Low Diastolic Blood Pressure and Cognitive Decline in Korean Elderly People: The Korean Longitudinal Study on Cognitive Aging and Dementia

Objective@#Cardiovascular diseases are representative risk factors for the onset of cognitive decline. The purpose of this study was to confirm the relationship between diastolic blood pressure and cognitive function in elderly people in Korea. @*Methods@#Data from subjects who were enrolled in the prospective Korean Longitudinal Study on Cognitive Aging and Dementia were used in this study. Data from 701 subjects whose diastolic blood pressure range did not change (≤79 mm Hg or ≥80 mm Hg) over 2 years were analyzed. To analyze the differences in cognitive function between the groups at the 2-year follow-up, an analysis of covariance was performed with covariates, which were significantly different between the two groups, and the baseline cognitive function. @*Results@#Significant differences were observed between the two groups, and the mean scores on the constructional praxis (η2=0.010) and word list recall tests (η2=0.018) in the diastolic blood pressure ≥80 mm Hg group were higher than those in the diastolic blood pressure ≤79 mm Hg group at the 2-year follow-up. @*Conclusion@#These results indicate that maintaining a DBP below 79 mm Hg presents a greater risk of cognitive decline in Korean elderly people.

Driving-Related Adverse Events in the Elderly Men: A Population-Based Prospective Cohort Study

Objective@#This study estimated the incidence of driving-related adverse events and examined the association of cognitive function with the risk of future driving-related adverse events in the elderly Korean male population. @*Methods@#We analyzed 1,172 male drivers aged 60 years or older in the Korean Longitudinal Study on Cognitive Aging and Dementia (KLOSCAD). Using the data from Korean National Police Agency, we classified the participants into three groups: safe driving (drove for 2 years after baseline without a traffic accident or repeated violations), driving cessation (stopped driving), and risky driving (one or more traffic accidents or repeated violations). We estimated the incidences of driving cessation and risky driving, and examined the effect of cognitive function on their risks. @*Results@#The incidence of driving cessation and risky driving in the Korean male drivers aged 60 years or older was 19.3 and 69.9 per 1,000 person-years respectively and increased in the late 80s. Drivers with better baseline Word List Memory Test scores showed less risky driving (OR=0.94, p=0.039). @*Conclusion@#Driving-related adverse events increased in late 80s, and better memory function was protective against these events.

Normal-But-Low Serum Folate Levels and the Risks for Cognitive Impairment

OBJECTIVE: This study aimed to examine the association between normal-but-low folate levels and cognitive function in the elderly population using a prospective cohort study. METHODS: We analyzed 3,910 participants whose serum folate levels were within the normal reference range (1.5–16.9 ng/mL) at baseline evaluation in the population-based prospective cohort study named the “Korean Longitudinal Study on Cognitive Aging and Dementia.” The association between baseline folate quartile categories and baseline cognitive disorders [mild cognitive impairment (MCI) or dementia] was examined using binary logistic regression analysis adjusting for confounding variables. The risks of incident MCI and dementia associated with the decline of serum folate level during a 4-year follow-up period were examined using multinomial logistic regression analysis. RESULTS: The lowest quartile group of serum folate (≥1.5, ≤5.9 ng/mL) showed a higher risk of cognitive disorders than did the highest quartile group at baseline evaluation (odds ratio 1.314, p=0.012). Over the 4 years of follow-up, the risk of incident dementia was 2.364 times higher among subjects whose serum folate levels declined from the 2nd–4th quartile group to the 1st quartile than among those for whom it did not (p=0.031). CONCLUSION: Normal-but-low serum folate levels were associated with the risk of cognitive disorders in the elderly population, and a decline to normal-but-low serum folate levels was associated with incident dementia. Maintaining serum folate concentration above 5.9 ng/mL may be beneficial for cognitive status.

