BACKGROUND: Hyperhomocysteinemia as a risk factor for cerebrovascular disease is well known. Our aim of this study was to demonstrate positive association between elevated homocysteine levels and cerebrovascular diseases in Koreans. METHODS: With a case-control design, 186 stroke (infarction 134, hemorrhage 52) patients, diagnosed by brain CT or MRI and 359 control patients were evaluated. We used multiple logistic regression analyses conditioned on the matching variables (sex, age, hypertension, DM, smoking, hyperlipidemia, hyperhomocysteinemia) and calculated odds ratio and 95% CIs. RESULTS: Multivariated adjusted odds ratios (OR) for cerebrovascular diseases associated with hypertension compared with normal blood pressure were 2.45 (95% CI, 1.16 to 5.15) in prehypertension and 3.33 (95% CI, 1.56 to 7.10) in stage 1 hypertension and 3.77 (95% CI, 1.32 to 10.74) in stage 2 hypertension. OR for cerebrovascular diseases associated with hyperhomocysteinemia compared with <10micromol/L were 2.06 (95% CI, 1.09 to 3.91) in 13.0 to 16.9micromol/L and 3.17 (95% CI, 1.70 to 5.90) in > or =17 micromol/L. CONCLUSION: Not only hypertension but also hyperhomocysteinemia was a significant risk factor for cerebrovascular diseases in Koreans.
Asian Continental Ancestry Group ; Blood Pressure ; Brain ; Case-Control Studies ; Hemorrhage ; Homocysteine ; Humans ; Hyperhomocysteinemia* ; Hyperlipidemias ; Hypertension ; Logistic Models ; Magnetic Resonance Imaging ; Odds Ratio ; Prehypertension ; Risk Factors ; Smoke ; Smoking ; Stroke

We report of a successfully treated case of fatal bronchospasm, which developed after N-acetylcysteine bolus intratracheal instillation in a 49-year-old female patient with bronchial asthma undergoing laparoscopic cholecystectomy. N-acetylcysteine has been widely used as a potent mucolytic agent since 1963, with few reported adverse reactions. Its mucolytic action is due to the breakage of disulfide bonds in mucus mucoproteins. Most adverse reactions to N-acetylcysteine are usually mild and respond to the termination of the medication and symptomatic treatment with antihistamine. However, several cases of fatal bronchospasm have been reported in asthmatic patients after inhaled or intravenous N-acetylcysteine. N-acetylcysteine induced bronchospasm could be avoided in most asthmatic patients if its concentration is not allowed to exceed 10%, and concomitant beta2-selective bronchodilators are utilized. Nevertheless, asthma is still a potent risk factor and requires special precautions, including careful risk-versus-benefit assessment, close observation and the immediate availability of resuscitation equipment and staff in the event of life-threatening bronchospasm.
Acetylcysteine* ; Asthma* ; Bronchial Spasm* ; Bronchodilator Agents ; Cholecystectomy, Laparoscopic ; Female ; Humans ; Middle Aged ; Mucoproteins ; Mucus ; Resuscitation ; Risk Factors

PURPOSE: To evaluate whether Extracorporeal Shock Wave Therapy (ESWT) is an effective treatment without side effects for chronically painful calcifying tendinitis. MATERIALS AND METHODS: Study subjects were 72 patients (17 males and 55 females) aged 37-64 years, with a mean of 48, showing chronic, symptomatic, calcifying tendinitis of the shoulder refractory to other conventional conservative therapies. Calcifications were type I or type II according to the classification of Gartner, and with a minimum diameter of 10 mm. Patients with type 3 calcific tendinitis were excluded, because this type has a strong tendency to spontaneous resolution. Extracorporeal shock wave therapy comprised one or two treatments, each consisting of 800 shocks, with a frequency of 120 impulse per minute and the energy density of 0.14 mJ/mm2. We assessed the presence and size of calcified deposits at 1, 3, 6 and 12 months by conventional radiography. All patients also underwent clinical examination, and the Constant (and Murley) score and pain were calculated. The intensity of pain was measured with the visual analogue scale (VAS) from 0 to 10 points, where 0 represents the absence of pain and 10 unbearable pain. RESULTS: One month after the treatment, complete resorption of the calcium deposits was observed in 19 patients (26%), partial resorption was observed in 26 patients (36%), and no modification in the calcium deposits was observed in 27 patients (38%). At six months the complete disappearance of the calcium deposits was noted in 42 patients (68%), but in the 10 patients (14%), calcium deposit appeared unchanged. This result is remained unvaried after 6 month follow-up. Using the Constant and Murley score, this study showed a significant decrease in pain and a significant increase in shoulder function (p<0.001). At six months, 76% of the patients presented satisfactory functional result. About 15% reported a subjective and objective recovery, and only 6 patients (8%), classified as poor result but in our series no differences were found between results at 6 month and 12 month follow-up. At 12 month follow-up there were differences in the Constant score between treated shoulder and contralateral side, respectively 77.6 (59-91) and 87.2 (74-96), but not significant. There were no side effects. CONCLUSION: ESWT is an effective treatment without side effects and an alternative therapy for chronically painful calcifying tendinitis of the shoulder refractory to conventional therapies.
Calcium ; Classification ; Follow-Up Studies ; Humans ; Male ; Radiography ; Shock* ; Shoulder* ; Tendinopathy*

PURPOSE: To evaluate the result and complication of treatment using Locking Compression Plate (LCP) for fracture of proximal humerus. MATERIALS AND METHODS: Between 2004 and 2006, 21 patients with two-part and three-part fractures of the proximal humerus were treated by LCP fixation. Their average age was 54.9 years. Postoperative mean follow-up period was 22.9 months. The reduction was qualified and complication were assessed with final radiographs. The functional outcome was evaluated by Neer's rating system. RESULTS: By Neer's functional evaluation, mean score of shoulder function was 86.3 and 18 case (86%) had excellent or satisfactory results. There was one case of nonunion but no infection or avascular necrosis of the humeral head. No correlation was found between the final result and the type of fracture, age, gender or quality of reduction. CONCLUSION: We obtained satisfactory result of LCP fixation for fracture of proximal humerus in this study. LCP fixation for proximal humerus fracture is a reliable method to obtain satisfactory reduction, rigid fixation and early exercise.
Follow-Up Studies ; Humans ; Humeral Head ; Humerus* ; Necrosis ; Shoulder

PURPOSE: This study examined the clinical results of the treatment of type 2 distal clavicle fracture with using a Wolter plate. MATERIALS AND METHODS: Between 2004 and 2007, 16 patient treated for type 2 distal clavicle fracture using a Wolter plate were included in this study. Their average age was 32.6 years and the postoperative mean follow-up period was 22.9 months. The reduction and union were qualified according to the immediate post-operative and final radiographs. The functional outcome was evaluated by Kona's system and the Constant score RESULTS: By Kona's functional evaluation, there were 12 cases with excellent results, 3 cases with good results and 1 case of fair results and the average Constant score was 90. All 16 cases showed bony union. As complications, there was 1 case in which the protruded hook of the plate could be palpated at the skin, and 1 case showed an acromial fracture, but all the cases dispalyed successful bony union and there was no acromioclavicular joint arthritis, infection or any other complications. CONCLUSION: Wolter plate fixation for type 2 distal clavicle fracture is a reliable surgical method for satisfactory reduction and rigid fixation, a lower incidence of nonunion and excellent clinical result
Acromioclavicular Joint ; Arthritis ; Clavicle ; Follow-Up Studies ; Humans ; Incidence ; Shoulder ; Skin