Purpose: In patients with nasolacrimal duct obstruction, the outcomes of surgery were evaluated according to the type or presence of flaps. Methods: In total, 509 eyes were compared retrospectively: 178 eyes in patients treated without flaps, 126 eyes in patients treated using nasal mucosa flaps, and 205 eyes in the patient group using nasal and lacrimal sac mucosal flap were compared retrospectively. We analyzed the factors of success according to the surgical method by comparing granulation and bony ostium obstruction at 1, 3, and 6 months after surgery in each group. Results: At 6 months after surgery, granulation was found in 6 eyes (2.93%) in the nasal and lacrimal sac mucosal flap group, 5 eyes (3.96%) in the nasal mucosal flap group, and 15 eyes (8.42%) in the group treated without flaps. Bony ostium obstruction was found in 3 eyes (1.46%) in the nasal and lacrimal sac mucosal flap group, 4 eyes (2.38%) in the nasal mucosal flap group, and 6 eyes (2.81%) in the group treated without flaps. The anatomical surgical success rate of patients treated with nasal and lacrimal sac mucosal flaps was 95.61%, which was higher than those of patients treated with nasal mucosal flaps (92.86%) and without flaps (88.20%). The functional and anatomical surgical success rate was 94.15% in the group treated with nasal and lacrimal sac mucosal flaps, 88.89% in the group treated with nasal mucosal flaps, and 84.83% in the group treated without flaps. Conclusions Endonasal dacryocystorhinostomy using the nasal and lacrimal sac mucosal flap is an effective method that minimizes the risk of granulation and bony ostium obstruction.

Purpose: In patients with nasolacrimal duct obstruction, the outcomes of surgery were evaluated according to the type or presence of flaps. Methods: In total, 509 eyes were compared retrospectively: 178 eyes in patients treated without flaps, 126 eyes in patients treated using nasal mucosa flaps, and 205 eyes in the patient group using nasal and lacrimal sac mucosal flap were compared retrospectively. We analyzed the factors of success according to the surgical method by comparing granulation and bony ostium obstruction at 1, 3, and 6 months after surgery in each group. Results: At 6 months after surgery, granulation was found in 6 eyes (2.93%) in the nasal and lacrimal sac mucosal flap group, 5 eyes (3.96%) in the nasal mucosal flap group, and 15 eyes (8.42%) in the group treated without flaps. Bony ostium obstruction was found in 3 eyes (1.46%) in the nasal and lacrimal sac mucosal flap group, 4 eyes (2.38%) in the nasal mucosal flap group, and 6 eyes (2.81%) in the group treated without flaps. The anatomical surgical success rate of patients treated with nasal and lacrimal sac mucosal flaps was 95.61%, which was higher than those of patients treated with nasal mucosal flaps (92.86%) and without flaps (88.20%). The functional and anatomical surgical success rate was 94.15% in the group treated with nasal and lacrimal sac mucosal flaps, 88.89% in the group treated with nasal mucosal flaps, and 84.83% in the group treated without flaps. Conclusions Endonasal dacryocystorhinostomy using the nasal and lacrimal sac mucosal flap is an effective method that minimizes the risk of granulation and bony ostium obstruction.

PURPOSE: Arrhythmias after an esophagectomy (most commonly atrial fibrillation) are a significant contributing factor to patient morbidity. However, the significance of an intraoperative arrhythmia is not completely understood. The aim of this retrospective study was to determine the occurrence and risk factors for developing intraoperative arrhythmias in patients undergoing an esophagectomy. MATERIALS AND METHODS: We reviewed the records of 427 patients who underwent a transthoracic esophagectomy between 2001 and 2005. Variables such as age, sex, hypertension, diabetes, cardiac disease, preoperative pulmonary function test (PFT) results, cancer level, combined radiochemotherapy, intrathoracic cavity adhesions and anastomosis site, hemoglobin, central venous pressure (CVP), fluid balance, serum potassium level, dose of vasopressors, temperature, and combined general and epidural anesthesia were analyzed as risk factors for the occurrence of an arrhythmia. We defined this arrhythmia as one not originating from the sinus node. RESULTES: The incidence of intraoperative arrhythmia in this subset of patients was 17.1%, with a 37.2% reoccurrence rate during the first three postoperative days. Univariate and multivariate analysis revealed the presence of heart disease, poor PFTs, cervical anastomosis, elevated CVP, and higher ephedrine doses to be independent predictors of the development of an intraoperative arrhythmia. CONCLUSION: The incidence of intraoperative arrhythmia during esophagectomy was 17.1% with a 37.2% of reoccurrence rate.
Aged ; Arrhythmias, Cardiac/*etiology/pathology ; Esophagectomy/*adverse effects/statistics & numerical data ; Female ; Humans ; Intraoperative Complications/*etiology/pathology ; Male ; Middle Aged ; Risk Factors