Overview of the Korean Longitudinal Study on Cognitive Aging and Dementia

OBJECTIVE: Due to an unprecedented rate of population aging, South Korea is facing a dementia epidemic. For this reason, the Korean Longitudinal Study on Cognitive Aging and Dementia (KLOSCAD) was launched in 2009 with support from the Korean Health Industry Development Institute to investigate the epidemiology, biopsychosocial risk factors, and outcomes of dementia and dementia-related conditions. METHODS: The KLOSCAD is the first nationwide multi-center population-based prospective cohort study. In October 2010, 12,694 individuals were randomly sampled from residents aged 60 years or older who lived in 13 districts across South Korea. In the baseline assessment, which was conducted from November 2010 through October 2012, 6,818 (53.7%) individuals participated. Follow-up assessments have been conducted every two years, with the first follow-up assessment conducted between November 2012 and October 2014, and the second between November 2014 and October 2016. The third is now in progress, and will span from November 2016 to October 2018. Diagnosis of cognitive disorders, neuropsychological battery, behavioral and psychological symptoms of dementia, activities of daily living, physical and neurologic examination and laboratory tests, life styles, quality of life, and identification of death were evaluated in each assessment. RESULTS: The cumulative drop-out rate at the second follow-up assessment was 38.7%. Dementia and mild cognitive impairment were 5.0% and 27.0%, respectively. CONCLUSION: The KLOSCAD may provide strong scientific evidence for advancing the fight against dementia both in Korea and globally.

MMPI Characteristics of Parents of Children with ADHD

OBJECTIVES: The current study investigated the personality characteristics of parents of children with attention-deficit hyperactivity disorder (ADHD) using the Minnesota Multiphasic Personality Inventory (MMPI), which is commonly used in clinical medicine. METHODS: Participants were 117 parents of children with ADHD (96 boys and 21 girls) and 77 parents of comparison children (50 boys and 27 girls), who completed the Korean version of the MMPI. RESULTS: The MMPI scores of the fathers of ADHD children were significantly higher on the Psychopathic Deviate (Pd), Masculinity-Femininity (Mf), Paranoia (Pa), and Psychasthenia (Pt) scales than the comparison group's were. In addition, the mothers of ADHD children had higher MMPI scores on the traits of Hypochondriasis (Hs), Psychopathic Deviate (Pd), and Schizophrenia (Sc) than the comparisong roup had, but were not significantly higher. CONCLUSION: The fathers of ADHD children might be antisocial, irresolute, passive, paranoid, and anxious. In addition, mothers of ADHD children might have hypochondriacal, antisocial, and/or psychological confusional traits, but these were not be significantly high. These results suggest that the psychopathology of parents of ADHD children might correlate with their children's ADHD.

Cognitive Behavioral Therapy in Childhood Tic Disorder: A Case of Report

Chronic tic disorder or Tourette syndrome is known to be a chronic neuro-behavioral disease for which cognitive behavioral therapy (CBT) strategies have recently been introduced. Here, we report the effectiveness of CBT in a case of childhood chronic tic disorder, which is very common in clinical settings. The DSM-IV clinical diagnosis was applied by a child psychiatrist. The Yale Global Tic Severity Scale, Kovac's children's depression inventory, Spielberger State-Trait Anxiety Inventory, Abbreviated Conners' Rating Scales, and the Dupaul ADHD Rating Scales were used. This case involved a pharmacological treatment-refractory patient over the previous year. Thus, psychiatric consultation was undertaken. Subsequently, we administered five sessions of CBT for four weeks, consisting of symptom evaluation and planning, habit reversal training, and ventilation training. Following four weeks of CBT administration, there were improvements in the scores of the Yale Global Tic Severity Scale and the Clinical Global Improvement scale. Our observations indicate that CBT may be effective in the treatment of childhood tic disorder.

