Purpose: This study examined the changes in the body mass index (BMI) and the effects of BMI on the knee function and risk factors for an increase in BMI after total knee arthroplasty (TKA) in Asians. Materials and Methods: A prospective observational study was conducted on 100 cases of TKA performed by one surgeon. Obesity was defined as BMI ≥25 kg/m 2 . The BMI and Knee Society Score, consisting of the Knee Score and Function Score, were measured on the day before surgery and one year after surgery. Results: The BMI decreased or was maintained in 34 cases (34%) and increased in 66 cases (66%) one year after surgery. An increase in BMI of 5% or more was considered a clinically significant increase in BMI and occurred in 28 cases (28%). The patients with an increased BMI by more than 5% showed a significantly lower knee function score. The age and preoperative function score were significantly associated with an increased BMI by more than 5%. As the age increased by one year, the odds ratio at which the BMI would increase by more than 5% one year after surgery was 0.905. Moreover, as the preoperative function score increased by one point, the odds ratio that the BMI would increase by 5% one year after surgery was 0.902. In other words, a younger preoperative age and a lower preoperative function score mean a higher risk of a more than 5% postoperative increase in BMI. Conclusion The BMI increased by more than 5% one year after surgery in 28% of the TKA patients examined. They had a lower functional score. The risk factors for a more than 5% increase in BMI after TKA were young age and a low preoperative function score. Therefore, surgeons should educate patients, particularly those who are young or have a low preoperative function score, so that the patient’s BMI would not increase after surgery.

No abstract available.
Humans

It is well known that the endothelium plays an important role in the circulation by modulating contractile responses of vascular smooth muscle. This study was designed to investigate the alterations and the mechanisms of endothelial modulation in chronic 2-kidney, 1 clip(2K1C) hypertensive rats. 2K1C hypertension was made by clipping the left renal artery and age-matched control rats received a sham treatment. Aortic rings were mounted in tissue baths for measurement of isometric tension. In rings with endothelium, norepinephrine evoked concentration-dependent contraction. Endothelium removal markedly enhanced the contraction, and the responses were less pronounced in 2K1C rats than control rats. Similar fashion of the contractions by endothelium removal was observed with norepinephrine and the alpha1 drenoceptor agonist phenylephrine in control rats, while phenylephrine did not alter the contraction by endothelium removal in 2K1C rats. The alpha2 drenoceptor agonist clonidine also greatly enhanced the contraction after endothelium removal, however the endothelial inhibition was still shown in 2K1C rats. In contrast to norepinephrine-induced contractions, the enhancement of serotonin-or prostaglandin F2alpha - induced contractions after endothelium removal was small and similar in 2K1C and control rats. NG-nitro-L-arginine methyl ester enhanced the contraction induced by agonists in aortic rings with endothelium, which was similar to the response in rings without endothelium. The relaxation response to acetylcholine was attenuated in 2K1C rats, while the response to sodium nitroprusside remained unaltered. These results indicate the endothelium plays an inhibitory role against contractions in rat aorta by releasing nitric oxide, but the characteristics of the endothelial inhibition are not identical against various agonists. The negative endothelial modulation is more pronounced during alpha1 and alpha2 renoceptor- mediated contractions than during contractions mediated by other receptors. In addition, the inhibitory role of the endothelium against alpha1 drenoceptor agonist-induced contraction is impaired in 2K1C renal hypertension.
Acetylcholine ; Animals ; Aorta ; Baths ; Clonidine ; Dinoprost ; Endothelium ; Hypertension ; Hypertension, Renal ; Muscle, Smooth, Vascular ; NG-Nitroarginine Methyl Ester ; Nitric Oxide ; Nitroprusside ; Norepinephrine ; Phenylephrine ; Placebos ; Rats* ; Relaxation ; Renal Artery ; Vasoconstriction*

