Seo J.-G.,Sungkyunkwan University |
Moon Y.-W.,Sungkyunkwan University |
Park S.-H.,National Health Insurance Corporation Ilsan Hospital |
Kim S.-M.,Sungkyunkwan University |
Ko K.-R.,Sungkyunkwan University
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2013
Purpose: Reduction in blood loss during surgery stabilizes hemodynamic status and aids in recovery after total knee arthroplasty (TKA). In this study, the authors examined whether different administration routes of tranexamic acid (TNA) might affect the amount of blood loss after TKA. Methods: A total of 150 patients were prospectively allocated to each of the three groups (intravenous, intra-articular, and placebo group) and underwent unilateral TKA. During closing the operative wound, TNA (1.5 g mixed in 100 cc of saline) was administered intravenously or intra-articularly according to the enrolled group, and an equivalent volume of normal saline was administered into the knee joint cavity and intravenously in the placebo group, respectively. The amount of blood loss and transfusion, and changes in haemoglobin levels were documented accordingly. Results: The mean blood loss in the intravenous, intra-articular, and placebo groups were 528 ± 227, 426 ± 197, and 833 ± 412 ml, respectively. About 66 % (intravenous), 80 % (intra-articular), and 6 % (placebo) of each group did not require transfusion for any reason, and the mean amount of transfusion was 273.6, 129.6, and 920.8 ml, respectively. Preoperative haemoglobin values decreased by 1.6 ± 0.8, 1.8 ± 0.8, and 2.0 ± 0.9 mg/dl, respectively. Conclusion: Compared to intravenous administration, intra-articular administration of TNA seems to be more effective in terms of reducing blood loss and transfusion frequency. TNA may improve the general conditions of patients given TKA by maintaining a hemodynamically stable state, aiding in recovery, and reducing the chance of transfusion-associated side effects and complications. Level of evidence: II. © 2012 Springer-Verlag.
Kim H.S.,National Health Insurance Corporation Ilsan Hospital |
Joo S.H.,National Health Insurance Corporation Ilsan Hospital |
Han Z.-A.,National Health Insurance Corporation Ilsan Hospital |
Kim Y.W.,Yonsei University
Journal of Ultrasound in Medicine | Year: 2012
Objectives-To define the relationship between body indices of healthy adults and cross-sectional areas of the carpal tunnel and median nerve and to obtain the nerve/tunnel index, which represents a new standard for diagnosing carpal tunnel syndrome using sonography. Methods-Body indices (height, weight, and body mass index) were analyzed in 60 healthy adults, and electromyography and sonography were also performed. The crosssectional areas of the proximal and distal median nerve and carpal tunnel were obtained by sonography. The proximal and distal nerve/tunnel indices were obtained by calculating the ratio between the proximal and distal cross-sectional areas of the median nerve to those of the carpal tunnel and multiplying the value by 100. Results-Although the proximal cross-sectional areas of the median nerve and body indices showed statistically significant relationships with weak positive correlations, the proximal and distal areas of the carpal tunnel showed relatively stronger correlations with body indices. Between sexes, there were significant differences in the proximalmedian nerve cross-sectional area (mean ± SD: male, 10.48 ± 3.21 mm 2; female, 8.81 ± 3.21 mm 2; P < .05) and proximal carpal tunnel area (male, 182.50 ± 21.15 mm2; female, 151.23 ± 21.14 mm 2; P < .05). There was no difference in the proximal nerve/tunnel index (male, 5.80% ± 1.72%; female, 5.91% ± 1.63%). There was a statistically significant difference in the distal carpal tunnel cross-sectional area (male, 138.90 ± 20.95 mm2; female, 121.50 ± 18.99 mm 2; P < .05) between sexes, but the distal median area (male, 9.99 ± 3.42 mm2; female, 8.46 ± 1.84 mm2) and distal nerve/tunnel index (male, 7.15% ± 2.00%; female, 7.01% ± 1.38%) showed no significant differences. The proximal index was significantly higher than the distal index (proximal, 5.85% ± 1.66%; distal, 7.08% ± 1.71%). Conclusions -The nerve/tunnel index is unaffected by body indices or sex and thus may be a useful and objective standard for diagnosing carpal tunnel syndrome. © 2012 by the American Institute of Ultrasound in Medicine.