Correlation of Telomerase Activity, hTERT mRNA Expression and HPV E6 Detection in Cervical Cancer Tissue / 대한산부인과학회잡지

OBJECTIVE: Telomerase is a ribonucleoprotein enzyme which stabilizes chromosomal structure, thereby inducing cellular immortality. We investigated telomerase activity and human telomerase reverse transcriptase (hTERT) mRNA expression in relation to high-risk human papillomavirus (HPV) DNA presence in cervical carcinomas. METHODS: From December 1995 to December 1999, at the department of obstetrics and Gynecology of Kyung-Hee University Hospital, 32 cervical carcinomas and 5 corresponding nontumor cervical tissues were obtained and the samples were immediately frozen and stored at -70 degree C. Telomerase activity was measured by using telomerase PCR ELISA, a modified version of the TRAP. Analysis of the expression of hTERT mRNA was performed by quantitative RT-PCR and the analysis of the HPV E6 gene was performed by DNA-PCR. RESULT: All of the carcinomas examined exhibited strongly positive for telomerase activity (OD>0.24), whereas telomerase activity was week or not found in the 5 corresponding nontumor cervical tissues. Quantitative RT-PCR analysis demonstrated significantly increased hTERT mRNA expression levels (>0.024) in most carcinomas comparing to control groups. There was no obvious relationship between telomerase activity levels and the clinical parameters examined including age, clinical stage, pathology, differentiation, tumour size, LN involvement and invasion depth except lymphovascular space invasion (p=0.03). In the correlation between the levels of hTERT mRNA expression and telomerase activity, correlation index which was 0.916, shows high correlation (p=0.01). According to the analysis of HPV E6 gene, 29 of 32 (90.6%) carcinomas showed HPV E6 positivity. CONCLUSION: There is a strong association between telomerase activity and hTERT mRNA expression, and up-regulation of hTERT probably plays a role in the progression of cervical carcinomas. Telomerase is at least partially activated by viral oncogenes of high-risk types. There is no obvious relationship between telomerase activity levels and the clinical parameters except LSVI (p=0.03). These findings provides that telomerase may play an important role in the early stage of carcinogenesis.

The Effects of Prenatal Dexamethasone Therapy for the Prevention of Respiratory Distress Syndrome of Premature Baby and Their Prognosis / 대한주산의학회잡지

No abstract available.

Bicervical Bicornuate Uterus with Unilateral Cervical Atresia and Homolateral Renal Agenesis / 대한산부인과학회잡지

Double uterus with unilateral hematometra and ipsilateral renal agenesis is a rare Mullerian duct malformation. This complex of anomalies is seen in adolescents and young women with progressive dysmenorrhea, abdominal pain, menstrual irregularities and a pelvic mass. Appropriate preoperative diagnosis and treatment will prevent unnecessary procedure and offer relief of symptoms. We report one case of bicornuated uterus with unilateral cervical atresia and homolateral renal agenesis with a brief review of concerned literatures.

A Case of Successful Transabdominal Cervicoisthimic Cerclage in a Patient with Incompetent Internal as of Cervix / 대한주산의학회잡지

Transvaginal cervical cerclage for the prevention of pregnancy loss in patients with cervical incompetence is well accepted. However, there is a small subject of patients with incompetence of cervix, congenital or surgical shortening of the cervix, previously failed transvaginal cerclage and deep cervical damage or tears in the fornices. We experienced a case of the transabdominal cervical cerclage. 'Ihe patient had a past history of deep cervical laceration due to vaginal delivery. Therefore, we present here a surgical technique of transabdominal cerdage and report it with brief review of literatures.

Ultrastructural changes of human testis after vasectomy / 대한비뇨기과학회지

Vasectomy is one of the most common forms of male contraception throughout the world. However, more vasectomy reversals are sought each year because of the increasing number of second marriages and other causes. Before recommending vasectomy, urologists may wish to resolve in their own mind the conflict between reports that maintain the testis is harmed by vasectomy and those that slate is not. We studied a group of patients undergoing vasectomy reversal to determine whether histopathologic change on light and electron microscopy would be detected. Only one testis specimen from post-vasectomy patients showed an abnormality correlated with spermatogenesis and five cases showed mild focal interstitial fibrosis without abnormality of spermatogenesis on light and electron microscopy. We found that vasectomy has some influence to the spermatogenesis and pathologic change.

