Traumatic Brain Injury (TBI) is as common in elderly people as it is in young adults. Compared to TBI among young adults, TBI among the elderly differs in mechanism of injury, clinical presentation, comorbidities, and prognosis. This article begins with an overview of the literature on epidemiology, unique characteristics and pathophysiology of geriatric head injuries. Neurological sequelae and indices of general outcome following TBI will be disussed. We will discuss the proposed relationship between TBI and Alzheimer's disease, which lead to a greater understanding of the pathogenesis of both TBI and Alzheimer's disease. The literature about the assessment and management of TBI will be reviewed.
Aged* ; Alzheimer Disease ; Brain Injuries* ; Comorbidity ; Craniocerebral Trauma ; Epidemiology ; Humans ; Prognosis ; Young Adult

Photodynamic therapy(PDT) is a treatment modality by highly reactive oxygen intermediates generated through the interaction of light with a photosensiziter. It has been shown to be an effective treatment for various cutaneous and noncutaneous malignancies. It is efficient for the curative and palliative treatment of epithelial skin tumor in situ or early invasive lesions. In effect, it is a useful alternative treatment for the lesions located on anatomically difficult areas or the large-sized lesions. We treated a case of Bowen's disease arising on the plantar area and 3rd and 4th toewebs of left forefoot in a 61-year-old man with PDT using the hematoporphyrin derivative, porfirmer sodium(Photofrin, Russia) as a photosensitizer and gold vapor laser as a visible light source. The outcome showed partial clinical improvement after about 2 months' follow-up.
Bowen's Disease* ; Follow-Up Studies ; Hematoporphyrin Derivative ; Humans ; Lasers, Gas ; Light ; Middle Aged ; Oxygen ; Palliative Care ; Photochemotherapy* ; Skin

BACKGROUND/AIMS: Hepatic arterial infusion chemotherapy (HAIC) with 5-fluorouracil and cisplatin for intractable advanced hepatocellular carcinoma (HCC) may have survival benefits. We aimed to determine the efficacy and safety of HAIC for advanced HCC as first-line therapy. METHODS: A total of 54 patients who received only HAIC with 5-fluorouracil (750 mg/m2 on days 1-4) and cisplatin (25 mg/m2 on days 1-4) for advanced HCC from Jan. 2009 to Dec. 2011 were selected. According to Child-Pugh class, the overall survival (OS), progression-free survival (PFS), and adverse events after HAIC were investigated retrospectively. RESULTS: Median OS and PFS between the Child-Pugh A group (n=24) and the Child-Pugh B/C group (n=30) were 8.7 (95% confidence interval [CI]: 4.7-12.7) vs. 3.7 months (95% CI: 2.0-5.3), and 7.1 (95% CI: 3.8-10.4) vs. 3.6 months (95% CI: 2.0-5.2), respectively. Although median OS and PFS were not statistically significant between the two groups (P=0.079, P=0.196), the Child-Pugh class B/C tended to influence poor OS. Serious adverse events > or = grade 3 occurred frequently in both groups (83.3 vs. 96.7%, P=0.159). Responders (22.2%, complete or partial response) significantly differed in median OS, compared to non-responders (13.1 vs. 4.4 months, P=0.019). Achievement of complete or partial response was an independent prognostic factor of OS (hazard ratio: 0.4, 95% CI: 0.2-0.8, P=0.011). CONCLUSIONS: Achievement of response after HAIC provide a survival benefit in patients with advanced HCC, but HAIC should be administered cautiously in patients with Child-Pugh class B/C, because of a relatively low survival and high incidence of serious adverse events.
Adult ; Aged ; Anemia/etiology ; Antineoplastic Agents/adverse effects/*therapeutic use ; Carcinoma, Hepatocellular/*drug therapy ; Cisplatin/adverse effects/*therapeutic use ; Diarrhea/etiology ; Disease-Free Survival ; Drug Therapy, Combination ; Female ; Fluorouracil/adverse effects/*therapeutic use ; Humans ; Infusions, Intra-Arterial ; Kaplan-Meier Estimate ; Liver Neoplasms/*drug therapy ; Male ; Middle Aged ; Neutropenia/etiology ; Retrospective Studies ; Severity of Illness Index ; Thrombocytopenia/etiology ; Treatment Outcome

