BACKGROUND: Recently, biplanar fluoroscopy is used to evaluate the cervical kinematics, especially to locate the instant center of rotation (ICR) during in vivo motion. This study aims to ascertain the ICR at each cervical segment in the sagittal plane during dynamic motion and assess the differences from previous studies. METHODS: While three healthy subjects were performing full flexion-extension, two oblique views aligned horizontally and angled at approximately 55° were obtained by biplanar fluoroscopy. The minimum degree to detect significant movement in a helical axis model was set at 2°, and anterior-posterior and superior-inferior locations of each ICR were defined. To evaluate the possible distribution area and overlapping area of the ICR with disc space, we drew a circle by using the calculated distance between each coordination and the mean coordination of ICR as the radius. RESULTS: During flexion-extension motion, the mean superior-inferior location of the ICR became progressively more superior, except the C5–6 segment (p = 0.015), and the mean anterior-posterior location of the ICR became progressively more anterior without exception from C2–3 to C6–7 segments, but anterior-posterior ICR locations were not significantly different among segments. The overlapping area with the distribution circle of ICR was mainly located in the posterior half in the C3–4 segment, but the overlapping area was about 80% of the total disc space in C4–5 and C6–7 segments. The overlapping was more noticeable in the lower cervical segments after exclusion of the outlier data of the C5–6 segment in subject 1. CONCLUSIONS: The ICR in the cervical spine showed a trend of moving progressively more superiorly and anteriorly and the disc space overlapping the distribution circle of ICR increased along the lower motion segments except the C5–6 segment. These findings could provide a good basis for level-specific cervical arthroplasty designs.
Arthroplasty ; Biomechanical Phenomena ; Fluoroscopy ; Healthy Volunteers ; Radius ; Spine

OBJECTIVE: To investigate the multivalent effects of isokinetic strengthening exercises in aged person. METHOD: Sixrteen physically active elderly men and women (age 64.40+/-3.66) were recruited. The subjects underwent a 12-week knee flexor/extensor isokinetic exercise program of concentric contractions at a velocity of 180 degrees/sec of the both knee twice a week for 12 weeks. Training was carried out on the isokinetic dynamometer. The subjects were evaluated with muscular strength at 90 degrees/sec, endurance at 180 degrees/sec, cardio-pulmonary function, balance, mood and life quality at baseline, 4-week, 8-week and 12-week. RESULTS: Six of 16 people gave up in the middle of the course, 10 people completed a muscle strengthening exercise program. Muscular strength, balance, mood and life quality improved. CONCLUSION: Isokinetic exercise of the knee joint muscle was carried out and showed the result of multivalent effect in old age. Therefore strengthening exercise in aged persons was thought to be provided for welfare policy of an aging society as well as personal health improvement.
Aged ; Aging ; Contracts ; Exercise ; Female ; Humans ; Knee ; Knee Joint ; Male ; Muscles ; Quality of Life

OBJECTIVES: The purpose of this study was to analyze the association between the pattern of prophylactic antibiotic use (PAU) and the surgical site infection (SSI) rate for major surgeries in Korea. METHODS: We retrospectively reviewed the medical records of patients who underwent cardiac, colon and gastric surgery, hysterectomies and hip/knee replacements at 20 hospitals, and inclusive of over 500 beds. We randomly sampled 60 cases per surgery type for patients discharged between September and November, 2006. A total fo 2,924 cases were included in our analysis. Cox's proportional hazard analysis was conducted to evaluate the association between the pattern of PAU and SSI rate. RESULTS: The proportion of patients who received their first prophylactic antibiotics (PA) 1 hour before incision was 65.5%, who received inappropriate PAs was 80.8%, and the proportion of patients whose PA was discontinued within 24 hours of surgery was 0.5%. The average duration of PAU after surgery was 9 days. The relative risk (RR) of SSI in patients who received their first PA more than 1 hour before incision was significantly higher than for those who received it within 1 hour prior to incision (RR=8.20, 95% CI=4.81-13.99). Inappropriate PA selection increased SSI rate, albeit with marginal significance (RR=1.97, 95% CI=0.96-4.03). Also, prolonged PAU following surgery had no effect on SSI rate. CONCLUSIONS: These results suggest that the pattern of PAU in the surgeries examined was not appropriate. Errors in the timing of PAU and of PA selection increase SSI rate. SSI rate remained unaltered following prolonged PAU after surgery.
Adolescent ; Adult ; Aged ; *Antibiotic Prophylaxis/methods ; Female ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Postoperative Care ; Preoperative Care ; Proportional Hazards Models ; Retrospective Studies ; Risk ; Surgical Wound Infection/*epidemiology/prevention & control

