Purpose: Dislocation is the second most common cause of failure, after implant loosening, in revisional THA (Total hip arthroplasty), and its evaluation and treatment still remain controversial issue. This study was undertaken to evaluate the risk factors after THA using the posterolateral approach and posterior soft tissue repair. Materials and Methods: Between January 1998 and May 2003, 211 consecutive primary total hip replacement arthroplasties using the posterolateral approach and posterior soft tissue repair were performed by the same surgeon. To compare the dislocation groups (6 cases) with the non-dislocation groups (205 cases), we randomized 120 of the non-dislocation cases. The risk factors for hip dislocation were categorized into patient factors and surgical factors. Patient factors included gender, age, preoperative diagnosis, underlying systemic disease, and alcoholic history. Surgical factors included position of the component (acetabular version and inclination, femoral anteversion), leg length discrepancy, and sum of anteversions of the cup and stem. Their parameters were measured on postoperative radiographs. Statistics were performed with Fishe`s Exact test and T test. Results: Dislocations occurred at an overall incidence rate of 2.8% (6/211cases). There were 4 (1.9%) cases of anterior dislocations and 2 (0.9%) cases of posterior dislocations. Dislocations occurred on average at postoperative day 6.1 and all dislocated hips were reduced with the closed method, except for one case that was treated surgically. There was no statistical significance in patient factors between the two groups, except for neurologic disease and alcoholic history. However, the sum of the acetabular and femoral anteversions in the anterior dislocation group was larger than that of the non-dislocation group by approximately 19 degrees. Conclusion: Our results demonstrated that by using the posterior approach and repair of soft tissue, the posterior dislocation rate after total hip replacement arthroplasty can be reduced and the sum of the acetabular and femoral anteversions had more influence on dislocations after THAs than did either anteversion alone.
Acetabulum ; Alcoholics ; Arthroplasty ; Arthroplasty, Replacement, Hip* ; Diagnosis ; Dislocations ; Hip Dislocation* ; Hip* ; Humans ; Incidence ; Leg ; Risk Factors*

We evaluated the clinical effects of amlodipine in 10 patients(7 male and 3 female) with angina pectoris in terms of the effect on the anginal pain, hemodynamic changes and side effects. The results obtained were as follows; 1) The clinical improvement was obsebed in 8(80.8%) of 10 and 9(88.9%) of 9 patients at 2 and 10 weeks after oral amlodipine. 2) The systolic and diastolic blood pressure was decreased significantly(136.0+/-16.5mmHg vs 117.0+/-10.6mmHg, p<0.01 and 85.0+/-9.7mmHg vs 75.0+/-5.3mmHg, p<0.01 respectively) but the heart rate was indepentent of amlodipine administration. 3) The adverse effects of amlodipine were as headache in 3, facial flushing in 3, palpitation, dizziness, urinary difficulty in 1 respectively and one of them discontinued amlodipine due to severe palpitation and facial flushing.
Amlodipine* ; Angina Pectoris* ; Blood Pressure ; Dizziness ; Flushing ; Headache ; Heart Rate ; Hemodynamics ; Humans ; Male

OBJECTIVES: This study examined socioeconomic inequalities in compliance with precautions and health behavior changes during the coronavirus disease 2019 (COVID-19) outbreak using a representative Korean sample. METHODS: This exploratory study utilized around 210,000 participants aged ≥25 years in the Korean Community Health Survey 2020. Socioeconomic status was measured with educational attainment and household income. Outcomes included non-compliance with 8 precaution measures and deterioration in 6 health behaviors. The relative inequality index (RII) was calculated to quantify the degree of inequality by education and income level. RII values >1.0 indicate that deprived people have a higher frequency of health problems, and RII values <1.0 conversely indicate a higher frequency of health problems in more advantaged groups. RESULTS: People with lower education or income levels tended to have higher rates of non-compliance with COVID-19 safety precautions (RII range, 1.20 to 3.05). Lower education and income levels were associated with an increased smoking amount (RII=2.10 and 1.67, respectively) and sleep duration changes (RII=1.21 and 1.36, respectively). On the contrary, higher education and income levels were associated with decreased physical activity (RII=0.59 and 0.77, respectively) and increased delivery food consumption (RII=0.27 and 0.37, respectively). However, increased alcohol drinking was associated with lower education and income levels in younger men (RII=1.73 and 1.31, respectively), but with higher levels in younger women (RII=0.73 and 0.68, respectively). CONCLUSIONS Our findings suggest the need to develop customized strategies, considering the characteristics of the target population, to decrease the burden and impact of the COVID-19 outbreak.

