Background: The purpose of this study was to evaluate the clinical and radiological outcomes of high-flexion total knee arthroplasty (TKA) using Vega Knee System (B. Braun, Aesculap) at a long-term follow-up and to analyze the implant survivorship. Methods: We enrolled 165 patients (232 knees) with a minimum 7-year follow-up after TKA (VEGA Knee System). For clinical assessment, range of motion (ROM), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) were used. For radiologic assessment, hip-knee-ankle angle, component position, and the existence of radiolucent lines and loosening were used. Survival analysis was conducted using the Kaplan-Meier method. Results: The mean follow-up period was 9.8 years. The mean ROM increased from 124.4° to 131.4° at the final follow-up. The WOMAC score decreased from 38.5 to 17.4 at the final follow-up (p < 0.001). All 5 subscales of the KOOS improved at the final follow-up (all subscales, p < 0.001). Revision TKA was performed in 10 cases (4.3%), which included 9 cases of aseptic loosing and 1 case of periprostatic joint infection. Of the 9 aseptic loosening cases (3.9%), 8 cases (3.4%) were loosening of the femoral component and 1 case (0.4%) was loosening of the tibial component. When revision for any reason was considered an endpoint, the 10-year survivorship was 96.2% (95% confidence interval [CI], 93.9%–98.5%). On the other hand, when revision for aseptic loosening was considered the endpoint, the 10-year survivorship was 96.6% (95% CI, 94.4%–98.8%). Conclusions The Vega Knee System provided good clinical results in the long-term follow-up period. Although the VEGA Knee System showed acceptable implant survivorship, loosening of the femoral component occurred in about 3.4% of the patients. For more accurate evaluation of the survivorship of high-flexion design TKA with a short posterior flange, it is necessary to conduct more long-term follow-up studies targeting diverse races, especially Asians who frequently perform high-flexion activities.

BACKGROUND AND OBJECTIVES: Nitroglycerin-mediated arterial dilation (NMD) was shown to be preserved in most previous studies, and this is possibly due to using a single high dose of nitroglycerin (NTG), which causes maximal arterial dilation. We sought to evaluate the clinical factors of flow-mediated dilation (FMD) and NMD at different doses of NTG in the patients with coronary artery disease (CAD). SUBJECTS AND METHODS: Thirty-two consecutive patients (mean age: 61 years old, 18 males) with angiographically proven CAD underwent FMD and NMD at total cumulative doses of 25microgram, 175microgram and 325microgram with using high-resolution ultrasound for the imaging. RESULTS: The FMD, NMD (25microgram), NMD (175microgram) and NMD (325microgram) were 4.72+/-1.82%, 7.08+/-3.02%, 13.33+/-6.14% and 15.89+/-7.24%, respectively (p<0.001 compared with each other). Univariate analysis showed that the FMD is associated with the serum homocysteine level, the NMD (25microgram) is associated with the body mass index, the NMD (175microgram) is associated with the fasting blood sugar and the ejection fraction, and the NMD (325microgram) is associated with the fasting blood sugar, while there was no significant difference of the FMD and NMD according to the presence of CAD risk factors. Multivariate analysis disclosed that the independent factors of FMD were the serum homocysteine and triglyceride levels, and those of NMD (25microgram) were hypertension, a low ejection fraction and severe coronary angiographic findings, while there was no independent factor for NMD (175microgram) and NMD (325microgram). CONCLUSION: This study suggests that hypertension, a low ejection fraction and significant stenotic coronary lesion may be associated with endothelium-independent smooth muscle dysfunction at low dose NTG, while the serum homocysteine and triglyceride levels are associated with endothelium-dependent endothelial dysfunction in the patients with CAD. Using low-dose NTG is important when measuring the NMD.
Blood Glucose ; Body Mass Index ; Coronary Artery Disease* ; Endothelium ; Fasting ; Homocysteine ; Humans ; Hypertension* ; Middle Aged ; Multivariate Analysis ; Muscle, Smooth* ; Nitroglycerin ; Risk Factors ; Triglycerides ; Ultrasonography

