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Plasma Levels of Soluble Adhesion Molecules in Patients with Acute Cerebral Ischemic Stroke.

Sung Wook YU ; Min Kyu PARK ; Kun Woo PARK ; Dae Hie LEE

Journal of the Korean Geriatrics Society.2003;7(2):146-153.

BACKGROUNDS: The inflammatory reaction after cerebral ischemia involving adhesion molecules aggravates neurologic deficit. This study aimed to study the change of plasma level of the adhesion molecules after acute cerebral ischemia. METHODS: Nineteen patients with acute cerebral infarction and ten control subjects without a history of cerebrovascular disease were included in this study. The patient groups were subgrouped into large artery atherosclerosis and small artery occlusion groups according to TOAST classification. Plasma levels of sP-selectin, sE-selectin, sICAM-1 and sVCAM-1 were measured within 24 hours and in 6 to 8 days after acute ischemic infarction. RESULTS: The plasma level of sP-selectin was elevated in acute stroke patients within 24 hours and in 6 to 8 days after stroke onset compared with control group(p<0.05). But plasma levels of sE-selectin, sICAM-1 and sVCAM-1 were not different from those of control group. The plasma level of sP-selectin was significantly elevated in large artery artherosclerosis group compared with control group. CONCLUSION: This study suggest that P-selectin actively involves in inflammatory process after acute ischemic stroke, especially associated with atherosclerosis.
Arteries ; Atherosclerosis ; Brain Ischemia ; Cerebral Infarction ; Classification ; Humans ; Infarction ; Neurologic Manifestations ; P-Selectin ; Plasma* ; Stroke*

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Pre and Postoperative Assessment of Depression and Cognitive Dysfunction Aged 65 Years or Older in Department of Surgery.

Hong Yong CHOI

Journal of the Korean Geriatrics Society.2003;7(2):135-145.

BACKGROUNDS: As the lifetime is prolonged, the chances of operation of elderly people are increased concomitantly. In general, elderly patients have more frequent and severe psychiatric problems as depression and cognitive dysfunction than young patients. But, the prevalence rate of depression and cognitive dysfunction pre and postoperatively is known a little. Also, the delirium which makes the surgeon embarrassed is high in dementia and elderly patients even diagnosed normally preoperatively. We tried to know how many elderly people has depression and cognitive dysfunction pre and postoperatively, also how many elderly patients become delirious postoperatively. METHOD: We obtained questionnaires from 100 elderly patients(mean age 75.0) undergoing operation pre and postoperatively. We used Short Portable Mental Status Questionnaire(SPMSQ) which calculated the wrong answer for the fact to evaluate the cognitive dysfunction and short version of Geriatric Depression Scale(GDS) which calculated the wrong answer defined previously to study the depression. The depression was suggestted if GDS score was above 6 and cognitive dysfunction was suggested if SPMSQ score was above 3. The dementia and postoperative delirium patients were diagnosed and managed by the psychiatrist and the operator. RESULTS: Pre and postoperative mean score of GDS was 10.1 and 9.5 respectively. Pre and postopera- tive incidence of depression was 65% and 67% respectively. Pre and postoperative mean errors of SPMSQ was 6.5 and 6.7 respectively. Pre and postoperative incidence of cognitive dysfunction was 30% and 31% respectively. The dementia patients were ten. The postoperative delirium patients were six. Three of them were dementia patients diagnosed preoperatively and the others had non-cognitive dysfunction preoperatively. CONCLUSION: The incidence of depression and cognitive dysfunction in elderly patients is relatively high. And the postoperative delirium is high in dementia patients. Even the patients diagnosed non- cognitive dysfunction preoperatively have high incidence rate than young people. So, we must do critical care with elderly patients pre and postoperatively and know the appropriate management of depression and cognitive dysfunction to prevent prolonged hospitalization, poor quality of life and conflict with patient`s family.
Aged ; Critical Care ; Delirium ; Dementia ; Depression* ; Hospitalization ; Humans ; Incidence ; Prevalence ; Psychiatry ; Quality of Life ; Surveys and Questionnaires

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Family Caregiver Burden of Stroke Patient.