The bleeding duodenal varices are a rare complication in patients with portal hypertension, but present a difficult diagnostic problem. If there is no bleeding esophageal, gastric fundal varices or ulcer in a patient with upper gastrointestinal bleeding and portal hypertension, the possibility of bleeding duodenal varices should be kept in mind. Thorough endoscopic examination of the entire duodenal mucosa is essential to document bleeding from duodenal varices. As an initial treatment, endoscopic sclerotherapy has had limited success in controlling active duodenal variceal bleeding. However, rebleeding rate is high, surgical treatment including shunt operation may be required for permanent control of bleeding and portal decompression. We report three cases of duodenal varices causing massive hemorrhage. All the patients had portal hypertension caused by liver cirrhosis of various etiologies and had varices in their esophagus. The second portion of the duodenum was the site of duodenal varices in all cases. The management was tailored to the condition of each patient, but only one patient among three survived.
Decompression ; Duodenum ; Esophageal and Gastric Varices ; Esophagus ; Gastrointestinal Hemorrhage* ; Hemorrhage ; Humans ; Hypertension, Portal ; Liver Cirrhosis ; Mucous Membrane ; Sclerotherapy ; Ulcer ; Varicose Veins*

OBJECTIVES: This study was carried out to measure the urinary cotinine concentrations of Korean tobacco harvesters with green tobacco sickness (GTS). METHODS: We conducted a questionnaire survey and measured the urinary cotinine concentrations among the cases who visited six health subcenters and the emergency room in the Health Center and County Hospital after harvesting tobacco leaves in Cheongsong-gun, from Jul 15 to Aug 15, 2002. Ten suspected GTS cases were compared to 10 controls matched for residence, age, and sex. Urinary cotinine was analyzed with a reverse-phase high performance liquid chromatography (HPLC) system and expressed as geometric mean and standard deviation. The data collected were evaluated using the SPSS/win statistical package and the urinary cotinine concentrations between the two groups were analyzed by Mann-Whitney U test. RESULTS: In both the 10 cases and controls, there were 3 males and 7 females. Ages ranged from 22 to 70 years old. Half of the cases were reported within the 6 hours between 12:00 pm and 17:59 pm. The median time from starting work to initially feeling ill was 4.3 hours (min. 2.5; max. 11.0). The GTS symptoms reported were nausea in 10 cases (100.0%), dizziness in 9 (90.0%), weakness in 8 (80.0%), headache in 7 (70.0%) and other symptoms. The geometric mean of urinary cotinine concentrations was significantly higher (p<0.01) in cases at 497.6 +/- 2.5 ng/ml (min. 73.1; max. 2,574.3) than in controls at 32.7 +/- 1.8 ng/ml (min. 13.3; max. 76.9). CONCLUSIONS: Our study suggests that many tobacco harvesters may suffer from GTS in Korea. Therefore, it is very important for doctors to diagnose exactly the GTS. Also we must develop the methods which can prevent GTS, and simple methods of analysis for urinary cotinine.
Aged ; Chromatography, Liquid ; Cotinine* ; Dizziness ; Emergency Service, Hospital ; Female ; Headache ; Hospitals, County ; Humans ; Korea ; Male ; Nausea ; Nicotine ; Questionnaires ; Tobacco*

Reactive perforating collagenosis(RPC) is a kind of perforating disorder characterized by the transepidermal elimination of altered dermal collagen. Two types have been recognized; the childhood or inherited form and the adult or acquired form. Acquired RPC is frequently associated with diabetes, chronic renal failure with nephropathy and liver disease. We describe a case of RPC in a 41-year-old woman of about 2 months' duration. She has had a problem of tricuspid regurgitation for 3 years. Skin lesions showed scattered umbilicated papules with central keratotic plugs, 0.3-0.8cm sized, located on the proximal extremities.
Adult ; Collagen ; Extremities ; Female ; Humans ; Kidney Failure, Chronic ; Liver Diseases ; Skin ; Tricuspid Valve Insufficiency*

