Age-related trend of diseases distribution in the elderly aged 60 years and older / 대한내과학회지

With increasing life expectance and improvement of the overall health of the elderly, the understanding of geriatric disease becomes an important aspect of medical services. In the elderly, the frequencies of hypertension, DM, & anemia are increased according to aging and renal function is decreased progressively. As screening test for cervical cancer Papanicolaou smear is recommended due to its cost-effective benefits in females. In age-adjusted elderly male and female study populations, authors investigated the alterations of the above diseases, hypercholesterolemia, liver disease, obesity, & proteinuria distributions. METHODS: This study included 1,181 aged 40 years (600 males, 581 females) visitors between January 1, 1997 and December 31, 1997 in National Medical Center, Seoul, South Korea. Authors divided these populations into two large groups such as group A and B. Group A was composed of 40-59 years, group B 60 years and older. Group A and B were subdivided into 4 subgroups each other, such as A-1, A-2, A-3 and A-4, B-1, B-2, B-3 and B-4 by means of age-adjusted dividing scale. We used our inclusion criteria to define each disease. RESULTS: Hypertension was the most common disease in males of group B, but obesity was in females. The age-adjusted frequencies of hypertension, anemia, obesity & proteinuria were increased according to aging in the elderly aged 60 years and older. Though hypercholesterolemia revealed non-specific distribution in each group, increased frequency was observed in females compared to males in group B. With increasing their age, abnormal findings of Papanicolaou smear were found in females of group B. CONCLUSIONS: As the frequencies of hypertension, anemia, obestiy, proteinuria & abnormal findings of Papanicolaou smear were increased in the elderly aged 60 years and older as increasing their age. Much more attentions and follow up plans for these disease should be needed in the elderly.

Clinical Analysis of Malarial Infections between January and September 1998 / 대한내과학회지

OBJECTIVE: Annually, the prevalence of indigenous and imported malarial infections is steadily increasing since 1993 in Korea. In order to understand the current characteristics of malarial infections and to prevent, the present research reviewed twenty-seven cases between January and September 1998. METHOD:In this study, all the twenty-seven (twenty- six patients) cases were obtained from admitted patients between January and September 1998. We had performed routine blood chemical studies, peripheral blood thin and thick smear, physical examination and abdominal sonography. Any patient with a previous history of a narcotic drug injection or had blood transfusion was excluded. RESULTS: Twenty cases (74.1%) were indigenous and seven (25.9%) were imported malaria. Yeonchon-Gun (nine cases) was the most prevalent area in the indigenous cases; Cambodia (three cases) were the most one in the imported cases. Peripheral blood thin smear revealed Plasmodium vivax in all (100%) indigenous malaria, while four cases (57.1%) were P. vivax and one (14.3%) was P. falciparum and two (28.6%) were mixed infections with P. vivax and P. falciparum in the imported cases. In a 3-month period between July and September, peak prevalence (80.4%) was observed. The negative conversion of peripheral blood smear was achieved much earlier in the indigenous (3.9+/-1.4day) than in the imported (5.7+/-1.9day) after the treatment but, was not statistically signifcant. CONCLUSION: Plasmodium ovale was the only unique causative species in the indigenous malaria. Also Yeonchon-Gun and Cheolwon-Gun had been the most important endemic areas as previous reports. One relapse case had been occurred in the imported malaria. On the basis of our data, more efforts for control of malaria should be necessary for eradication and prevention of indigenous and imported malarial infections in Korea.

Change of 24 Hours Heart Rate Variablity in Older Healthy Subjects and Older Hypertensive Patients

BACKGROUND : Heart rate variability informed us to diagnose impairment of autonomic nervous system in patient with diabetes, hypertension, ischemic heart disease, chronic renal disease, arrhythmia. Change of autonomic nervous system is related to circadian rhythm, stress, physical activity, age and so on. Especially, impairment of vagal nervous system with age help us to expect sudden cardiac death, myocardial infarction, arrhythmia. So we survey heart rate variability by using 24 hours Holter monitoring to expect impairment of autonomic nervous system in elderly hypertensive patients. METHODS : In order to assess 24 hours heart rate variability, we used Del Mar Avionics 563 Holter monitoring on 15 older hypertensive patient (>or=65 years), 15 older hypertensive patient(or=65 years). The following frequency domain variables were considered: low frequency(LF), high frequency(HF) power spectral parameter, and LF/HF ratio. Results : 1) There was significant decrease in LF power spectral parameter in older groups compared with younger groups 394.0+/-237.8 vs 127.7+/-96.3, p<0.05, 171.8+/-173.5 vs 40.8+/-33.8, p<0.05). 2) In hypertensive patients, there was significant decrease in HF power spectral parameter compared with healthy subjects(989.2+/-553.8 vs 526.0+/-364.7, p<0.05, 804.2+/-404.5 vs 368.8+/-241.2, p<0.05). 3) Although there was no significant difference, L/H ratio decreased in older groups compared with younger gourps. 4) In circadian rhythm, control subjects had low HF power spectral parameter at morning. LF/HF ratio was high at morning in younger groups. CONCLUSION : L/H ratio was depressed in older groups. HF was blunted in hypertensive groups. Thus, impairment of autonomic nervous system was accelerated by age and hypertension.

24 hour circadian pattern of blood pressure and its related target organ damage in hypertensive subjects / 대한내과학회지

OBJECTIVE: Pattern with essential hypertension generally shows the same circadian pattern as the normothensive person with a night-time reduction or "DIP" in blood pressure in sleep. The definition of "Dipper" and "Non-dipper" are assigned according to arbitrary criteria e.g. a night time average blood pressure which is at least 10% less than the average daytime blood pressure. Prospective evidence that the absence of an overnight dip is a strong adverse prognostic indicator for target organ damage .Thus we investigate circardian rhythm of blood pressure, related target organ damage, its frequency & drug in hypertensive subjects. Method : 24hr ambulatory blood pressure monitoring, history taking, physical examination, fundoscopy, ECG, chest X ray, dipstick urinanlysis, serum creatinine level are performed in essential hypertensive subjects. Exclusion criteria are duration of hypertension over 5 years, DM, renovascular hypertension & heart failure. RESULTS: Total 42 patients performed study.17 subjects classify dipper group,25 subjects classify non-dipper group. Between dipper & non-dipper group shows no significantly difference at stroke history, C/T ratio over 0.5 in chest X-ray, left ventrcular hypertrophy in ECG,ST-T change in ECG, proteinuria & serum creatinine level. Non-dipper group shows significantly difference to dipper group in frequency of hypertensive retinopathy and number of combined drug used subjects. CONCLUSION: Number of hypertensive retinopathy is significantly frequency in non-dipper group. Hypertensive retinopathy is atherosclerotic complication, thus we predict other target organ damage, therefore non-dipper type circardian rhythm of blood pressure is adverse prognostic factor for target organ damage of hypertensive subjects.