PURPOSE: Correlations between maximum flexion and functional outcomes in total knee arthroplasty (TKA) patients are reportedly weak. We investigated whether there are differences between passive maximum flexion in nonweight bearing and other types of maximum flexion and whether the type of maximum flexion correlates with functional outcomes. MATERIALS AND METHODS: A total of 210 patients (359 knees) underwent preoperative evaluation and postoperative follow-up evaluations (6, 12, and 24 months) for the assessment of clinical outcomes including maximum knee flexion. Maximum flexion was measured under five conditions: passive nonweight bearing, passive weight bearing, active nonweight bearing, and active weight bearing with or without arm support. Data were analyzed for relationships between passive maximum flexion in nonweight bearing by Pearson correlation analyses, and a variance comparison between measurement techniques via paired t test. RESULTS: We observed substantial differences between passive maximum flexion in nonweight bearing and the other four maximum flexion types. At all time points, passive maximum flexion in nonweight bearing correlated poorly with active maximum flexion in weight bearing with or without arm support. Active maximum flexion in weight bearing better correlated with functional outcomes than the other maximum flexion types. CONCLUSIONS: Our study suggests active maximum flexion in weight bearing should be reported together with passive maximum flexion in nonweight bearing in research on the knee motion arc after TKA.
Arm ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Follow-Up Studies ; Humans ; Knee ; Weight-Bearing

Unilateral brachial plexus injury is a rare complication of thoracoscopic sympathectomy, which is generally considered to be a simple and safe procedure. We report on a 20-year-old female patient who developed persistent pain and weakness of the left arm after thoracoscopic sympathectomy for hyperhidrosis. An electromyographic study revealed evidence of denervation at the C5-C7 level, and a nerve conduction study on the left brachial plexus showed decreased amplitude of the compound muscle action potential of the left musculocutaneous and axillary nerves. The above findings are compatible with left brachial plexopathy, with predominant involvement of the lateral and posterior cord. We suggest that this complication was caused by stretch and/or compression of the left brachial plexus when the arm was hyperabuducted upwards during the operation. Careful attention to positioning by the surgeon and anesthesiologist is needed to prevent this debilitating injury.
Action Potentials ; Arm ; Brachial Plexus Neuropathies ; Brachial Plexus* ; Denervation ; Female ; Humans ; Hyperhidrosis ; Neural Conduction ; Sympathectomy* ; Young Adult

BACKGROUND: Recently, we reported the antiapoptotic effect of ghrelin in spinal cord injury-induced apoptotic cell death of oligodendrocytes. However, how ghrelin inhibits oligodendrocytes apoptosis, is still unknown. Therefore, in the present study, we examined whether ghrelin inhibits microglia activation and thereby inhibits oligodendrocyte apoptosis. METHODS: Using total cell extracts prepared from BV-2 cells activated by lipopolysaccharide (LPS) with or without ghrelin, the levels of p-p38 phosphor-p38 mitogen-activated protein kinase (p-p38MAPK), phospho-c-Jun N-terminal kinase (pJNK), p-c-Jun, and pro-nerve growth factor (proNGF) were examined by Western blot analysis. Reactive oxygen species (ROS) production was investigated by using dichlorodihydrofluorescein diacetate. To examine the effect of ghrelin on oligodendrocyte cell death, oligodendrocytes were cocultured in transwell chambers of 24-well plates with LPS-stimulated BV-2 cells. After 48 hours incubation, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and terminal deoxynucleotidyl transferase 2'-deoxyuridine, 5'-triphosphate nick end labeling staining were assessed. RESULTS: Ghrelin treatment significantly decreased levels of p-p38MAPK, p-JNK, p-c-Jun, and proNGF in LPS-stimulated BV-2 cells. ROS production increased in LPS-stimulated BV-2 cells was also significantly inhibited by ghrelin treatment. In addition, ghrelin significantly inhibited oligodendrocyte cell death when cocultured with LPS-stimulated BV-2 cells. CONCLUSION: Ghrelin inhibits oligodendrocyte cell death by decreasing proNGF and ROS production as well as p38MAPK and JNK activation in activated microglia as an anti-inflammatory hormone.
Apoptosis ; Blotting, Western ; Cell Death* ; Cell Extracts ; DNA Nucleotidylexotransferase ; Ghrelin* ; JNK Mitogen-Activated Protein Kinases ; Microglia ; Oligodendroglia* ; Phosphotransferases ; Protein Kinases ; Reactive Oxygen Species ; Spinal Cord