OBJECTIVE: To assess retrospectively the treatment results of ethanol embolization of peripheral arteriovenous malformations (AVMs) with a dominant outflow vein (DOV). MATERIALS AND METHODS: Nineteen patients who had peripheral AVMs with a DOV were enrolled in this study (mean age, 29.7 years; range, 15-42 years). Fifty-one ethanol embolizations (mean, 2.7; range, 1-8) were performed by direct puncture (n = 29), the transarterial approach (n = 13), the transvenous approach (n = 5), or a combination of methods (n = 4) under general anesthesia. Coil and/or core-removed guide wire embolization of the DOV or another flow occlusion technique (i.e., use of an external pneumatic pressure cuff) to achieve vascular stasis were required in all patients during ethanol embolization. Clinical follow-up (mean, 22.2 months; range, 1-53 months) was performed for all patients, and imaging follow-up (mean, 22.1 months; range, 2-53 months) from the last treatment session was performed for 14 patients. The therapeutic outcome (cure, improvement, no change, or aggravation) was assessed according to the clinical response and the degree of devascularization at angiography. RESULTS: Ethanol embolization was considered as an effective procedure in all patients. Thirteen (68%) of 19 patients were cured and six displayed improvement. Three of six patients with improvement needed further treatment sessions for residual AVMs. Four patients (21%) experienced a total of eight complications. Five complications (three events of a distal embolism and one event each of a urinary bladder necrosis and a brain infarct related to the accidental cannulation of the common carotid artery during insertion of the Swan-Ganz catheter) were major and three complications (skin necrosis) were minor. CONCLUSION: Peripheral AVMs with a DOV can be effectively treated with a high cure rate by the use of ethanol embolization alone or in conjunction with the use of coil and/or core-removed guide wire embolization.
Adolescent ; Adult ; Arteriovenous Malformations/*therapy ; Embolization, Therapeutic/*methods ; Ethanol/*therapeutic use ; Female ; Follow-Up Studies ; Humans ; Male ; Retrospective Studies ; Treatment Outcome

PURPOSE: Skin hyperpigmentation in end stage renal disease patients is known to be attributed to the accumulation of middle molecular weight (MMW) substances such as urochromic pigments and carotenoids. Therefore, there is a possibility that hyperpigmentation may be improved by high-flux hemodialysis (HF-HD) and online hemodiafiltration (HDF). This prospective study was undertaken to investigate the quantitative changes in skin color in HD patients according to dialysis modality. METHODS: Eighty-two stable ESRD patients undergoing HD were enrolled and divided into three groups according to their dialysis modality. Melanin index and erythema index of forearm and abdomen (nonsun exposed area), and forehead (sun exposed area) were measured by narrow-band reflectance spectrophotometer at baseline and after 12 months. RESULTS: There were no significant differences in the baseline values of melanin and erythema indices among the three groups. But the changes in forehead melanin index were significantly lower in HDF patients (-1.0+/-2.4%) compared to the LF-HD group (0.3+/-1.6%) (p<0.05), and forehead erythema index was significantly decreased in patients treated by HDF (-1.6+/-2.5%) relative to the lowflux hemodialysis group (-0.1+/-2.5%) (p<0.05). CONCLUSION: The changes in skin color of sun exposed area were reduced by HDF, suggesting that enhanced removal of MMW substances by convective therapy may be of advantage to skin hyperpigmentation in ESRD patients.
Abdomen ; Carotenoids ; Dialysis ; Erythema ; Forearm ; Forehead ; Hemodiafiltration ; Humans ; Hyperpigmentation ; Imidazoles ; Kidney Failure, Chronic ; Melanins ; Molecular Weight ; Nitro Compounds ; Prospective Studies ; Renal Dialysis ; Skin ; Solar System

PURPOSE: Several methods are used to estimate glomerular filtration rate (GFR), but there are limitations in each method. We investigated the variation in GFR measured by different methods in patients with chronic kidney disease (CKD). METHODS: 549 patients with CKD stages 2-5, who underwent creatinine clearance (Ccr) and (99m)Tc-DTPA renal scan, were enrolled. GFR was calculated by using Cockcroft-Gault equation (CG-GFR) and MDRD equation (MDRD-GFR). The correlations between MDRD-GFR and GFR estimated by other methods were analyzed according to CKD stages and age groups (<40, 40-59, and > or = 60 years). RESULTS: The mean age of patients was 55+/-19 year (male 60%). CG-GFR, Ccr, and estimated GFR by (99m)Tc-DTPA renal scan (DTPA-GFR) correlated significantly with MDRD-GFR in all CKD stages and all age groups (p<0.01). Compared to patients with stages 2-4 CKD, however, the possibilities of CGGFR, Ccr, and DTPA-GFR to be within 30% of MDRD-GFR were significantly lower in stage 5 CKD patients (p<0.05). In addition, the ratio of DTPA-GFR/MDRD-GFR in stage 5 CKD patients was 2.24+/-1.40, indicating overestimation of DTPA-GFR in these patients. On the other hand, the accuracy of various GFR-estimating methods was higher in patients aged more than 60 years compared to the others. CONCLUSION: CG-GFR, Ccr, and DTPA-GFR correlated significantly with MDRD-GFR, but there was a wide variation in GFR estimated by various methods. Therefore, a careful interpretation of estimation in GFR is needed according to the stage of CKD and the age of patients.
Aged ; Creatinine ; Glomerular Filtration Rate ; Hand ; Humans ; Renal Insufficiency, Chronic