To investigate the significance of precordial ST-segment depression in acute inferior myocardial infarction, electrocardiographic findings in 51 consecutive patients with acute inferior myocardial infarction were analysed with clinical findings and coronary artery angiography. Thirty patients(Group A) had no or <1.0mm ST depression, and twenty one patients(Group B) had > or =1.0mm ST depression in two or more precordial(VI-6) leads were included in this study. Patients in Group B thd greater summed ST-segment elevation in leads II, III, AVF(6.3+/-6.1 vs 2.4+/-2.3mm, p<0.05), higher plasma peak CK levels(1776.8+/-1503.3 vs 5666.6+/-587.7 IU/L, p<0.05), higher plasmal peak CK-MB levels(141.2+/-1553.3 vs 34.1+/-35.7 IU/L, p<0.05), more prevalence of proximal left anterior descending coronary artery disease (46.6% vs 16.6%, p<0.05) than patients in Group A. There was no significant difference between Group A and Group B in the LV ejection fraction, delta area decreasing rate, infarction related asynergy, complications during hospitalization and cardiac events during follow up period. In conclusion, patients with acute inferior myocardial infarction who have associated with precordial ST depression had more extensive myocardial damage probably due to concomitant left anterior descending coronary artery disease.
Angiography ; Coronary Artery Disease ; Coronary Vessels ; Depression* ; Electrocardiography ; Follow-Up Studies ; Hospitalization ; Humans ; Infarction ; Inferior Wall Myocardial Infarction* ; Plasma ; Prevalence

To substantiate the hypothesis that patients with antecedent angina(> or =24hr before myocardial infarcton) are more likely to have a significant residual stenosis than are those without antedecent angina, the coronary angiogram of 27 patients with successful coronary thrombolysis for acute myocardial infarction were reviewed. In comparison with the patients without antecedent angina the patient with antecedent angina had an increased mean stenosis (86.9% vs 69.3%) and had a more decreased ejection fraction(52.3% vs 65.6%). These findings suggest that angina pectoris before acute myocardial infarction would be regarded as one of high risk factors after acute myocardial infarction.
Angina Pectoris* ; Constriction, Pathologic* ; Humans ; Myocardial Infarction* ; Risk Factors

PURPOSE: We estimated scattered radiation doses to the patients and medical practitioneer and revealed risk factors associated with increasing radiation doses during extracorporeal shock wave lithotripsy(ESWL). MATERIALS AND METHODS: At first, we measured radiation doses 2 times using thermoluminescence dosimeter to simulative patients and medical practitioneer without any shield during 10 minutes of ESWL and determined mean radiation dose/minute. From June to August 2007 at our institution, we prospectively measured radiation exposured time during respective ESWL for treatment of urinary stones. Thereafter, we calculated practical radiation doses to patients and medical practitioneer from respective mean radiation dose/minute. We also analyzed which factors were associated with increasing radiation doses. RESULTS: A total of 50 ESWL were analyzed from 38 patients. Mean radiation dose/minute to simulative patients and medical practitioneer was 16.20, 0.006mSv respectively. At 1 time ESWL, median radiation exposured time was 360 seconds(130-980), therefore, median radiation dose to patients and medical practitioneer was calculated as 97.20mSv(35.10-264.60), and 0.04mSv(0.01-0.08) respectively. Larger stone size had a correlation with increasing radiation dose and additional pain control group had higher radiation dose than otherwise. CONCLUSIONS: During ESWL, patients were relatively exposed to high radiation which were roughly corresponded to that of 3 times of computed tomography. But the radiation dose to medical practitioneer was insignificant consider international guideline. Medical practitioneer should be aware of radiation hazard and try to minimize radiation dose to the patients at the time of ESWL.
Humans ; Lithotripsy ; Prospective Studies ; Risk Factors ; Shock ; Urinary Calculi