Eun Kyung KIM ; Eun Jung LEE ; Jeehyun SOHN ; Byung Chul LEE

Journal of the Korean Geriatrics Society.2003;7(2):101-124.

BACKGROUND: After the group education program for the families of stroke patients, we found there were improvement in family members' mental health state and coping skills. However, we also found that family caregiver's burden varied depending on patient and family factors. The purpose of this study, therefore, were to explore which factors affected caregiver's burden on family members of stroke patients and to make a background for suggesting an effective intervention strategies for them. METHOD: The subjects of this study were 187 family members of stroke patients who received the treatment from Hospital located in Seoul and Kyunggi area and they completed the written questionnaire. RESULTS: While Family member's health state, share of care responsibility, patient's functional status and family and friends support were predictors of subjective care burden, patients age and left hemiparesis among patient's functional status were predictors of objective care burden. CONCLUSIONS: Family members play a critical role in the long-term rehabilitation of a stroke patient. Hence reducing family members' care burden is very important for a patient as well as their family members. Therefore if we make intervention strategies considering these influential factors, it could be more effective to reduce family caregiver's burden.
Adaptation, Psychological ; Caregivers* ; Education ; Friends ; Gyeonggi-do ; Humans ; Mental Health ; Paresis ; Surveys and Questionnaires ; Rehabilitation ; Seoul ; Stroke*

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Effects of Ca2+ Channel Blockers on Expression of L-type Voltage Dependent Ca2+ Channels in Vascular Smooth Muscle Cells Obtained from the Aorta of Diabetic Rats.

Hyung Joon YOO

Journal of the Korean Geriatrics Society.2003;7(2):95-100.

BACKGROUND: The proliferation of vascular smooth muscle cells(VSMCs) is an important process in the pathogenesis of atherosclerosis. VSMCs proliferation is closedly related to the cytosolic calcium flux via L-type voltage dependent calcium channel. OBJECTIVES: To investigate the role of cytosolic Ca2+ in the proliferation of VSMCs. METHODS: The proliferation of aortic vascular smooth muscle cells of streptozotocin induced diabetic rats, acquired by enzymatic method. Cell counting, and calcium agonists(Bay K 8644 10(-6)M) or calcium antagonists(verapamil 10(-6)M). Cytosolic calcium ion was measured with Fura 2 method. Calcium channel gene expression was detected with RT-PCR method. RESULTS: VSMCs of diabetic rats were more proliferated than those of nondiabetic ones. Bay K 8644 enhanced VSMCs proliferation of both groups. Verapamil blocked the incremental effects induced by Bay K 8644. Expression of calcium channel gene was enhanced by Bay K 8644 and was reversed by vera- pamil. CONCLUSION: The enhanced proliferation of VSMCs is associated with the increment in cytosolic calcium, which is accompli shed through the expression of L-type voltage dependent calcium channel.
3-Pyridinecarboxylic acid, 1,4-dihydro-2,6-dimethyl-5-nitro-4-(2-(trifluoromethyl)phenyl)-, Methyl ester ; Animals ; Aorta* ; Atherosclerosis ; Calcium ; Calcium Channels ; Cell Count ; Cytosol ; Fura-2 ; Gene Expression ; Muscle, Smooth, Vascular* ; Rats* ; Streptozocin ; Verapamil

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Geriatric Trauma.

Soon Joo WANG ; Jae Myung CHUNG

Journal of the Korean Geriatrics Society.2003;7(2):85-94.

No abstract available.

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A Case of Rhino-orbito-Cerebral Mucormycosis Presenting with Recurrent Transient Ischemic Attacks(TIAs).

Woo Youl KANG ; Ju Hun LEE ; Young Hee SUNG ; Il Soo CHOI ; Hong Ki SONG ; Byung Chul LEE

Journal of the Korean Geriatrics Society.2002;6(3):239-242.

