BACKGROUND: Decreased heart rate variability(HRV) has been shown to be an independent predictor of poor outcome after acute myocardial infarction, Spectral analysis of HRV has recently been shown to be a reliable noninvasive test for quantiative assessment of cardiovascular autonomic regulatory response. We estimated the reproducibility and circadian rhythm of HRV parameters in patients with acute myocardial infarction. METHODS: Three consecutive 24-hour ambulatory electrocardiographic recordings were made in 24 patients with acute myocardial infarction, with 10~14 days after the acute attack, and analyzed for HRV parameters of both frequency and time domains. Parameters of frequency domain include low frequency(LF) and high frequency(HF) components. Parameters of time domain include sdRR, SDANN, SD, pNN50, rMSSD, HRV index. RESULTS: Mean total, low frequency and high frequency amplitude spectral densities were 33msec, 19msec and 11msec, respectively. Mean values of sdRR, SDANN, SD, rMSSD, pNN50 and HRV index were 103msec, 90msec, 47msec, 28msec, 7% and 32, respectively. Coefficients of variation(CV) of total amplitude spectral density, and low and high frequency components were 7%, 9% and 12%, respectively. CV of most HRV parameters of time domain were also around 10% except rMSSD and pNN50. Heart rate increased in the morning to be sustained during the day time and decreased in the night. Heart rate variability of high frequency component decreased in the early morning to be sustained during day time with increase in the night. CONCLUSIONS: We conclude that in the predischarge period of acute myocardial infarction, HRV parameters of frequency and time domains are reproducible and there are some morning fall of cardiac vagal activity.
Circadian Rhythm ; Electrocardiography ; Heart Rate* ; Heart* ; Humans ; Myocardial Infarction*

Total knee arthroplasty is a surgical treatment for end-stage osteoarthritis of the knee. Postoperative lower limb alignment is one of the factors determining the long-term prognosis after total knee arthroplasty. Navigation-assisted surgery can be used to achieve an accurate lower limb alignment. Particular situations, such as severe extra-articular deformity in the femur or tibia and retained hardware, are a good indication for navigation-assisted surgery. On the other hand, thorough preoperative planning and an understanding of each steps of surgery are necessary to perform total knee arthroplasty successfully in these special cases. In this review article, preoperative radiological measurements and surgical planning for extra-articular deformity correction will be elucidated. The surgical steps and necessary instruments for navigation-assisted total knee arthroplasty will be described in cases of extra-articular deformity or retained hardware. A literature review showed that the radiological and clinical results after total knee arthroplasty using navigation in osteoarthritis with extraarticular deformity were good. Therefore, it is essential to use navigation when performing total knee arthroplasty in patients with extraarticular deformity or retained hardware.

No abstract available.
Pancytopenia*

The increased use of magnetic resonance imaging (MRI) has increased the frequency of diagnosis of cavernous hemangioma, but its presentation of an epidural lesion with foraminal extension without intramedullary involvement is very rare. We describe a 31-year-old woman admitted to our department with pain in the left side of her neck and shoulder. Gadolinium enhanced cervical MRI revealed a brightly enhanced, extradural mass (112 cm sized) with widened neural foramen; after surgical excision, it was histologically confirmed as a cavernous hemangioma. Postoperatively, the patient has no neurological deficit or specific complication. Although this lesion mimicked an epidural- neurogenic tumor, its enhancement pattern indicated a cavernous hemangioma. Accurate preoperative diagnosis is necessary for treatment planning. Cavernous hemangioma must be included in the differential diagnosis of a brightly enhanced, extradural tumors.
Adult ; Caves ; Diagnosis, Differential ; Female ; Gadolinium ; Hemangioma, Cavernous ; Humans ; Magnetic Resonance Imaging ; Neck ; Shoulder

