A dual mobility acetabular component has a structure that combines a polyethylene liner and a femoral head, unlike the general design of acetabular cups, making the dissociation of a polyethylene liner highly unlikely. In addition, it increases the range of motion and reduces the possibility of dislocations by increasing a jump distance. A fifty-one-year-old male who had received total hip arthroplasty with the dual mobility acetabular component visited a hospital for a posterior hip dislocation 10 weeks after the operation. At the emergency room, closed reduction was performed and the dislocation was reduced. However, plain imaging test revealed polyethylene liner dissociation after the closed reduction. Revision surgery was performed. We will report a rare case of early dislocation of the dual mobility acetabular component and dissociation of polyethylene liner accompanied with a literature review.
Acetabulum* ; Arthroplasty, Replacement, Hip ; Dislocations* ; Emergency Service, Hospital ; Femur Head ; Head ; Hip Dislocation ; Hip Joint ; Hip Prosthesis ; Humans ; Male ; Polyethylene* ; Range of Motion, Articular

BACKGROUND AND OBJECTIVES: Flow-mediated brachial artery vasoactivity has been recently proposed as a noninvasive means for assessing endotheial function. This endothelial function is impaired in certain cardiovascular conditions, including essential hypertension. METHODS: The study population included 50 healthy subjects aged 22 to 62 years (mean+/-SD, 42+/-12 years), all normotensive, nondiabetic with cholesterol level <220 mg/dL and no family history of premature vascular disease. Normal subjects were classified according to age into those younger than and those older than 40 years. Using high-resolution ultrasound, brachial artery diameter and flow were measured at rest, during reactive hyperemia (with flow increase causing flow-mediated dilation [FMD], which depends on normal endothelial function), and after sublingual nitroglycerin, an endothelium-independent vasodilation. To better characterize this technique, this study was an attempt to assess the flow-mediated vasodilation in two separate protocols (as follows); (1) the stimulus response to various duration of occlusion (using 1 and 5 min), and (2) the stimulus response to various pressure of occlusion (using low and high pressure). In 28 patients (mean+/-SD, 52+/-7 years) with essential hypertension, this study was additionally evaluated endothelial function. The measurements have been compared with those of 14 healthy control subjects. In all subjects, the intima-media thickness (IMT) of the common carotid artery was also measured. This study sought to 1) determine whether endothelial dysfunction was presented in patients with essential hypertension, and 2) examine IMT in these patients. RESULTS: 1) Both in the younger and the older groups, the basal diameter and flow of the brachial artery were significantly increased in men than women. The values were 4.4+/-0.1 mm and 186+/-16 ml/min in men and 3.6+/-0.09 mm and 125+/-13 ml/min in women (p<0.001; p<0.01). In subjects younger than 40 years, flow-mediated dilation (FMD) and the difference in flow response were similar between men and women. But, in subjects older than 40 years, FMD was decreased in men than women (6.6+/-1.6 vs. 14.7+/-1.6%. p<0.01) and the difference in flow response was also decreased in men than women (217+/-24.3 vs. 314+/-40.5%, p<0.05). In younger and older groups, there were no significant change in the nitroglyserin response in either gender. 2) Fifteen normal subjects underwent sequential evaluation following 1 and 5 min of upper arm blood pressure cuff occlusion. There were substantial increase in brachial artery diameter and flow immediately after release of 1 and 5 min of occlusion. The FMD and the difference in flow response following release of occlusion between 5 min duration (11.5+/-1.9%, 253+/-36%) and 1 min duration (6.6+/-1.2%, 53+/-11%) were statistically significant (p<0.05; p<0.001). But, the percent change of diameter following release of occlusion between 5 and 1 min was not statistically significant (p<0.05). 3) Fourteen normal subjects was evaluated the effects of various pressure on endothelial cell function. Inflation pressure was maintained at 30 mm Hg higher than systolic pressure for 5 min and 200 mm Hg (70-90 mm Hg higher than systolic pressure) for 5 min in a random fashion, and then the cuff was suddenly deflated. The diameter and flow response following release of occlusion between high and low pressure were not statistical significance (p>0.05). 4) Flow-mediated dilatation was significantly lower in patients with essential hypertension than in normotensive control subjects (4.2+/-0.8 vs. 7.3+/-1.3 %, p<0.05). Intima-media thickness was significantly higher in patients with hypertension than in normotensive control subjects (0.82+/-0.04 vs. 0.64+/-0.04 mm, p<0.05). Nitroglycerin-mediated vasodilation (9.5+/-1.4 %) in patients with essential hypertension did not differ significantly from those in normotensive control subjects (10.0+/-2.6%, p>0.05). CONCLUSIONS: The study demonstrated that 1) in men older than 40 years, flow-mediated, endothelium-dependent vasodilation of the brachial artery was declined, 2) longer brachial artery occlusion resulted in more vasodilation despite similar hyperemic responses, 3) using low (30 mm Hg higher than systolic pressure) and high (70-90 mm Hg higher than systolic pressure) pressure, each pressure of occlusion was similar hyperemic response, and 4) in patients with essential hypertension, flow-medeiated vasodilation was significantly impaired and IMT was increased than in normotensive control subjects.
Adult* ; Arm ; Blood Pressure ; Brachial Artery ; Carotid Arteries ; Carotid Artery, Common ; Cholesterol ; Dilatation ; Endothelial Cells ; Female ; Humans ; Hyperemia ; Hypertension* ; Inflation, Economic ; Male ; Nitroglycerin ; Ultrasonography ; Vascular Diseases ; Vasodilation

