BACKGROUND: The purpose of this study was to evaluate the effects of lung disease on the difference between arterial and end-tidal carbon dioxide tension by placing patients from the supine to the lateral decubitus position and by the changes from two lung ventilation (TLV) to one lung ventilation (OLV) during thoracic surgery. METHOD: Fifteen patients who had no parenchymal lung disease were selected for control group and 15 patients who had parenchymal lung disease on non-dependent lung were selected for disease group. All patients had been intubated with double lumen endobronchial tubes and respiration was controlled with a rate of 14-15 breaths per minute and tidal volume 8 ml/kg. End-tidal and arterial carbon dioxide tension were measured at three different measurement periods (supine plus TLV, lateral decubitus plus TLV, lateral decubitus plus OLV). RESULTS: The arterial to end-tidal carbon dioxide tension difference was more increased in disease group than control group. But there was no significant difference in arterial to end-tidal carbon dioxide tension with position change, ventilation method change in each groups. CONCLUSION: We conclude that the arterial to end-tidal carbon dioxide tension difference is increased in lung disease, but it does not changed with position and ventilation method change.
Carbon Dioxide* ; Carbon* ; Humans ; Lung Diseases* ; Lung* ; One-Lung Ventilation ; Respiration ; Thoracic Surgery ; Tidal Volume ; Ventilation

The local laser solidification treatment among the therapys of age-related macular degeneration, which is immensely important in the field of ophthalmology, has been admited to be of effect. The accurate scope and the times of the cure not only play a important role of convalescence but also have a great influence on eyesight in the laser remedy. The retinal image photographed by a recent technology of ICG(Indocyanine Green) give us easy observation of avascular zone, and let us understand and predict objectively the degree of age-related macular degeneration. In this paper, we introduce the ICGI Analyzer and explain ICG image analysis methods that masure in quantities regions of hyperfluorescein area by choroidal neovascularization and detect transformations of it by image processing techniques. Also, we descript a method that ophthalmologist classify ICGA into several types on the basis of position of CNV(Choroidal NeoVascularization) using this system. We present results of applying ICG retinal image of patients to ICG Analyzer and typical frequency of age-related macular degeneration investigated by experts for testing the objectivity and accuracy of proposed methods.
Angiography* ; Choroidal Neovascularization ; Convalescence ; Humans ; Indocyanine Green* ; Linear Energy Transfer ; Macular Degeneration ; Ophthalmology ; Retinaldehyde*

In order to identify the correlations between clinical results and quantitative data of gait analysis, we analyzed the results of 20 cases of total knee joint replacement arthroplasty in 15 patients with degenerative arthritis. We also evaluated the gait analysis of ten age-matched healthy candidates as a control group. Mean follow-up periods were 30 months. Clinical results included post-operative HSS (Hospital for Special Surgery) knee rating scores and the changes of the tibiofemoral angles. The three dimensional gait analysis included clinical assessment, video-taping, three dimensional kinematics and kinetics. The three dimensional kinematics were obtained using a 5 camera VICON system, and the three dimensional kinetic data was collected using two AMTI force plates. There was no statistical difference in linear parameters between the patient and control group. In patients group, however, double support time decreased as the HSS score increased, and range of knee motion and maximum knee flexion increased in accordance with the increase of pain score. Kinematic data of the patients group revealed that some parameters, such as knee flexion during loading response, knee flexion in swing phase, and knee varus during swing phase, were decreased. On the other hand, internal rotation of the knee from initial contact to initial swing was increased when compared with that of control group. There was no significant correlation between the degrees of tibiofemoral angle and coronal plane moment in the patients group. In three cases which showed mild varus instability post-operatively, knee flexion during loading response decreased and valgus moment in midstance increased as compared with the cases without instability. We believe that three dimensional gait analysis will be a good modality for evaluation of the results after total knee arthroplasty. With further accumulation of long term. follow-up data of gait analysis, we might be able to predict the long term results of total knee arthroplasty including possibility of loosening.
Arthroplasty* ; Arthroplasty, Replacement ; Biomechanical Phenomena ; Follow-Up Studies ; Gait* ; Hand ; Humans ; Kinetics ; Knee Joint ; Knee* ; Osteoarthritis

