No abstract available.
Tibial Fractures*

No abstract available.

Epidermal cysts slowly growing, intradermal or subcutaneous tumors that usually cease growing after having reached 1 to 5 cm in diameter. We report a case of giant epidermal cyst on the scapular region with the appearance of well delineated huge mass measured 19×17×14cm in size. Its clinical and surgical management are illustrated.
Epidermal Cyst

PURPOSE: We evaluated the usefulness of a home-based device (SwimCount™) compared with World Health Organization (WHO) 5th semen analysis in screening for male fertility in Asian men.MATERIALS AND METHODS: One hundred Asian men who visited CHA Seoul Station Fertility Center for evaluation of fertility were included. Semen samples were analyzed and compared with the SwimCount™ results. An aliquot of 0.5 mL of the semen sample was added to the SwimCount™ and a WHO 5th semen analysis was performed. Results were categorized as low (<5×10⁶/mL), and normal to high (≥5×10⁶/mL) total progressively motile sperm concentration. Receiver operating characteristic curve analysis was performed to evaluate the accuracy of the SwimCount™.RESULTS: The mean total progressively motile sperm concentration was 26.7×10⁶/mL. Semen analysis revealed that 28% of the samples were below the threshold count of 5 million/mL total progressively motile sperm concentration. The mean total progressively motile sperm concentration of the light color SwimCount™ result group determined by semen analysis was 7.5×10⁶/mL, and the mean total progressively motile sperm concentration of the moderate to dark color SwimCount™ result group was 34.2×10⁶/mL. An area under the receiver operating characteristic curve of 0.85 (95% confidence interval, 0.77–0.94; p<0.001) was obtained when the SwimCount™ was compared with semen analysis. The sensitivity and specificity were obtained at a cut off value of 5.0×10⁶/mL total progressively motile sperm concentration, giving a sensitivity and specificity of 87.5% and 73.4%.CONCLUSIONS: We confirmed the reliability of the SwimCount™ as a home-based device for male fertility by evaluating the total progressively motile sperm concentration.

This is pilot study to evaluate the relationship of physical fitness with age, body fat, work pattern and life style among 20-9 aged male workers (n=417). Physical fitness was measured by maximum oxygen uptake, forced vital capacity, 1 second forced expiratory volume, grip strength, back strength, sit ups and trunk flexion. Life style was self-reported on a questionnaire about regular exercise, smoking, alcohol consumption, coffee consumption, degree of stress, and percent of body fat measured by bioelectrical impedance fat meter. Age was significantly and negatively related to physical fitness except grip strength. Obesity was next to most significant factor for physical fitness, it was associated with maximum oxygen uptake, grip strength, back strength, trunk flexion. Regular exercise was associated with maximum oxygen uptake. Others was insignificantly related to physical fitness. Performance of physical fitness test was significantly correlated with age, obesity and regular exercise.
Adipose Tissue* ; Alcohol Drinking ; Coffee ; Electric Impedance ; Forced Expiratory Volume ; Hand Strength ; Humans ; Life Style* ; Male* ; Obesity ; Oxygen ; Physical Fitness* ; Pilot Projects ; Questionnaires ; Smoke ; Smoking ; Vital Capacity

