Recently attention to the behavior and psychological symptoms of dementia (BPSD) is increasing repidly. Agitation is one of the BPSDs that contributes to the heavy burden on the caregiver and family. But, the definition of the agitation is controversial, and the rating scales for its measurements have limitations. We reviewed the literatures and our experiences to propose a rational strategy for controlling the agitating behaviors in the demented elderly. In the assessment of agitation in dementia, the top priority is a careful evaluation of the patient's medical, psychiatric, and environmental status. After pertinent medical conditions have been identified and managed, significant agitation may still be present and require intervention. Basically both behavior/environmental intervention and psychopharmacologic management are recommended in almost all situations. For patients with mild agitation, the clinician may consider implementing behavioral/environmental intervention singwarly. In severe agitation, however, pharmacologic approach is a preferred strategy, and can be administered according to the prevailing syndromes, such as psychosis, depression, delirium, anxiety, and so on. In practice high potency conventional antipsychotics and benzodiazepines are fregnently prescribed, but recently, drugs that have fewer long-term side effects, such as risperidone and divalproex are highly recommended. Due to the decreased pharmacokinetics and pharmacodynamics, drug dosages for the demented elderlies are much lower compared to younger patients. Side effects of the maintaining psychotropics should be monitored cautiously as well. Although some patients require long-term treatment, it is important to taper off and discontinue the medication periodically following a satisfactory improvement.
Aged ; Antipsychotic Agents ; Anxiety* ; Benzodiazepines ; Caregivers ; Delirium ; Dementia ; Depression ; Dihydroergotamine* ; Drug Therapy ; Humans ; Pharmacokinetics ; Psychotic Disorders ; Risperidone ; Valproic Acid ; Weights and Measures

OBJECTIVE: This study was designed to evaluate the cause of mortality in patients with dementia, including Alzheimer's disease and multi-infarct dementia, and those without dementia. METHOD: Hospital records of geriatric patients (> or =65) in nursing home having dementia were reviewed retrospectively for 6 years. The total number of patients was 351 (the number of demented patients was 146 and those without dementia was 68). Of the ones with dementia, 146 had dementia of Alzheimer's type, 101 patients had vascular dementia, and 36 patients had non-specific dementia. This study focused on the different complications associated with Alzheimer's disease and cerebrovascular dementia. RESULT: 1) The average age at death of demented patient is higher than the non-demented population;however, there is no difference in age between Alzheimer's disease and vascular dementia. 2) There is no difference in time spent in the nursing home among the non-demented group, Alzheimer's disease and vascular dementia group from admission to death. The life expectancy of male patients with Alzheimer's disease after admission to the nursing home is significant shorter than their female counterpart. 3) Patients with vascular dementia have a higher incidence of hypertension, atherosclerotic disease, and diabetes than the Alzheimer's patients. 4) The main overall causes of the death (in nursing home patients) are infection and sepsis. In Alzheimer's disease's, sepsis is the major cause of death, while in vascular dementia, atherosclerotic disease is the number one cause. CONCLUSION: Knowledge of the causes of the death in demented patients may help the management of the possible complications associated with the different types of dementia. However, long-term research is then needed to analyze the survival rates of demented nursing home patients.
Alzheimer Disease ; Cause of Death ; Dementia* ; Dementia, Multi-Infarct ; Dementia, Vascular ; Female ; Hospital Records ; Humans ; Hypertension ; Incidence ; Life Expectancy ; Male ; Mortality* ; Nursing Homes* ; Nursing* ; Retrospective Studies ; Sepsis ; Survival Rate

PURPOSE: The purpose of this study was to identify the influences of recognition on low fertility and views of marriage on childbirth will in university students. METHODS: Participants were 190 university students in Chungchungnamdo province, Korea. The data were collected from May to October 2018 and examined using descriptive statistics, t-test, analysis of variance, Pearson correlation and multiple regression with IBM SPSS Statistics ver. 24.0. RESULTS: Childbirth will was significantly correlated with recognition on low fertility (r=0.20, p=0.002) and views on marriage (r=0.53, p<0.001). Factors associated with childbirth will were views on marriage (β=0.24, p<0.001). CONCLUSION Theses results suggests that views on marriage have important influences on childbirth will in university students. To improve childbirth will, the positive views on marriage need to be formulated in university students.

BACKGROUND: Opioids are widely used in boluses and patient-controlled analgesia (PCA) for postoperative pain control. In this study, we compared the effects of oxycodone and fentanyl on postoperative pain in patients with intravenous patient-controlled analgesia (IV-PCA) after laparoscopic gynecological surgery. METHODS: Seventy-four patients undergoing elective total laparoscopic hysterectomy or laparoscopic myomectomy were randomly assigned to the administration of either fentanyl or oxycodone using IV-PCA (potency ratio 1 : 60). The cumulative dose administered in the patient-controlled mode during the initial 48 hours after the operation was measured. Patients were also assessed for postoperative pain severity, adverse effects, and patient satisfaction. RESULTS: No significant differences were observed in patient satisfaction with the analgesia during the postoperative period. Patients in the oxycodone group experienced significantly more dizziness compared to the fentanyl group. Patients in the oxycodone group showed significantly lower consumption of opioid in the patient-controlled mode (10.1 +/- 8.5 ml vs. 16.6 +/- 12.0 ml, P = 0.013). CONCLUSIONS: Our data suggest that oxycodone and fentanyl demonstrated similar effects, and therefore oxycodone may be a good alternative to fentanyl in postoperative pain management. Further studies in various clinical settings will be needed to determine the adequate potency ratio.
Analgesia ; Analgesia, Patient-Controlled* ; Analgesics, Opioid ; Dizziness ; Female ; Fentanyl* ; Gynecologic Surgical Procedures* ; Humans ; Hysterectomy ; Oxycodone* ; Pain, Postoperative ; Patient Satisfaction ; Postoperative Period