Kang H.M.,Yonsei University |
Chung E.J.,National Health Insurance Corporation Ilsan Hospital |
Kim Y.M.,Siloam Eye Hospital |
Koh H.J.,Yonsei University
Graefe's Archive for Clinical and Experimental Ophthalmology | Year: 2013
Background: To evaluate the baseline spectral-domain optical coherence tomography (SD-OCT) characteristics of macular edema (ME) due to branch retinal vein occlusion (BRVO) for visual outcome after intravitreal bevacizumab injection. Methods: Fifty-nine patients treated in one eye with intravitreal bevacizumab for ME due to BRVO were retrospectively reviewed. Stepwise multiple regression analysis was used to evaluate the relative contribution of several variables, including SD-OCT characteristics such as photoreceptor inner segment/outer segment (IS/OS) integrity and external limiting membrane (ELM status), baseline best-corrected visual acuity (BCVA), and baseline central retinal thickness (CRT) with final visual outcome. Results: Thirty-one patients (52.5 %) had disrupted photoreceptor IS/OS integrity. The mean BCVA improved significantly from 0.50 logMAR (20/63 Snellen equivalent) to 0.10 logMAR (20/25 Snellen equivalent) in the intact photoreceptor group (p = 0.000, paired t-test). However, the mean BCVA was improved in the disrupted photoreceptor group, from 1.10 logMAR (20/252 Snellen equivalent) to 0.94 logMAR (20/174 Snellen equivalent), which was not statistically significant (p = 0.177, paired t-test). ELM was disrupted in 23 patients (39.0 %). The mean BCVA improved significantly from 0.63 logMAR (20/85 Snellen equivalent) to 0.26 logMAR (20/36 Snellen equivalent) in the intact ELM group (p = 0.000, paired t-test), however, not significantly improved in the disrupted ELM group, from 1.09 logMAR (20/246 Snellen equivalent) to 1.01 logMAR (20/205 Snellen equivalent) (p = 0.563, paired t-test). The strongest individual predictor of final BCVA among patients with ME due to BRVO was the integrity of photoreceptor IS/OS layer on SD OCT (r 2 = 0.514, p = 0.000, stepwise multiple regression), but the most efficient model was the combination of the photoreceptor IS/OS integrity, ELM status, and baseline BCVA (r 2 = 0.671, p = 0.000, stepwise multiple regression). The strongest predictor of final BCVA was the status of photoreceptor IS/OS integrity (β = 0.532, p = 0.000, stepwise multiple regression), followed by ELM status (β = 0.325, p = 0.006, stepwise multiple regression), and the baseline BCVA (β = 0.238, p = 0.013, stepwise multiple regression). Conclusion: Our results suggest that baseline SD-OCT characteristics, the status of photoreceptor IS/OS and ELM can be helpful in predicting the final visual outcome after intravitreal bevacizumab injection in these patients. © 2012 Springer-Verlag.
Kang J.W.,Yonsei University |
Choi H.S.,National Health Insurance Corporation Ilsan Hospital |
Kim K.,Hallym University |
Choi J.Y.,Yonsei University
American Journal of Clinical Nutrition | Year: 2014
Background: Previous animal studies have shown that vitamins may prevent age-related hearing loss. However, no concrete conclusions have been reached about the association between vitamin intake and presbycusis in humans. Objective: We investigated the association between dietary vitamin intake and hearing thresholds in adults between 50 and 80 y of age by using data from a large population-based survey. Design: We used data from the 2011 Korea National Health and Nutrition Examination Survey. A pure-tone audiogram and physical examination of the ear were performed, and vitamin intake was calculated by using the 24-h recall method. Data from 1910 participants were analyzed through univariate and multivariate linear regression analyses. Results: After adjustment for age, sex, smoking, and exposure to occupational and explosive noise, intake of vitamin C correlated with better hearing at midfrequency (2000 and 3000 Hz) (coefficient: 20.012; 95% CI: 20.022, 20.002). Dietary supplement use was positively associated with better hearing at all frequencies. The univariate analysis indicated that dietary intakes of retinol, riboflavin, niacin, and vitamin C were positively correlated with better hearing at most frequencies. In contrast, serum concentrations of vitamin D were associated with worse hearing at mid and high (4000 and 6000 Hz) frequencies. Conclusions: Dietary intake of vitamin C was associated with better hearing in the older population. Because less than one-half of elderly participants in this study consumed a sufficient amount of vitamins, and vitamin intake decreased with age, we should consider proper diet counseling to prevent hearing decline. © 2014 American Society for Nutrition.