BACKGROUND AND METHOD: Pharmacological coronary vasodilation induced by dipyridamole is often used in association with thallium-201 scintigraphy to evaluate the presence and prognostic significance of coronary artery disease(CAD). Although dipyridamole has traditionally been used for this purpose, it causes frequent side effect, which at times can be life-threatening. Moreover, dipyridamole dose not elicit maximal coronary vasodilation in a substantial number of patients receiving the usual i.v. dose. Adenosine is an endogenously produced compound that has significant effects as a coronary vasodilator and rapid onset action and extremely short half-life(<10 seconds). The safety and diagnostic accuracy of intravenous adenosine Tc-99m MIBI imaging were evaluated in 248 patients who were referred for evaluation of CAD; 51 of the patients underwent coronary angiography and 25 of those exercise Tc-99 MIBI imaging. Adenosine was infused intravenously at a dose of 0.14 mg/kg/body weight per minute for 6 min and MIBI was injected at 3 min. RESULTS: Adenosine induced a significant decrease in systolic(p<0.05) and diastolic(p<0.001) blood pressures as well as a significant increase in heart rate(p<0.001) and rate-pressure product(p<0.01). The PR interval was slightly prolonged(p-NS). The overall sensitivity, specificity and predictive accuracy for CAD detection was 85%, 82%, and 83%, respectively. The diagnostic accuracy for individual CAD was low in left circumflex CAD. The agreement of segmental perfusion on adenosine and exercise Tc-99 MIBI imaging was 92% (Kappa index-0.83, p<0.001). Side effects occurred in 84% of 248 patients. Flushing (47%), dyspnea(45%), chest pain(28%) and headache(28%) were common. ST depression> or =1.0mm occurred in 8% and lst-, 2nd- and 3rd-degree atrioventricular block in 7%, 4%, and 1%, respectively. Side effects were mostly mild and transient except in 3 patients in whom premature termination of adenosine infusion and treatment were necessary. Aminophylline was used in only two patients. CONCLUSION: Thus, these facts suggest that pharmacological coronary vasodilation with adenosine in conjuction with Tc-99m MIBI myocardial scintigraphy appears to be a feasible, safe and valuable test for the diagnosis of coronary artery disease, particulary in patients unable to exercise.
Adenosine* ; Aminophylline ; Atrioventricular Block ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis ; Dipyridamole ; Flushing ; Heart ; Humans ; Myocardial Perfusion Imaging ; Perfusion Imaging* ; Perfusion* ; Radionuclide Imaging ; Sensitivity and Specificity ; Thorax ; Vasodilation

PURPOSE: Icodextrin in peritoneal cavity is absorbed via the lymphatics to the blood and metabolized to maltose and maltriose which may interfere with correct measurement of glucose. In an attempt to evaluate the effects of icodextrin on the erroneous results of blood glucose, we measured blood glucose by different methods. METHODS: Peripheral capillary blood and venous blood were obtained from 12 patients using icodextrin and from 12 patients not using icodextrin. Venous blood glucose was measured by using the laboratory technique (glucose oxidase method), and capillary blood glucose was measured by using a Surestep (glucose oxidase method) and an Acucheck (GDH-PQQ method). To estimate icodextrin and its metabolites indirectly, we calculated osmolal gap. We measured blood icodextrin and its metabolites with amyloglucosidase in icodextrin group. RESULTS: In icodextrin group, glucose was overestimated in the results of the GDH-PQQ method (delta= GDH-GOD=56.2+/-30 mg/dL [vein] 58+/-32 mg/dL [capillary]), but in the control group, there were no significant differences in the results between the glucose oxidase method and the GDH-PQQ method. There was a correlation between the osmolal gap and the differences in the results (delta=GDH-GOD) (r=0.741, p=.006 [vein], r=0.671, p=.017 [capillary]). Blood icodextrin and its metabolites were related with the differences in the results (delta=GDH-GOD) (p=.026, r=0.635), but there was no significant correlation between the osmolal gap and the icodextrin and its metabolites (p=0.086, r=0.515). CONCLUSION: Icodextrin and its metabolites may lead to erroneously high blood glucose levels when measured by GDH-PQQ method. It is necessary to be aware of this factor in order to prevent overlooking dangerous hypoglycemia.
Blood Glucose* ; Capillaries ; Glucan 1,4-alpha-Glucosidase ; Glucose ; Glucose Oxidase ; Humans ; Hypoglycemia ; Maltose ; Oxidoreductases ; Peritoneal Cavity ; Peritoneal Dialysis, Continuous Ambulatory*

PURPOSE: Endothelial dysfunction is an event in the atherosclerotic process usually considered reversible at its early stage. Early detection, therefor, may improve the prognosis in the cardiovascular disease. The aim of this study was to investigate the vascular function in hemodialysis (HD) patients and to explore its relation to other various parameters with a specific emphasis on systemic inflammatory reaction (SIR), nutritional status and the presence of ischemic heart disease (IHD). METHODS: Flow-mediated endothelium-dependent vasodilatation (FMD) was measured, using Doppler sonogram, in 37 stable HD patients, 11 healthy people and 24 hypertensive controls. Nitroglycerine- induced endothelium-independent vasodilatation (EIV) and peak reaction time (PT) of each FMD and EIV were also measured. RESULTS: FMD in HD patients was decreased compared to healthy group whereas it was comparable in HD patients and hypertensive control. EIV in HD patients was significantly decreased compared to healthy and hypertensive controls. PT of each FMD and EIV was significantly delayed in HD patients. Each FMD and EIV showed a negative correlation with serum hsCRP level, but no significant correlations of FMD with other parameters were noted. Both FMD and EIV were further decreased in HD patients with IHD than non-IHD group. CONCLUSION: Our study confirmed a characteristic pattern of vascular dysfunction in HD patients: the impaired endothelial and smooth muscle function with a delayed reaction time. Importantly, SIR was one of the important factors determining vascular dysfunction in HD patients. Further studies will be necessary to define the causative role of SIR on endothelial dysfunction and the effect of inflammation- modulating therapy.
C-Reactive Protein ; Cardiovascular Diseases ; Humans ; Inflammation ; Muscle, Smooth ; Myocardial Ischemia ; Nutritional Status ; Prognosis ; Reaction Time ; Renal Dialysis ; Vasodilation

