PURPOSE: To evaluate the passive subluxation of the tibia on MR' images in patient with both anterior cruciate ligament (ACL) and medial collateral ligament (MCL) tears and to demonstrate the usefulness of its measurement. MATERIALS & METHODS: The authors performed a retrospective study of 123 knees with tears of both ACL (complete, n=70, partial, n=53) and MCL (complete, n=10, partial, n=113). ACL tears were documented at arthroscopy and MCL tears were interpreted by abnormal MR findings. One hundred normal knees were also studied for comparison. Using new internal landmarks, anterior subluxation was measured on an intercondylar sagittal image and lateral subluxation was measured on a mid-coronal image. RESULTS: Anterior subluxation of 3 mm or more was seen in 45/123(37%) abnormal knees, lateral subluxation of 3 mm or more in 20/123 (16%), and anterolateral subluxation in 15/123 (12%). Anterior subluxation of 5mm or more was seen in 25/70 (36%) complete ACL tears, and no knees with partial ACL tears showed anterior subluxation of 5 mm or more. CONCLUSION: Static anterolateral subluxation of the tibia occurs in knees with combined ACL and MCL tears, as measured on routine MR imaging. These measurements may help confirm the presence of ligament injuries and differentiate complete from partial ACLtear.
Anterior Cruciate Ligament ; Arthroscopy ; Collateral Ligaments* ; Humans ; Knee* ; Ligaments ; Magnetic Resonance Imaging ; Retrospective Studies ; Tibia*

OBJECTIVES: There is increasing evidence of an association between suicide and psychiatric disorders. This is the first report in Korea that investigated the differences of clinical and demographic characteristics between suicide completers and suicide attempters who had visited emergency room. METHODS: For this study, we enrolled patients who had visited the emergency rooms of university-affiliated medical centers or hospitals, due to psychiatric problems, between January 2003 and December 2006. In October 2007, we used the Korea national statistical office to identify the suicide completers among these enrollees. We then conducted a retrospective chart review comparing clinical and demographic characteristics between suicide attempters and completers. RESULTS: During the study period, 1106 subjects visited the emergency room of a university affiliated medical center or hospital. Among these subjects, the number of suicide attempters and suicide completers was 162 and 13, respectively. The proportion of suicide completion in the suicide related behavior was higher in patients with schizophrenia (27.3%) and anxiety/somatoform disorder (50.0%) compared with those with other psychiatric disorders. Suicide completers used more violent methods of suicide. CONCLUSION: These results suggest that patients with schizophrenia and anxiety/somatoform disorder make more fatal suicide attempts. The proportion of suicide completion within the suicide-related behaviors of these patients was higher than found in other psychiatric disorders. A greater number of risk factors should be elucidated to provide effective suicide prevention programs in Korea.
Emergencies ; Humans ; Korea ; Retrospective Studies ; Risk Factors ; Schizophrenia ; Suicide

Background: Female infertility is a crucial problem with significant implications for individuals and society. In this study, we explore risk factors for infertility in Korean women. Methods: A total of 986 female patients who visited six major infertility clinics in Korea were recruited from April to December 2014. Fertile age-matched controls were selected from two nationwide survey study participants. Conditional logistic regression after age-matching was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of each risk factor for infertility. Results: Women with a body mass index (BMI) < 18.5 kg/m2 had 1.35 times higher odds of infertility (OR, 1.35; 95% CI, 1.03–1.77), while those with a BMI ≥ 25.0 kg/m2 had even higher odds (OR, 2.06; 95% CI, 1.61–2.64) compared to women with a normal BMI (18.5 kg/m2 ≤ BMI < 25 kg/m 2 ). Ever-smokers exhibited 4.94 times higher odds of infertility compared to never-smokers (95% CI, 3.45–8.85). Concerning alcohol consumption, women who consumed ≥ 7 glasses at a time showed 3.13 times significantly higher odds of infertility than those who consumed ≤ 4 glasses at a time (95% CI, 1.79–5.48). Lastly, women with thyroid disease demonstrated 1.44 times higher odds of infertility compared to women without thyroid disease (95% CI, 1.00–2.08). Conclusion Female infertility in Korea was associated with underweight, obesity, smoking, alcohol consumption, and thyroid disease.