Kim C.O.,Yonsei University |
Huh A.J.,National Health Insurance Corporation Ilsan Hospital |
Han S.H.,Yonsei University |
Kim J.M.,Yonsei University
Archives of Gerontology and Geriatrics | Year: 2012
In this work, it was examined the possibility of lipopolysaccharide (LPS) causing cellular senescence in lung alveolar epithelial cells. Then, it was clarified how this cellular senescence phenomenon is associated with oxidative stress effect induced by LPS and whether antioxidants could inhibit reduced cellular viability by oxidant stress effect of LPS. In cell viability using cell counting kit-8, exposure to LPS decreased cellular viability and induced growth arrest in a concentration-dependent manner. The pre-apoptotic concentration of LPS was determined by caspase activation using a Caspase-Glo 3/7 luminescence assay kit. This concentration of LPS caused morphologic characteristics shown in senescent cells and elevated senescence-associated β-galactosidase activity. In addition, lysosomal content associated with senescence was increased by LPS at the pre-apoptotic concentration. However, this concentration of LPS did not shorten the telomere length. Exposure to LPS resulted in the formation of hydrogen peroxide in a concentration-dependent manner. The ability of LPS to reduce cellular viability was inhibited by the presence of glutathione. This study revealed that LPS could induce cellular senescence in lung alveloar epithelial cells, and these phenomena were closely associated with hydrogen peroxide production by LPS. Taken together, it is suggested that LPS-induced cellular senescence may play an important role in limiting the tissue repair response after sepsis. © 2011.
Consumption of whole grains and legumes modulates the genetic effect of the APOA5 -1131C variant on changes in triglyceride and apolipoprotein A-V concentrations in patients with impaired fasting glucose or newly diagnosed type 2 diabetes
Kang R.,Yonsei University |
Kim M.,Yonsei University |
Chae J.S.,Yonsei University |
Lee S.-H.,National Health Insurance Corporation Ilsan Hospital |
Lee J.H.,Yonsei University
Trials | Year: 2014
Background: The apolipoprotein A5 gene (APOA5) -1131 T > C polymorphism is associated with mild hypertriglyceridemia in type 2 diabetic subjects, and interacts with dietary fat in the determination of triglyceride concentrations. We examined whether a substitution of whole grains and legumes for refined rice in a high carbohydrate diet (about 65% of energy derived from carbohydrate) may modify the effect of this variant on changes in apolipoprotein A-V (apoA-V) and triglyceride concentrations.Methods: We genotyped the APOA5 -1131 T > C in individuals with impaired fasting glucose (IFG) or newly diagnosed type 2 diabetes, who were randomly assigned to either a group ingesting whole grain and legume meals daily or a control group for 12 weeks.Results: After dietary intervention, we observed significant interactions between the APOA5 -1131 T > C polymorphism and carbohydrate sources (whole grains and legumes versus refined rice) in the determination of mean percent changes in triglyceride and apoA-V (P interactions <0.001 and =0.038, respectively). In the refined rice group (n = 93), the carriers of the risk C allele (n = 50) showed a greater increase in the mean percent changes of triglyceride and apoA-V than noncarriers after adjusting for HOMA-IR (P = 0.004 and 0.021, respectively). The whole grain and legume group (n = 92), however, showed a decrease in fasting glucose, HOMA-IR, and triglyceride, and an increase in apoA-V, irrespective of genotype.Conclusions: The data showed that the magnitude of the genetic effect of the APOA5 -1131C variant on triglyceride and apoA-V levels was modulated when substituting consumption of whole grains and legumes for refined rice as a carbohydrate source in IFG or diabetic subjects.Trial registration: ClinicalTrials.gov: NCT01784952. © 2014 Kang et al.; licensee BioMed Central Ltd.
Jang J.Y.,Yonsei University |
Kim Y.S.,National Health Insurance Corporation Ilsan Hospital
Korean Journal of Urology | Year: 2012
Purpose: The results of all prostate biopsies may be positive and suggestive of adenocarcinoma in patients with prostate-specific antigen (PSA) values higher than 100 ng/ml. We considered that the prostate cancer in patients with high PSA might be advanced disease and therefore that the treatment strategy should not be changed according to pathological reports. Thus, we assessed the role of prostate biopsy when diagnosing prostate cancer in patients with extremely high PSA levels. Materials and Methods: We reviewed the records of 1,150 cases undergoing prostate biopsies. Patients with urinary tract infection and acute urinary retention were excluded. According to the pre-biopsy PSA level, patients were divided into 6 groups (group A, 4 to 20 ng/ml; B, 20 to 40 ng/ml; C, 40 to 60 ng/ml; D, 60 to 80 ng/ml; E: 80 to 100 ng/ml; and F, above 100 ng/ml). Results: The calculated positive predictive value (PPV) for prostate cancer was 22% in group A, 54% in group B, 73% in group C, 75% in group D, 89% in group E, and 100% in group F, respectively. Pathological diagnosis was adenocarcinoma in all patients in group F (n=56). Among them, 38 patients (67.9%) had lymph node metastasis or extra-prostatic disease or both and 43 patients (76.8%) had bony metastasis. In group F, all cases were advanced prostate cancer (stage III or IV). All of them received hormonal therapy following diagnosis. Conclusions: We suggest the possibility for biopsy-free diagnosis of prostate cancer in patients with extremely high levels of serum PSA and evidence of advanced disease in imaging studies, especially in older patients with comorbid medical problems. © The Korean Urological Association, 2012.
