Influencing Factors of Activity of Daily Living in Patients Admitted to the Acute Elderly Care Unit

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.

Clinical significance of anemia in frail elderly patients admitted to the acute elderly care unit / 대한내과학회지

BACKGROUND: Anemia is a common medical problem among the elderly; it is more frequent with advancing age. Anemia has been associated with adverse outcomes such as hospitalization, disability and mortality. However, the clinical significance of anemia in frail elderly patients, especially those admitted to acute care units, has not been investigated. METHODS: From May 2004 to April 2005, 308 patients 65 years of age or older, admitted to the Acute Elderly Care Unit at the Seoul National University Bundang hospital, were enrolled in the current study. Comprehensive geriatric assessment including medical, psychosocial and functional evaluation was performed by the geriatric team. Clinical and laboratory evaluations were carried out to determine the prevalence and etiology of the anemia. RESULTS: Anemia (Hb < 13 g/dL in male, < 12 g/dL in female) was identified in 149 patients (48.4%). The leading cause of anemia was anemia of chronic disease (N=75, 50.3%). Comparison between the anemic group and a control group was performed. Anemic patients were older, male, had an impaired functional status as well as a poor nutritional status. Moreover, the development of delirium was more frequent in the anemic group compared to the control group (11.0% vs 20.7%, p=0.021). In addition, the duration of hospitalization was significantly increased in patients with anemia (12.97+/-1.24 vs 18.07+/-1.77, p=0.019). However, in the multiple regression analysis, the presence of anemia did not affect the length of hospitalization as an independent factor. CONCLUSIONS: Anemia is common in frail elderly patients and has been associated with a poor clinical outcome. Although anemia was not an independent risk factor in the elderly patients, the anemia was associated with multiple co-morbidities, disability and frailty. Therefore, the presence of anemia in the elderly requires active investigation and management.

Steroid Therapy in Phenytoin Hypersensitivity Syndrome Patient

No abstract available.

Innominate vein occlusion treated by percutaneous transluminal angioplasty with endovascular stent in a hemodialysis patient / 대한내과학회지

Although central vein stenosis associated with vascular access is relatively common in a hemodialysis patient, innominate vein stenosis is very rare. We here report a case of innominate vein occlusion treated successfully by percutaneous transluminal angioplasty with endovascular stent in a hemodialysis patient. A 61-year-old woman on hemodialysis developed progressive swellingof and headache. She had an history of subclavian vein catheterization. Venography disclosed totally obstructed left innominate vein, multiple collaterals and retrograde flow into left internal jugular vein. Percutaneous transluminal angioplasty with endovascular stent was performed. Venography performed after this procedure showed complete resolution of collaterals and no residual stenosis and arm swelling and headache disappeared.

A Case of Acyclovir Induced Acute Interstitial Nephritis / 대한신장학회잡지

Acyclovir is a remarkably safe drug with potent antiviral effect against herpes virus. The two most serious adverse effects are neurotoxicity and nephrotoxicity. We here report the case of a 64-year old woman with acyclovir induced acute interstitial nephritis. She developed non-oliguric acute renal failure following the administration of oral acyclovir(800mg five times per day) to treat herpes zoster of left 2nd and 3rd thoracic nerves. We documented a normal serum creatinine level just before exposure to the drug. On admission, serum creatinine level was 2.4 mg/dL(baseline level; 0.8mg/dL). Percutaneous renal biopsy revealed interstitial infiltration of lymphocyte and eosinophil with interstitial edema, but there was no crystal formation in the tubules or collecting ducts. After withdrawal of the acyclovir, renal function returned to normal within 1 week.

Protein Losing Enteropathy in a Patient with Henoch-Sch nlein Purpura: Successful Treatment with Steroid / 대한신장학회잡지

Although gastrointestinal manifestations are very common in patients with Henoch-Sch nlein purpura, protein losing enteropathy is a rare complication. We here report a case of protein losing enteropathy in a patient with Henoch-Sch nlein purpura. A 52-year old woman presented with lower abdominal pain, purpura and edema on lower extremity. Serum albumin was 1.9g/dL and 24 hour urine protein was 4.7g/ day. Skin and kidney biopsy revealed leukocytoclastic vasculitis and mesangial proliferative glomerulonephritis consistent with Henoch-Sch nlein purpura, respectively. Colonoscopy showed diffuse mucosal erosion at right colon. 99mTc-human serum albumin scintigraphy and fecal alpha-1-antitrypsin clearance confirmed protein losing enteropathy. The protein losing enteropathy improved with steroid treatment.

Two Cases of Misdiagnosis of Acute Appendicitis in a Patient with Hemorrhagic Fever with Renal Syndrome and a Patient with Tsutsugamushi Disease

Both tsutsugamushi disease and hemorrhagic fever with renal syndrome frequently cause abdominal pain with tenderness; therefore they are occasionally misdiagnosed as surgical abdomen. Two patients presented with symptoms of acute abdomen, and under the suspicion of acute appendicitis they underwent appendectomies. Nevertheless there were no operative findings of acute appendicitis in both patients, and the clinical conditions were deteriorated after the operation. Acute infectious disease was suspected by thrombocytopenia, elevated liver enzymes, and proteinuria. Indirect immunoflourescence test confirmed tsutsugamushi disease and hemorrhagic fever with renal syndrome, respectively. The patient with tsutsugamushi disease improved with administration of doxycycline and the patient with hemorrhagic fever with renal syndrome spontaneously improved.