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Subclinical Thyroid Dysfunction in the Elderly.

Journal of the Korean Geriatrics Society.2014;18(3):111-121. doi:10.4235/jkgs.2014.18.3.111

Subclinical thyroid dysfunction, including both subclinical hyperthyroidism and subclinical hypothyroidism is biochemically defined as an abnormal thyroid-stimulating hormone (TSH) level and thyroid hormone level within its reference range. The prevalence of this condition varies according to the reference range for TSH and geographic or demographic factors, but is common in the elderly and in women. Subclinical thyroid dysfunction has various causes. Thus, careful clinical assessment is needed. Subclinical thyroid dysfunction can be likely to progress to overt thyroid disease and be associated with various health outcomes. However, to date, supporting data are lacking and levels of evidence for the associations are different. Although the management of subclinical thyroid dysfunction is controversial, recommendations are based on the degree to which TSH levels have deviated from normal, age, symptoms, and underlying comorbidities. Further studies are needed to inform how to best care for the elderly with subclinical thyroid dysfunction.
Aged* ; Comorbidity ; Demography ; Female ; Humans ; Hyperthyroidism ; Hypothyroidism ; Prevalence ; Reference Values ; Thyroid Diseases ; Thyroid Gland* ; Thyrotropin

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Reversible Abducens Nerve Palsy Following Transvenous Embolization of Cavernous Sinus Dural Arteriovenous Fistula.

Jong Hee SOHN ; Hui Chul CHOI ; Sang Moo LEE ; Seung Hun SHEEN

Journal of the Korean Geriatrics Society.2009;13(1):53-56. doi:10.4235/jkgs.2009.13.1.53

Transvenous embolization has become the treatment of choice for cavernous sinus dural arteriovenous fistula(cDAVF). However, there are potential complications associated with this procedure such as cranial nerve palsies and venous perforations. A 66-year-old woman presented with a 2-week left periorbital swelling and conjunctival injection. Brain MRI showed engorgement of the left superior ophthalmic vein. Cerebral angiography revealed a dural arteriovenous shunt of the cavernous sinus with retrograde venous drainage into the superior ophthalmic vein. Her proptosis and conjunctival injection resolved completely after transvenous embolization of cDAVF. However, an abducens nerve palsy developed the day after the procedure, which, fortunately, resolved spontaneously. She was symptom-free at the follow- up evaluation 2 months later. The abducens nerve palsy related to the transvenous embolization of cDAVF was presu- med due to either dense packing of the sinus, venous thrombosis, or direct nerve injury. We report a case of transient abducens nerve palsy associated with transvenous embolization of cDAVF, suggesting the benign course of this com- plication.
Abducens Nerve ; Abducens Nerve Diseases ; Aged ; Brain ; Cavernous Sinus ; Caves ; Central Nervous System Vascular Malformations ; Cerebral Angiography ; Cranial Nerve Diseases ; Drainage ; Exophthalmos ; Female ; Humans ; Veins ; Venous Thrombosis

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A Case of Leptomeningeal Carcinomatosis Presenting as a Neurological Complication of Stomach Cancer.

Eun Young OH ; Sang Bong LEE ; Seon Young RYU ; In Uk SONG ; Jung Hea LEE

Journal of the Korean Geriatrics Society.2009;13(1):49-52. doi:10.4235/jkgs.2009.13.1.49

Leptomeningeal carcinomatosis, an important and serious neurological complication of malignant cancers, is asso- ciated with severe disability and high mortality. It is most commonly seen in patients with breast cancer, lung cancer and malignant melanoma. However, leptomeningeal carcinomatosis induced by gastric cancer has been rarely reported, although gastric cancer is one of the most common causes of cancer-related deaths in Korea. We report a case of a 76- year-old woman with leptomeningeal carcinomatosis presenting as a neurological complication of gastric cancer and con- firmed by cytology examination of the cerebrospinal fluid and brain magnetic resonance imaging with gadolinium enhan-cement.
Brain ; Breast Neoplasms ; Carcinoma ; Female ; Gadolinium ; Humans ; Korea ; Lung Neoplasms ; Magnetic Resonance Imaging ; Melanoma ; Meningeal Carcinomatosis ; Stomach ; Stomach Neoplasms

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A Case of Successful Conservative Treatment of Esophageal Perforation from Penetration of Esophageal Wall by a Fish Bone.