Excretion of urinary citric acid in stone patients / 대한비뇨기과학회지

Urinary citric acid reduces urinary saturation of calcium oxalate and phosphate salts by forming complexes with calcium and retards crystallization of stone forming salts. Hypocitraturia, important factor in stone formation, has been 19-63% of stone patients in various reports. We measured the 24 hour excretion of citric acid. calcium and calcium/citric acid ratio in 100 renal stone patients and 30 healthy controls. The results were as follows: 1. The 24-hour urinary excretion of citric acid was lower in stone patients than in controls, but statistically insignificant (P>0.05). 2. The 24-trour urinary excretion of calcium was higher in stone patients significantly than in Controls (P<0.05). 3. In stone patients, hypocitraturia showed in 19 patients (19%), hypercalciuria in 22 patients (22%). 4. The 24-hour urinary excretion of citric acid had positive correlation with 24-hour urinary excretion of calcium in stone patients (P<0.05) 5. Urinary calcium/citric acid ratio was significantly higher in stone patients than in controls (P<0.05). As results, urinary calcium/citric acid ratio was more significant than the amount of citric acid in stone patients, furthermore it seems to be a useful measure for stone formation and recurrence.

Three cases of the emphysematous pyelonephritis / 대한비뇨기과학회지

Emphysematous pyelonephritis is a rare complication of acute pyelonephritis that occurs in diabetics or urinary obstruction and spontaneous gas formation around renal parenchyme. Diagnosis. in appropriate clinical setting. is confirmed radiographically. Plain film demonstrates a surprising pneumonephrogram, mottled gas shadow in the renal parenchyme as well as perirenal gas. Surgical intervention after unsuccessful antibiotics and conventional medical measurement is necessary. We experienced 3 cases of emphysematous pyelonephritis which occurred in diabetic women with brief review of the literature.

ESWL for management of steinstrasse / 대한비뇨기과학회지

Early in the experience of ESWL, steinstrasse was recognized as potential complication and suggestions for management were proposed. including retrograde ureteral manipulation. placement of ureteral stent or percutaneous nephrostomy, etc. Recently ESWL has been challenged due to less invasive and safer procedure. We experienced 18 cases (2.1%) of steinstrasse in 850 patients with ESWL (EDAP LT-01) from February, 1989 to February, l99l and treated with ESWL. The results were obtained as follows. 1. The primary stones in 18 cases of steinstrasse were renal stones in l7 cases (complete staghorn calculi; 4 cases. partial staghorn calculi; 5 cases) and upper ureteral stone in 1 case: 2. The sites of steinstrasse were lower ureter in 13 cases and upper ureter in 5 cases. The lengths of steinstrasse were 1.4~8.3cm (mean: 3.19cm). The site and length of steinstrasse were not related with clinical symptoms. 3. Of l8 cases. 13 cases were type 1. 3 cases type II and 2 cases type III. Type of steinstrasse was not related with clinical symptoms. 4. Six cases were asymptomatic and 3 cases of symptomatic steinstrasse required hospitalization. 5. Fifteen cases were treated with ESWL only and 2 cases of solitary kidney were treated with ESWL, after percutaneous nephrostomy. Early experienced 1 case was treated with ureteroscopic removal of stone. 6. Of 17 cases treated with ESWL, stone fragments expelled out within 1 month in 13 cases, 2 months in 3 cases and 4 months in 1 case of solitary kidney. All symptoms of steinstrasse were relieved within 3 days after ESWL.

Relationship of the patterns of pelvic bone fracture and bladder rupture / 대한비뇨기과학회지