Percutaneous mitral ballon valvuloplasty(PMV) is an effective nonsurgical procedure for patients with mitral stenosis. PMV was performed in 13 patients(mean age, 41 years) with mitral stenosis. All patients underwent echophonocardiography(Echophono) before and after PMV. Two dilatation balloons were used in which the diameters approximately equaled the mitral valve annulus diameter as determined. After PMV, the mean mitral valve pressure gradient decreased(22.3+/-1.89mmHg to 5.2+/-2.6mmHg), the mean left atrial pressure decreased(21.3+/-5.1mmHg to 9.0+/-4.5mmHg) and the mitral valve area increased from 0.8+/-0.3cm2 to 1.7+/-0.6cm2. The Echophono data are correlated with clinical and hemodynamic changes produced by PMV. PMV resulted in echophono changes consistent with decresed severity of mitral stenosis ; shortening of Q-S1, from 88+/-14 to 73+/-11 mses(p<0.01) and (Q-S1)-(S2-OS), from 0.9+/-1.7 to -2.1+/-1.6(p<0.001) ; prolongation of S2-OS from 80+/-15 to 103+/-14 msec(p<0.001) and increase of EF slope from 14.7+/-5.4 to 26.7+/-8.1 mm/sec(p<0.001). Compared with pre-PMV, post-PMV Echophono showed significant decrease in the severity of mitral stenosis. Thus Echophono is a simple, low cost method helpful in evaluation and follow-up patients undergoing PMV.
Atrial Pressure ; Balloon Valvuloplasty ; Dilatation ; Follow-Up Studies ; Hemodynamics ; Humans ; Mitral Valve ; Mitral Valve Stenosis

Certain angiographic patterns outlining the morphologic characteristics of vessels and defining the lesion-specific characteristics have recently been shown to greatly influence the likelihood of a successful dilation. In 1988, ACC/AHA Subcommitte on percutaneous transluminal coronary angioplasty proposed the lesion-specific classification as a guide for estimating the likelihood of a successful procedure as well as the the likelihood of developing abrupt vessel closure. To determine the lesion-specific predictors for successful dilation and complications after percutaneous transluminal coronary angioplasty, nine angiographic charateristics of 200 lesions in 164 patients who underwent coronary angiplasty between May, 1983 and September, 1989 were analyzed. 1) Successful dilation, defined as a reduction in stenosis diameter to less than 50% without acute myocardial infarction or emergency coronary artery bypass graft, occurred in 175 of 212 lesions(82.5%). 2) Successful dilation occurred in 13 of 15 type A lesions(86.6%), 148 of 178 type B lesions(83.1%) and 3 of 7 type C lesions(42.8%)(p<0.05 for A or B vs C). 3) Acute closure syndrome occurred in none of type A lesions, 6 of type B lesions(3.4%), 2 of type C lesions(28.5%)(p<0.005 for A or B vs C). 4) multivariate analysis showed that lesion-specific characteristic predictors for successful dilation were length of lesion(p<0.05) and accessibility(p<0.05) ; for ischemic events were major branch involvement(p<0.05) and eccentricity(p<0.05); for acute closure syndrome were accessibility(p<0.05) and eccentricity(p<0.05). 5) Procedural predictors for ischemic events were coronary artery dissection(p<0.01), post-PTCA diameter stenosis(p<0.05) and balloon/artery diameter ratio(p<0.01) ; For acute closure syndrome was coronary artery dissection(p<0.005). In this analysis, we found that angiographic lesion-specific characteristics related very importantly to procedural success and were able to define three major independent lesionspecific risk factors whose presence beforehand decreased the likelihood of successful dilation and increased the likelihood of acute closure. In the absence of any of these risk factors, the risk of acute closure is very small. Thus, identification of these factors and their associate risk should improve patients selection and better define the role of coronary angioplasty in the management fo patients with coronary artery disease.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Classification ; Constriction, Pathologic ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Vessels ; Emergencies ; Humans ; Multivariate Analysis ; Myocardial Infarction ; Risk Factors ; Transplants