Matrix metalloproteinases (MMPs) are zinc-dependent endopeptidases that degrade the extracellular matrix and other extracellular proteins. Upregulation of MMPs activity is known to be required for the inflammatory cell infiltration after spinal cord injury (SCI) and most likely contributes to early blood spinal barrier disruption and inflammation, thereby leading to the impairment of functional recovery. Here, we examined the effect of ethanol extract of Bupleurum falcatum (BF) on functional recovery by inhibiting MMP-2 and -9 activation and inflammation after SCI. Rats received a moderate, weight-drop contusion injury to spinal cord were administered orally with BF at a dose of 100 mg/kg for 14 d and functional recovery was measured by Basso-Beattie-Bresnahan locomotor open field behavioral rating test, inclined plane test and foot print analysis. To examine the neuroprotective effect of BF, TUNEL staining and counting were also performed. In addition, the expression and/or activation of MMP-2, MMP-9 and inflammatory mediators such as TNF-alpha, IL-1beta, COX-2, and iNOS were examined by RT-PCR and gelatin zymography using spinal cord tissue from 1 d after injury. Our data showed that BF significantly inhibited the expression and activation of both MMP-2 and MMP-9 after SCI. The mRNA expressions of TNF-alpha, IL-1beta, COX-2, and iNOS were also significantly attenuated by BF. Furthermore, BF reduced apoptotic cell death at 1 d after injury, thereby significantly reduced lesion volume and improved functional recovery. Taken together, these results suggest that BF can be used as a potential therapeutic agent for treating acute spinal injury.
Animals ; Blood-Brain Barrier ; Bupleurum ; Cell Death ; Contusions ; Endopeptidases ; Ethanol ; Extracellular Matrix ; Foot ; Gelatin ; In Situ Nick-End Labeling ; Inflammation ; Matrix Metalloproteinases ; Neuroprotective Agents ; Proteins ; Rats ; RNA, Messenger ; Spinal Cord ; Spinal Cord Injuries ; Spinal Injuries ; Tumor Necrosis Factor-alpha ; Up-Regulation

Twenty-six nalidixic acid-resistant Shigella sonnei strains isolated from 1982 to 2001 and 56 nalidixic acid-resistant mutants induced by quinolone drugs from susceptible wild strains were analyzed by sequencing the gyrA gene. All the 22 nalidixic acid-resistant isolates from 1998 to 2001 showed identical amino acid substitution of Ser to Leu (TCG --> TTG) at codon 83 while 7 different mutation types were detected in artificially induced nalidixic acid-resistant mutants. Asp87 (GGC) type was observed most commonly among mutants induced by nalidixic acid while Ser83 (TTG) type was common among mutants induced by ciprofloxacin or norfloxacin. All the isolates collected between 1998 and 2001 showed identical or nearly identical pulsed-field gel electrophoresis pattern. These results suggest that the explosive increase of S. sonnei infection after 1998 was mainly due to the spread of restricted number of clones resistant to nalidixic acid.
Amino Acid Substitution ; Ciprofloxacin ; Clone Cells ; Codon ; Electrophoresis, Gel, Pulsed-Field ; Epidemiology ; Molecular Epidemiology* ; Nalidixic Acid* ; Norfloxacin ; Shigella sonnei* ; Shigella*

PURPOSE: To evaluate the preventive effect of deep vein thrombosis (DVT) by low molecular weight heparin (LMWH) after hip arthroplasty. MATERIALS AND METHODS: We analyzed 98 consecutive patients (107 cases) who were older than forty years of age and were scheduled to have elective primary or revision hip arthroplasty from August 1996 to March 1998. All of them received prophylactic LMWH, Nadroparin calcium (Fraxi-parine, Sanofi France). The effectiveness and safety of LMWH were evaluated in a prospective randomized trial. LMWH was injected subcutaneously once daily, from twelve hours before the operation to the tenth postoperative day with fixed dosage according to patient s body weight. For the detection of DVT after hip arthroplasty, patients were evaluated with color doppler image (CDI) preoperatively, postoperatively 7-10 days and six weeks consecutively. RESULTS: DVT was detected in six patients (5.61%) and no symptomatic pulmonary embolism occurred. Asymptomatic isolated calf vein thrombosis was identified in four patients, they had no therapeutic treatment for the thrombosis but the thrombi were resolved spontaneously without any proximal propagation. Proximal vein DVT was identified in two patients and the thrombi were resolved within 6 weeks with additional treatment using Nadroparin calciurn administration. In three cases, late developing thrombi was detected at follow-up CDI carried out at the sixth postoperative week. There were three cases of bleeding complications. CONCLUSIONS: Compared to our previous report of the incidence of DVT using low molecular weight dextran (12.2%) and warfarin (16.6%) with the incidence of DVT using low molecular weight heparin (5.61%), we considered that prophylaxis with LMWH is more effective in preventing DVT after hip arthroplasty. We also found that asymptomatic isolated calf vein thrombosis is resolved spontaneously. For the detection of late developing thrombosis, we recommend consecutive follow-up CDI.
Arthroplasty* ; Body Weight ; Dextrans* ; Follow-Up Studies ; Hemorrhage ; Heparin, Low-Molecular-Weight* ; Hip* ; Humans ; Incidence ; Molecular Weight* ; Nadroparin* ; Prospective Studies ; Pulmonary Embolism ; Thromboembolism* ; Thrombosis ; Veins ; Venous Thrombosis* ; Warfarin*

