Ankylosing spondylitis is a chronic inflammatory disease which most frequently affects the sacro-iliac joints of young men, and also the synovial joints of the whole spine. Bony fusion of these joints and ossification along the longitudinal ligaments lead to total immobility of the vertebrae. Sixty-two cases of ankylosing spondylitis treated at the Severance Hospital from June 1980 to June 1986 were analysed clinically and the followings were obtained. 1. The average age was 38 years and the sex ratio between the male and the female was 58: 4(Male=94%). 2. The most frequent location of pain was low back (32%), and the pain was usually bilateral (81%). 3. The main stiff regions were the hip joint (35%) and the lumbar spine (27%). 4. The most frequent joint affected was the hip (44%), and the extraarticular manifestations were pleuropulmonary disease (29%), gastrointestinal disorder (15%), iritis (10%), etc. 5. The characteristic X-ray findings were sacro-iliac changes (72%), facet joint blurring (53%), and syndesmophyte (37%). 6. Laborstory findings showed increased ESR (85%), positive HLA B-27 (97%), negative rheumatoid factor (94%), and the serum immunoglobulins snd complements were not decreased.
Clinical Study ; Complement System Proteins ; Female ; Hip ; Hip Joint ; Humans ; Immunoglobulins ; Iritis ; Joints ; Longitudinal Ligaments ; Male ; Rheumatoid Factor ; Sex Ratio ; Spine ; Spondylitis, Ankylosing ; Zygapophyseal Joint

BACKGROUND: The safety of ergonovine provocation for coronary vasospasm (CVS) performed outside the catheterization laboratory has been questioned. We sought to address the issues of safety, feasibility and clinical impact of noninvasive diagnosis of CVS. METHOD AND RESULTS: We retrospectively analyzed the results of bedside ergonovine provocation testing with monitoring of left ventricular regional wall motion abnormalities (RWMAs) by 2-dimensional echocardiography (ergonovine echocardiography, Erg Echo). After confirmation of no significant fixed epicardial coronary artery disease, 1,504 Erg Echo were performed in 1,372 patients from July 1991 to December 1997. Erg Echo was prematurely terminated in 13 patients (0.9%) due to limiting side effects unrelated with myocardial ischemia. Among 1,491 completed tests, 32% (477) showed positive results with development of RWMAs in 467 tests (98%) or ST displacement in ECG in 10 tests (2%). During the test, transient arrhythmias developed in 1.7% (26/1491) including transient ventricular tachycardia (2) and atrioventricular block (4), which were promptly reversed with nitroglycerin. There were no procedure-related death or development of myocardial infarction. On the basis of angiographic criteria in 218 patients, who also underwent invasive spasm provocation test during coronary angiography, the sensitivity and specificity of Erg Echo for the diagnosis of CVS were 93% and 91% respectively. From 1990 to 1997, total 2,073 spasm provocation tests were performed either during invasive coronary angiography in the catheterization or in the echocardiography laboratory. Since 1994, noninvasive Erg Echo became a more popular diagnostic method and comprised more than 95% of all spasm provocation tests in recent 3 years. Erg Echo was also performed safely in outpatient clinic setting without hospital admission in 34% (500/1491). CONCLUSIONS: Erg Echo is highly feasible, accurate and safe for diagnosis of CVS and can replace the invasive spasm provocation test during coronary angiography in the catheterization laboratory.
Ambulatory Care Facilities ; Arrhythmias, Cardiac ; Atrioventricular Block ; Catheterization ; Catheters ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vasospasm* ; Diagnosis* ; Echocardiography ; Echocardiography, Stress* ; Electrocardiography ; Ergonovine* ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Nitroglycerin ; Retrospective Studies ; Sensitivity and Specificity ; Spasm ; Tachycardia, Ventricular