Sang Ho LEE ; Sang Un SEO ; Sun Kyu CHOI ; Seung Wook BAK ; Hwang Yong JI ; Kyung Uk JO ; Cheol KOO

Journal of the Korean Geriatrics Society.2009;13(1):43-48. doi:10.4235/jkgs.2009.13.1.43

A 71-year-old man with a history of percutaneous transluminal coronary angioplasty(PTCA) was referred to our clinic with a one-day history of a continuous substernal chest pain radiating to his left shoulder. In retrospect, he experien- ced chest discomfort after eating fish one day before but did not seek medical attention then. An upper gastrointestinal endoscopy was performed. The cause was not visible during the advancement of the endoscope through the eso- phagus, but a small segment of a fish bone protruding from an ulcerative lesion in the lower esophagus was iden- tified while withdrawing the endoscope. The fishbone was immediately removed. A follow-up CT scan revealed pneumo- mediastinum. Now hemodynamically stable, the patient underwent conservative medical treatment including total parenteral nutrition(TPN) and intravenous antibiotic drugs. The patient made complete recovery. We report a case of a 71- year-old male found to have an esophageal perforation from an ingested fish bone, which was managed successfully with conservative treatment. A pertinent literature review is also included.
Aged ; Chest Pain ; Eating ; Endoscopes ; Endoscopy, Gastrointestinal ; Esophageal Perforation ; Esophagus ; Follow-Up Studies ; Foreign Bodies ; Humans ; Male ; Mediastinitis ; Mediastinum ; Shoulder ; Thorax ; Ulcer

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Esophageal Metastasis of Malignant Melanoma in a 66-year-old Female Patient.

Hee Seok MOON

Journal of the Korean Geriatrics Society.2009;13(1):39-42. doi:10.4235/jkgs.2009.13.1.39

Malignant melanoma is a malignant neoplasm originating from the melanocytes, which are cells derived from the neural crest. Gastrointestinal metastasis that spreads through lymphatic or hematogenous routes is an important prog- nostic factor; however, esophageal metastasis has rarely been reported. A number of immunohistochemical stai- ning methods for the pathological confirmation of esophageal metastasis have been introduced recently. Metastatic malignant melanoma is treated with chemotherapy and immunotherapy, but the prognosis is very poor. We report the case of a 66-year-old female who presented with difficulty swallowing, epigastric discomfort, and multiple variable- sized esophageal nodules diagnosed as esophageal metastases from subcutaneous malignant melanoma.
Aged ; Deglutition ; Female ; Humans ; Immunotherapy ; Melanocytes ; Melanoma ; Neoplasm Metastasis ; Neural Crest ; Prognosis

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Interactive Effects of Forward, Backward Walking Exercise and Pelvic Floor Muscle Exercise on Sexual Function and Functional Fitness in the Elderly Male Population.

Young Soo JIN ; Kwang Lae KIM ; Hye Young LEE ; Eun Kyung PARK ; Sung Il SONG ; Yong Hwan KIM ; Duk Han KO ; Tai Young AHN

Journal of the Korean Geriatrics Society.2009;13(1):31-38. doi:10.4235/jkgs.2009.13.1.31

BACKGROUND: To assess the effect of forward, backward walking exercise and pelvic floor muscle exercise on sexual function and functional fitness in elderly males. METHODS: Twenty two elderly males participated in this study. They were divided into two groups. The Complex Exercise(CE) group(n=11) performed the forward, backward walking exercise(3 days/week, 12 weeks) and pelvic floor muscle exercises(PFME; 5 days/week, 12 weeks). The PFME group(n=11) only performed PFME(5 days/week, 12 weeks). Both groups performed the PFME in the same manner. Outcomes were evaluated by IIEF-5(5-item version of the interna- tional index of erectile function), 6min walk, and 30sec & 1min sit-to-stand before exercise training, and at week 4, week 8, and week 12. RESULTS: Total scores and erectile function scores had significant interaction effect(p<0.05) in group and period. 6min walk wassignificantly different(p<0.05) in exercise period and 30sec(p<0.001) & 1min sit-to-stand(p<0.01) had signi- ficant interaction effectin group and period. CONCLUSION: Three months of forward, backward walking and pelvic floor muscle exercises did not have significant positive effects on sexual function and functional fitness in elderly males.
Aged ; Exercise ; Humans ; Male ; Muscles ; Pelvic Floor ; Sesquiterpenes ; Walking

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Clinical Analysis of Acute Poisoning in Elderly Patients.

