Background: A decrease in computed tomography (CT)-derived skeletal muscle radiodensity (SMD) reflects age-related ectopic fat infiltration of muscle, compromising muscle function and metabolism. We investigated the age-related trajectory of SMD and its association with vertebral trabecular bone density in healthy adults. Methods: In a cohort of healthy adult kidney donors aged 19 to 69 years (n=583), skeletal muscle index (SMI, skeletal muscle area/height2), SMD, and visceral-to-subcutaneous fat (V/S) ratio were analyzed at the level of L3 from preoperative CT scans. Low bone mass was defined as an L1 trabecular Hounsfield unit (HU) <160 HU. Results: L3SMD showed constant decline from the second decade (annual change –0.38% and –0.43% in men and women), whereas the decline of L3SMI became evident only after the fourth decade of life (–0.37% and –0.18% in men and women). One HU decline in L3SMD was associated with elevated odds of low bone mass (adjusted odds ratio, 1.07; 95% confidence interval, 1.02 to 1.13; P=0.003), independent of L3SMI, age, sex, and V/S ratio, with better discriminatory ability compared to L3SMI (area under the receiver-operating characteristics curve 0.68 vs. 0.53, P<0.001). L3SMD improved the identification of low bone mass when added to age, sex, V/S ratio, and L3SMI (category-free net reclassification improvement 0.349, P<0.001; integrated discrimination improvement 0.015, P=0.0165). Conclusion L3SMD can be an early marker for age-related musculoskeletal changes showing linear decline throughout life from the second decade in healthy adults, with potential diagnostic value for individuals with low bone mass.

PURPOSE: This is a report of the surgical treatment and prognosis of retroperitoneal liposarcoma (RPLS) in Koreans. MATERIALS AND METHODS: Nineteen patients treated for RPLS between July 1, 1984, and March 31, 2009, were included. Patient demographics, histopathologic subtypes, survival rate, disease recurrence rate and interval, and adjuvant therapy were reviewed and analyzed. RESULTS: Of the 19 patients diagnosed with RPLS, 26.3% presented with well-differentiated RPLS, 10.5% with dedifferentiated RPLS, 15.8% with myxoid/round cell type, and 47.4% with mixed-type liposarcoma. The mean follow-up period was 66.8 months (range, 6 to 165 months). Primary RPLS was treated in 17 patients. Nine patients (52.9%) had recurrent disease, and recurrence developed at a mean of 47.7 months after primary or repeated surgical treatment. The overall survival rate was 84.2% during a mean follow-up of 66.8 months. The 3- and 5-year survival rates were 86.9%, and the 10-year survival rate was 69.5%. The recurrence interval was significantly shorter in recurrent RPLS cases (p=0.023). The mean growth rate of locally recurrent tumors was 0.34 cm per month. CONCLUSIONS: The survival rates reported here were higher than in previous studies. Locally recurrent tumors presented with a low growth rate, which may have contributed to the relatively high survival rate. A high prevalence of mixed-type RPLS was also noted, and its cause and prognosis require further research.
Demography ; Follow-Up Studies ; Humans ; Liposarcoma ; Prevalence ; Prognosis ; Recurrence ; Retroperitoneal Neoplasms ; Sarcoma ; Survival Rate

To characterize the association between chronic kidney disease (CKD), mortality, severity of coronary artery disease (CAD), treatment modality of CAD, and type of coronary stents among patients undergoing coronary angiography (CAG), we retrospectively reviewed the electronic medical records of the patients who underwent CAG at Seoul National University Bundang Hospital in Korea between May 2003 and January 2006. CKD was staged using an estimated glomerular filtration rate (eGFR) from the creatinine value prior to CAG. There were 3,637 patients included. The presence of CAD was 48% in CKD stage 1, 61% in stage 2, 73% in stage 3, 87% in stage 4, and 81% in stage 5. Survival rate gradually diminished for patients with decreasing renal function. No significant differences in all-cause and cardiac mortality were observed by medical treatment, PCI or CABG, in CKD patients with an eGFR less than 60 mL/min/1.73 m(2). CKD patients with drug-eluting stents showed significantly lower all-cause mortality (5.4% vs. 13.3%) and incidence of myocardial infarction (1.7% vs. 10%) than those with bare metal stents. In conclusion, an eGFR is a strong independent prognostic marker among patients undergoing CAG and the severity of CAD increases progressively with worsening renal function.
Aged ; Coronary Angiography/*methods ; Coronary Artery Disease/complications/*diagnosis/mortality ; Female ; Glomerular Filtration Rate ; Humans ; Hypertension ; Kidney/pathology/*physiology ; Kidney Diseases/complications/*diagnosis/mortality ; Kidney Function Tests ; Male ; Middle Aged ; Stents ; Time Factors ; Treatment Outcome