PURPOSE: Recently, many studies have investigated that Methylenetetrahydrofolate Reductase (MTHFR) polymorphism may be not a only cause for hyperhomocysteinemia, but also an independent risk factor for cardiovascular disease or atherosclerosis in renal failure patients. In this study, we analyzed MTHFR polymorphisms in chronic renal failure (CRF) patients, and investigated relationship between MTHFR polymorphism and peripheral atherosclerosis. METHODS: One hundred twenty eight CRF patients with GFR < 30 mL/min were enrolled. We analyzed their MTHFR polymorphism by standard PCR/restriction fragment length polymorphism and measured their ankle brachial index (ABI) using blood pressure cuff and Doppler stethoscope. Plasma homocysteine, vitamin B12, and folic acid levels were measured. 170 healthy peoples were enrolled for control group. RESULTS: The distribution of MTHFR 677 polymorphism of CRF patients was as follows: CC genotype, 33.6%; CT, 47.7% and TT 18.7%. Plasma homocysteine concentration was higher in TT group than in CC group (p < 0.05). The distribution of MTHFR 1298 polymorphism of CRF patients was as follows: AA type, 63.78%; AC, 33.07% and CC 18.7%. The distributions of MTHFR polymorphisms in control group were not different from patients group, respectively. There was no definite correlation between ABI and plasma homocysteine concentration. A trend of lower ABI in TT type compared with CC type within CRP patients group, but no statistical significance was shown. CONCLUSIONs: No difference of the distribution of MTHFR polymorphism was noted between CRF patients and healthy population. In CRF patients, MTHFR C677T mutation was closely associated with hyperhomocysteinemia, but both did not significantly influence to peripheral arterial disease.
Ankle Brachial Index ; Atherosclerosis* ; Blood Pressure ; Cardiovascular Diseases ; Folic Acid ; Genotype ; Homocysteine ; Humans ; Hyperhomocysteinemia* ; Kidney Failure, Chronic* ; Methylenetetrahydrofolate Reductase (NADPH2)* ; Peripheral Arterial Disease ; Peripheral Vascular Diseases ; Plasma ; Renal Insufficiency ; Risk Factors ; Stethoscopes ; Vitamin B 12

Cyclosporine is one of the most useful immunosuppressants for many diseases including nephrotic syndrome, glomerulonephritis, organ transplantation, and other autoimmune diseases. However, cyclosporine is known to cause renal tubular acidosis (RTA) due to a decrease in urinary ammonium excretion. Cyclosporine also can lead to significant hypocitraturia due to a higher proximal tubular reabsorption of citrate and increase the risk for nephrolithiasis. Citrate excretion is essential for the prevention of urinary supersaturation and hypocitraturia is a major risk factor for nephrocalcinosis and nephrolithiasis. Now we report two cases of nephrolithiasis treated with cyclosporine. The first patient is a renal transplantation recipient and the second patient has membranous glomerulonephritis. Therefore, these two cases lead us to conclude that patients treated with cyclosporine have to be regularly followed up for nephrolithiasis caused by cyclosporine-induced tubular dysfunction.
Acidosis, Renal Tubular ; Autoimmune Diseases ; Citric Acid ; Cyclosporine ; Glomerulonephritis ; Glomerulonephritis, Membranous ; Humans ; Immunosuppressive Agents ; Kidney Transplantation ; Nephrocalcinosis ; Nephrolithiasis ; Nephrotic Syndrome ; Organ Transplantation ; Quaternary Ammonium Compounds ; Risk Factors ; Transplants