Woon Jeong LEE ; Se Min CHOI ; Yeon Young KYONG ; Hyung Min KIM ; Chun Song YOUN ; Si Kyoung JEONG ; Seon Hee WOO ; Kyu Nam PARK

Journal of the Korean Geriatrics Society.2009;13(1):24-30. doi:10.4235/jkgs.2009.13.1.24

BACKGROUND: Incidents of suicide attempts and acute poisonings in the elderly population is rising. This study com- pared elderly and younger patients to investigate the influence of age on the clinical nature of acute poisoning. METHODS: We retrospectively investigated 147 patients with acute poisoning who visited the emergency department within 6 hours of exposure. Patients were divided into two groups, young adult(20-40 yrs) and elderly(> or =55 yrs). Information on type of toxic material, age, sex, duration of time to arrive to the emergency department(ED) after poisoning, cause of poisoning, usage of activated charcoal and gastric lavage, previous suicide attempts, and past psy- chiatric history were collected. And, the mean arterial pressure, respiratory rate, base excess, aspartate aminotransfe- rase(AST), serum creatinine, rate of discharge against medical advice, intensive care unit(ICU) admission rate, discharge rate, duration in ICU, usage of mechanical ventilator, and death rate were analyzed. Initial and final Poisoning Severity Scores(PSS) of each patient were calculated. RESULTS: The mean age of the young adult group and the elderly group were 30.6+/-6.1 yrs and 66.6+/-8.2 yrs, respectively. Cause of poisoning was accidental more often in the elderly group than in the young adult group. AST and creatinine levels were higher and base excess was lower in the elderly group. ICU admission rate, duration in ICU, usage of mechanical ventilator, death rate, and initial and final PSS were all higher in the elderly group as well. CONCLUSION: This study showed that the PSS and death rate from acute poisoning were higher in the elderly group than in the young adult group.
Aged ; Arterial Pressure ; Aspartic Acid ; Charcoal ; Creatinine ; Emergencies ; Gastric Lavage ; Humans ; Critical Care ; Respiratory Rate ; Retrospective Studies ; Suicide ; Ventilators, Mechanical ; Young Adult

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The Relationship between Left Ventricle Diastolic Dysfunction and Carotid Plaques in Elderly Patients with Ischemic Stroke.

Hyun Ju YOON ; Won Yu KANG ; Min Gu LEE ; Kye Hun KIM ; Ju Han KIM ; Younggeun AHN ; Myung Ho JEONG ; Jung Gwan CHO ; Jung Chaee KANG ; Jun Tae KIM ; Man Seok PARK ; Ki Hyun CHO ; Jong Chun PARK

Journal of the Korean Geriatrics Society.2009;13(1):16-22. doi:10.4235/jkgs.2009.13.1.16

BACKGROUND: Atherosclerotic plaques in the carotid artery have been considered a potential source of cerebrovas- cular events. Carotid plaques are associated with an increased risk of ischemic stroke. We performed this study to evaluate the relationship between atherosclerotic carotid plaques and cardiac function measured by echocardiography in elderly patients with ischemic stroke. METHODS: A total of 415 patients aged >60 yrs with acute ischemic stroke were divided into two groups according to the presence(groups I, n=195, 140 males) or absence(group II, n=220, 112 males) of carotid plaques. We evaluated the asso ciation of the presence of plaques with age, sex, potential vascular risk factors, other carotid images, and cardiac function by echocardiography. RESULTS: Of the 415 patients, carotid plaques were found in 195 cases. Mean plaque size was 2.44+/-0.7mm on the right side and 2.32+/-0.75mm on the left. Plaques were located more frequently in the carotid bulb(68%) than in the common carotid artery(32%). 57% were calcified plaques and 72%, multiple plaques. Group I(with carotid plaques) had a significantly higher percentage of males(73.6%, p<0.001), hypertension(68.5%, p=0.043), diabetes(28.7%, p=0.029), and dyslipidemia(60.1%, p=0.008). In addition, group I had thicker carotid IMT than group II(Right: 0.86 vs. 0.70mm, p<0.001, Left: 0.90 vs. 0.73mm, p<0.001), lower common carotid artery end diastolic flow velocity(Right: 13.37 vs. 15.73m/s, p=0.002, Left: 14.46 vs.17.24m/s, p=0.004), and higher E/E'level(11.57 vs. 9.36, p=0.001). Old age, dyslipidemia, and diastolic dysfunction were independently associated with carotid plaques. CONCLUSION: Our results indicated that old age, male gender, diabetes, hypertension, and dyslipidemia are more com- mon in patients with carotid plaques than in those without. Old age, male gender, dyslipidemia, and diastolic dysfunc- tion are independent risk factors of carotid plaques in elderly patients with ischemic stroke. We further concluded that though left ventricle systolic function is not associated with carotid plaques in elderly patients with ischemic stroke, left ventricle diastolic dysfunction is.
Aged ; Carotid Arteries ; Carotid Artery, Common ; Dyslipidemias ; Echocardiography ; Heart Ventricles ; Humans ; Hypertension ; Male ; Plaque, Atherosclerotic ; Risk Factors ; Stroke

