No abstract available.
Protein-Losing Enteropathies

No abstract available.
Diagnosis*

OBJECTIVES: The purpose of this study is to investigate the clinical significance of activity of daily living(ADL) and to identify the influencing factors on ADL in elderly patients admitted to the hospital-based acute geriatric care unit. METHODS: We studied a total of 279 patients aged 65 years and older who admitted to the Acute Elderly Care Unit at Seoul National University Bundang Hospital between May, 2004 and April, 2005. Comprehensive geriatric assessment including medical, psychosocial and functional evaluation was performed by the geriatric team. RESULTS: Most of the patients need ADL(62.7%) and IADL(68.8%) assistance. Dependent ADL patients were older (p<0.01), admitted via emergency room(p<0.01), demented(p<0.01), and associated with depression(p<0.01), malnutrition(p<0.01), and stroke(p<0.05) compared to independent ADL group. The length of stay was also significantly increased in dependent ADL group(p<0.01) and six-month mortality rate was higher in dependent ADL group(p<0.01). In correlation analysis, MMSE-KC score(r=0.708, p<0.01), nutritional state(r=0.581, p<0.01), the length of stay(r=-0.433, p<0.01), depression(r=-0.309, p<0.01), the numbers of chronic disease(r=-0.287, p<0.01), age (r=-0.236, p<0.01) showed significant association with ADL. In multivariate analysis, cognitive impairment(OR=5.80), emergent admission(OR=4.33), over the 75 years old age(OR=3.33), malnutrition(OR=2.86), and depression(OR=2.61) were identified as the independent influencing factors on ADL dependency. CONCLUSION: ADL dependency is common in elderly inpatient and significantly associated with poor prognosis. Identifying and controlling the influencing factor on ADL decline may improve the patients' functional status and clinical outcome.
Activities of Daily Living ; Aged* ; Cognition ; Depression ; Emergencies ; Geriatric Assessment ; Humans ; Inpatients ; Length of Stay ; Mortality ; Multivariate Analysis ; Prognosis ; Seoul

PURPOSE: This study describes the perception of comfort by hospital nurses. Q-methodological was used. METHOD: The participants completed a 37-item Q sort made up of statements which could be ranked in terms of their relevance to the subjective meaning of comfort. RESULT: Three interpretable types of comfort were identified. They are as follows: Type I, emotional and spiritual well-being style: The nurses perceived that patients feel comfortable when they feel emotional support from others and spiritual easiness. The nurses felt that the patients put worth in hope for a healthy life, free from pain and fear of death. Type II, acceptive medical environment style: The nurses perceived that patients have a secure and satisfied attitude towards prompt responses, exact information and skilled intervention techniques. They also perceived that patients feel safe and secure when they feel free of pain and medical staff are kind. Type III, physical well-being style; The nurses perceived that patients feel safe and comfortable when they feel free of pain and have a good sleep and are able to maintain a comfortable position. They perceived that patients put a high value on meeting the basic needs of safety, such pain, sleep and positioning. CONCLUSION: The result of this study can be used as a basis to develop nursing measures for promoting comfort. Further studies are recommended on factors which influence nurses' perception of comfort and strategies to promote comfort according to the style of the patients.
Hope ; Humans ; Medical Staff ; Nursing ; Q-Sort

This paper describes a Q-methodological study on the perception of comfort in hospital inpatients. The participants completed a 37-item Q sort made up of statements which could be ranked in terms of their relevance to the subjective meaning of comfort. Three interpretable types of comfort were identified through this Q study: Type I, positive medical action style, feel secure and satisfied when medical staff show a positive attitude towards them as patients. They put a high value on prompt responses from medical staff and physical aspects of care like non-invasive procedures or comfortable position. Type II, social relation style, experience a state of comfort when they perceive support or concern from medical staff, relatives or other patients suffering from similar diseases. They feel safe and secure when medical staff are kind and have a good reputation or when the size of the hospital is big enough. Type III, emotional wellbeing style, feel that hope for a healthy life or maintaining self-care activities are highly valuable. They feel safe and comfortable when their privacy is protected. They put worth on independent thinking, strong will, and emotional or psychological comfort.The results of this study can be used as a basis to develop nursing measures for comfort. Further studies on factors which influence perception of comfort and intervention strategies according to the above types of comfort need to be done.
Hope ; Humans ; Inpatients ; Medical Staff ; Methods ; Nursing ; Privacy ; Q-Sort ; Self Care ; Thinking