A retrospective analysis has been made of 40 patients with pineal region tumors and CNS germ cell tumors who were treated at Yonsei University Hospital, Department of Radiation Oncology between 1971 and 1985. A tissue diagnosis was obtained before radiotherapy in 19 patients and 21 patients were irradiated without histological diagnosis. Among 19 biopsy-proven cases, 14 were germinomas, 2 were teratomas, and the others were two pineocytomas and one pineoblastoma. In the earlier period, every attempt was made to obtain a tissue pathology by either stereotaxic biopsy or open craniotomy before irradiation. However, in recent years, with the advent of CT scan, a trial radiotherapy with a modest dose of 20 Gy in 2 weeks was attempted in cases of highly suspected germinomas by CT scan findings. Further management after trial radiation depended on the radiation response shown on the follow-up CT scan and tumor marker study. Radiation fields varied from a small local field to whole brain or entire neuroaxis irradiation. Most patients received 40-50 Gy to the primary tumor site and 20-30 Gy to the neuroaxis. Twenty-nine of the total 40 patients are alive without of disease 22-144 months after treatment and the overall 5-year recurrence-free survival rate was 74.4%, Univariate analysis of prognostic factors at presentation showed that tumor type was highly correlated with outcome. Two of fourteen biopsy-proven germinomas and none of nine presumed germinomas by trial radiation recurred. On the other hand, five of six patients who showed poor response to trial radiation died of uncontrolled disease and only one patient with elevated AFP in serum and CSF was salvaged by chemotherapy. On the basis of the results of this study, application of trial radiation therapy without tissue biopsy is well justified as a treatment modality in a suspected germinoma by CT scan finding. Aggressive combined modality approaches with surgery, radiotherapy and chemotherapy need to be investigated to improve results in radioresistant tumors.
Biopsy ; Brain ; Craniotomy ; Diagnosis ; Drug Therapy ; Follow-Up Studies ; Germ Cells* ; Germinoma ; Hand ; Humans ; Neoplasms, Germ Cell and Embryonal* ; Pathology ; Pinealoma ; Radiation Oncology ; Radiotherapy ; Retrospective Studies ; Survival Rate ; Teratoma ; Tomography, X-Ray Computed

BACKGROUDN: The ratio of mitral inflow (E) and annular velocity (E') to stroke volume (E/E'/SV) has been used as an index of diastolic elastance (Ed). However, its change during exercise has not been evaluated. We hypothesized that Ed values obtained during exercise would be abnormal in patients with apical hypertrophic cardiomyopathy (ApHCM). METHODS: Ed was measured at rest and during graded supine bicycle exercise (25 Watts, 3 minute increments) in 15 patients with ApHCM (12 male; mean age, 57 years) and in 15 age- and gender-matched control subjects. RESULTS: Ed was not significantly different at rest and during 25 W of exercise. However, Ed was significantly higher at 50 W of exercise in patients with ApHCM compared to control subjects (0.21+/-0.05 vs. 0.15+/-0.04 cm/s, p=0.0059). There was significant positive correlation between the magnitude of change in proBNP levels during exercise and the change of Ed from rest to 50 W of exercise (r2=0.69, p<0.0001). CONCLUSION: Noninvasively-determined Ed was similar at rest and during mild exercise between patients with ApHCM and control subjects. However, Ed was significantly higher during moderate exercise in ApHCM patients, suggesting a dynamic change in LV stiffness during exercise in these patients.
Cardiomyopathy, Hypertrophic* ; Humans ; Male ; Stroke Volume

BACKGROUDN: The ratio of mitral inflow (E) and annular velocity (E') to stroke volume (E/E'/SV) has been used as an index of diastolic elastance (Ed). However, its change during exercise has not been evaluated. We hypothesized that Ed values obtained during exercise would be abnormal in patients with apical hypertrophic cardiomyopathy (ApHCM). METHODS: Ed was measured at rest and during graded supine bicycle exercise (25 Watts, 3 minute increments) in 15 patients with ApHCM (12 male; mean age, 57 years) and in 15 age- and gender-matched control subjects. RESULTS: Ed was not significantly different at rest and during 25 W of exercise. However, Ed was significantly higher at 50 W of exercise in patients with ApHCM compared to control subjects (0.21+/-0.05 vs. 0.15+/-0.04 cm/s, p=0.0059). There was significant positive correlation between the magnitude of change in proBNP levels during exercise and the change of Ed from rest to 50 W of exercise (r2=0.69, p<0.0001). CONCLUSION: Noninvasively-determined Ed was similar at rest and during mild exercise between patients with ApHCM and control subjects. However, Ed was significantly higher during moderate exercise in ApHCM patients, suggesting a dynamic change in LV stiffness during exercise in these patients.
Cardiomyopathy, Hypertrophic* ; Humans ; Male ; Stroke Volume

OBJECTIVES: This study was conducted to investigate the association between the symptoms of boys with attentiondeficit hyperactivity disorder (ADHD) and the attention-deficit hyperactivity symptoms, temperament and character patterns of their parents. METHODS: Forty-five boys with ADHD and who met the DSM-IV criteria were evaluated by using the ADHD rating scale (ADHD-RS), and their parents completed the Korean Adult ADHD scale (K-AADHDS) and the Temperament and Character Inventory (TCI). RESULTS: The parental K-AADHDS scores were not associated with the ADHD-RS total score and the subscale scores of their siblings. The most potent variable related to the ADHD-RS total score was the maternal self-directedness, and the second was the maternal persistence. The maternal self-directedness was the variable that was most correlated with the hyperactivity/impulsivity subscale scores of the ADHD-RS. CONCLUSIONS: The results suggest that the paternal ADHD symptoms may not be related to the ADHD symptoms of boys with ADHD. Higher maternal self-directedness and persistence may decrease overall the ADHD symptoms of these boys, and higher maternal self-directedness itself may predict lower hyperactivity/impulsivity symptoms of the boys with ADHD.
Adult ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Parents ; Siblings ; Temperament

