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*

Multiple cardiac myxomas are rare in children. However, myxomas may be lethal because of their various manifestations such as blood flow obstruction, embolization and constitutional changes. Especially, the cerebral infarction due to tumor fragmentation are more likely to be misdiagnosed of acute disseminated encephalomyelitis. We report a case of multiple cardiac myxoma complicating recurrent right hemiparesis in a 12-year-old child who at first had a wrong diagnosis of acute disseminated encephalomyelitis (ADEM). Consequently, a child who show unrepresentative symptom of ADEM, should be examined rapidly by various tools to rule out the cerebral infarction from cardiogenic cause.
Cerebral Infarction ; Child* ; Diagnosis* ; Encephalomyelitis, Acute Disseminated* ; Humans ; Myxoma* ; Paresis*

No abstract available.
Neurilemmoma*

PURPOSE: Smoking is a known risk factor for lung cancer, cardiovascular diseases, and atherosclerosis. The link between smoking and erectile dysfunction(ED) has been supported from in vitro studies, animal studies, and epidemiological evidence. We evaluated the effect of smoking on penile hemodynamics in ED. MATERIALS AND METHODS: Patients aged 40~80 years who visited our urological institute for ED were enrolled. We performed a standard ED evaluation that included medical history, physical examination, and measurements of serum glucose, testosterone, and prolactin. We excluded ED patients with abnormal androgen profiles and patients with ED risk factors other than smoking. A total of 108 ED patients entered the study, including 51 current smokers, 24 non-smokers, and 33 ex-smokers. All patients then underwent extensive evaluation, including nocturnal penile tumescence and rigidity(NPTR) monitoring with Rigiscan(R), and pharmacopenile Doppler ultrasonography for peak systolic velocity(PSV), and end diastolic velocity(EDV). RESULTS: The average ages of the current smokers, non-smokers, and ex-smokers were 55.7+/-4.6, 53.7+/-3.9, and 56.5+/-4.3 years, respectively(p=0.07). Of current smokers, 78% had abnormal NPTR testing, compared with 64% of non-smokers and 67% of ex-smokers(p=0.04; current vs non-smokers, p=0.04; current vs ex-smokers). The average PSV for current smokers, non-smokers, and ex-smokers was 26.8+/-3.2, 31.2+/-4.5, and 29.7+/-4.4 cm/s, respectively(p=0.06; current vs non-smokers, p=0.07; current vs ex-smokers). The average EDV for current smokers, non-smokers, and ex-smokers was 5.9+/-2.7, 4.4+/-1.6, and 4.2+/-1.5 cm/s, respectively(p=0.04; current vs non-smokers, p=0.03; current vs ex-smokers). In the currently-smoking patients, there was no significant correlation between NPTR, PSV, or EDV and the amount or duration of smoking. CONCLUSIONS: We concluded that dysfunction of penile veno-occlusive mechanism plays a substantial role in the development of ED in smokers.
Animals ; Atherosclerosis ; Blood Glucose ; Cardiovascular Diseases ; Erectile Dysfunction* ; Hemodynamics* ; Humans ; Lung Neoplasms ; Male ; Penile Erection ; Physical Examination ; Prolactin ; Risk Factors ; Smoke* ; Smoking* ; Testosterone ; Ultrasonography, Doppler

The caudal block has been used as an alternative to general anesthesia in specific circumstances such as anal surgery, perineal surgery or surgery of lower extremity etc. It has been also used as an adjunct to general anesthesia, administered at the completion of surgery to provide postoperative analgesia especially in children. But, it has variable complications such as generalized intoxication, pain on the injection site, infection or urinary retention etc. We report an unusual case of metastatic sacrococcygeal tumor from adenocarcinoma of lung presenting as severe anal pain and sciatica which was aggravated after the trial of caudal anesthesia.
Adenocarcinoma* ; Analgesia ; Anesthesia, Caudal* ; Anesthesia, General ; Child ; Humans ; Lower Extremity ; Lung* ; Sciatica ; Urinary Retention

Xanthogranulomatous pyelonephritis is a chronic inflammatory condition that can only be diagnosed by histological examination, and is often associated with renal calculi, obstruction and urinary tract infection. We report a case of bilateral xanthogranulomatous pyelonephritis in a child with end stage renal disease, which was misdiagnosed as renal cell carcinoma preoperatively.
Carcinoma, Renal Cell ; Child* ; Humans ; Kidney Calculi ; Kidney Failure, Chronic ; Pyelonephritis, Xanthogranulomatous* ; Urinary Tract Infections

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

BACKGROUND: The relationship between infection of microorganism and atherosclerosis has been studied because the pathophysiology after infection is similar to those of cell injury and/or lipid theory. Although there are many reports which described the relationships between the infection of chalamydia pneumoniae and the atherosclerosis. In Korea, even the prevalence of chlamydia infection has not been studied yet. This study was purposed on the prevalence of chlamydia infection and it's correlation to atherosclerosis. METHODS: 235 subjects were enrolled and age and sex adjusted subjects were divided into two groups, normal controls (n=43), atherosclerosis (AS, n=90) group:coronary artery disease (CAD, n=61) and cerebrovascular disease (CVD, n=29). Serum total cholesterol (TC), triglyceride (TG), HDL-cholesterol (HDL-C) were measured, LDL-cholesterol (LDL-C) was calculated. Serum IgG chlamydia antibody were measured by ELISA method. RESULTS: TG was significantly higher in AS (162.51+/-100.04 mg/dL vs 122.91+/-63.31 mg/dL, mean+/-SD, p=0.019), and HDL-C was significantly higher in controls (47.30+/-9.88 mg/dL vs 39.38+/-8.29 mg/dL, p<0A65A>0.01). Levels of LDL-C and TC were not statistical significant. Serum IgG chlamydia antibody was positive in 29.8% (70/235), 30% (27/90) in AS group and 28% in controls and there was no statistical significance between groups (p=0.804). CONCLUSION: In conclusion, there was no significant differences in positivity of IgG chlamydia antibody in AS compared with that of controls. Overall positivity of chlamydia antibody was lower in Korea than in other country. It is still controversial whether Chlamydia pneumoniae is a primary etiologic agent of atherosclerosis or not. This study could not demonstrate the relationship between chlamydia infection and atherosclerosis in Korea. The effectiveness and indications of antichlamydial antibiotics for prevention of cardiovascular complications in atherosclerosis and overall chlamydia infection in general population will be needed in large scale trials.
Anti-Bacterial Agents ; Arteries ; Atherosclerosis* ; Chlamydia Infections ; Chlamydia* ; Chlamydophila pneumoniae* ; Cholesterol ; Coronary Artery Disease ; Enzyme-Linked Immunosorbent Assay ; Immunoglobulin G ; Korea ; Pneumonia ; Prevalence ; Triglycerides