Cyclooxygenase (COX) is an enzyme involved in the conversion of arachidonic acid to prostaglandins(PGs), and exists in two forms, COX-1 and COX-2. COX has been reported to be involved in early implantation by secretion of PGs which causes permeability of vessels and reaction of decidual cells around the implantation site. Recently, in mice and sheep studies, COX-1 and COX-2 expression in the endometrium has been reported to be different according to implantation and stages of the estrous cycle, but expression of COX-1 and COX-2 in human endometrium during the menstrual cycle has not yet been established. The purpose of this stuffy was to observe the variances of COX-1 and COX-2 expression by immunohistoehemical staining in endometrial samples obtained from human hysterectomy specimens and biopsies of women of reproductive age according to different stages of the menstrual cycle. Also, we attempted to observe COX-1 and COX-2 expression in the epithelial and stromal cells of the endometrium obtained during the mid-secretory phase, which were cultured separately. COX-2 showed a cyclic pattern of expression according to the different stages of the menstrual cycle and was strongly expressed particularly at the mid-secretory phase which corresponds to the time of implantation. However, COX-1 tended to be increased in the early proliferative, and mid- and late secretory phases, but was also expressed in the whole menstrual cycle showing no particular pattern. In the separately cultured cells COX-1 was expressed in epithilial cells and COX-2 in the stromal cells. The above results suggest that since COX-2 is expressed at the same time as implantation and cultured cells display a specific secretory pattern, COX-2 has inductive endocrine enzyme properties and has an important effect on endometrial cells during implantation. Also, COX-2 expression in endometrial cells may be utilized as a useful marker of endometrial maturation.
Animals ; Arachidonic Acid ; Biopsy ; Cells, Cultured ; Cyclooxygenase 1* ; Endometrium* ; Estrous Cycle ; Female ; Humans* ; Hysterectomy ; Menstrual Cycle ; Mice ; Permeability ; Prostaglandin-Endoperoxide Synthases ; Sheep ; Stromal Cells

To evaluate the effect of alteration of left atrial pressure. volume and wall tension on the circulating plasma level of atrial natriuretic peptide(ANP), 15 patients with left atrial hypertension due to mitral stenosis were studied at the time of percutaneous balloon mitral valvuloplasty(PMV). Hemodynamic measurements and plasma atrial natriuretic peptde levels were obtained before, immediately(5-10min) after and 24h after valvuloplasty, and echocardiographic left atrial size, wall tension and mitral valve area were measured bdfore and 24h after valvuloplasty. 1) Immediately after valvuloplasty, left atrial pressure, pulmonary atrial pressure and mean diastolic pressure gradient across the mitral valve decreased, and the mitral valve area by Gorlin's method increased, significantly. Plasma atrial natriuretic peptide level(atright and left atrium, pulmonary artery and aorta) rose significantly after balloon inflation. This rising may reflect a transient increase in left atrial pressure and volume expansion associated with mitral valve occlusion by balloon. 2) Twenty four after valvuloplasty, mitral valve area increased, and left atrial volume and wall tension decreased, significantly. Plasma atrial natriuretic peptide level(at right atrium, pulmonary artery and aorta) fell significantly, too. In conclusion, change of plasma atrial natriuretic peptide le.vel before and after percutaneous balloon mitral valvuloplasty reflect hemodynamic alteration of right and left atrium.
Atrial Pressure ; Blood Pressure ; Echocardiography ; Heart Atria ; Hemodynamics ; Humans ; Hypertension ; Inflation, Economic ; Mitral Valve ; Mitral Valve Stenosis ; Plasma* ; Pulmonary Artery