PURPOSE: When performing donor screening for living donor liver transplantation (LDLT) for an adult patient with end- stage liver disease, ABO blood group incompatibility is the most common cause of donor exclusion. To cope with this problem without performing ABO-incompatible LDLT, living donor exchange program has been maintained at the Asan Medical Center, Seoul, Korea since September 2003. Here we introduce the clinical experience of 6 cases of adult LDLT allocated by living donor exchange program. METHODS: From February, 1997 to December 2006. 1208 cases of adult LDLT were performed in our institution. Among them, there were 6 cases allocating through donor exchange program to avoid ABO blood group mismatching. Three sets of 2 donor-recipient combination pairs were made after direct one-to-one donor-recipient matching. RESULTS: Two sets of donor exchange LDLT were performed on elective surgery basis, but one in emergency situation. Two living donors and 2 recipients underwent LDLT operations at the same time at the same institution. All 6 living donors recovered well. All of the 6 recipients are doing well to date although 1 recipient had undergone prolonged intensive care for surgical complications. There was no emotional or psychological conflict related to donor exchange program. CONCLUSION: This is the world-first report on donor exchange adult LDLT. Although this is a preliminary report with only 3 sets, donor exchange program for adult LDLT appears to be a feasible modality to promote LDLT. We believe it can be applicable to a wider population of LDLT after widespread consensus formation.
Adult ; Blood Group Incompatibility ; Critical Care ; Consensus ; Donor Selection ; Emergencies ; Humans ; Korea ; Liver ; Liver Diseases ; Liver Transplantation ; Living Donors ; Phosphatidylethanolamines ; Tissue Donors

OBJECTIVE: To explore accuracy and validity of a VO2max prediction equation of the multistage model using by modified Bruce protocol submaximal exercise test in healthy subjects. METHOD: Thirty three healthy subjects (age: 44.0+/-12.9) were recruited. VO2max was measured during treadmill by direct gas analysis from a maximal incremental test. VO2max was then predicted from multistage model equation with age, measured oxygen consumption and heart rate during a maximal incremental treadmill test. And the predicted VO2max values from equation were compared with the measured VO2max values. RESULTS: The predicted VO2max values and the measured VO2max values were highly correlated (r=0.9, p<0.001). The predicted VO2max values (2,285.3+/-536.0 ml/min) were not significantly different from the measured VO2max values (2,285.5+/-598.5 ml/min). CONCLUSION: In healthy subjects, the multistage model equation offers a fairly accurate VO2max prediction. Therefore the equation can be used in the estimation of VO2max at modified Bruce protocol in an aerobic exercise program.
Exercise ; Exercise Test ; Heart Rate ; Oxygen Consumption

Left pulmonary artery agenesis, accompanied by a coronary arterial fistula, is a very rare anomaly. Although unilateral pulmonary artery agenesis is associated with other cardiovascular defects, like as ventricular septal defect, patent ductus arteriosus, and tetralogy of fallot, this anomaly, accompanied by a coronary arterial fistula, has not yet been reported. Most patients with no associated cardiac anomalies have only minor, or absent, symptoms, and survive to adulthood, but some patients may suffer from recurrent respiratory infections and hemoptysis. The vessel to the affected lung in many of the proved cases has been described as arising from either the bronchial artery or the aortic arch. The blood supply from the coronary artery to the affected lung has never been reported. Recently, a case of left pulmonary artery agenesis, accompanied with a coronary arterial fistula was experienced, which was diagnosed by coronary angiography and a chest CT, which is presented, with the review of relevant literature.
Aorta, Thoracic ; Arteries* ; Bronchial Arteries* ; Coronary Angiography ; Coronary Vessels ; Ductus Arteriosus, Patent ; Fistula* ; Heart Septal Defects, Ventricular ; Hemoptysis ; Humans ; Lung ; Pulmonary Artery* ; Respiratory Tract Infections ; Tetralogy of Fallot ; Tomography, X-Ray Computed

Behcet's disease is a disorder of a multisystemic involvement with unknown etiology. Involvement of the cardiovascular system and intestinal tract are rare, but serious complications. We present a case with Behcet's disease demonstrating aneurysm of the abdominal aorta as well as hemorrhagic ileal ulcerative lesions and requiring surgical treatment.
Aneurysm* ; Aorta, Abdominal* ; Aortic Aneurysm ; Behcet Syndrome ; Cardiovascular System ; Ileitis ; Ileum* ; Ulcer*