OBJECTIVE: To compare the usefulness of unenhanced spiral CT (UCT) with that of excretory urography (EU) in patients with acute flank pain. MATERIALS AND METHODS: Thirty patients presenting with acute flank pain under-went both UCT and EU. Both techniques were used to determine the presence, size, and location of urinary stone, and the presence or absence of secondary signs was also evaluated. The existence of ureteral stone was confirmed by its removal or spontaneous passage during follow-up. The absence of a stone was determined on the basis of the clinical and radiological evidence. RESULTS: Twenty-one of the 30 patients had one or more ureteral stones and nine had no stone. CT depicted 22 of 23 calculi in the 21 patients with a stone, and no calculus in all nine without a stone. The sensitivity and specificity of UCT were 96% and 100%, respectively. EU disclosed 14 calculi in the 21 patients with a stone and no calculus in eight of the nine without a stone. UCT and EU demon-strated secondary signs of ureterolithiasis in 15 and 17 patients, respectively. CONCLUSION: For the evaluation of patients with acute flank pain, UCT is an excellent modality with high sensitivity and specificity. In near future it may replace EU.
Adult ; Colic/*radiography ; Female ; Human ; Male ; Middle Age ; Sensitivity and Specificity ; Tomography, X-Ray Computed/*methods ; Ureteral Calculi/*radiography ; Ureteral Diseases/*radiography ; *Urography

Pulmonary hypertension (PH) is characterized by structural and functional changes in the lung including proliferation of vascular smooth muscle cells (VSMCs) and excessive collagen synthesis. Although connective tissue growth factor (CTGF) is known to promote cell proliferation, migration, adhesion, and extracellular matrix production in various tissues, studies on the role of CTGF in pulmonary hypertension have been limited. Here, we examined CTGF expression in the lung tissues of male Sprague Dawley rats treated with monocrotaline (MCT, 60 microgram/kg), a pneumotoxic agent known to induce PH in animals. Establishment of PH was verified by the significantly increased right ventricular systolic pressure and right ventricle/left ventricle weight ratio in the MCT-treated rats. Histological examination of the lung revealed profound muscular hypertrophy in the media of pulmonary artery and arterioles in MCT-treated group. Lung parenchyma, vein, and bronchiole did not appear to be affected. RT-PCR analysis of the lung tissue at 5 weeks indicated significantly increased expression of CTGF in the MCT-treated group. In situ hybridization studies also confirmed abundant CTGF mRNA expression in VSMCs of the arteries and arterioles, clustered pneumocytes, and infiltrated macrophages. Interestingly, CTGF mRNA was not detected in VSMCs of vein or bronchiole. In saline-injected control, basal expression of CTGF was seen in bronchial epithelial cells, alveolar lining cells, and endothelial cells. Taken together, our results suggest that CTGF upregulation in arterial VSMC of the lung might be important in the pathogenesis of pulmonary hypertension. Antagonizing the role of CTGF could thus be one of the potential approaches for the treatment of PH.
Animals ; Blood Pressure/drug effects ; Bronchi/cytology/drug effects/metabolism ; Endothelial Cells/cytology/drug effects/metabolism ; Epithelial Cells/cytology/drug effects/metabolism ; Hypertension, Pulmonary/chemically induced/*metabolism ; Immediate-Early Proteins/genetics/*metabolism ; Intercellular Signaling Peptides and Proteins/genetics/*metabolism ; Lung/cytology/drug effects/*metabolism ; Male ; Monocrotaline/*toxicity ; Pulmonary Alveoli/cytology/drug effects/metabolism ; Pulmonary Artery/cytology/drug effects/metabolism ; Rats ; Rats, Sprague-Dawley ; Research Support, Non-U.S. Gov't ; Reverse Transcriptase Polymerase Chain Reaction ; Up-Regulation