A clinical observation was made on 64 cases of the bladder rupture who were admitted to our hospital during the period from June, 1979 to February, 1991. The results are as following ; 1. Of 355 cases of the genitourinary tract injury, the bladder rupture were 64 cases (18.0%), which were composed of 40 cases (62.5%) of bladder rupture without pelvic bone fracture and 24 cases (37.5%) of bladder rupture with pelvic bone fracture. The bladder rupture without pelvic bone fracture were composed of 35 cases (87.5%) with intraperitoneal bladder rupture and 5 cases (12.5%) with extraperitoneal bladder rupture, the bladder rupture with pelvic bone fracture were composed of 13 cases (12.5%) with intra and extraperitoneal bladder rupture. 2. In 24 patients with pelvic bone fracture, the most common site of bladder ruptures were found on the lateral wall in 12 cases (50%), and followed by the dome in 9 cases (37.5%), multiple areas in 3 cases (12.5%). In 40 patients without pelvic bone fracture, the most common site of bladder ruptures were found on the dome in 33 cases (82.5%), and followed by the multiple areas in 4 cases (10%), lateral wall in 3 cases (7.5%). 3. The average size of the bladder rupture was 6.5cm in cases without pelvic bone fracture, 6. 8cm in cases with pelvic bone fracture, especially comminuted pelvic ring fracture had most severed bladder rupture (average; 8.3cm). 4. Of 24 pelvic bone fractures, pubic rami fractures were most common (41.6%), and followed by comminuted pelvic ring fracture (25%), anterior and posterior pelvic ring fractures (12.5%), acetabulum and isolated fractures (8.3%), symphyseal separation fractures (4.1%) in order of frequency. 5. 5 cases (20%) of pelvic bone fractures were associated with posterior urethral injury, especially 60% in The pubic rami fracture. There was no significant relation between the type of pelvic fracture and the type of bladder rupture, but the fractures involving pubic arch were more often associated with posterior urethral injury.

Experience of Stamey operation for female stress urinary incontinence / 대한비뇨기과학회지

Stamey endoscopic suspension of bladder neck is a reliable technique among various surgical techniques with high success rate and little morbidity. We treated 8 patients complaining of urinary incontinence with Stamey operation from February 1988 to May 1990 and Follow-up for over 6 months. The results as follows; 1. Patients varied in age from 31 to 63 (mean;45) years. All patients were multiparous average 2.87 (2-4) times of previous deliveries 2. All patients showed frequency and nocturia. Severities of incontinence were Grade I in2 patients, Grade II in 5, Grade III in 1 3. No significant changes were identified between preoperative and postoperative urethral pressure profiles. 4. On preoperative lateral cystourethrograms, bladder base was descended about -2.10+-0.74cm from SCIPP line and elevated about +1.2 cm+/-0.49 cm from SCIPP line on postoperative lateral cystourethrograms. 5. Incontinence was disappeared in 7 patients, but 1 patients was recurred due to rupture of suture material during lifting heavy material.

A case of adult Wilms' tumor / 대한비뇨기과학회지

Wilms' tumor is malignant renal tumor, originated from undifferentiated mesonephric blastema. Adult Wilms' tumor, unlike that of childhood, is a rare disease and a total of l67 cases have been reported in the world medical literature until 1980. Diagnosis of adut Wilms` tumor is very difficult preoperatively and the pathologic hallmark is the presence of abortive or embryonal glomerulotubular structure with an immature spindle cell stroma. The therapeutic guidelines and surgical principles that govern childhood Wilms' tumor should be applied to adult Wilms' tumor. We reported a case of Wilms' tumor developed in 34 year-old male patient complaining of right flank pain with gross hematuria for 2 months.

A case of XX male syndrome / 대한비뇨기과학회지

The 46, XX male or sex-reversal syndrome is a rare entity, which may be reported first by de la Chapelle and associates in 1964, an additional 135 cases have been recognized, yet only 20 percent of these patients have been diagnosed during childhood. The 46, XX male may be associated with hypogonadism and infertility in adult, and occasionally, sexual ambiguity in the neonate. At least 10% of patients have had hypospadia or ambiguous external genitalia. The 46, XX male was diagnosed with cytogenic study, H-Y antigen, hormonal study testicular biopsy, radiologic study. Here, we report a case of 19 month-old child XX-male with hypospadia and chordee.

A Case of Seminal Vesicle Cyst / 대한비뇨기과학회지

Seminal vesicle cysts are rare. Since the first case of a seminal vesicle cyst was reported by Zinner in 1914, about 20 cases have been reported in literature up to 1976. They are presented at the age of high sexual activity. They may be asymptomatic and discovered by rectal examination or may manifest with symptoms of bladder irritation, perineal or testicular pain, pain on ejaculation, etc. Here, we report a case of seminal vesicle cyst in a 38 years-old-man who was admitted under the impression of pelvic abscess.