Rhino-orbito-cerebral muconnycosis is an uncommon fatal fringal infection, almost exclusively seen in diabetic or other itnmunocompromised patients. Recurrent transient ischemic attacks(TIAs) as initial presenting sign of rhino-orbito-cerebral mycormycosis has not been reported to our knowledge. We report a patient with muconnycosis unusually presenting with recurrent TIAs, followed by central retinal artery occlusion, multiple cranial nerve palsies, and then cerebral infarction in the territory of middle cerebral artery.
Cerebral Infarction ; Cranial Nerve Diseases ; Humans ; Middle Cerebral Artery ; Mucormycosis* ; Retinal Artery Occlusion

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Immunohistochemical Study on the Distribution of Estrogen Receptor-alpha in the Hippocampus of the Normal Aged Rat.

Eunju LEE ; Dong Hoon SHIN ; Choong Ik CHA ; Young Soo LEE

Journal of the Korean Geriatrics Society.2002;6(3):233-238.

BACKGROUND: In recent years, estrogen has also been shown to modulate the development and function of the brain, bur not exclusively in areas involved with sexual behavior. Among the most novel and fascinating effects of estrogen are those on cognitive function and memory process and their alterations during aging and neurodegenarative disease like Alzheimer. Estrogen receptors distributed not only in the hypothalamus but many different areas, like cerebral cortex, hippocampus, basal forebrain, midbrain, spinal cord, and the diverse action of estrogen is supported by this fact. Numerous studies suggest thai estrogen may be beneficial in preserving cognitive function, but it is not clear yet. PURPOSE: In this study, we perform the immunohistochemical staining in the hippocampus of normal aged rat, and show the distribution of estrogen receptor compared with the neonatal rat. METHODS: we have used antibodies against a estrogen receptor(ER)-alpha to determine their distribution in neonatal and aged SD rat hippocampus. RESULTS: In neonatal rat hippocampus, ER-alpha immunoreactivity was observed in the nucleus of Purkinje cells, whereas in aged rat hippocampus, ER-a immunoreactivity was found mainly in the cytoplasm of Purkinje cells. CONCLUSION: We showed the age related intracellular differential distribution of ER-alpha immunoreactivity in the rat hippocampus. But, further investigations are required to establish whether functional relations like cognitive ability exist with this different intracellular expression of ER-alpha immunoreactivity.
Aging ; Animals ; Antibodies ; Asian Continental Ancestry Group ; Brain ; Cerebral Cortex ; Cytoplasm ; Estrogens* ; Hippocampus* ; Humans ; Hypothalamus ; Memory ; Mesencephalon ; Prosencephalon ; Purkinje Cells ; Rats* ; Receptors, Estrogen ; Sexual Behavior ; Spinal Cord

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Jae Young LIM ; Hyung Ik SHIN ; Gyu Ree KIM ; Dong A KIM ; Ji Young KIM ; In Soo RHA ; Eun Seon LEE

Journal of the Korean Geriatrics Society.2002;6(3):222-232.

BACKGROUND: The growing number of spinal cord injured individuals facing old age makes the understanding of age related limitations increasingly important. This study was to investigate the age-related differences in rehabilitation outcome according to the level of cervical spinal cord injury and each category of activity of daily living(ADL). METHODS: Subjects were 79 adults with tetraplegia all of whom were admitted in National Rehabilitation Hospital. The level of injury was classified into upper cervical(C4, C5), mid-cervical(C6), and lower cervical(C7, C8) spinal cord injury. Eight ADL categories including feeding, grooming, bathing, dressing, toileting, bed-transfer, toilet/tub transfer, and indoor mobility were assessed using the scale of Spinal Cord Independence Measure. Age related differences were examined by separating the sample into two age groups(> or =40 and <40 years) RESULTS: There was no age related difference in rehabilitation outcome in upper cervical cord injury patients. In mid-cervical cord injury level, ADL capacities differed only in the feeding and grooming activities. In lower cervical cord injury level, older patients showed lower rehabilitation outcome than younger counterparts in all ADL categories examined. CONCLUSION: Along with injury level, age should be considered when formulating rehabilitation plans and functional prognostic statements in tetraplegic patients.
Activities of Daily Living ; Adult ; Animals ; Bandages ; Baths ; Grooming ; Humans ; Quadriplegia ; Rehabilitation* ; Spinal Cord Injuries* ; Spinal Cord* ; Treatment Outcome*

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Percutaneous Vertebroplasty in the Treatment of Senile Osteoporotic Vertebral Body Compression Fractures: Treatment Efficacy and Complications.