A 27-year-old man presented with a 6-month history of a dark-reddish nodule on the dorsal aspect of the right fifth finger. The lesion was a smooth-surfaced asymptomatic polypoid feature, measuring 0.4x0.9x0.5cm. Past and personal history were unremarkable. The excisional biopsy specimen showed numerous nests of spindle cells with some epithelioid cells in the entire dermis. The junctional activity was not present. On immunohistochemical staining, nest cells were strong positive for S-100 protein, but weak positive for HMB-45. No relapse was noted during a period of 6-month follow-up.
Adult ; Biopsy ; Dermis ; Epithelioid Cells ; Fingers* ; Follow-Up Studies ; Humans ; Nevus, Epithelioid and Spindle Cell* ; Recurrence ; S100 Proteins

BACKGROUND: Onychomycosis is a common disease and has a tendency to increase in its incidence. Although there have been many reports about onychomycosis, very few studies about onychomycosis in the elderly have yet been conducted. OBJECTIVE: The purpose of this study was to investigate the clinical and mycological features of onychomycosis in the elderly, and to evaluate the concept and attitude of the elder patients towards onychomycosis, which would affect the treatment and further infections of onychomycosis. METHOD: Sixty eight onychomycosis patients over 60 years old were examined clinically and surveyed by questionnaire to evaluate their concern about the onychomycosis. All the patients were confirmed by potassium hydroxide (KOH) examinations and underwent cultures on the both cornmeal potato agar with and without cycloheximide. An additional culture was done a week later when the initial culture showed contamination or no growth. RESULTS: Among 648 patients with onychomycosis, 68 patients (10.5%) were over 60 years old. Fifty (73.5%) were female and 18 (26.5%) were male. Twenty six (38.2%) had systemic illness. The average duration of onychomycosis was 13 years and the average number of onychomycosis involving nails was 4.7. Sixty three patients (92.6%) had toe nail onychomycosis. Sixty six patients (97.1%) showed distal subungal onychomycosis. Trichophyton rubrum was the main causative organism in 38 patients (55.9%). Forty one patients (60.3%) discontinued the medication in 4 weeks, and 11 (16.2%) were treated over 12 weeks. From the questionnaire, only 10 patients reported previous treatment for this problem, but with duration of treatment no longer than one month. Fifty three patients had mere understanding atypical alternation in their nails before the visit. The main reasons of the discontinuing the medication were the cost of the treatment, physical discomfort due to age, and extended duration of the therapy. CONCLUSION: From this study, we noticed that the elder onychomycosis patients could be long time carriers of fungi because of their lack of the knowledge of onychomycosis and insufficient treatment. Therefore, it is necessary to educate and support to treat the elder patients effectively.
Agar ; Aged* ; Cycloheximide ; Female ; Fungi ; Humans ; Incidence ; Male ; Middle Aged ; Onychomycosis* ; Potassium ; Solanum tuberosum ; Toes ; Trichophyton ; Surveys and Questionnaires