Many factors are associated with the development of low back pain. Among them, exercise, obesity, smoking, age, educational level and stress are the most common. This study examined the association of these factors with low back pain. An additional aim was to determine a procedure for preventing low back pain. This study analyzed the responses to a questionnaire sent to 772 individuals who had undergone a medical examination at this hospital in 2003 and excluded the individuals who had shown symptoms or their test results indicated a particular disease. Assuming that there were no variables, individuals who exercised regularly 3-4 times per week would have a lower chance of having low back pain than those who did not exercise regularly. The analysis revealed that individuals with a college degree or higher education have a lower chance of experiencing low back pain than those with only a high school education or even college drop-outs. When the other variables were constant, age, extent of obesity (body mass index), smoking and level of stress were not found to affect the development of low back pain. The level of education was associated with the development of low back pain. However, regular exercise 3-4 times per week or more would be most effective in reducing the incidence and duration of low back pain.
Stress, Psychological/epidemiology ; Statistics ; Smoking/epidemiology ; Sex Distribution ; Risk Factors ; Risk Assessment/*methods ; Prognosis ; Physical Examination/*statistics & numerical data ; Obesity/epidemiology ; Middle Aged ; Male ; Low Back Pain/diagnosis/*epidemiology/prevention & control ; Korea/epidemiology ; Humans ; Female ; *Exercise ; Educational Status ; Comorbidity ; Aged, 80 and over ; Aged ; Age Distribution ; Adult ; Adolescent

OBJECTIVES: The aging process affects responsiveness and other functions of endothelium and vascular smooth muscle cells, predisposing the old vessels to the development of atherosclerotic lesions. Endothelial nitric oxide synthase (ecNOS) gene polymorphisms were shown to affect the occurrence of acute myocardial infarction (AMI). We hypothesized that aging may affect the association between the ecNOS gene polymorphism and AMI. METHODS: We investigated the age-related distribution of the ecNOS gene a/b polymorphism in 121 male AMI patients and 206 age-matched healthy male controls. RESULTS: The aa, ab and bb genotypes were found in 1, 49 and 156 cases among the control subjects and 5, 23 and 93 cases among the AMI patients, respectively. There was a significant correlation between the ecNOS polymorphism and AMI (p +AD0- 0.045). When the correlation was analyzed by age, the significance remained only in the group below the age of 51 (p +AD0- 0.009). The proportion of smokers was increased in the young patients when compared to the old patients (p +AD0- 0.033), indicating that smoking also has greater effect on the younger population. The incidences of hypertension and diabetes mellitus, however, were similar in both populations. CONCLUSION: Our work provides the first evidence that links ecNOS polymorphism to the risk of AMI in relation to age. Young persons who smoke or have ecNOSaa genotype may have an increased risk of developing AMI. The functional as well as structural changes associated with aging in the vascular endothelium may mask the effect of the ecNOS polymorphism in the development of AMI in old persons.
Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Aging/physiology+ACo- ; Chi-Square Distribution ; Comorbidity ; Diabetes Mellitus/epidemiology ; Endothelium, Vascular/enzymology+ACo- ; Genotype ; Human ; Hypertension/epidemiology ; Korea/epidemiology ; Male ; Middle Age ; Myocardial Infarction/physiopathology+ACo- ; Myocardial Infarction/epidemiology ; Nitric-Oxide Synthase/metabolism+ACo- ; Nitric-Oxide Synthase/genetics+ACo- ; Polymerase Chain Reaction ; Polymorphism (Genetics)+ACo- ; Risk Assessment ; Statistics, Nonparametric

BACKGROUND: Patients with Alzheimer's disease (AD) at an early stage present with memory decline and impairments of language and visuospatial functions. However, some AD patients occasionally show frontal lobe dysfunctions in the early stage those are known to emerge only at the advanced stage. This subtype of AD is called a frontal variant of AD (frontal AD). We report neuropsychological and FDG-PET findings of three cases of frontal AD. METHODS: Three patients met the diagnostic criteria of probable AD proposed by the NINCDS-ADRDA. However, they unusually showed clinical symptoms associated with frontal lobe dysfunctions even if they were relatively in the early stage of dementia. All the patients underwent neuropsychological tests and brain FDG-PET scans. Distribution of glucose hypometabolism was analyzed using statistical parametric mappings (SPM). RESULTS: Results of neuropsychological tests were consistent with findings of AD except that frontal lobe dysfunctions were prominent. FDG-PET scans and SPM analysis of these images showed hypometabolism in the frontal as well as temporo-parietal regions. Unlike the hypometabolism pattern found in frontotemporal dementia, frontal hypometabolism in our patients was not as severe as parietal hypometablism and hypometabolic regions within the temporal lobe were in the middle or posterior part of the middle and inferior temporal gyri rather than in the anterior part. CONCLUSIONS: Detailed neuropsycholgical tests and FDG-PET may help differentiate AD with frontal involvement in its early stage (frontal AD) from frontotemporal dementia. Future studies with FDG-PET in a larger series of frontal AD cases, especially with histologically proven cases, may be needed.
Alzheimer Disease* ; Brain ; Dementia ; Frontal Lobe ; Frontotemporal Dementia ; Glucose ; Humans ; Memory ; Neuroimaging* ; Neuropsychological Tests ; Rabeprazole ; Temporal Lobe