Sung K.S.,National Health Insurance Corporation Ilsan Hospital |
Hak C.,Seoul National University
Journal of Craniofacial Surgery | Year: 2012
Alloplastic synthetic dura is widely used in dura mater reconstruction. Although the incidence of postoperative alloplastic dura infection is not common, the possibility of intractable postoperative wound infection despite appropriate antibiotic use exists. Rectus free flap is composed of well-vascularized muscle and fascial tissues. This flap is appropriate for volumetric replacement in large defects, whereas the fascia is appropriate for dura mater reconstruction. We report a case of successful reconstruction in a patient who had intractable postsurgical wound infection with staged operation using vascularized rectus muscle and fascial flap in a patient with meningioma reconstructed with alloplastic dura graft (Neuropatch; B. Braun Melsungen AG, Melsungen, Germany) and additionally achieved aesthetic results. In the first step, vascularized rectus fascia and muscle were transferred to contaminated reconstructed dura after craniectomy. The removed calvarial bone was banked to the abdominal donor-site pocket after cleansing. Finally, in the second stage, cranioplasty was performed with the banked autologous calvarial bone. Copyright © 2012 Mutaz B. Habal, MD.
Jeon T.Y.,Sungkyunkwan University |
Jeon P.,Sungkyunkwan University |
Jeon P.,National Health Insurance Corporation Ilsan Hospital |
Kim K.H.,Sungkyunkwan University
Korean Journal of Radiology | Year: 2011
Objective: To evaluate the prevalence of incidentally found unruptured intracranial aneurysms (UIAs) on the brain MR angiography (MRA) from a community-based general hospital. Materials and Methods: This was a prospectively collected retrospective study, carried out from January 2004 to December 2004. The subjects included 3049 persons from a community-based hospital in whom MRA was performed according to a standardized protocol in an outpatient setting. Age- and sex-specific prevalence of UIAs was calculated. The results by MRA were compared with intra-arterial digital subtraction angiography (DSA) findings. Results: Unruptured intracranial aneurysms were found in 137 (5%) of the 3049 patients (M:F = 43:94; mean age, 60.2 years). The prevalence of UIAs was 5% (n = 94) in women and 4% (n = 43) in men, respectively (p = 0.2046) and showed no age-related increase. The most common site of aneurysm was at the distal internal carotid artery (n = 64, 39%), followed by the middle cerebral artery (n = 40, 24%). In total, 99% of aneurysms measured less than 12 mm, and 93% of aneurysms measured less than 7 mm. Direct comparisons between MRA and DSA were available in 70 patients with 83 UIAs; the results revealed two false positive and two false negative results. Conclusion: This community-hospital based study suggested a higher prevalence of UIAs observed by MRA than previously reported. These findings should be anticipated in the design and use of neuroimaging in clinical practice.
An C.,Yonsei University |
Park S.,National Health Insurance Corporation Ilsan Hospital |
Choi Y.J.,National Health Insurance Corporation Ilsan Hospital
Korean Journal of Radiology | Year: 2013
A 64-year-old male patient with liver cirrhosis underwent a CT study for hepatocellular carcinoma surveillance, which demonstrated a 1.4-cm hypervascular subcapsular tumor in the liver. On gadoxetic acid-enhanced MRI, the tumor showed brisk arterial enhancement and persistent hyperenhancement in the portal phase, but hypointensity in the hepatobiliary phase. On diffusion-weighted MRI, the tumor showed an apparent diffusion coefficient twofold greater than that of the background liver parenchyma, which suggested that the lesion was benign. The histologic diagnosis was intrahepatic bile duct adenoma with alcoholic liver cirrhosis.