Veterans Health Service Medical Center

Songgang-dong, South Korea

Veterans Health Service Medical Center

Songgang-dong, South Korea
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Do K.H.,Veterans Health Service Medical Center
American Journal of Physical Medicine and Rehabilitation | Year: 2017

ABSTRACT: Pregabalin is often used for the treatment of neuropathic pain in patients with spinal cord injury (SCI). We reported a patient with C5 [S(C5/C6)] ASIA Impairment Scale C SCI due to cervical myelopathy who presented CO2 retention when taking a therapeutic dosage of pregabalin. An 88-year-old patient with cervical SCI was transferred to the department of physical medicine and rehabilitation. When he had transferred, his neuropathic pain had been treated with 150-mg pregabalin per day (75 mg twice a day); however, he still exhibited severe neuropathic pain with a Numeric Pain Rating Scale score of 7 to 8. Dosage for the pregabalin increased from 150 mg/d (75 mg twice a day) to 225 mg/d (150 mg at morning and 75 mg at dinner). That afternoon, he presented drowsiness and confusion, and arterial blood gas analysis (ABGA) demonstrated respiratory acidosis with CO2 retention; pH, 7.312; PaCO2, 62.8 mm Hg; PaO2,58.9 mm Hg; HCO3 concentration, 30.8 mmol/L; base excess, 3.2 mmol/L; and oxygen saturation, 90.4%. Finally, he required tracheal intubation and ventilation. After 6 weeks, the patient was transferred to a general ward, and the follow-up ABGA and end-tidal CO2 showed normal range with the discontinuation of pregabalin. We demonstrated CO2 retention via ABGA in a patient with SCI due to cervical myelopathy who developed hypercapnia after taking a therapeutic dose of pregabalin. Physicians should pay particular attention to CO2 retention when prescribing a therapeutic dosage of pregabalin in a patient with cervical SCI. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

Choi G.W.,Korea University | Kim H.J.,Korea University | Yeo E.D.,Korea University | Yeo E.D.,Soonchunhyang University | And 2 more authors.
Bone and Joint Journal | Year: 2013

In a retrospective study we compared 32 HINTEGRA total ankle replacements (TARs) and 35 Mobility TARs performed between July 2005 and May 2010, with a minimum follow-up of two years. The mean follow-up for the HINTEGRA group was 53 months (24 to 76) and for the Mobility group was 34 months (24 to 45). All procedures were performed by a single surgeon. There was no significant difference between the two groups with regard to the mean AOFAS score, visual analogue score for pain or range of movement of the ankle at the latest follow-up. Most radiological measurements did not differ significantly between the two groups. However, the most common grade of heterotopic ossification (HO) was grade 3 in the HINTEGRA group (10 of 13 TARs, 76.9%) and grade 2 in the Mobility group (four of seven TARs, 57.1%) (p = 0.025). Although HO was more frequent in the HINTEGRA group (40.6%) than in the Mobility group (20.0%), this was not statistically significant (p = 0.065).The difference in peri-operative complications between the two groups was not significant, but intra-operative medial malleolar fractures occurred in four (11.4%) in the Mobility group; four (12.5%) in the HINTEGRA group and one TAR (2.9%) in the Mobility group failed (p = 0.185). © 2013 The British Editorial Society of Bone & Joint Surgery.

Yoon J.-R.,Veterans Health Service Medical Center | Oh K.-J.,Konkuk University | Wang J.H.,Sungkyunkwan University | Yang J.-H.,Veterans Health Service Medical Center
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2015