No abstract available.
Animals ; DNA* ; Mice* ; Vaccination*

OBJECTIVE: The use of methotrexate for the treatment of cervical pregnancy is now common practice. Our study was performed to determine the risk factors when the primary methotrexate treatment of cervical pregnancy was failed. METHODS: From January 1985 to December 1999, we studied 32 women with cervical pregnancies who were treated with methotrexate intramuscularly according to a repeated intramuscular injections protocol. For evaluation of the efficacy of therapy, pretreatment serum concentrations of human chorionic gonadotropin, the size of the gestational mass, fetal cardiac activity, and the presence of fluid in the peritoneal cavity were measured. This findings were analyzed and compared by means of the chi-square test, Fisher exact test, and student's t-test between the success and failure. RESULTS: There was no relation between the women's age, parity, the size of the conceptus, or the presence of fluid in the peritoneal cavity and the efficacy of treatment. A cervical pregnancy that presented with a serum human chorionic gonadotropin concentration of >or= 10,000mIU/ml, fetal cardiac activity was considered to be associated with a higher failure rate of primary methotrexate treatment. CONCLUSION: Among cervical pregnancies, a high serum human chorionic gonadotropin concentration and fetal cardiac activity were the important factors associated with failure of treatment with methotrexate.
Chorionic Gonadotropin ; Female ; Humans ; Injections, Intramuscular ; Methotrexate* ; Parity ; Peritoneal Cavity ; Pregnancy* ; Risk Factors

BACKGROUND: When aortic stenosis is associated with atrial fibrillation, estimation of the aortic valve area(AVA) by continuity equation refuires averaging of 8-12 beats of LVOT-TVI and AV-TVI to calculate mean LVOT-TVI and mean AV-TVI. Since this method labour intensive, we therefore propose a new simplified method. METHODS: We studied 9 patients of aortic stenosis with atrial fibrillation. We recorded LVOT velocity and aortic valve velocity in 4-chamber view and measure the LVOT area in the parasternal long axis view. We measured RR interval(RR) and diastolic filling time(DFT) of preceding beat in ECG recorded simultaneously. AVA(mean)was defined as the aortic valve area calculated from the mean LVOT-TVI and mean AV_TVI of 10 veats by using continuity equation. AVA)RR), AVA(DFT), AVA(rTT) and AVA-rDDFT) were defined as the aortic valve area calculated from the 1 beat of LVOT-TVI and AV_TVI normalized by RR, DDFT, rRR and rDFT respectively. 20 sets of AVA(mean), AVA(RR), AVA(DFT),AVA(rTT) and AVA(DFT) were calculated in each patient and their means and standard deviations are compared. RESULTS: 1) R values of the correlation of RR, DFT, rTT, rDFT is 0.87, 0.87, 0.89 with LVOT-TVI and 0.91, 0.93, 0.94 with AV-TVI. 2) Averages of AVAs are AVA(mean) 0.76+/-0.35cm2, AVA(rRR) 0.75+/-0.04cm2, AVA(RR) 0.76+/-0.11cm2, AVA(DFT) 0.82+/-0.35cm2, AVA(rRR) 0.75+/-0.15cm2, AVA(rDFP) 0.76+/-0.10cm2. 3) Averages of AVAs showed no significant difference. Standard deviation of AVA(mean) was significantly smaller than other new AVAs(p<0.01). THe standard deviation of AVA(rDFT) was significantly smaller than that of AVA(RR), AVA(DFT) and AVA(RR)(p=0.35, p=0.05,p=0.008). CONCLUSION: When aortic stenosis is associated with atrial fibrillation, newly derived AVA(rDFT) could be more easily calculated compared to conventional AVA(mean) and was also a reproducibe and precise estmate of aortic valve area.
Aortic Valve Stenosis* ; Aortic Valve* ; Atrial Fibrillation* ; Axis, Cervical Vertebra ; Electrocardiography ; Humans