PURPOSE: To determine the potential of spiral CT as a functional imaging modality of the lung asid from its proven value in morphological depiction. MATERIALS AND METHODS: Spiral CT scan was performed in ten normal female and nine normal male adults (mean age: 39, height: 163cm, weight: 62kg) after single full breath-holding. Three dimensional lung images were reconstructed (minimal threshold value: -1,000HU, maximal threshold values: -150,-250, -350, -450HU) to obtain total lung volume(TLV) on a histogram. Total lung volume measured by spiral CT was compared with TLV obtained by spirometry. RESULTS: Mean TLV measured by spirometry was 5.62 Land TLV measured by CT at maximal threshold values of -150, -250, -350, and -450HU was 6.63, 5.33, 5.15, and 4.98 L, respectively. Mean absolute differences between the modalities of 0.17L(3%), 0.32L(5.6%), 0.48L(8.5%), 0.65L(11.5) were statistically significant(p<0.001). Linear regression coefficients between the modalities were 0.99, 0.97, 0.95,and 0.94 and no statistically significant differences in accuracy of threshold levels in the estimation of lung volume(r=0.99, standard error=0.034L in all) were seen. CONCLUSION: TLV measured by spiral CT closely approximated that measured by spirometry. Spiral CT may be useful as a means of evaluating lung function.
Adult ; Female ; Humans ; Linear Models ; Lung ; Male ; Spirometry* ; Tomography, Spiral Computed* ; Total Lung Capacity*

Background: There is a need to update the cardiovascular (CV) Sequential Organ Failure Assessment (SOFA) score to reflect the current practice in sepsis. We previously proposed the modified CV SOFA score from data on blood pressure, norepinephrine equivalent dose, and lactate as gathered from emergency departments. In this study, we externally validated the modified CV SOFA score in multicenter intensive care unit (ICU) patients. Methods: A multicenter retrospective observational study was conducted on ICU patients at six hospitals in Korea. We included adult patients with sepsis who were admitted to ICUs. We compared the prognostic performance of the modified CV/total SOFA score and the original CV/total SOFA score in predicting 28-day mortality. Discrimination and calibration were evaluated using the area under the receiver operating characteristic curve (AUROC) and the calibration curve, respectively. Results: We analyzed 1,015 ICU patients with sepsis. In overall patients, the 28-day mortality rate was 31.2%. The predictive validity of the modified CV SOFA (AUROC, 0.712; 95% confidence interval [CI], 0.677–0.746; P < 0.001) was significantly higher than that of the original CV SOFA (AUROC, 0.644; 95% CI, 0.611–0.677). The predictive validity of modified total SOFA score for 28-day mortality was significantly higher than that of the original total SOFA (AUROC, 0.747 vs. 0.730; 95% CI, 0.715–0.779; P = 0.002). The calibration curve of the original CV SOFA for 28-day mortality showed poor calibration. In contrast, the calibration curve of the modified CV SOFA for 28-day mortality showed good calibration. Conclusion In patients with sepsis in the ICU, the modified SOFA score performed better than the original SOFA score in predicting 28-day mortality.

Esophageal intramural pseudodiverticulosis is a rare condition with an unknown etiology, and it is characterized by the typical morpholgic findings of multiple tiny pseudodiverticula in a portion of, or in the entire length of the esophagus. It has two peaks in incidence, the teen years and between the 5th and 7th decade. Most patients present with dysphagia, and radiological narrowing of the esophagus is commonly seen. The clinical course of this condition is benign and dilatation of any strictures, if present, results in an excellent clinical response. We report here on a case of esophageal intramural pseudodiverticulosis in a 76-year-old man who had a 6-year history of dysphagia, and we also include a review of the literature.
Adolescent ; Aged ; Constriction, Pathologic ; Deglutition Disorders ; Dilatation ; Esophagus ; Humans ; Incidence

In rare cases, early gastric cancer resembles the endoscopic features of a submucosal tumor (SMT). A correct histological diagnosis is difficult with repeated biopsy specimens because they are covered with normal mucosa. Some features known to suggest malignant SMT include a size greater than 3 to 5 cm, a rapid growth rate, echoheterogeneity and irregular margins on endoscopic ultrasonography (EUS). Various techniques including US-guided biopsy, partial removal by an endoscopic snare excision, as well as EUS with a fine needle aspiration were used to enhance the diagnostic accuracy. We recently experienced a case of early gastric cancer, presenting as a submucosal tumor-like lesion, which was confirmed by endoscopic mucosal resection. We report this case with a review of the relevant literature.
Adenocarcinoma* ; Biopsy ; Biopsy, Fine-Needle ; Diagnosis ; Endosonography ; Mucous Membrane ; SNARE Proteins ; Stomach Neoplasms