Dong Ho KANG ; Ki Jeong KIM ; Chul Hee LEE ; Soo Hyun HWANG ; Eun Sang KIM ; Jin Myung JUNG

Journal of the Korean Geriatrics Society.2002;6(3):212-221.

BACKGROUNDS: The purpose of this study is to clarify therapeutic efficacy of percutaneous vertebroplasty(PVP) using polymethylmethacrylate(PMMA) for the osteoporotic compression fractures of the spine and to define the complications following the procedures. METHODS: The authors retrospectively analyzed the clinical outcome of 51 consecutive patients with recent osteoporotic compression fractures undergone PVP between January, 2000 and December, 2001. We reviewed medical records, radiographic findings, and telephone questionaires. The clinical outcomes were categorized by visual analogue scale(VAS). RESULTS: The mean age of the patients was 70.2 years old(range, 60~84) and the male/female ratio was 9:42(17.6%:82.4%). Mean duration of symptom was 2.75 months(0.25~12). Mean follow up periods were 12.2 months(5~27). Among the 63 treated segments, most of them were thoracolumbar junction(69.8%, 44/63) and treated via bipedicular route(bipedicular/unipedicular: 47/16). Thirty-eight patients showed complete or partial relief of pain(82.6%). Age, sex, duration of symptom, number of involved segments, and approach(uni-/bipedicular) had no statistical significance to clinical outcome. Nonetheless leakage of acrylic cement was noted in 37 patients(72.5%), most of them were asymptomatic. The complications were 4 symptomatic leakages(4 transient radicular pain), 1 pulmonary embolisms, and 1 fractured acrylic cement. CONCLUSION: PVP using PMMA is a minimally invasive, safe and effective treatment modality providing primary stability and prompt pain relief for the osteoporotic vertebral compression fractures. As most of the complications are related with leakage of acrylic cement, preoperative CT scan, vertebral phlebography and fluoroscopic guidance are mandatory as well as cautious injection of adequate amount of PMMA.
Follow-Up Studies ; Fractures, Compression* ; Humans ; Medical Records ; Phlebography ; Polymethyl Methacrylate ; Pulmonary Embolism ; Retrospective Studies ; Spine ; Telephone ; Tomography, X-Ray Computed ; Treatment Outcome* ; Vertebroplasty*

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Effects of Enternal Nutritional Support on Tube-fed Elderly Patients.

Eun Seung SONG ; Cheol Soo POO

Journal of the Korean Geriatrics Society.2002;6(3):204-211.

BACKGROUNDS: As life expectancy is increasing, it is necessary to evaluate the health and nutritional status in elderly, especially in tube-fed elderly patients whose malnutritional status is related to the increase in mortality. This study was conducted to improve the nutritional status in tube-fed elderly patients. METHODS: Effects of nutritional support on tube-fed elderly patients(> or =65years) for 8 weeks were investigated by biochemical assessment and weight. RESULTS: When comparing the biochemical changes of the control group(n=8) with those of the case group(n=8), it showed significant differences in total protein, serum albumin and TLC(p<0.05), not in serum transferrin, serum iron, hemoglobin, hematocrit and weight(p>0.05). CONCLUSION: This study suggests the in tube-fed elderly patients can be improved if nutritional support is properly administrated.
Aged* ; Hematocrit ; Humans ; Iron ; Life Expectancy ; Mortality ; Nutritional Status ; Nutritional Support* ; Serum Albumin ; Transferrin

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