Purpose: In vivo comparative gap measurements were performed in three different patella positions (reduced, subluxated and everted) using offset-type-force-controlled-spreader-system. Methods: Prospectively, 50 knees were operated by total knee arthroplasty using a navigation-assisted gap-balancing technique. The offset-type-force-controlled-spreader-system was used for gap measurements. This commercially available instrument allows controllable tension in patella-reduced position. The mediolateral gaps of knee extension (0°) and flexion (90°) angle were recorded in three different patella positions; reduced, subluxated and everted. Any gap differences of more than 3 mm were considered as a meaningful difference. Correlation between the difference with the demographic data, preoperative radiologic alignment and intraoperative data was analysed. For statistical analysis, ANOVA and Pearson’s correlation test were used. Results: The gaps in patella eversion demonstrated smaller gaps both in knee extension and flexion position compared to the gaps of patella reduction position. The amount of decreased gaps was more definite in knee flexion position. Statistically significant difference was observed for the lateral gap of patella eversion compared to gap of patella reduction in knee flexion position (p < 0.05). There were notable cases of variability in knee flexion position. Significant portion of 12 (24 %) knees of patella subluxation and 33 (66 %) knees of patella evertion demonstrated either increased or decreased gaps in knee flexion position compared to the gaps of patella reduction position. Conclusion: The gaps in patella eversion demonstrated smaller gaps both in knee extension and flexion position compared to the gaps of patella reduction position. The amount of decreased gaps was more definite in knee flexion position. Therefore, the intraoperative patellar positioning has influence on the measurement of the joint gap. Keeping the patella in reduced position is important during gap balancing. Level of evidence: I. © 2014, Springer-Verlag Berlin Heidelberg.

Yoon J.-R.,Veterans Health Service Medical Center | Jeong H.-I.,Korea Orthopedic Clinic | Oh K.-J.,Konkuk University | Yang J.-H.,Veterans Health Service Medical Center
Journal of Arthroplasty | Year: 2013

Achieving rectangular flexion and extension gaps is important during gap balancing technique in total knee arthroplasty (TKA). However, assessment of gaps throughout the range of knee motion is obscure. One hundred knees operated by TKA using a navigation-assisted gap balancing technique were evaluated. Intraoperatively, after achieving rectangular flexion and extension gaps, mediolateral gaps in each flexion angle (0°, 45°, 90°, 120°) were recorded. Patients were divided into 4 groups; Group I: no gap difference (n = 64), Group II: lax in midflexion (n = 20), Group III: lax in deep flexion (n = 8) and Group IV: lax in both midflexion and deep flexion (n = 8). This study demonstrated that significant proportion (36%) of TKA cases had laxity in midflexion (45°) even when rectangular extension (0°)-flexion (90°) gap was achieved. © 2013 Elsevier Inc.

Kim H.-K.,Veterans Health Service Medical Center | Kim H.-K.,Seoul National University | Kim S.-H.,Seoul National University
Dental Materials | Year: 2014

Objective This study was aimed to investigate the effect of the number of coloring liquid applications on the optical properties of monolithic zirconia. Methods Eighteen monolithic zirconia specimens (27.6 mm × 27.6 mm × 2.0 mm) were fabricated and divided into 6 groups (n = 3). Each group was designated by the number of A2-coloring liquid applications (Group I to Group V) and Group O as a control. Color and spectral distribution of the specimens were measured with a double-beam spectrophotometer. CIE L*, a* and b* relative to the standard illuminants D65 were measured in reflectance and transmittance modes. Color difference (ΔEab*), translucency parameter (TP) and opalescence parameter (OP) were calculated. All measurements were performed on five different areas of each specimen. All data were analyzed by ANOVA and multiple comparison Scheffé test, Pearson correlations and linear regression analysis (α = 0.05). Results With the increase of the number of coloring liquid applications, CIE L* (R2 = 0.878) and OP values (R2 = 0.701) were decreased, but CIE b* (R 2 = 0.938) was increased. However, TP values were not significantly changed. The color differences among groups ranged from 1.3 to 15.7 ΔEab* units. Strong correlation was found between OP and Δb* (R2 = 0.982, P <.01). Significance Within the limitations of this study, it can be concluded that the number of coloring liquid applications with a single shade affects the lightness, yellow chromaticity and opalescence of monolithic zirconia, although its translucency cannot be controlled by the coloring procedure. © 2014 Academy of Dental Materials.

