As the number of elderly people rises, the incidence of surgery in elderly patients would become higher. This study was undertaken to examine the changes in pulmonary gas exchange that occurs with advancing age.
Arterial blood gases were analysed in 106 elderly patients over the age of 65 and 40 adult patients(control group) during breathing of room air preoperatively. Alveolar oxygen partial pressure(PAO2), alveolar-arterial partial pressure gradient for oxygen(AaDO2), arterial/alveolar oxygen partial pressure(a/A) ratio were calculated using PaO2 and PaCO2 and PAO2 and measured the relationship between the PaO2 and age.
PaO2 declined as age increased significantly and the regression equation was PaO2=103.6-0/332×age(r=0.55). There was no significant difference in PaCO2 and PAO2 but AaDO2 increased and a/A ratio decreased significantly.
As the AaDO2 and a/A ratio were changed significantly, it is necessary for monitoring of oxygenation during perioperative periods in elderly patients.
Urolithiasis is the most common and important disease in the field of Urology, and recently the incidence of urolithiasis has increasing tendency according to the improvement of living condition in Korea. In the management of urolithiasis, open surgery was done mainly until several years ago. But not with the development of extracorporeal shock wave lithotriptor (ESWL), endourology and other new instruments, the urolithiasis is easily treated, not surgically.
The author analyzed patients with urolithiasis who had been admitted to Ewha Womans University Hospital from April 1976 to December 1995 to know the change ofoccurrent trend and treatment for urolithiasis for the past 20 years.
The following results were obtained ;
1) During the periods, 3,069 cases were urolithiasis(31.1%) of the 9,868 total admitted patients in urology. The total number and rate of incidence were increased constantly especially until late eighties, but since the year of 1991 those were slightly decreased.
2) The sex ratio of male to female was not changed significantly. The occurrent rate under age of 20 years old was decreased but increased after 6th decades. The seasonal occurrence was the highest in summer until 1985, but after then there was no seasonal difference.
3) The incidence of ureter, bladder and urethral calculi was decreased but that of renal calculi was increased.
4) In the management, the open surgery and expectant therapy were decreased after October 1986, but the rate of nephrectomy was slightly increased. In endourological management, the success rate of ESWL, PNL and URS was 92.8%, 86.6% and 96.7% respectively.
For the past 20 years, the trend of urolithiasis was changed and modalities of treatment were changed, especially since the late of 1980s.
Citations
, Hyung-Chul Kang Recently, autologous epidermal graft using suction-blister has been used in the treatment of depigmented diseases. The suction-blister is produced by separation of epidermis from dermis by negative pressure, and the separated epidermis is a good source for studying the properties of the epidermis itself.
In this day, we measured the pre-expanded control diameter and post-expanded diameter induced by negative pressure in the anterior chest and abdomen of patients and calculated the expansibility of epidermis from the measurements, and studied the morphological changes of the expanded epidermis using scanning electron microscope and transmission electron microscope.
As a result, the diameter of epidermis was elongated 46.4%, from a mean of 7.6mm to 11. 0mm and the calculated area was expanded 115.0%, from a mean of 45.0mm2 to 95.9mm2 by suction. Both were statistically significant(p<0.05). And morphologically, the thickness of epidermis was markedly decreased and the basal keratinocytes, their nuclei and intercellular bridges were elongated parallel to the skin surface, and paranuclear vacuolization was observed in keratinocytes and melanocytes.
In conclusion, above results are helpful in understanding the physical property and structure of epidermis and can be used for estimating the exact size of the donor skin needed for epidermal graft.
, Jung Yeon Lee, Su Jin Heo, Yoen Kyung Kee, Seung Hyeok Han Among the possible venous thromboembolic events in nephrotic syndrome, renal vein thrombosis and pulmonary embolism are common, while portal vein thrombosis (PVT) is rare. This report describes a 26-year-old man with histologically proven minimal change disease (MCD) complicated by PVT. The patient presented with epigastric pain and edema. He had been diagnosed with MCD five months earlier and achieved complete remission with corticosteroids, which were discontinued one month before the visit. Full-blown relapsing nephrotic syndrome was evident on laboratory and clinical findings, and an abdominal computed tomography revealed PVT. He immediately received immunosuppressants and anticoagulation therapy. An eight-week treatment resulted in complete remission, and a follow-up abdominal ultrasonography showed disappearance of PVT. In conclusion, PVT is rare and may not be easily diagnosed in patients with nephrotic syndrome suffering from abdominal pain. Early recognition of this rare complication and prompt immunosuppression and anticoagulation therapy are encouraged to avoid a fatal outcome.
, Jong Oh Kim In order to evaluate clinical significance of MR signal change within vertebral body marrow, we investigated the relationship between signal change of marrow and duration of low back pain, hight of disc, segmental hypermobility, disc degeneration and degree of disc herniation.
We reviewed retrospectively simple radiograph, flexion-extension dynamic radiograph and MR images of the lumber spines(L3-S1) of 100 patients, who underwent discectomy at Ewha Womans University Mokdong Hospital from September 1993 to October 1996.
1) There were Modic type 2 changes in 36 patients of 100 patients(36%) and in 52 segments of 300 segments(17.3%). 2) Average was older in the group with signal change in marrow than in that without signal change. 3) Signal change of vertebral body marrow was not significantly related to duration of low back pain. 4) Decreased disc heght was more frequently found in segments with signal change in marrow than in those without signal chagne. 5) Modic type 2 changes was not related to lumbar segmental hypermobility. 6) Degeneration of disc was more frequently found in segments with signal change in marrow than in those without signal change. 7) Signal change of vertebral body marrow was not directly related to degree of disc herniation.
Signal change of vertebral body marrow in MRI was significantly related to age, disc height and degree of disc degeneration, and it suggests that the marrow change can be induced by response of vertebral body to the changed mechanical environment, which is due to long-standing disc degeneration.
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