Twelve patients with primary lymphomas of the central nervous system were treated in the Department of Radiation Oncology, Yonsei University College of Medicine, between 1976 and 1987. There were seven males and five females ranging from 19 to 63 years of age. They had single (6 cases) or multiple (6 cases) discrete intracerebral nodules. All patients were treated with radiation therapy. Surgical resection was performed in five cases and intrathecal chemotherapy with methotrexate was performed in seven cases after radiotherapy. All patients except one had received whole brain irradiation with a median dose of 4000 cGy. The radiation dose for a primary tumor was 4800-6000 cGy (median 5560 cGy). Initial response to radiation was excellent with a 91.7% complete response rate, but late recurrences were noted and the median survival was 42.3 months. Intracranial recurrences were observed in two patients who received less than 4000 cGy to the whole brain without intrathecal chemotherapy. Although intracranial recurrence was not seen in the patients receiving intrathecal chemotherapy after radiation, a high incidence of necrotizing leukoencephalopathy was noted. High dose irradiation with a minimum of 4000 cGy to the whole brain and more than 5000 cGy to the primary tumor is recommended for the treatment of primary CNS lymphomas. Combined use of chemotherapy should be carefully attempted because of the increased toxicity.
Adult ; Central Nervous System Diseases/radiography/*radiotherapy ; Combined Modality Therapy ; Female ; Human ; Lymphoma/radiography/*radiotherapy ; Male ; Middle Age ; Support, Non-U.S. Gov't ; Tomography, X-Ray Computed

BACKGROUND: The Cordis coronary stent is a flexible, balloon expandable, radiopaque tantalum stent. Previous reports have shown excellent initial clinical outcomes. To our knowledge, there is no report of the long-term clinical outcomes. The intensely radiopaque tantalum may interfere with the angiographic assessment. We intended to evaluate long-term clinical and angiographic restenosis rates after successful implantation of the Cordis tantalum coronary stent. METHOD: Two hundred and eighty-five consecutive patients with 300 lesions were treated with 366 Cordis stents. An angiographic follow-up substudy was performed in 190 lesions ; 6 month follow-up angiograms were available in 167(88%). At follow-up, intravascular ultrasound(IVUS) was performed to (1) determine the pattern of restenosis and (2) to validate the quantitative coronary angiographic(QCA) caliper measurements. RESULTS: IVUS and QCA caliper measurement of minimal luminal diameter correlated reliably (r=0.767, p<0.001). The QCA analysis detected diffuse in-stent restenosis more reliably than focal in-stent restenosis(p<0.01). The overall angiographic restenosis rate was 19%, The factors affecting angiographic restenosis were post-stent minimum lumen diameter, type C lesion, and reference vessel size. CONCLUSION: We concluded 1) The angiographic restenosis rate of Cordis stent was comparable to that of other slotted-tube stent. 2) The QCA caliper method is reliable for the assessment of Cordis in-stent restenosis, especially in the detection of diffuse in-stent restenosis. However, QCA may miss focal in-stent restenosis only detectable by IVUS
Coronary Artery Disease ; Follow-Up Studies ; Humans ; Phenobarbital ; Stents* ; Tantalum*

BACKGROUND: Recently, several reports regarding the protected and/or unprotected left main stenting suggested the possibility of percutaneous intervention for this prohibited area. We intented to evaluate immediate and long-term outcomes after elective stenting of unprotected left main coronary artery in selected patients. METHOD: Forty eight consecutive patients with unprotected left main coronary artery stenosis and normal left ventricular function were treated with stents implantation. The poststent antithrombotic regimen were aspirin, ticlopidine with warfarin in 14 pateints or without warfarin in 34 patients. The stents for left main coronary artery stenosis were Palmaz-Schatz stent in 25, NIR stent in 8, Multi-link stent in 3, Cordis stent in 7, Palmaz stent in 2, Gianturco-Roubin stent II in 2, and Microstent in 1 patient. Intravascular ultrasound was performed in selected patients before predilation and after stenting at late stage of this study. RESULTS: The procedural success rate was 100%. Regardless of anticoagulation, the in hospital complication including stent thrombosis, myocardial infarction, emergency bypass surgery and death did not occur. Six-months follow-up angiography was performed in 31 patients(82%) of 38 eligible patients. The angiographic restenosis occurred in 7 patients(22%) who subsequently underwent elective coronary bypass surgery in 5 patients and rotational atherectomy/balloon angioplasty in 2 patients. The target lesion revascularization rate was 18%. One death(3%) occurred 2 days after elective coronary bypass surgery during follow-up period. CONCLUSION: Stenting of unprotected left main coronary artery stenosis might be a safe and effective alternative to bypass surgery in carefully selected patients with normal left ventricular function. However, further clinical study should be needed for the late outcomes with larger numbers of patients.
Angiography ; Angioplasty ; Aspirin ; Coronary Stenosis* ; Coronary Vessels* ; Emergencies ; Follow-Up Studies ; Humans ; Myocardial Infarction ; Stents* ; Thrombosis ; Ticlopidine ; Ultrasonography ; Ventricular Function, Left ; Warfarin