Lee C.S.,Seoul National University | Lee S.D.,Korean Armed Forces Capital Hospital | Kang S.-H.,Veterans Health Service Medical Center | Park H.Y.,Seoul National University | Yoon I.-Y.,Seoul National University
European Journal of Neurology | Year: 2014

Background and purpose: It is not clear which is preferred between iron supplement and a dopamine agonist in the treatment of restless legs syndrome (RLS) with iron deficiency. The efficacies of oral iron supplementation and pramipexole for treatment of RLS with low-normal serum ferritin (15-50 ng/ml) were compared. Methods: Thirty RLS patients who took either oral iron or pramipexole for 12 weeks and were followed at 2, 4, 8 and 12 weeks after treatment commencement were enrolled. Severities of RLS symptoms were assessed using the international RLS study group rating scale for severity (IRLS) at every visit. Treatment response was defined as a decrease in IRLS score of at least 50% from baseline. Results: The 30 subjects were assigned equally to an iron or pramipexole group. At baseline, IRLS scores and serum ferritin levels were similar between these two groups. After 12 weeks, IRLS scores were lower than those at baseline in both groups (iron -9.1 ± 7.07, P < 0.001; pramipexole -8.7 ± 8.31, P = 0.001) and similar between the two groups. Changes in IRLS scores from baseline were similar between the two groups at each visit. The response rates of the groups were identical at 46.7%. Conclusions: Pramipexole was not different from oral iron in terms of efficacy and improvement speed in RLS patients with a low-normal serum ferritin, but response rate of either oral iron or pramipexole alone was moderate. Some proportion of RLS patients with iron deficiency might benefit from combined use of oral iron and dopamine agonists. © 2013 The Author(s) European Journal of Neurology © 2013 EFNS.

Yoon J.-R.,Veterans Health Service Medical Center | Yoon J.-R.,Korea University
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association | Year: 2014

PURPOSE: The purpose of this study was to determine the size of each meniscus and compare it with the contralateral limb using conventional knee magnetic resonance imaging (MRI) taken from previously uninjured, healthy, young volunteers.METHODS: The knee joints of 60 healthy volunteers (aged 21 to 43 years, 30 men and 30 women) were enrolled in this study. Standard 3.0-T MRI in a controlled setting was used. By use of the mid-coronal images, the height and width of each medial and lateral meniscus were measured. By use of the mid-sagittal images, the height and width of the anterior and posterior horns of each meniscus was measured. The whole length spanning from the most anterior margin to the most posterior margin of each meniscus was also measured. Mean, standard deviation, and 95% confidence interval values were determined for each measurement.RESULTS: There were 3 incomplete discoid lateral menisci (10%) in men and 2 incomplete discoid menisci (6.7%) in women. The study group with non-discoid knees comprised 27 men and 28 women. The power of this study ranged from 0.57 to 0.66. All values showed good reliability (intraclass correlation coefficient range, 0.887 to 0.974). There were no significant differences between right and left menisci (all P > .05). There were significant differences between genders. All parameters showed significant differences (P < .05) except the medial meniscus width (P = .221).CONCLUSIONS: In this small subset of patients, there were no differences between right and left meniscal measurements according to MRI. Therefore, when one is performing meniscal allograft transplantation, contralateral knee MRI may be useful to determine the required size. Identifying both the overall width and length of each meniscus is important when preparing an allograft.CLINICAL RELEVANCE: Contralateral knee MRI may be used for more accurate meniscal size measurement in patients undergoing meniscal allograft transplantation. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Kang H.J.,Veterans Health Service Medical Center | Yoon J.S.,Korea University
Muscle and Nerve | Year: 2016