It has been reported that the maintenance of proper ligament balance around the knee joint and the proper location of tibio-femoral joint line position are very important factors for obtaining good knee joint function after the total knee replacement arthroplasty. but, yet the exact effect of the change of joint line on the result of total knee replacement arthroplasty has not been elucidated. The purpose of this study is to evaluate the effect of the change of joint line on the patellar position and the postoperative knee joint function as well as the effect of antero-posterior offset of tibial component on the clinical result. The authors performed the clinical and radiological analysis of 85 knees, in which total knee replacement arthroplasty was performed and followed over 1 year. Tibio-femoral joint line changed from -7mm to +6.8mm (average -0.07) and in this range, the change of joint line did not influence the clinical result and the patellar position. As tibio-femoral joint line migrated proximally, the patella migrated distally and as tibio-femoral joint line migrated distally, the patella migrated proximally. Postoperative pain decreased as the patella and patellar articular surface moved proximally. As the patellar bone height from tibial tuberosity decreased postoperatively. The range of motion decreased. Antero-ppsterior offset of tibial component distributed from -4.2mm to +4.5mm (average 0.62mm) and no effect on cllinical result in this range. In conclusion, it may be suggested that the change of joint line in total knee replacement arthroplasty must be changed as little as possible for the good postoperative range of motion and relief of pain.
Arthroplasty* ; Arthroplasty, Replacement, Knee* ; Joints* ; Knee ; Knee Joint ; Ligaments ; Pain, Postoperative ; Patella ; Range of Motion, Articular

BACKGROUND/AIMS: Propofol sedation is increasingly being used when performing upper gastrointestinal endoscopy because of its rapid onset and good recovery profile. For achieving safe sedation during endoscopy, close monitoring of the vital signs is necessary because of the sedation's potentially serious adverse effects. There are only a few studies on the induction of sedation with using propofol for endoscopy in Korea. The present study was undertaken to evaluate the adequate initial injected dose of propofol for achieving safe and effective sedation when performing upper gastrointestinal endoscopy in Koreans. METHODS: From March 2008 to July 2008, 150 subjects who visited Kwangju Christian Hospital were randomized into 3 groups. An initial bolus dose of 0.5 mg/kg, 1.0 mg/kg and 1.5 mg/kg of propofol was allocated to groups A, B and C, respectively. The effectiveness and safety profiles of each injected dose of propofol were prospectively assessed by measuring various parameters of the vital signs and the adverse events. RESULTS: Group C had a significantly shorter induction time and the patients in group C did not require additional injections of propofol without increasing adverse events, as compared to that of the other 2 groups. CONCLUSIONS: 1.5 mg/kg of propofol was found to be more appropriate than 0.5 mg/kg or 1.0 mg/kg of propofol as the initial injected dose for induction of sedation during performance of upper gastrointestinal endoscopy in Koreans.
Endoscopy ; Endoscopy, Gastrointestinal ; Humans ; Korea ; Propofol ; Prospective Studies ; Vital Signs

PURPOSE: Over the several decades, there has been a considerable improvement in the survival of patients who undergo renal transplantation due to newer immunosuppressive agents and development of surgical technique and post-operative management. However, life expectancy beyond 10 years is still considerably less than that in the general population. We studied the causes of patient death after kidney transplantation to determine the major causes of death, to decrease the mortality rate of patient and to increase the graft survival rate. METHODS: From Jan. 1990 to Dec. 2002, 1353 renal transplantation were performed at Asan Medical Center. There had been 63 cases of patient death and we reviewed the causes of death, recipient-donor relationship, immunosuppressive agents, history of rejection and the time of death after transplantation in these patients, retrospectively. RESULTS: The major causes of patient death were infection (36.5%), cardiovascular disease (14.3%), malignancy (9.5%), hepatic failure (11.1%), miscellaneous (11.1%) and unknown (22.2%). Thirty-nine (61%) of total death occurred in the first year of transplantation and major cause in first year of transplants was infection (46.2%). Of 63 deaths, 35(55.6%) were with graft function and 49 (77.8%) had history of rejection. The patients with brain- death donor had a higher death rate than that of the patients with living donors (3.7% vs 7.8%, P=0.002). The patients who had history of rejection have higher death rate than the patient with no history of rejection (22.6% vs 1.3%, P<0.001). CONCLUSION: Active efforts for the prevention of rejection and infection in early phase of transplantation and close surveillance of malignancy and cardiovascular disease in long-term follow up will decrease the death of transplanted patients and increase the graft survival rate.
Cardiovascular Diseases ; Cause of Death* ; Chungcheongnam-do ; Graft Survival ; Humans ; Immunosuppressive Agents ; Kidney Transplantation* ; Kidney* ; Life Expectancy ; Liver Failure ; Living Donors ; Mortality ; Retrospective Studies ; Tissue Donors ; Transplants