Informed consent is the procedure that respects the autonomy of patients ; doctors protect patients' choices and rights through informed consent. Competence and voluntariness are prerequisite for the informed consent. In recent years, the necessity of informed consent from the Psychiatric department has been raised. Regarding informed consent from the Psychiatric department, there is a need to consider from two perspectives : respect for the patient's decision-making ability and the psychiatrist's legal self-protection. In competence and voluntariness, psychiatric patients were excluded due to lack of decision-making ability and willingness. However, not all psychiatric patients were able to perform the given task. Therefore, informed consent is needed in the point of view regarding the decision-making ability of psychiatric patients. Psychotropic medications, particularly antipsychotics, can cause several side effects, including extrapyramidal syndrome and metabolic syndrome. Therefore, preannouncement of these patients for these side effects is needed. However, when the informed consent is only applied to psychiatric hospitals, it may increase prejudices and misconceptions about psychiatric medications and treatment. Therefore, the informed consent should first be considered carefully and thoughtfully.
Antipsychotic Agents ; Hospitals, Psychiatric ; Human Rights ; Humans ; Informed Consent* ; Mental Competency ; Prejudice

Repeated administration of amphetamine (AMPH) produces behavioral sensitization, a proposed model for the escalation of drug use characteristic of human addicts. beta-Phenylethylamine (PEA) is an endogenous trace amine found in mammalian brain and resembles AMPH both structurally and behaviorally. Previously, it has been reported that chronic PEA administration produces behavioral sensitization to the challenges of AMPH. However, these data were obtained with very high amount of PEA for a relatively long period of time. Further, the effect of PEA challenge on the expression of behavioral sensitization developed by AMPH pre-exposures has not been tested yet. Thus, we examined in the present experiment the expression of behavioral sensitization with AMPH challenge after a mild chronic PEA treatment. Rats were repeatedly administered with systemic injections of saline, beta-phenylethylamine (PEA) (10 or 50 mg/kg), or amphetamine (AMPH) (1.5 mg/kg). When challenged a week after the last pre-injection, rats pre-exposed to either PEA or AMPH showed behavioral sensitization to AMPH (1.0 mg/kg), while these effects were not observed to PEA (50 mg/kg) itself. These results demonstrate that repeated exposure to PEA produces behavioral sensitization to AMPH challenge, while PEA challenge has no effect on the expression of behavioral sensitization developed by AMPH pre-exposures, suggesting that PEA may play a role in the development of locomotor sensitization to AMPH, but not in the expression of it.
Amphetamine ; Animals ; Brain ; Humans ; Peas ; Phenethylamines ; Rats ; Schizophrenia

Endometriosis is the abnormal growth of endometrial tissue outside the uterine cavity. Involvement of the gastrointestinal tract is seen in 3~34% of patients affected by this condition. Although the commonest sites involved are the sigmoid colon and rectum, only 4 cases have been reported in Korea. The most frequent symptoms are lower abdominal and pelvic pain typically worsening at the time of menstruation. Bleeding per rectum is uncommon since the mucosa is rarely involved. Endoscopy has not been thought to be helpful in the evaluation of patients with suspected colonic endometriosis. However, endoscopy is often used as the first test in patients with rectal bleeding, excluding malignancy or other sources of bleeding. There are few reports of endoscopic documentation of colorectal endometriosis. A 26 year-old woman having a history of endometriosis with cyclic hematochezia and lower abdominal pain is herein reported. A flexible sigmoidoscopy revealed a protrusion of hyperemic mucosa with a surrounding fold formation on the rectum 8 cm above the anal verge. The subsequent biopsy of the lesion gave rise to a diagnosis of endometriosis.
Abdominal Pain ; Adult ; Biopsy ; Colon ; Colon, Sigmoid ; Diagnosis ; Endometriosis* ; Endoscopy ; Female ; Gastrointestinal Hemorrhage ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Korea ; Menstruation ; Mucous Membrane ; Pelvic Pain ; Rectum ; Sigmoidoscopy

PURPOSE: To compare the effectiveness of a trochanter stabilizing plate with a dynamic hip screw, with using a dynamic hip screw only in the treatment of an unstable intertrochanteric fracture of elderly patients. MATERIALS AND METHODS: From January 2000 to December 2004, 70 patients, who were treated surgically for unstable intertrochanteric fractures, were evaluated. The patient s age were above 65 years and the T-score <-3.0 and they were followed up for more than 6 months. The patient were divided into two groups. One group was treated with DHS only (Group 1, 38 cases), and the other was treated with DHS and TSP (Group 2, 32 cases). The two groups were compared clinically and radiologically. RESULTS: There was no difference in the prevalence of lag screw sliding. However, there were significant differences in the extent of sliding between the two groups, (an average of 8.8 mm p<0.05). There was a significant difference between two groups in the extent of lateralization of the great trochanter, (An average of 6.0 mm p<0.05). However, there was no difference in the leg length between two groups (p>0.05), but the postoperative functional loss of the hip joint was significantly lower in the group 2 (p<0.05), who required additional surgery due to reduction loss or metal failure. CONCLUSION: Although it is a relatively simple technique, the use of DHS with TSP is more effective for the buttress effect on proximal fragment and additional fixation of great trochanter than just DHS only. It decreases the excessive slippage of the lag screw, lateral displacement of the greater trochanter and postoperative functional loss of the hip joint. Therefore, it may be a useful treatment for unstable or comminuted intertrochanteric fractures in elderly patients with osteoporosis.
Aged ; Femur* ; Hip Fractures* ; Hip Joint ; Hip* ; Humans ; Leg ; Osteoporosis ; Prevalence