Introduction: We used ultrasonography (US) to investigate the effects of finger motion on movement of the median nerve in patients with carpal tunnel syndrome (CTS) and the correlation between these US parameters and CTS severity. Methods: Ultrasonographic measures were performed in 23 control wrists and 22 CTS wrists in women. During first through third finger flexion and grip motion, median nerve movements were obtained using US and a tracing program. Results: Nerve movements during third finger flexion in the dorsopalmar axis and grip motion in both axes, and during second finger flexion in the radioulnar axis, differed significantly between the control and CTS groups. US parameters correlated negatively with cross-sectional area. Conclusions: This study shows that transverse median nerve movements decreased during grip using US and correlated negatively with CTS severity. Muscle Nerve, 2016 Muscle Nerve 54: –, 2016 Muscle Nerve 54: 738–742, 2016. © 2016 Wiley Periodicals, Inc.

Yang H.S.,Asan Medical Center | Lee J.,Veterans Health Service Medical Center | Choi S.,Veterans Health Service Medical Center
American Journal of Ophthalmology | Year: 2013

Purpose: To evaluate the ocular biometric parameters associated with intraocular pressure (IOP) reduction after phacoemulsification. Design: Prospective, observational case series. Methods: The study included 999 patients who had undergone uncomplicated phacoemulsification. IOP and ocular biometric parameters were checked preoperatively and 3 months postoperatively using anterior segment optical coherence tomography, optical biometry, and ultrasonic biomicroscopy. The relationship between IOP change and the parameters, including preoperative IOP, anterior chamber depth, axial length, angle opening distance at 500 μm, anterior chamber area, corneal thickness, lens thickness, and iris thickness at 750 μm, was evaluated. Results: The mean patient age was 67.1 ± 4.3 years. The average change in IOP was -1.6 mm Hg (-11.8%). In univariate analysis, axial length, corneal thickness, and iris thickness were not significantly associated with IOP reduction. However, preoperative IOP, anterior chamber depth, angle opening distance, anterior chamber area, and lens thickness were significantly associated with IOP change (P <.05). Furthermore, changes in anterior chamber depth (standardized coefficient beta [B] = -0.082), angle opening distance (B = -0.095), and anterior chamber area (B = -0.380) were more strongly correlated with IOP change than were preoperative factors (B = -0.078, B = -0.071, and B = -0.067, respectively). In multivariate analysis, preoperative IOP, lens thickness, angle opening distance change, and anterior chamber area change were significantly associated with IOP change (P <.005). Conclusion: In addition to preoperative IOP and lens thickness, parameters such as changes in anterior chamber area and angle opening distance were significantly associated positively with reduced IOP after phacoemulsification. © 2013 by Elsevier Inc. All rights reserved.

Kim W.S.,Veterans Health Service Medical Center | Kim E.Y.,Veterans Health Service Medical Center
Annals of Rehabilitation Medicine | Year: 2014

Objective: To find the characteristics of elderly gait, we compared the elderly walking at a moderate speed with the young adult walking at a slow, moderate, and fast speed. Methods: 3D gait analysis was performed on 15 elderly and 15 young adults. Temporo-spatial, kinematic, and kinetic parameters were obtained. Self-selected moderate speed of the elderly walking was compared with self-selected varying speed of the young adults walking. Results: The elderly walked at slower speeds and had shorter step length, but showed similar cadences compared to the young adults. These results remained identical even after the normalization with height. The kinematic and the kinetic graph patterns did not show specific differences between the elderly and the young subjects. Ankle plantarflexion (APF) motion was prominently decreased in the elderly subjects. Hip flexion (HF) motion remained within similar range for the young adults'. HF moment and power were similar with the young adults', but APF power and hip extension power were decreased in the elderly subjects'. Conclusion: A decreased APF motion and power were thought to be specific findings in the elderly walking. The preservation of HF motion and power could be considered a compensation mechanism or a modified neuromuscular pattern in the elderly. The characteristics of the elderly walking should be taken into account when planning rehabilitation strategies of elderly gait training and for future studies on the elderly population. © 2014 by Korean Academy of Rehabilitation Medicine.

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