PURPOSE: Virtual colonoscopy (VC) is a newly developing non-invasive technique used to detect polyps and cancers of the colon. The aim of this study is to assess the efficacy of VC in the detection of synchronous polyps or cancers in preoperative patients as well as metachronous polyps of postoperative colorectal cancer patients. METHODS: Both VC and conventional colonoscopy (CFS) were performed on 40 patients with colorectal cancer (10 cases of preoperative state and 30 cases of postoperative follow-up) during Sep. 2002 to June 2003 in Daegu Catholic Medical Centre, Catholic University of Daegu, Republic of Korea. The success rate and the detection rate of polyps or cancers along with the locations and sizes of masses and the findings of anastomotic site were compared between VC and CFS. RESULTS: The entire colon was clearly visualized by CFS in all cases. In the preoperative group, VC was successfully performed in 8 out of 10 cases (80%). 8 out of 10 cancers, 4 out of 4 polyps (5 mm or more in diameter) and 3 out of 6 polyps (5 mm or less in diameter) were identified. The success rate of VC in the postoperative group were 58% of low anterior resection (LAR) from cecum to hepatic flexure, 89% of LAR, 45% of right hemicolectomy (RHC) from hepatic flexure to splenic flexure, 63% of LAR, 45% of RHC from splenic flexure to sigmoid colon, and 53% of LAR, 72% of RHC in rectum. The causes of failure were inadequate bowel distension and retained fluid. In postoperative group, VC identified only 3 of 7 polyps(5 mm or more in diameter), 1 of 10 polyps (5 mm or less in diameter) and 1 of 1 recurrent cancer. The anastomotic site was clearly seen by VC in 9 of 19 cases (47%) of LAR and 3 of 11 cases (27%) of RHC. VC also identified 28 extracolonic findings. CONCLUSIONS: Although the efficacy of VC in postoperative colorectal cancer follow up seems to be disappointing, but it can be used as an alternative method for patients with incomplete conventional colonoscopy due to anastomotic site stricture or for other failed cases. Further technological advancement of VC is needed in order for it to replace conventional colonoscopy as a postoperative follow-up test.
Cecum ; Colon ; Colon, Sigmoid ; Colon, Transverse ; Colonography, Computed Tomographic* ; Colonoscopy ; Colorectal Neoplasms* ; Constriction, Pathologic ; Daegu ; Follow-Up Studies ; Humans ; Polyps ; Rectum ; Republic of Korea

A massive intracoronary thrombus, during percutaneous coronary intervention (PCI), implies a high risk of major adverse cardiac events. We experienced a case of successful PCI, using Percusurge(r), in an acute myocardial infarc-tion patient, with massive intracoronary thrombi. The TIMI 3 coronary flow could not be restored during a primary PCI of the right coronary artery, despite repeated ballooning, intracoronary urokinase injection, parenteral abciximab and heparin. However, successful PCI, with stenting, was performed by aspiration of the large intracoronary thrombi, with the Percusurge(r) system, 5 days after the primacy PCI.
Angioplasty, Balloon, Coronary ; Coronary Vessels ; Heparin ; Humans ; Percutaneous Coronary Intervention* ; Stents ; Thrombosis ; Urokinase-Type Plasminogen Activator

A massive intracoronary thrombus, during percutaneous coronary intervention (PCI), implies a high risk of major adverse cardiac events. We experienced a case of successful PCI, using Percusurge(r), in an acute myocardial infarc-tion patient, with massive intracoronary thrombi. The TIMI 3 coronary flow could not be restored during a primary PCI of the right coronary artery, despite repeated ballooning, intracoronary urokinase injection, parenteral abciximab and heparin. However, successful PCI, with stenting, was performed by aspiration of the large intracoronary thrombi, with the Percusurge(r) system, 5 days after the primacy PCI.
Angioplasty, Balloon, Coronary ; Coronary Vessels ; Heparin ; Humans ; Percutaneous Coronary Intervention* ; Stents ; Thrombosis ; Urokinase-Type Plasminogen Activator