In anterior communicating artery aneurysm that accounts for about 30% of intracranial aneurysms, it has been pointed out that the hemodynamic factor plays a very important role in all stages such as initiation, growth and rupture of aneurysm. Based upon the relationship between the findings of brain CT and those of cerebral angigram, the authors reviewed 96 cases of ruptured anterior communicating artery aneurysms that were operated on at the Department of Neurosurgery of Hanyang University Hospital from Jan. 1985 to June 1990, to suggest a point referred to which carotid artery should be selected first when direct carotid angiography is inevitable. The results were summarized as followings: 1) Of 96 cases, hemorrhagic evidence was observed in 92 case(95.8%) and among them, subarachnoid hemorrhage accompanying intracerebral hematoma(37 cases, 38.5%) was the most common type of hemorrhage. 2) Of 96 cases, left A1 was operated as afferent artery in 61 case(63.5%), right A1 in 23 cases(24.0%), and both A1, in 12 cases(12.5%). And the direction of aneurysm was to the right in 49 cases(51.0%), to the left in 12 cases(12.5%) and to the midline in 35 cases(36.5%). 3) Of 53 cases which had intracranial hematoma, 28 cases showed unilateral predominance. Among them the predominance of hematoma was opposite to the afferent artery in 82.1%(23/28) and was ipsilateral to the direction of aneurysm in 64.3%(18/28). 4) Of 91 cases which had subarachnoid hemorrhage, 29 cases showed unilateral predominance. Among them the predominance of hemorrhage was opposite to the afferent artery in 72.4%(21/29) and was ipsilateral to the direction of aneurysm in 58.6%(17/29). 5) Above findings suggest that in the cases with suspicious ruptured anterior communicating artery aneurysms on brain CT and direct carotid angiography is inevitable, contralateral carotid angiography should be undertaken at first when intracranial hematoma or subarachnoid hemorrhage shows unilateral predominance on brain CT, and left carotid antiography is preferable than the right one if there is no predominance of intracranial hematoma or subarachnoid hemorrhage on brain CT.
Aneurysm ; Angiography ; Arteries ; Brain ; Carotid Arteries ; Cerebral Angiography ; Hematoma ; Hemodynamics ; Hemorrhage ; Intracranial Aneurysm* ; Neurosurgery ; Rupture ; Subarachnoid Hemorrhage

OBJECTIVE: To test the hypothesis that a safety margin may affect local tumor recurrence (LTR) in subsegmental chemoembolization. MATERIALS AND METHODS: In 101 patients with 128 hepatocellular carcinoma (HCC) nodules (1-3 cm in size and < or = 3 in number), cone-beam CT-assisted subsegmental lipiodol chemoembolization was performed. Immediately thereafter, a non-contrast thin-section CT image was obtained to evaluate the presence or absence of intra-tumoral lipiodol uptake defect and safety margin. The effect of lipiodol uptake defect and safety margin on LTR was evaluated. Univariate and multivariate analyses were performed to indentify determinant factors of LTR. RESULTS: Of the 128 HCC nodules in 101 patients, 49 (38.3%) nodules in 40 patients showed LTR during follow-up period (median, 34.1 months). Cumulative 1- and 2-year LTR rates of nodules with lipiodol uptake defect (n = 27) and those without defect (n = 101) were 58.1% vs. 10.1% and 72.1% vs. 19.5%, respectively (p < 0.001). Among the 101 nodules without a defect, the 1- and 2-year cumulative LTR rates for nodules with complete safety margin (n = 52) and those with incomplete safety margin (n = 49) were 9.8% vs. 12.8% and 18.9% vs. 19.0% (p = 0.912). In multivariate analyses, ascites (p = 0.035), indistinct tumor margin on cone-beam CT (p = 0.039), heterogeneous lipiodol uptake (p = 0.023), and intra-tumoral lipiodol uptake defect (p < 0.001) were determinant factors of higher LTR. CONCLUSION: In lipiodol chemoembolization, the safety margin in completely lipiodolized nodule without defect will not affect LTR in small nodular HCCs.
Adult ; Aged ; Carcinoma, Hepatocellular/radiography/*therapy ; Chemoembolization, Therapeutic ; Cone-Beam Computed Tomography ; Ethiodized Oil/*administration & dosage ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms/radiography/*therapy ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Recurrence, Local/radiography