PURPOSE: The aim of this study was to evaluate the usefulness of the intra-operative synovial fluid culture and post-operative suction drainage tip culture as a method for predicting the development of a deep infection after primary TKA. MATERIALS AND METHODS: Between July 1998 and July 2002, 324 primary total knee arthroplasty procedures were performed and aerobic and anaerobic bacterial cultures for intra-operative synovial fluid and post-operative suction drainage tip were obtained. The results of culture of intra-operative synovial fluid and post-operative suction drainage tip of total 324 primary TKA cases were analyzed. The sensitivity, specificity and predictive value were calculated. positive culture rate for osteoarthritis was compared with rheumatoid arthritis and the results of a single TKA was compared with both simultaneous TKA. RESULTS: 14 out of 324 knees showed a positive intra-operative synovial fluid culture and 10 cases showed a positive post-operative suction drainage tip culture. Only 1 case out of the 4 deep infection cases showed a positive on suction drainage tip culture with S. aureus being isolated. The specificity of the intra-operative synovial culture was 95.6% and the negative predictive value was 98.7%. The sensitivity of the post-operative suction drainage tip culture was 25%, the specificity was 97%, the positive predictive value was 10% and the negative predictive value was 99%. The positive culture rate was similar in the osteoarthritis and rheumatoid arthritis cases (respectively p=0.4717, p=0.6550). However, the culture positive rate between single and both simultaneous TKA was numerically different, approximately 2 times (3.2% vs 6.31% for intra-operative synovial culture and 4.0% vs 9.47% for post-operative suction drainage tip culture) but it was not statistically significant (respectively p=0.311, p=0.1051). CONCLUSION: In primary TKA, a culture of intra-operative synovial fluid and post-operative suction drainage tip cannot predict a postoperative deep wound infection. It is recommended that careful observation for other signs of a deep infection be examined when a clinically significant true pathogen isisolated.
Arthritis, Rheumatoid ; Arthroplasty ; Knee ; Knee Joint ; Osteoarthritis ; Sensitivity and Specificity ; Suction* ; Synovial Fluid* ; Wound Infection

OBJECTIVE: There have been a kind of transmethylation theory that high homocysteine serum concentration affects schizophrenia by neurotoxic mechanism and clinical reports that some schizophrenic patients with high homocysteine were improved by high folate ingestion. This study was done to confirm previous research results and find the clinical characteristics of schizophrenia showing high serum homocysteine and low folate. METHOD: We compared the serum levels of homocysteine, folate and vitamin B12 level between 234 schizophrenic patients(male 99, female 135) group and 234 normal controls(male 99, female 135) group. The subjects of two groups were age and sex matched. The evaluated clinical characteristics items were sex, age, onset of disease, hereditary loading, disease course, hallucination and subtype of schizophrenia. RESULTS: 1) Homocysteine level of the schizophrenia group was significantly higher than the normal control group and folate level of the schizophrenia group was significantly lower than the normal control group. Homocysteine level was more negatively correlated with folate level in the schizophrenia group than the normal control group. 2) The percentage of high homocysteine(above 12.46umol/L;90 percentile of normal control) was 33.8% of schizophrenia patients and 51.5% of male schizophrenia. The percentage of low folate(below 3.8nM/L;bottom tertile of normal control) was 66.2% of schizophrenia. 3) In low folate group and not-low folate group, schizophrenia showed significantly higher homocysteine level than normal control. Especially, low folate schizophrenia group showed significantly higher homocysteine level than low folate normal control group. CONCLUSIONS: Some schizophrenia patients with high serum homocysteine may be genetic defector and having low folate serum level. In that case, folate ingestion could be a good management for clinical improvement.
Eating ; Female ; Folic Acid* ; Genetic Diseases, Inborn ; Hallucinations ; Homocysteine* ; Humans ; Male ; Schizophrenia ; Vitamin B 12* ; Vitamins*

Unilateral pulmonary artery hypoplasia (UPAH) is a rare disease in adults and is frequently accompanied by a congenital cardiac anomaly at a young age. The diagnosis is usually based on computed tomography (CT), angiography, and magnetic resonance imaging (MRI). However, no reports are available on retrograde flow in patients with UPAH. We describe a 68-year-old man with isolated UPAH and retrograde blood flow. He was admitted for dyspnea on exertion for the past 23 years. His diagnosis was delayed, as his symptoms and signs mimicked his underlying pulmonary diseases, such as emphysema and previous tuberculous pleurisy sequelae. A discrepancy was detected between the results of a ventilation-perfusion scan and the CT image. This was resolved by MRI, which showed retrograde blood flow from the right to the left pulmonary artery. Using MRI, we diagnosed this patient with isolated pulmonary artery hypoplasia and retrograde flow.
Adult ; Aged ; Angiography ; Dyspnea ; Emphysema ; Humans ; Lung Diseases ; Magnetic Resonance Imaging ; Pulmonary Artery ; Rare Diseases ; Regional Blood Flow ; Tuberculosis, Pleural