigned sedation as follows: 1) control (n = 25), 2) propofol (n = 25); propofol infusion rates were, 8 mg/kg/h for the first 3 min, 4 mg/kg/h for the next 10 min, and 2 mg/kg/h for the next 15 min. Temperatures were recorded after beginning surgery at 5-min intervals for 30 min. RESULTS: Core temperature was significantly decreased after 15, 20, 30 min of surgery in the propofol group, and this result was statistically different between the two groups. Forearm skin temperature decreased in the control group and increased in the propofol group, without significance. Fingertip skin temperature did not changed significantly in the control group, but increased significantly after 15 min in the propofol group and continued to increasing to 30 min. Forearm minus finger skin temperature gradients were not changed significantly in control group, but decreased between 5 and 30 min in the propofol group, which was statistically significant. CONCLUSIONS: Low dose propofol may induce a degree of hypothermia during spinal anesthesia. Close monitoring is needed to prevent core hypothermia, if sedation is induced using propofol during spinal anesthesia.
Anesthesia ; Anesthesia, Spinal* ; Fingers ; Forearm ; Hot Temperature ; Humans ; Hypothermia ; Lower Extremity ; Propofol* ; Skin Temperature ; Vasodilation

BACKGROUND: Capsular contracture is the most frequently reported complication after implant-based breast reconstruction. This study was first undertaken to present our experience with acellular dermal matrix for prevention of capsular contracture in implant-based immediate breast reconstruction with latissimus dorsi flap, and to assess the final aesthetic outcome. METHODS: We performed a retrospective review of all patients who underwent immediate latissimus dorsi flap breast reconstruction in combination with implant and acellular dermal matrix from January 2014 to December 2015. Demographics and clinical characteristics and postoperative complications, especially focused on capsular contracture, were assessed. They were also analyzed as the potential risk factors for the development of capsular contracture. The aesthetic outcome of the overall reconstruction and the final outcome of the inframammary fold were evaluated. RESULTS: During the study period, a total of 30 patients (30 breasts) were reviewed. The mean Baker grades for all 29 breasts (one breast was dropped out due to implant loss), evaluated at one year after reconstruction, was 1.21±0.49 capsular contracture. None of risk factors except seroma/hematoma (P=0.033) were significantly associated with the development of capsular contracture. Overall aesthetic outcome was 8.2±1.2 and aesthetic outcome of the inframammary fold was 3.5±0.6 for physician and 3.4±0.6 for patients. CONCLUSIONS: In this study, we have shown the ability of acellular dermal matrix to prevent capsular contracture observed in implant-based immediate breast reconstruction with latissimus dorsi flap and its use was proven to create superior aesthetic results.
Acellular Dermis* ; Breast Implants ; Breast* ; Contracture ; Demography ; Female ; Humans ; Mammaplasty* ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Superficial Back Muscles* ; Surgical Flaps

Purpose: The study was examined to investigate the influence of nurse manager and peer group caring behaviors on organizational socialization and nursing performance Methods: The subjects were 286 clinical nurses from a general hospital in S city. The collected data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation and hierarchical regression analysis with the SPSS 25.0 program. Nurse manager and peer group caring behaviors, organizational socialization, and nursing performance were measured using organizational climate for caring scale, peer group caring interaction scale, organizational socialization and performance measurement scale for hospital nurses. Results There was no significant difference in organizational socialization between nurse manager and peer group caring behaviors. The significant predictors of nursing performance were position (β=-.26), nurse manager caring behaviors (β=.23), and peer group caring behaviors (β=.17). These variables explained 23% of the variance in nursing performance. Conclusion: The results suggest that it is necessary to increase both manager and peer group caring behaviors in order to improve nursing performance.

Angiomyolipomas commonly originate from renal parenchyma but extremely rarely from perinephric space. We report a case of angiomyolipoma of the perinephric space confirmed by radical nephrectomy. A 13-year-old boy presented with left flank pain and abdominal distension, first experienced five months earlier. Ultrasonography and CT indicated that in the space surrounding the left kidney, a huge fat-containing mass with linear strands was present.
Adolescent ; Angiomyolipoma* ; Flank Pain ; Humans ; Kidney ; Male ; Nephrectomy ; Ultrasonography