OBJECTIVE: The incidence of spinal metastases continues to increase, likely a result of increasing survival times for patients with cancer. This retrospective study was undertaken to analyze the results of surgery and the outcome of patients with extradural metastases in the cervical spine. METHODS: Thirty-three patients with cervical spine metastases who underwent spinal surgery by two surgeon at a single center in a 14-year period(1993-2007) were analyzed. Indications for surgery include intractable pain, neurological deficits, spinal cord compression, and the need for stabilization of impending pathological fractures. Numerous factors affect outcome including the nature of the primary cancer, the presence of fracture or dislocation, approach of surgery, and the severity of spinal cord compression. The change of predominant symptoms and survival time were evaluated after surgery. RESULTS: There were 17 male and 16 female patients aged from 29 to 78 years old(mean age, 59.9 years). Among the metastatic tumors, colon, breast, and liver were the most common primary sites of origin, and lung, kidney, stomach and thyroid were also common. All patients had bony invasion and 24 patients had pathologic vertebral fracture and 6 patients had dislocation. Based on the tumor location, approaches included 12 anterior, 6 posterior and 15 combined. Epidural spinal cord compression on the axial T2-weighted magnetic resonance(MR) image was noted in 31 patients(93.9%). The American Spinal Injury Association(ASIA) impairment scale scores in preoperative state were stable in 29 patients(87.9%) who presented with ASIA Score D and E. The most common predominant symptoms of patients were cervical and/or radiating pain(26 patients) and 23 patients had neurological deficits. At Follow-up, predominant preoperative symptoms improved in 28(84.8%) patients who had pain or neurological deficits. The overall mean survival duration for patients with cervical metastatic tumors after diagnosis was 7.4 months in 28 expired patients and 17.4 months in 5 survived patients. There were four major early and late complications in this study. One patient suffered from the immediate postoperative epidural hematoma and improved after evacuation of hematoma. There were three cases of instrumentation failure. One of them was symptomatic and underwent second-look surgery. CONCLUSION: Surgery for the treatment of cervical spine metastases is effective for improvement of the neurological deficits and relief the local pain in a significant proportion of patients with acceptable complication rates. The tech- nical evolution of cervical implants has improved our ability to achieve long-term rigid fixation, particularly over the cervicothoracic junction.
Aged ; Asia ; Breast ; Cervical Vertebrae ; Colon ; Dislocations ; Female ; Follow-Up Studies ; Fractures, Spontaneous ; Hematoma ; Humans ; Incidence ; Kidney ; Liver ; Lung ; Magnetics ; Magnets ; Male ; Neoplasm Metastasis ; Pain, Intractable ; Retrospective Studies ; Spinal Cord Compression ; Spinal Injuries ; Spine ; Stomach ; Thyroid Gland

PURPOSE: The chronic kidney disease (CKD) is defined as structural or functional abnormalities of the kidney diagnosed by abnormalities of pathology, composition of blood or urine, imaging tests and glomerular filtration rate (GFR) less than 60 mL/min/1.73m2. GFR less than 60 mL/min/1.73m2 is known to increase the number of complications. This guideline is universally used but there are no studies on whether the guideline is applicable to Korean people, especially to elderly population. METHODS: We randomly selected 1,000 subjects aged more than 65 years who lived in Seong-nam city during September, 2005. We used the modified MDRD equation to estimate the glomerular filtration rate (eGFR) and categorized the subjects into 5 groups (group 1: GFR >70, group 2: 60-70, group 3: 50-60, group 4: 40-50, group 5: <40 mL/min/1.73m2). RESULTS: The mean creatinine level was 1.1 (+/-0.3) mg/dL and the mean value of eGFR was 60.9 (+/-12.9) mL/min/1.73m2. The frequency of subjects with eGFR less than 60 mL/min/1.73m2 was 48%. The frequencies of old age, female, hypertension, coronary heart disease, anemia, hypoalbuminemia, proteinuria, and increased waist circumference increased as eGFR fell. When evaluating the odds ratios of complications of CKD (Group 2-5 versus Group 1), the risk of coronary heart disease was increased in Group 3, 4, 5, hypertension in Group 4, 5 and diabetes mellitus, anemia, and proteinuria in Group 5, respectively. CONCLUSION: The prevalence of CKD in the elderly population was high. The elderly Koreans with CKD showed increasing comorbidities at a lower GFR.
Aged ; Anemia ; Comorbidity ; Coronary Disease ; Creatinine ; Diabetes Mellitus ; Female ; Glomerular Filtration Rate ; Humans ; Hypertension ; Hypoalbuminemia ; Kidney ; Odds Ratio ; Prevalence ; Proteinuria ; Renal Insufficiency, Chronic ; Waist Circumference