BACKGROUND: Recent investiogations have shown that aortic valve area derived by continuity equation as well as Gorlin formula varied with transvalvular volume flow rate. This study was designed to investigate the effect of heart rate on aortic valve area calculated by continuity equation. METHODS: We studied 10 patients of with cath-proven aortic stenosis. Patients underwent echocardiography recording during right atrial pacing with 80, 100 and 120 beats/min. Flow rate and continuity equation valve area were obtained at each heart rate by doppler echocardiography. RESULTS: Transvalvular flow rates were 194+/-30 ml/sec, 208+/-38 ml/sec and 200+/-39 ml/sec with pacing at 80, 100 and 120 beats/min respectively, and there was no significant change in flow rate with heart rate. Aortic valve areas derived by continuity equation were 0.77+/-0.14cm2, 0.81+/-0.14cm2and 0.86+/-0.15cm2with pacing at 80, 100 and 120 beats/min. There was signifcant increase in aortic valve area between heart rate 120 and 100 beat/min(p=0.02), and between heart rate 120 and 80 beas/min([=0.003). there was no significant change in aortic valve area between heart rate 100 and 80 beat/min. CONCLUSION: Although there was no significant change in transvalvular flow rate with heart rate increase, aortic valve area derived by continuity equation significantly increased with increased heart rate. This relation should be considered when interpretion continuity equation valve area in aortic stenosis.
Aortic Valve Stenosis ; Aortic Valve* ; Echocardiography ; Echocardiography, Doppler ; Heart Rate* ; Heart* ; Humans

BACKGROUND AND OBJECTIVES: It has been well known that the Braunwald classification is an appropriate clinical parameter in the prediction of the outcome in patients with unstable angina. However, the ability of the classification to predict prognosis of unstable angina according to treatment strategy is not established. We evaluated the relation between severity of angina on admission and outcome of primary unstable angina with early invasive strategy. MATERIALS AND METHOD: 148 patients (M 85, F 63, age 61+/-10) with suspected unstable angina were divided into three subgroups on the basis of the Braunwald classification on admission. The patients were followed up to 6 months prospectively if the final diagnosis was primary unstable angina. Early invasive strategy was used for the treatment of unstable angina. Major cardiac events were assessed during hospitalization and 6 months follow-up period according to the Braunwald classification. RESULTS: Unstable angina was diagnosed in 95 patients (64%). Among these patients, 89 patients with primary unstable angina were followed up to 6 months. Clinical characteristics including number of patients, mean age, sex ratio, risk factors, coronary angiographic findings and revascularization rate during hospitalization were not different in three subgroups of these patients. Among these patients, early coronary revascularizations was performed in 67 patients (75%) and 2 (2%) deaths/myocardial infarctions occurred during hospitalization. During the follow-up period, 1 (1%) myocardial infarction/death and 12 (13%) revascularizations occurred. Cardiac event rate (death, myocardial infarction or revascularization) was not different during hospitalization and 6 months follow-up period among subgroups of severity class. CONCLUSION: Clinical outcome should be reevaluated after early coronary intervention to predict cardiac event in patients with unstable angina.
Angina, Unstable* ; Classification ; Diagnosis ; Follow-Up Studies ; Hospitalization ; Humans ; Infarction ; Myocardial Infarction ; Prognosis ; Prospective Studies ; Risk Factors ; Sex Ratio

PURPOSE: To compare the dose distributions between three-dimensional (3D) and four-dimensional (4D) radiation treatment plans calculated by Ray-tracing or the Monte Carlo algorithm, and to highlight the difference of dose calculation between two algorithms for lung heterogeneity correction in lung cancers. MATERIALS AND METHODS: Prospectively gated 4D CTs in seven patients were obtained with a Brilliance CT64-Channel scanner along with a respiratory bellows gating device. After 4D treatment planning with the Ray Tracing algorithm in Multiplan 3.5.1, a CyberKnife stereotactic radiotherapy planning system, 3D Ray Tracing, 3D and 4D Monte Carlo dose calculations were performed under the same beam conditions (same number, directions, monitor units of beams). The 3D plan was performed in a primary CT image setting corresponding to middle phase expiration (50%). Relative dose coverage, D95 of gross tumor volume and planning target volume, maximum doses of tumor, and the spinal cord were compared for each plan, taking into consideration the tumor location. RESULTS: According to the Monte Carlo calculations, mean tumor volume coverage of the 4D plans was 4.4% higher than the 3D plans when tumors were located in the lower lobes of the lung, but were 4.6% lower when tumors were located in the upper lobes of the lung. Similarly, the D95 of 4D plans was 4.8% higher than 3D plans when tumors were located in the lower lobes of lung, but was 1.7% lower when tumors were located in the upper lobes of lung. This tendency was also observed at the maximum dose of the spinal cord. Lastly, a 30% reduction in the PTV volume coverage was observed for the Monte Carlo calculation compared with the Ray-tracing calculation. CONCLUSION: 3D and 4D robotic radiotherapy treatment plans for lung cancers were compared according to a dosimetric viewpoint for a tumor and the spinal cord. The difference of tumor dose distributions between 3D and 4D treatment plans was only significant when large tumor movement and deformation was suspected. Therefore, 4D treatment planning is only necessary for large tumor motion and deformation. However, a Monte Carlo calculation is always necessary, independent of tumor motion in the lung.
Four-Dimensional Computed Tomography ; Humans ; Lung ; Lung Neoplasms ; Organothiophosphorus Compounds ; Population Characteristics ; Prospective Studies ; Spinal Cord ; Tumor Burden