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Effects of Angiotensin-Converting Enzyme Inhibitor on Arterial Stiffness, Diastolic Function, and Exercise Performance in Patients with Hypertension.

Kye Hun KIM ; Jong Chun PARK ; Chun Soon OH ; Seung Hee CHOI ; Mi Ran KIM ; Woo Seok LEE ; Hyun Ju YOON ; Youngkeun AHN ; Myung Ho JEONG ; Jeong Gwan CHO ; Jung Chaee KANG

Journal of the Korean Geriatrics Society.2009;13(1):7-15. doi:10.4235/jkgs.2009.13.1.7

BACKGROUND: The aim of this study was to investigate the relations between arterial stiffness, diastolic function, and exercise performance and the effects of angiotensin-converting enzyme inhibitor(ACEI), perindopril, in these three areas in patients with hypertension(HT). METHODS: A total of 39 patients(60.9+/-4.9 years, 23 males) with a newly diagnosed or untreated HT, stage I, were enrolled. Arterial stiffness measured by pulse wave velocity, diastolic function measured by echocardiography, and exercise performance and hemodynamic parameters measured by a treadmill exercise test were compared before and after 6 months of medical treatment with an ACEI. RESULTS: The parameters for arterial stiffness, diastolic function, and exercise performance did not show significant correlations with each other at baseline. Systolic(from 147.6+/-6.5mmHg to 134.3+/-9.6mmHg, p<0.001) and diastolic blood pressures(from 87.7+/-7.5mmHg to 82.9+/-6.2mmHg, p<0.001) decreased significantly after 6 months of ACEI treatment. Except for duration of total exercise time, the parameters for arterial stiffness, diastolic function, and the hemodynamic response to exercise also improved significantly after 6 months of ACEI treatment. CONCLUSION: Though the parameters for arterial stiffness, diastolic function, and exercise performance were not asso- ciated with each other at baseline, they all improved significantly after 6 months of medical treatment with an ACEI in elderly patients with stage I HT. The results of this study suggest the possibility of additional benefits of ACEI beyond lowering blood pressure.
Aged ; Echocardiography ; Exercise Test ; Hemodynamics ; Humans ; Perindopril ; Pulse Wave Analysis ; Vascular Stiffness

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Geriatrics Education and Training Experience in the United States.

Sabine VON PREYSS-FRIEDMAN

Journal of the Korean Geriatrics Society.2009;13(1):1-6. doi:10.4235/jkgs.2009.13.1.1

Over the last several decades great strides have been made in the United States to meet the needs of an aging American population. This paper reviews the development of geriatric medicine in the United States, which is cha- racterized by leadership and investment from both the public and private sector. The establishment of the National Institute of Aging, as well as, Centers of Excellence and initiatives from the Veterans Administration supported the development and growth of geriatric medicine training programs. While significant advances have been made, we continue to be faced with the challenge of an aging population and not enough geriatricians to care for them. Current strategies will need to intensify geriatric training at the medical student level and teach all physicians, regardless of specialty, how to take care of older patients.
Aging ; Geriatrics ; Growth and Development ; Humans ; Investments ; Leadership ; Private Sector ; Students, Medical ; United States ; United States Department of Veterans Affairs

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