BACKGROUND: The safety of ergonovine provocation for coronary vasospasm (CVS) performed outside the catheterization laboratory has been questioned. We sought to address the issues of safety, feasibility and clinical impact of noninvasive diagnosis of CVS. METHOD AND RESULTS: We retrospectively analyzed the results of bedside ergonovine provocation testing with monitoring of left ventricular regional wall motion abnormalities (RWMAs) by 2-dimensional echocardiography (ergonovine echocardiography, Erg Echo). After confirmation of no significant fixed epicardial coronary artery disease, 1,504 Erg Echo were performed in 1,372 patients from July 1991 to December 1997. Erg Echo was prematurely terminated in 13 patients (0.9%) due to limiting side effects unrelated with myocardial ischemia. Among 1,491 completed tests, 32% (477) showed positive results with development of RWMAs in 467 tests (98%) or ST displacement in ECG in 10 tests (2%). During the test, transient arrhythmias developed in 1.7% (26/1491) including transient ventricular tachycardia (2) and atrioventricular block (4), which were promptly reversed with nitroglycerin. There were no procedure-related death or development of myocardial infarction. On the basis of angiographic criteria in 218 patients, who also underwent invasive spasm provocation test during coronary angiography, the sensitivity and specificity of Erg Echo for the diagnosis of CVS were 93% and 91% respectively. From 1990 to 1997, total 2,073 spasm provocation tests were performed either during invasive coronary angiography in the catheterization or in the echocardiography laboratory. Since 1994, noninvasive Erg Echo became a more popular diagnostic method and comprised more than 95% of all spasm provocation tests in recent 3 years. Erg Echo was also performed safely in outpatient clinic setting without hospital admission in 34% (500/1491). CONCLUSIONS: Erg Echo is highly feasible, accurate and safe for diagnosis of CVS and can replace the invasive spasm provocation test during coronary angiography in the catheterization laboratory.
Ambulatory Care Facilities ; Arrhythmias, Cardiac ; Atrioventricular Block ; Catheterization ; Catheters ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vasospasm* ; Diagnosis* ; Echocardiography ; Echocardiography, Stress* ; Electrocardiography ; Ergonovine* ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Nitroglycerin ; Retrospective Studies ; Sensitivity and Specificity ; Spasm ; Tachycardia, Ventricular

No abstract available.
Kidney Calculi*

No abstract available.

Ossification of the ligamentum flavum (OLF) has been recognised as a definite clinical entity as an ossification of the posterior longitudinal ligament. It has been known that the incidence of OLF is high in Japan and OLF usually occurs in the thoracic and lumbar region. Recently OLF has received considerable attention as a cause of myelopathy. OLF is quite distinct from “hypertrophy” of the ligamentum flvum. We experienced 2 cases of OLF with neurological symptom, which were treated by decompressive laminectomy and removal of the ossified ligamentum flavum. So remarkable symptomatic improvement was obtained.
Incidence ; Japan ; Laminectomy ; Ligamentum Flavum ; Longitudinal Ligaments ; Lumbosacral Region ; Spinal Cord Diseases ; Spine

BACKGROUND: Epinephrine used in surgery to provide hemostasis may elicit ventricular arrhythmias. A desirable anesthetic would not sensitize the myocardium to exogenously administered epinephrine. So the effect of sevoflurane, which was introduced to clinical anesthesia recently, on cardiac arrhythmias induced by the infusion of epinephrine was compared with those of halothane which was already known to epinephrine-induced arrhythmia in the 14 mongrel dogs. METHODS: The authors compared the arrhythmogenicity (three or more premature ventricular contractions, PVCs)of intravenously administered epinephrine in 14 mongrel dogs who were randomly assigned to receive sevoflurane (1.7 vol%) or halothane (0.75 vol%) anesthesia equipotently. The arrhythmogenic doses of epinephrine determined in this comparative study were expressed by both infusion rates of epinephrine during sevoflurane and halothane anesthesia. RESULTS: The mean values of the arrythmogenic infusion rates of epinephrine were 27.1 7.6 g/kg for sevoflurane and 2.7 0.8 g/kg for halothane. CONCLUSIONS: We concluded that the arrythmogenic doses of epinephrine during sevoflurane were significantly higher than those during halothane anesthesia.
Anesthesia* ; Animals ; Arrhythmias, Cardiac ; Dogs* ; Epinephrine* ; Halothane* ; Hemostasis ; Myocardium ; Ventricular Premature Complexes