Allopurinol is widely used for chronic tophaceous gout as a uric acid lowering agent. Hypersensitivity to allopurinol occurrs in about 10% of patients, which limits the usage of allopurinol. The successful oral and intravenous desensitization of allopurinol has been reported worldwide since 1976. We recently experienced a 51-year-old male patient with gouty arthritis and hyperuricemia, who had previously experienced skin rash after allopurinol treatment. When allopurinol was retried, erythematous and foliative skin rash developed on entire body. Because allopurinol was essential in controlling hyperuricemia, the oral desensitization of allopurinol was tried. We report successful rapid oral allopurinol desensitization in the patient with chronic tophaceous gout, who exhibited exfoliative dermatitis as allopurinol hypersensitivity.
Allopurinol* ; Arthritis, Gouty ; Dermatitis, Exfoliative* ; Exanthema ; Gout ; Humans ; Hypersensitivity ; Hyperuricemia ; Male ; Middle Aged ; Uric Acid

Anaphylaxis after an animal bite is uncommon. Especially, anaphylaxis after a hamster bite is very rare with only a few reported cases. A 19-year-old previously healthy female arrived complaining of respiratory difficulty, facial swelling and skin rash after her pet hamster bite. Her symptoms started 5 minutes after the bite and arrived 30 minutes after the incidence. Epinephrine, antihistamine and steroid were injected and her symptoms were relieved. She was discharged 3 hours after treatment with no other complications.
Anaphylaxis* ; Animals ; Bites and Stings ; Cricetinae* ; Epinephrine ; Exanthema ; Female ; Humans ; Incidence ; Young Adult

BACKGROUND: Although an increasing number of breast abnormalities are detected by screening mammography, most breast cancers are presented as a palpable mass. Cytologic specimens are frequently diagnostic and may be easier to obtain. This study was done to compare the diagnostic accuracies of clinical breast exam, fine needle aspiration biopsy (FNAB), mammography and ultrasonography, and to establish the algorithm to manage the patients based on the results of FNAB. METHODS: From Jan. 1992 to Dec. 1997, one hundred and twenty-seven women out of 470 patients with a clinically palpable mass underwent concurrent FNAB, mammography, and ultrasonography. All patients ultimately had histologic confirmation by surgical biopsy. RESULTS: The sensitivity and the specificity of the tests were as follows: 79.2% and 74.4%, respectively, for clinical breast exam; 62.2% and 98.6%, for mammography; 55.8% and 93.3% for ultrasonography; and 66.7% and 100% for FNAB. Of note, the accuracy of the FNAB was significantly higher for lesions 2 cm or larger than for lesions smaller than 2 cm (p=0.034). All patients who were positive for malignancy on FNAB (n=20) presented with breast cancer. Among the 16 patients with suspicious results on FNAB and breast cancer on surgical biopsy, 3 had normal findings on mammography and ultrasonography. In the cases of negative findings for malignancy in three tests (n=55), no breast cancer was found on the final surgical specimen. CONCLUSION: It is recommended that FNAB must be performed on all palpable masses and that when the FNAB is postive for cancer, definitive surgery be performed with intraoperative frozen biopsy. Patients in whom mammography, ultrasonography and FNAB were negative for malignancy can be observed without the need for an open biopsy. Additionally, (1) when the results of FNAB are suspicious or (2) when the mammagraphy and ultrasonography results are suspicious even though the FNAB results are negative for malignancy, an open biopsy is required to exclude the possibility of the breast cancer.
Biopsy* ; Biopsy, Fine-Needle* ; Breast Neoplasms ; Breast* ; Female ; Humans ; Mammography* ; Mass Screening ; Sensitivity and Specificity ; Ultrasonography*