BACKGROUND: Kawasaki disease (KD) is an acute inflammation of middle-sized arteries such as the coronary artery. KD is an important disease due to its high mortality rate, which approaches 1-2% without appropriate treatment. Since the various mucocutaneous lesions of KD are related to the dermatologic field, dermatologists should take an interest in this disorder and understand the lesions. OBJECTIVE: To evaluate the characteristics of cutaneous lesions in Korean patients with KD. METHODS: A total of 919 patients with KD were assessed at the department of pediatric cardiology and dermatology, Myongji hospital between January 2006 and December 2010. RESULTS: Of the 919 patients, 566 (61.6%) were diagnosed with typical KD and 353 (38.4%) with atypical KD. KD was most frequent in the 4 year-old group (22.7%), and the ratio of male to female was 1.5:1. Among the mucocutaneous manifestations, erythema of the oropharyngeal mucosa (75.7%) occurred most frequently, followed by polymorphous trunk rash (41.7%), and changes of palms and soles (25.6%). A total of 606 patients (65.9%) with KD had associated diseases as follows: pneumonia (211 patients; 34.8%), pharyngotonsilitis (168 patients; 27.7%), gastroenteritis (132 patients; 21.8%), asthma (15 patients, 2.5%), atopic dermatitis (11 patients, 1.8%). CONCLUSION: Our study shows that change in the lips or oral cavity is the most common mucocutaneous manifestation in both classic and atypical KD. Also, morbiliform rash is the most common pattern of polymorphous rashes. Interestingly, erythema multiforme-like lesions occupied accounted for a considerable portion of KD cases compared to previous studies.
Arteries ; Asthma ; Cardiology ; Coronary Vessels ; Dermatitis, Atopic ; Dermatology ; Erythema ; Exanthema ; Female ; Gastroenteritis ; Humans ; Inflammation ; Lip ; Male ; Mouth ; Mucocutaneous Lymph Node Syndrome ; Mucous Membrane ; Pneumonia

Xanthogranulomatous osteomyelitis (XO) is a rare chronic inflammatory bone disease characterized by the presence of cholesterol-laden foam macrophages, histiocytes, and plasma cells. We report the case of a 41-year-old man with end-stage renal disease who had undergone deceased donor kidney transplantation 4 years earlier. He presented with a chest wall mass that he had first identified 2 weeks prior to admission. Computed tomography revealed a periosseous heterogeneously enhancing soft tissue mass adjacent to the sternal end of the left clavicle, accompanied by irregular and destructive osteolytic lesions on the left side of the sternal manubrium. A total mass resection, which included partial clavicle and sternum removal, was performed. Pathological examination revealed foamy histiocytes along with numerous lymphoplasmacytic cells, confirming the diagnosis of XO. This case underscores the potential for XO to develop following kidney transplantation.

Xanthogranulomatous osteomyelitis (XO) is a rare chronic inflammatory bone disease characterized by the presence of cholesterol-laden foam macrophages, histiocytes, and plasma cells. We report the case of a 41-year-old man with end-stage renal disease who had undergone deceased donor kidney transplantation 4 years earlier. He presented with a chest wall mass that he had first identified 2 weeks prior to admission. Computed tomography revealed a periosseous heterogeneously enhancing soft tissue mass adjacent to the sternal end of the left clavicle, accompanied by irregular and destructive osteolytic lesions on the left side of the sternal manubrium. A total mass resection, which included partial clavicle and sternum removal, was performed. Pathological examination revealed foamy histiocytes along with numerous lymphoplasmacytic cells, confirming the diagnosis of XO. This case underscores the potential for XO to develop following kidney transplantation.

Xanthogranulomatous osteomyelitis (XO) is a rare chronic inflammatory bone disease characterized by the presence of cholesterol-laden foam macrophages, histiocytes, and plasma cells. We report the case of a 41-year-old man with end-stage renal disease who had undergone deceased donor kidney transplantation 4 years earlier. He presented with a chest wall mass that he had first identified 2 weeks prior to admission. Computed tomography revealed a periosseous heterogeneously enhancing soft tissue mass adjacent to the sternal end of the left clavicle, accompanied by irregular and destructive osteolytic lesions on the left side of the sternal manubrium. A total mass resection, which included partial clavicle and sternum removal, was performed. Pathological examination revealed foamy histiocytes along with numerous lymphoplasmacytic cells, confirming the diagnosis of XO. This case underscores the potential for XO to develop following kidney transplantation.

Xanthogranulomatous osteomyelitis (XO) is a rare chronic inflammatory bone disease characterized by the presence of cholesterol-laden foam macrophages, histiocytes, and plasma cells. We report the case of a 41-year-old man with end-stage renal disease who had undergone deceased donor kidney transplantation 4 years earlier. He presented with a chest wall mass that he had first identified 2 weeks prior to admission. Computed tomography revealed a periosseous heterogeneously enhancing soft tissue mass adjacent to the sternal end of the left clavicle, accompanied by irregular and destructive osteolytic lesions on the left side of the sternal manubrium. A total mass resection, which included partial clavicle and sternum removal, was performed. Pathological examination revealed foamy histiocytes along with numerous lymphoplasmacytic cells, confirming the diagnosis of XO. This case underscores the potential for XO to develop following kidney transplantation.

No abstract available.
Arthritis, Rheumatoid ; Bone Density* ; Estrogens* ; Etidronic Acid* ; Female ; Humans ; NF-kappa B ; Osteoporosis, Postmenopausal*