PURPOSE: In surgical procedures under general anesthesia, 6 to 8 hours of a nulla per os (NPO; nothing by mouth) has been regarded as essential for prevention of respiratory complication such as aspiration. However, recent studies have reported that oral intake of water and other clear fluids up to 2 hours before induction of anesthesia does not increase respiratory problems. The purpose of this pilot study is to investigate the safety and efficacy of a newly developed carbohydrate-rich solution in elective hernia repair surgery patients. METHODS: A group of 30 adult patients scheduled for elective surgeries under general anesthesia were enrolled. The enrolled study group of patients was permitted to drink a carbohydrate-rich solution until two hours before the operation without volume limitation. Respiratory complication was investigated in the patients using the carbohydrate-rich solution until two hours before induction of general anesthesia. The feelings of thirst, hunger sense were measured pre- and post-operatively. In addition, hoarseness of voice, nausea and vomiting were investigated post-operatively. Satisfaction regarding the short time of fasting was measured. Visual analogue scale (VAS) was used for measurement of these six variables. RESULTS: No patients showed serious respiratory complication such as dyspnea, desaturation. Eight of 30 study group patients complained of mild hoarseness. Most symptoms of hoarseness were mild, with VAS score less than 3 out of 10. Two patients complained 5 out of 10. Six patients felt nausea and 1 patient had vomiting. Pre/post-operative hunger sense and thirst feeling were 1.63/1.60 and 1.90/5.76, respectively. The satisfaction score was 3.00 out of 4. CONCLUSION: Allowing the administration of an oral carbohydrate-rich solution in elective surgery patients requiring general anesthesia is safe without serious respiratory complications and effective in providing satisfaction.
Adult* ; Anesthesia ; Anesthesia, General ; Dyspnea ; Fasting ; Herniorrhaphy ; Hoarseness ; Humans ; Hunger ; Nausea ; Pilot Projects* ; Thirst ; Vomiting ; Water

To identify the long-term survival rate and prognostic factors of AMI in Korea, total 404 patients who presented between Jan 1984 and mar 1989 at Seoul National University Hospotal were followed for and average of 24.9+/-18.2 months(range 1 to 69 months). 50 patients(12.4%) died during the in-hospital period and 25 patients(6.2%) died after discharge. Among the survivors reinfarction developled in 11 patients(3.3%). Overall survival rates were 0.87, 0.85, 0.83, 0.81, 0.79, 0.77 and event-free survival rates were 0.87, 0.84, 0.83, 0.79, 0.77, 0.72 at 1, 6, 12, 24, 36, 48 months respectively. During the in-hospital period sex, age, peak creatine kinase level, Killip class, Q wave in ECG, heart failure, and AV block in anterior infarction were of prognostic value. After discharge age, exercise duration on pre-discharge treadmill test, cardiac index, ejection fraction, and presence of heart failure were significant prognostic factors. Pre-discharge coronary angiographies were performed in 217 cases. There was no statistically significant difference in survival rate between multiple vessel disease and single vessel disease. But the more the number of involved vessels was, the higher the incidence of reinfarction was. In the group with jeopardy score less than 8, event-free survival rate was signigicantly higher. Overall survival rate was higher and reinfarction rate was lower in the group, but both were not statistically significant. On discriminant analysis of in-hospital prognostic factors, Killip class, heart failure and age were independent prognostic factors, but other factors had no additional prognostic value.
Atrioventricular Block ; Coronary Angiography ; Creatine Kinase ; Disease-Free Survival ; Electrocardiography ; Exercise Test ; Heart Failure ; Humans ; Incidence ; Infarction ; Korea ; Myocardial Infarction* ; Seoul ; Survival Rate* ; Survivors