PURPOSE: Paradoxical puborectalis contraction (PPC) or Anismus is known to have a pathogenesis of abnormal contraction of puborectalis at defecation and its managements are not satisfactory. Recently, therapy of PPC and its associated symptoms using Botulinum toxin-A (BTX-A) has been introduced. we evaluate the effect of BTX-A injection to the puborectalis for the patients with PPC. METHODS: Fourteen patients were diagnosed as paradoxical puborectalis contraction on defecography and/or anorectal manometry and electromyography (EMG) during September 1998 to January 2001 in Daegu Catholic Medical Centre, Catholic University of Daegu. All patients were underwent 30 (15 15) units of BTX-A injection on each side of puborectalis guided by EMG. Among them, five patients needed further injection of 20 (10 10) units because the expected results were not satisfied. Follow-up were conducted on one month and one year after BTX-A injection and the patients were assessed for the constipation score and anorectal manometry. RESULTS: After injection of BTX-A, constipation score was significantly decreased from 15.5 +/- 3.5 (mean SD) to 5.7 +/- 4.3. Maximal resting and squeezing pressure also decreased from 48.4 +/- 22 mmHg, 96.9 +/- 39.8 to 41.2 +/- 17, 68.3 +/- 38.2, respectively. Twelve patients who were followed up more than one year after injection, the constipation score (n=12) increased up to 7.7 +/- 2.9 (mean SD). Among them, three patients have had stool softeners or laxatives to evacuate and the remained nine patients did not have any kinds of drug or food for defecation. There was no complication for the injection BTX-A. CONCLUSIONS: BTX-A injection seems to be effective for the treatment of PPC and the long term therapeutic effect can be defined through double blind placebo-controlled trials.
Constipation ; Daegu ; Defecation ; Defecography ; Electromyography ; Follow-Up Studies ; Humans ; Laxatives ; Manometry

BACKGROUND AND OBJECTIVES: We performed this study to elucidate whether there were significant correlations 1) between intima-media thickness (IMT) of carotid artery and the extent of coronary atherosclerosis and 2) between carotid IMT and risk factors of atherosclerosis in patients with coronary atherosclerosis. SUBJECTS AND METHODS: All study subjects (n=326, 200 males, 59+/-10 years) had chest pain and underwent coronary angiography. IMT was measured in the far wall of the internal and common carotid arteries and the carotid bulb using high-resolution ultrasound with a 3-11 MHz linear probe. We also evaluated the presence of plaque in the carotid artery. The extent of coronary atherosclerosis was divided into 4 groups (0, 1, 2, and 3) according to the number of coronary arteries narrowed more than 50% of the diameter. RESULTS: In patients with one or more diseased coronary vessels, IMT of the common carotid artery was thicker (0.81+/-0.15 mm vs. 0.91+/-0.28 mm, p<0.05) and plaques were more frequently found (16% vs. 40%, p<0.05). There was also a significant correlation between the extent of coronary artery atherosclerosis and IMT of the common carotid artery (r=0.217, p<0.001) and the internal carotid artery (r=0.177, p<0.01). Multiple regression analysis revealed hypertension and smoking, among the atherosclerosis risk factors, as independent factors in the IMT of the common carotid artery and carotid bulb. CONCLUSION: We concluded that there was a significant correlation between the extent of coronary artery disease and IMT of the carotid artery;and that hypertension and smoking, of all atherosclerosis risk factors, were independent factors in the IMT of the carotid artery.
Atherosclerosis ; Carotid Arteries* ; Carotid Artery, Common ; Carotid Artery, Internal ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels ; Humans ; Hypertension ; Male ; Risk Factors ; Smoke ; Smoking ; Ultrasonography