OBJECTIVES: Chronic pain is one of the most common experiences of humans and a typical psychophysiological disorder. The aim of this study was to measure the psychophysiological responses in chronic pain patients using a biofeedback system, and to compare them with the results from normal healthy subjects. METHODS: Forty two patients with chronic pain (17 males and 25 females, average age 44.67+/-11.10 years) and 42 normal healthy controls (17 males and 25 females, average age 45.17+/-10.46 years) participated in this study. Electromyography (EMG), skin conductance (SC), and skin temperature (ST) were recorded using biofeedback system during the 3 phases (baseline, stress, and recovery) of stress reactivity test, and average values of them were calculated. Difference of values between two groups in each corresponding phase was analyzed with independent t-test, and change of values across phases of stress reactivity test was analyzed with paired t-test (all two-tailed, p<0.05). RESULTS: Compared to normal controls, chronic pain patients had higher value of EMG (baseline : 8.10+/-5.97 micronV vs 4.72+/-1.52 micronV, t=-3.56, p<0.01 ; stress : 11.25+/-6.89 micronV vs 8.49+/-4.78 micronV, t=-2.13, p<0.05 ; recovery : 7.12+/-3.77 micronV vs 4.78+/-1.59 micronV, t= -3.70, p<0.01) and SC (baseline : 1.06+/-1.0 micronS vs 0.42+/-0.29 micronS, t=-4.0. p<0.01 ; stress : 1.87+/-2.05 micronS vs 1.03+/-0.86 micronS, t=-2.47, p<0.05 ; recovery : 1.74+/-1.77 micronS vs 0.64+/-0.59 micronS, t=-3.8, p<0.01) in all the 3 phases. But, skin temperature comparison did not reveal significant differences in all the 3 phases between two groups. CONCLUSION: Psychophysiological responses of chronic pain patients in stress reactivity test were different from those of normal healthy controls. These results suggest that sympathetic nervous system is more activated in chronic pain patients.
Biofeedback, Psychology ; Chronic Pain ; Electromyography ; Female ; Humans ; Male ; Psychophysiologic Disorders ; Psychophysiology ; Skin ; Skin Temperature ; Sympathetic Nervous System

We have analyzed 785 ICU patients admitted between May 24, 1989 and April 30, 1990, to obtain better guidance and management in the ICU. The results of analysis are as follows: 1) Total number of patients was 785; 459 male and 326 female. The number of patients admitted was 337 (42.9%) from the Department of neurosurgery, 259 (33.0%) from internal medicine and 70 (8.9%) from genreal surgery. 2) 183 patients were involved in 51~60 age group, 166 in 61~70 age group, 138 in 41-50 age group and 85 in over 71 age group. 3) The number of patients by admission days was 223 (28.4%) in 3~4 days group, 197 (250%) in 1~2 days group and 128 (16.3%) in 5~6 days group. 4) The total number of expired patients was 103 (mortality rate, 13,1%); 66 male and 37 female. The expired 63 patients admitteed in ICU due to medical problems and 40 patients due to surgical problems. The number of expired patients was 54 (52.4%) from the Department of internal medicine, 31 (30.1%) from neurosurgery and 5 (4.9%) from general surgery. 5) The highest mortality group was 51~60 age group by age and 1~2 days group by duration of admission.
Female ; Humans ; Intensive Care Units* ; Critical Care* ; Internal Medicine ; Male ; Mortality ; Neurosurgery

Induction of general anesthesia with tracheal intubation is routine proeedure but causes varying degrees of sympathetic stimulation such as increases in blood pressure and heart rate. Many approaches have been tried to attenuate these hemodynamic responses To evaluate the effects of clonidine, a-2 adrenergic receptor agonist, on the hemodynamic changes induced by intubation, we administered clonidine(5 ug/kg, P.O.) 90 minutes before induction of anesthesia. We measured systolic pressure, diastolic pressure and heart rate before premedication, before induction, after intubation and 5, 10 minutes after intubation and compared with control group. The results were as follows: 1) After intubation systolic and diastolic blood pressures increased significantly in both group(P<0.05) but the increasing rate was significantly less than in clonidine group. (P<0.05) 2) After intubation the increaae in heart rate in clonidine group was significantly less than in control group (p<0.05). 3) The trend of increase in heart rate in clonidine group was more stabilized than control group. 4) Systolic blood pressure and heart rate in clonidine group were significantly decreased in preinduction period after premedication.
Adrenergic Agonists ; Anesthesia ; Anesthesia, General ; Blood Pressure ; Clonidine* ; Heart Rate ; Hemodynamics ; Intubation* ; Premedication