BACKGROUND: Recently, patients' demands for emergency medicine are increasing, and most of prehospital medical care, including basic life support, cardiopulmonary resuscitation and triage, are provided by paramedics or emergency medical technicians. Evaluation of the adequacy of prehospital management and triage has become important for improving the quality and the effectiveness of the emergency medical system. METHODS: The 202 patients who were transferred by ambulance with paramedics, nurses, or emergency medical technicians to the Emergency Department in Gil Medical Center from July 1, 1999, to September 31, 1999, were enrolled. This study was conducted prospectively by using the emergency physician's log and newly devised protocols recorded by paramedics or nurses. RESULTS: 1) Male to female ratio was 1:0.8, and the peak age of the patients were the 4th(18.8%) and 6th decade(15.3%). 2) Of the 202 patients, 84 patients were transferred for trauma and 118 for medical problems. The mean transfer time was 6+/-1.73 minutes. 3) The validities of prehospital triage and decisions using the trauma severity measure and the disease severity measure, were 33.3% in trauma patients and 57.6% in medical patients. 4) The results for the adequacy rate in prehospital management analyzed by using the rate of necessity of treatment, performance of treatment, and adequate treatment were as follows: oxygen supply, 38.1/41.6/93.8; wound dressing, 19.3/71.8/92.9; immobilization of the cervical spine, 15.8/56.3/92.9; application of a spinal board, 12.9/42.3/72.7; application of a splint, 9.9/50.0/60.0; manual maintenance of an airway, 9.9/55.0/63.6; and CPR, 4.5/66.7/0.5) Kind of ALS(Advanced Life Support) were not conducted(peripheral IV, EKG, intubation medical administration, defibrillation, pacing). The rates of necessity of treatment were as follows: peripheral IV, 40.6%; ECG monitoring, 23.3%; endotracheal intubation, 8.9%; medical administration, 8.9%; defibrillation, 3.5%; and pacing, 1.5%. CONCLUSION: The adequacy of prehospital triage and decisions using trauma and disease severity measures was relatively low. To improve the adequacy of BLS(Basic Life Support) and to increase the performance of ALS(Advanced Life Support), we must create challenges to develop new protocols and to supplement new equipment.
Allied Health Personnel ; Ambulances ; Bandages ; Cardiopulmonary Resuscitation ; Electrocardiography ; Emergencies ; Emergency Medical Technicians ; Emergency Medicine ; Emergency Service, Hospital ; Female ; Humans ; Immobilization ; Intubation ; Intubation, Intratracheal ; Male ; Oxygen ; Prospective Studies ; Spine ; Splints ; Triage* ; Wounds and Injuries

The authors reviewed angiographic findings of 96 cases of ruptured anterior communicating artery aneurysms that were operated at the Department of Neurosurgery of Hanyang University Hospital from Jan. 1986 to June 1990. The results were summarized as follows ; 1) Asymmetricity of caliber of A1 was observed in 71.9%(69/96) and which was 3 times more frequent than that of reported incidence of control group(2~23%). 2) The incidence of predominance of left A1 was 54.2%(53/96) and that of right A1 was 17.7%(17/96). Among them, predominant A1 was operated as afferent artery of aneurysm in 94.2%(65/69). 3) Of 69 cases in which a unilateral A1 showed predominance, the direction of aneurysm was opposite to the side of predominant A1 in 66.7%(46/69) and ipsilateral to the predominant A1 in only 2.9%(2/69). 4) Above findings suggest that it is desirable to approach the anterior communicating artery aneurysm via the side of predominant A1 when the direction of aneurysm is uncertain on cerebral angiogram.
Aneurysm ; Arteries ; Cerebral Angiography ; Incidence ; Intracranial Aneurysm* ; Neurosurgery