A case of pregnancy associated osteoporosis in a 26 year old woman with backache and vertebral com-pression fracture is presented. The radioactive 45-Ca uptake test showed a disturbance in intestinal calcium absorption. The bone densitometry measured by dual photon absorptiometry revealed severe osteoporosis the entire lumbar spine. After months without therapy, bone mineral density of the lumbar spine and femur were increased markedly and spontaneously.
Adult ; Back Pain/etiology ; Calcium/pharmacokinetics ; Case Report ; Female ; Fractures, Spontaneous/etiology ; Human ; Osteoporosis/*diagnosis ; Pregnancy ; Pregnancy Complications/*diagnosis ; Spinal Injuries/etiology

A case of pregnancy associated osteoporosis in a 26 year old woman with backache and vertebral com-pression fracture is presented. The radioactive 45-Ca uptake test showed a disturbance in intestinal calcium absorption. The bone densitometry measured by dual photon absorptiometry revealed severe osteoporosis the entire lumbar spine. After months without therapy, bone mineral density of the lumbar spine and femur were increased markedly and spontaneously.
Adult ; Back Pain/etiology ; Calcium/pharmacokinetics ; Case Report ; Female ; Fractures, Spontaneous/etiology ; Human ; Osteoporosis/*diagnosis ; Pregnancy ; Pregnancy Complications/*diagnosis ; Spinal Injuries/etiology

BACKGROUND/AIMS: Propofol is an effective sedative drug in endoscopic procedures, but it has potentially serious adverse effects, so close monitoring of the vital signs should be performed during endoscopy. This study was undertaken to determine the adequate induction dose of propofol for safe and effective sedation during esophagogastrodudenoscopy (EGD) in persons 60 years or older. METHODS: Three hundred patients who visited our hospital for EGD were randomly assigned to three groups (A,B and C). An initial induction dose of 0.5 mg/kg, 0.75 mg/kg and 1.0 mg/kg of propofol was allocated to groups A, B and C, respectively. RESULTS: The 0.5 mg/kg, 0.75 mg/kg and, 1 mg/kg dose of propofol were all safe as an initial dose of propofol for achieving sedation during EGD in persons 60 years or older. There was no difference in the total amount of propofol among the three groups. Group C had a significantly shorter induction time and a lower dose was required for an additional injection of propofol without increasing adverse events, as compared to the two other groups. CONCLUSIONS: We suggest that 1 mg/kg of propofol is an effective induction dose for sedation during EGD in persons 60 years or older.
Aged ; Conscious Sedation ; Endoscopy ; Endoscopy, Digestive System ; Humans ; Propofol ; Vital Signs

PURPOSE: To investigate the coronary angiographic findings of left atrial thrombi associated with mitral stenosis. MATERIALS AND METHODS: In 98 patients who had undergone coronary angiography and in whom the presence of left atrial thrombi was confirmed by surgery or repeated transesophageal echocardiography, evaluated the pattern, origin and location of abnormal vasculature suggestive of left atrial thrombi such; abnormalities included neovascularity, staining, dye collection and fistula. RESULTS: Abnormal vasculature was observed in 70 patients (71.4%). It arose from the left circumflex artery in 66 patients (including the sinus nodal branch in four), the right coronary artery in 14 (including the sinus nodal branch in 7 and conal branch in 2), the left anterior descending artery in one, and the left main coronary artery in one. The patterns of abnormal vasculature arising from the left coronary artery were fistula in 50, dye collection in 32, staining in 29 and neovascularity in 24; those arising from the right coronary artery were fistula in four, dye collection in two, staining in four and neovascularity in nine. Abnormal vasculature located at the anterior third of the left atrium in 50 cases, the middle in 20, and the posterior region in 12. CONCLUSION: The abnormal vasculature suggested by left atrial thrombi most commonly arose from the left circumflex artery and was located at the anterior one-third of the left atrial cavity. Fistula was the most common finding of left atrial thrombi, and for that these detection of the abnormal vasculature thrombi give rise to, selective coronary angiography was the useful modality.
Arteries ; Coronary Angiography ; Coronary Vessels ; Echocardiography, Transesophageal ; Fistula ; Heart Atria ; Humans ; Mitral Valve Stenosis*