We present a rare case of an intradural ventral arteriovenous fistula (AVF) mimicking an intramedullary ependymoma. A 46-year-old woman presented with sudden onset of right leg weakness, which she had been experiencing for two weeks. Whole-spine magnetic resonance imaging (MRI) scan revealed a 0.5-cm-sized intramedullary lesion of high signal with a dark signal rim on a T2-weighted image at the T9 level. The T1-weighted MRI after contrast enhancement revealed a nodular and rim-like enhancement. However, a signal void, likely to be seen in the case of an engorged vein, was not obvious, thus giving the impression of an intramedullary ependymoma. Surgery was planned, but was aborted due to the observation of a large engorged vein as soon as the dura was opened.
Arteriovenous Fistula ; Ependymoma ; Female ; Humans ; Leg ; Magnetic Resonance Imaging ; Middle Aged ; Veins

10 Patients with primary hypercholesterolemia were treated for 12 weeks with lovastation(20mg t.i.d). Lovastatin reduced mean total and low density lipoprotein cholesterol by 43% and 57% respectively(p<0.001). High density lipoprotein cholesterol and triglyceride levels were unchanged by the drug. Adverse effects attributable to lovastatin were not observed. Thus lovastatin is considered as an effective lipid lowering agent for the treatment of primary moderate hypercholesterolemia.
Cholesterol, HDL ; Cholesterol, LDL ; Humans ; Hypercholesterolemia* ; Lovastatin* ; Triglycerides

BACKGROUND: Anesthesia induction time is related to speed of injection, injected volume, and Keo. In the case of target controlled infusion, induction time can be controlled by adjusting the induction time mode. The aim of this study was to estimate the effect of induction time mode on variable parameters and vital signs during anesthesia induction with propofol using a target controlled infusion (TCI). METHODS: Sixty unpremedicated adult patients (ASA class I or II, 18 55 yrs) scheduled for elective surgery were randomly allocated to four groups according to induction mode. Group 1 was assigned a flash induction mode, and groups 2, 3 and 4 were assigned 2, 3 and 4min respectively. The end point of anesthesia induction was loss of eyelash reflex. Various parameters including induction time, infused volume, current/effect concentration at induction, and vital signs were compared. RESULTS: As the induction time mode was prolonged, induction time was delayed, but there was no difference in infused volume. Also, the current concentration decreased gradually, but the effect concentration did not show any difference. The vital signs were more stable in groups 3 and 4 compared with groups 1 and 2. CONCLUSIONS: For anesthesia induction, a rapid induction mode showed more rapid induction and low current concentration, but vital signs were relatively unstable and the effect concentration at induction showed no difference. For critically ill patients or patients with unstable hemodynamics, a more gradual induction mode for anesthesia induction in propofol TCI is recommended.
Adult ; Anesthesia* ; Critical Illness ; Hemodynamics ; Humans ; Propofol* ; Reflex ; Vital Signs*

BACKGROUND: In athlete's heart, functional and structural alteration are main features. We studied electrocardiograms(ECG's) and echocardiograms(UCG's) in soccer players before and after intensive training. METHODS: Fifteen soccer players with the mean age and career of 19.3 and 8.5 years,respectively,underwent intensive training for 5-5.5 months, which included running of 2 km daily during the last 2-2.5 months. Comparisons of ECG's and UCG's recorded before and after the training were made. RESULTS: The major abnormal finding in pre-training ECG's was high voltage being seen in 40% of the cases, and in UCG's left ventricular(LV) dilatation and/or hypertrophy or asymmetrical septal hypertrophy(ASH) were noted in approximately 80% of the cases. The incidences of these finding after the intensive training were essentially unchanged, and the mean of pre-and post-training fractional shortening(FS) and LV and left atrial dimensions were similar. The high voltage in ECG's showed no close correlation with LV dilatation or hypertrophy on UCG's. After the training, however, the mean values of the thickness of LV posterior wall and ventricular septum along with LV mass were significantly increased, and the right ventricular dimension was significantly decreased. CONCLUSIONS: The most frequent finding in ECG's and UCG's in soccer players, before and after intensive training,were high voltage, LV dilatation and /or hyperophy with or without ASH. The intensive training of 5-5.5 months duration caused no change in F8,but caused significant increase in the thickness of LV posterior wall and ventricular septum, and LV mass.
Dilatation ; Electrocardiography* ; Heart ; Hypertrophy ; Incidence ; Running ; Soccer* ; Ventricular Septum