BACKGROUND AND OBJECTIVES: Angiotensin-converting enzyme (ACE) inhibitors have been shown to improve the endothelial dysfunction and prevent the development of atherosclerosis in animal models. We performed this study to investigate the effects of the ACE inhibitor, ramipril, on carotid atherosclerosis and endothelial dysfunction of the brachial artery in patients with coronary artery disease (CAD). SUBJECTS AND METHODS: We studied 69 subjects with a mean age of 59yrs, and divided them into two groups according to ramipril use (39 patients with ramipril and 30 without). Using a double-blind, randomized, prospective design, we measured the flow-mediated vasodilatation (FMD) of the brachial artery and intima-media thickness (IMT) of the carotid artery, prior to, and 1, 3 and 6 months following coronary angiograms in CAD patients. RESULTS: The FMD was significantly increased in the ramipril group from 4.6+/-2.2% baseline to 5.3+/-2.5% at the 1 month follow-up (p<0.05), but at the 3 and 6 month follow-ups no significant changes were found. There were no significant differences in the FMD between the two groups at any of the follow-up periods, and no changes in the IMT were found in relation to time for either group. CONCLUSION: Ramipril improved the endothelial dysfunction in patients with CAD for the first month; however this effect did not persist 3 or 6 months after taking ramipril. Ramipril had no effect on the atherosclerotic vascular changes to the IMT of carotid arteries.
Atherosclerosis ; Brachial Artery ; Carotid Arteries ; Carotid Artery Diseases ; Coronary Artery Disease* ; Coronary Vessels* ; Endothelium ; Follow-Up Studies ; Humans ; Models, Animal ; Prospective Studies ; Ramipril* ; Vasodilation

STUDY DESIGN: Retrospective study. OBJECTIVES: To determine the exact distal fusion level in the treatment of single thoracic idiopathic scoliosis (King III and IV) with segmental pedicle screw fixation and rod rotation. SUMMARY OF LITERATURE REVIEW: Pedicle screw fixation effectively shortens the distal fusion extent by improved 3-D deformity correction. However, the selection of distal fusion extent remains controversial in single thoracic idiopathic scoliosis. MATERIAL AND METHODS: Forty-two single thoracic adolescent idiopathic scoliosis patients subject to segmental pedicle screw fixation and rod rotation with minimum follow-up of 2 years (2-6 years) were analyzed. The patients were grouped according to the distal fusion level with reference to the standing neutral vertebra (NV) for comparison of deformity correction, radiological and clinical spinal balance using standing radiographs. Distal fusion down to NV +1 was in 9 patients, NV in 5, NV-1 in 9, NV-2 in 12 and NV-3 in 7 patients respectively. RESULTS: Preoperative 50+/-11 degrees of thoracic deformity was corrected to 13+/-5 degrees showing 74% of curve correction. Preoperative 23+/-7 degrees of lumbar deformity was corrected to 2+/-8 degrees showing 93% of curve correction. Postoperative adding on deformity was obtained in 14 patients. Significant difference was found not by King classification but by distal fusion level: significantly higher chance of unsatisfactory results from not going to the NV-1 (p=0.001). CONCLUSIONS: In correction of single thoracic idiopathic scoliosis with segmental pedicle screw fixation, the curve should be fused to NV-1 saving one or more motion segments when compared to the fusion to the stable vertebra.
Adolescent ; Classification ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Retrospective Studies ; Scoliosis* ; Spine

We report two cases of radiofrequency catheter ablation (RFCA) with atrioventricular nodal reentrant tachycardia (AVNRT) in patients associated with persistent left superior vena cava (PLSVC). AVNRT with PLSVC differs in terms of catheter positioning and location of slow AV nodal pathway as compared with AVNRT alone. In our two patients, a coronary sinus electrode catheter was easily introduced through the PLSVC and directly into the coronary sinus. Successful RFCA was performed with the energy delivery at the bed of the proximal portion of the markedly enlarged coronary sinus without any complications in the two patients.
Catheter Ablation* ; Catheters ; Coronary Sinus ; Electrodes ; Humans ; Tachycardia, Atrioventricular Nodal Reentry* ; Vena Cava, Superior*