Actinomyces normally colonizes the mouth, colon, and vagina. Although disruption of mucosa may lead to infection at virtually any site, central nervous system actinomycosis is rare. A 45-year-old man presented with seizure and magnetic resonance imaging showed brain abscess. He was diagnosed with actinomycotic and streptococcal infection of brain by histologic and microbiologic examination. After stereotactic aspiration and biopsy, he was treated successfully by prolonged antibiotic therapy using intravenous penicillin-G and oral amoxicillin.
Actinomyces ; Actinomycosis ; Amoxicillin ; Biopsy ; Brain ; Brain Abscess ; Central Nervous System ; Colon ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Mouth ; Mucous Membrane ; Seizures ; Streptococcal Infections ; Vagina

Syphilis is re-emerging worldwide due to the HIV epidemic. Prior to the introduction of penicillin, syphilis was the second most common primary cause of all cases of uveitis. Today, ocular syphilis is a rare disease, especially in an immunocompetent patient. Variable manifestation without pathognomonic signs of ocular syphilis often lead to delayed diagnosis, resulted in irreversibile loss of vision. In Korea, syphilitic uveitis has not been reported in an immunocompetent patient since 1984. We experienced a case of syphilitic uveitis in an immunocompetent man with visual deterioration. As the incidence of syphilis is increasing in these days, a high degree of clinical suspicion should be considered in patients with unexplained ocular inflammation and visual disturbances.
Delayed Diagnosis ; HIV ; Humans ; Incidence ; Inflammation ; Korea ; Penicillins ; Rare Diseases ; Syphilis ; Uveitis ; Vision, Ocular

Actinomyces normally colonizes the mouth, colon, and vagina. Although disruption of mucosa may lead to infection at virtually any site, central nervous system actinomycosis is rare. A 45-year-old man presented with seizure and magnetic resonance imaging showed brain abscess. He was diagnosed with actinomycotic and streptococcal infection of brain by histologic and microbiologic examination. After stereotactic aspiration and biopsy, he was treated successfully by prolonged antibiotic therapy using intravenous penicillin-G and oral amoxicillin.
Actinomyces ; Actinomycosis ; Amoxicillin ; Biopsy ; Brain ; Brain Abscess ; Central Nervous System ; Colon ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Mouth ; Mucous Membrane ; Seizures ; Streptococcal Infections ; Vagina

Syphilis is re-emerging worldwide due to the HIV epidemic. Prior to the introduction of penicillin, syphilis was the second most common primary cause of all cases of uveitis. Today, ocular syphilis is a rare disease, especially in an immunocompetent patient. Variable manifestation without pathognomonic signs of ocular syphilis often lead to delayed diagnosis, resulted in irreversibile loss of vision. In Korea, syphilitic uveitis has not been reported in an immunocompetent patient since 1984. We experienced a case of syphilitic uveitis in an immunocompetent man with visual deterioration. As the incidence of syphilis is increasing in these days, a high degree of clinical suspicion should be considered in patients with unexplained ocular inflammation and visual disturbances.
Delayed Diagnosis ; HIV ; Humans ; Incidence ; Inflammation ; Korea ; Penicillins ; Rare Diseases ; Syphilis ; Uveitis ; Vision, Ocular

Activated phosphoinositide 3-kinase δ syndrome (APDS)1 is caused by gain-of-function mutations in PIK3CD, which encodes the catalytic p110δ subunit of phosphoinositide 3 kinase. We describe three patients with APDS1, the first thereof in Korea. Therein, we investigated clinical manifestations of APDS1 and collected data on the efficacy and safety profile of sirolimus, a mammalian target of rapamycin inhibitor and pathway-specific targeted medicine. The same heterozygous PIK3CD mutation was detected in all three patients (E1021K). After genetic diagnosis, all patients received sirolimus and experienced an excellent response, including amelioration of lymphoproliferation and improvement of nodular mucosal lymphoid hyperplasia in the gastrointestinal tract. The median trough level of sirolimus was 5.5 ng/mL (range, 2.8–7.5) at a dose of 2.6–3.6 mg/m2. Two patients who needed highdose, short-interval, immunoglobulin-replacement treatment (IGRT) had a reduced requirement for IGRT after initiating sirolimus, and the dosing interval was extended from 2 and 3 weeks to 4 weeks. The IgG trough level after sirolimus treatment (median, 594 mg/dL; range, 332–799 mg/dL) was significantly higher than that before sirolimus treatment (median, 290 mg/dL; range, 163–346 mg/dL) (p<0.001). One episode of elevated serum creatinine with a surge of sirolimus (Patient 2) and episodes of neutropenia and oral stomatitis (Patient 1) were observed. We diagnosed the first three patients with APDS1 in Korea. Low-dose sirolimus may alleviate clinical manifestations thereof, including hypogammaglobulinemia.