BACKGROUND: An important constituent of normal human oral microflora has long been recognized. The increase in the incidence of candidal infections has been associated with the increase in the number of patients at risk. Especially, diabetic patients have been increased susceptibility to general and local infections, but it is often equivocal whether or not risk factors such as oral-ambient conditions are related to candidal colonization. OBJECTIVE: The isolates of candidal species were evaluated in the oral cavity of diabetic patients in comparison with non-diabetic, non-immunocompromized subjects. Risk factors that could influence candidal colonization in diabetic patients were also studied. METHOD: Candidal species were isolated from the oral mucosa of 205 diabetics and 62 non-diabetics, using oral swab and smear technique. They were identified by germ tube test, Cornmeal-Tween agar and API 20C system. RESULTS: The frequency of oral candidal isolates was more common in 130 isolates (63.4%) in diabetic patients compared with 23 (37.1%) isolates in controls (p<0.05), but insignificantly related in age and sex distribution of both groups (p>0.05). Germ tubes were formed in the 102 species and chlamydospores in the 105 species in diabetic patients. Candida(C) albicans among the species was the most frequent isolates in both groups (80.8% vs 69.6%). The isolated 130 candidal species, identified by API 20C system, in diabetic patients, showed C. albicans (104), C. tropicalis (16), C. parapsilosis (6), C. krusei (1), C. kefyr (1) and unidentified species (2) compared with C. albicans (16), C. tropicalis (2), C. parapsilosis (2), C. krusei (3), C. kefyr (3) in 23 of controls. These results were almost same in both groups except for the relative high frequency of C. kefyr in controls. As for the risk factors, the isolates were increased in diabetic patients who were smokers (p<0.05), but insignificantly associated with sex, age, glycosylated hemoglobin and wearing of denture (p>0.05). Candidal culture rate and diabetic duration were not correlated (p>0.05). The number of colonies in SDA plate was significantly increased in smokers and denture-wearers (p<0.05). CONCLUSION: The frequency of oral candidal isolates in diabetic patients is higher than in that of controls. Oral-ambient factors such as smoking, probably involve in the development of oral candidal colonization, but not being the result of a single factor.
Agar ; Candida ; Colon ; Dentures ; Hemoglobin A, Glycosylated ; Humans ; Incidence ; Mouth ; Mouth Mucosa ; Risk Factors ; Sex Distribution ; Smoke ; Smoking

BACKGROUND: An important constituent of normal human oral microflora has long been recognized. The increase in the incidence of candidal infections has been associated with the increase in the number of patients at risk. Especially, diabetic patients have been increased susceptibility to general and local infections, but it is often equivocal whether or not risk factors such as oral-ambient conditions are related to candidal colonization. OBJECTIVE: The isolates of candidal species were evaluated in the oral cavity of diabetic patients in comparison with non-diabetic, non-immunocompromized subjects. Risk factors that could influence candidal colonization in diabetic patients were also studied. METHOD: Candidal species were isolated from the oral mucosa of 205 diabetics and 62 non-diabetics, using oral swab and smear technique. They were identified by germ tube test, Cornmeal-Tween agar and API 20C system. RESULTS: The frequency of oral candidal isolates was more common in 130 isolates (63.4%) in diabetic patients compared with 23 (37.1%) isolates in controls (p<0.05), but insignificantly related in age and sex distribution of both groups (p>0.05). Germ tubes were formed in the 102 species and chlamydospores in the 105 species in diabetic patients. Candida(C) albicans among the species was the most frequent isolates in both groups (80.8% vs 69.6%). The isolated 130 candidal species, identified by API 20C system, in diabetic patients, showed C. albicans (104), C. tropicalis (16), C. parapsilosis (6), C. krusei (1), C. kefyr (1) and unidentified species (2) compared with C. albicans (16), C. tropicalis (2), C. parapsilosis (2), C. krusei (3), C. kefyr (3) in 23 of controls. These results were almost same in both groups except for the relative high frequency of C. kefyr in controls. As for the risk factors, the isolates were increased in diabetic patients who were smokers (p<0.05), but insignificantly associated with sex, age, glycosylated hemoglobin and wearing of denture (p>0.05). Candidal culture rate and diabetic duration were not correlated (p>0.05). The number of colonies in SDA plate was significantly increased in smokers and denture-wearers (p<0.05). CONCLUSION: The frequency of oral candidal isolates in diabetic patients is higher than in that of controls. Oral-ambient factors such as smoking, probably involve in the development of oral candidal colonization, but not being the result of a single factor.
Agar ; Candida ; Colon ; Dentures ; Hemoglobin A, Glycosylated ; Humans ; Incidence ; Mouth ; Mouth Mucosa ; Risk Factors ; Sex Distribution ; Smoke ; Smoking