Jung-Won Ha

Relationship between paraoxonase-1 activity, carotid intima-media thickness and arterial stiffness in hypertensive patients.

Relationship between paraoxonase-1 activity, carotid intima-media thickness and arterial stiffness in hypertensive patients

Operative Treatment for Proximal Phalangeal Neck Fractures of the Finger in Children

Displacement and inappropriate treatment of a proximal phalangeal neck fracture may result in malunion of the fracture with consequent loss of motion and gross deformity, especially in children. We performed a retrospective study of twenty-four patients who had undergone operative treatment for a proximal phalangeal neck fracture, with a mean follow-up evaluation of 14 months (range: 12-30 months). We analyzed the types of fractures, their causes, operative treatments, complications, and functional outcomes. The age of the patients ranged from 2 to 14 years (average: 4.8 years). Twenty of the 24 patients had open reduction and internal fixation, and fourteen of these 20 patients had criss-cross pin fixation. Four of the 24 patients had closed reduction and percutaneous pinning. The average length of immobilization was 3.5 weeks. Excellent or good results were seen in 18 patients (75%). Two patients had complications, which included volar angular deformity and mild button-hole deformity. We recommend that careful initial radiography, particularly, true lateral view radiographs, be required for proper diagnosis. The best results can only be obtained with accurate anatomical reduction of the fracture and early active motion exercise.

Endothelial Nitric Oxide Synthase Glu298Asp Gene Polymorphism is Associated with Hypertensive Response to Exercise in Well-Controlled Hypertensive Patients

Purpose Hypertensive response to exercise (HRE) is known to be an adverse prognostic factor for future cardiovascular events and may be associated to endothelial dysfunction. Previous studies regarding endothelial nitric oxide synthase (eNOS) Glu298Asp polymorphism focused upon its relation to hypertension. In this study, we hypothesize that the polymorphism may be associated with inherent difference in endothelial response to exercise. Patients and Methods Two hundred sixty nine patients who underwent treadmill test were enrolled in this study; 77 patients (mean age 55.8 ± 9.4 years) had hypertensive response (peak systolic BP of ≥ 210mmHg in men and ≥ 190mmHg in women). Pulse wave velocity (PWV) was measured on 153 patients of them. The Glu298Asp exchange in exon 7 was determined by the methods of single base extension with amplifying primers and probes for TaqMan. Results The percentages of the GG, GT and TT genotypes were 81.0, 18.6 and 0.4%, respectively. The presence of GT or TT genotype was independently associated with prevention of HRE when controlled for age, sex, baseline systolic BP and homeostatic model assessment (HOMA) index (OR = 0.35, p = 0.016). Subgroup analysis showed that preventive effect for HRE of T allele was significant in females (p < 0.001) and patients without insulin resistance (p = 0.009). Conclusion In our study, eNOS Glu298Asp polymorphism was significantly associated with HRE. This result suggests that the presence of T allele of the Glu298Asp polymorphism may be a favorable factor to in preventing HRE, especially in female and patients without insulin resistance.

Sexual dysfunction in men with paraparesis in lumbar burst fractures.

Study Design. A retrospective follow-up study. Objectives. To review and analyze the sexual function of patients who have sustained lumbar fractures with incomplete paraparesis. Summary of Background Data. As a result of advances in surgical techniques, most patients with lumbar fractures have significant recovery of neurologic status. Because motor functions are important to patients, most of the studies have concentrated their analyses on motor recovery. Many patients who have almost completely recovered motor function, however, may have sexual dysfunction, especially men. Methods. Forty-three patients with lumbar fractures that resulted in incomplete paraparesis were analyzed. American Spinal Injury Association motor index points were determined for each patient before and after surgery and used for comparison between American Spinal Injury Association motor index and international index of erectile function score. Eleven male patients who reported sexual dysfunction were evaluated by using Rigiscan. Results. During the follow-up period, 42 patients showed neurologic recovery. Average improvement of American Spinal Injury Association motor score was 13.1 and average international index of erectile function score was 45. Average improvement of American Spinal Injury Association motor score for patients who had not reported sexual dysfunction was 12.5, and average international index of erectile function score was 52. For 11 patients in the sexual dysfunction group, preoperative motor score was 28.0, and average improvement of score was 14.9. Nocturnal penile tumescence monitoring results were abnormal in four cases. Averaged international index of erectile function score was 15. There was a statistically significant difference between the sexually healthy and dysfunctional groups in international index of erectile function score (P < 0.05), whereas no difference was noted in American Spinal Injury Association motor score.— Conclusions. Neurologic recovery after lumbar fractures was improved. Regardless of neurologic recovery, most patients reported some disability, usually caused by pain and occasionally sexual dysfunction. Impairment of sexual function was present in four patients (9.3%). Although these patients may preserve psychiatric erection potential, they usually experienced sexual problems.

Radiographic and functional outcome after surgical management of severe scoliosis in skeletally immature patients with muscular dystrophy.

Objective: Most patients with muscular dystrophy (MD) develop progressive scoliosis after losing ambulatory status, but some cases develop severe scoliosis at a skeletally immature age before losing ambulatory status. Only a few studies have been conducted in skeletally immature patients with severe scoliosis. The purpose of this study was to assess the functional and cosmetic outcome in skeletally immature patients with severe scoliosis. Methods: Preoperative, immediate postoperative, and final follow-up radiographs were analyzed in 10 consecutive skeletally immature patients with respect to the Cobb angle degree and the pelvic obliquity angle correction, how long the correction was maintained, and the development of the crankshaft phenomenon. In the functional assessment, the ability to sit balanced, according to the Mulcahy method, and the ability to use hands, according to the Rhyu method, were evaluated. Furthermore, the degree of subjective satisfaction was evaluated in these patients. Results: The average age of the patients was 10.4 years, and the average follow-up period was 33 months with minimum 2 years’ follow-up. All 10 patients survived and were available at the follow-up. The mean Cobb and pelvic obliquity angles were 80° and 17° at the time of the surgery, 31° and 3.7° immediately after the surgery, and 35° and 4.7° at the time of the final follow-up, respectively. The initial mean Cobb angle correction averaged 61%, with 78% of pelvic obliquity corrected. These corrections were maintained over time in most cases. At the time of the surgery, the mean volume of blood loss was 1111 mL, with an average operation time of 411 minutes. There were no major complications. At the time of the last follow-up, no patient showed development of the crankshaft phenomenon. The average score for the ability to sit balanced improved from 4.4 to 6.6 according to the Mulcahy evaluation method. The scores for hand use were 2.2-2.7. However, the forced vital capacity of the lungs decreased from a preoperative 48% to 46.1%. Conclusions: These results indicate that even in very young MD patients with severe scoliosis, acceptable curve correction can be achieved and maintained with surgery. The improved pelvic obliquity and scoliosis angle stabilized the spine, freeing the upper extremities and allowing productive activities characteristic of childhood.

Dual-band branch-line couplers with three parallel lines for arbitrary power-split ratios

This work demonstrates the design procedure for a dual-band branch-line coupler that is capable of having an arbitrary coupling level. Simply with an additional parallel line that connect the centers of the two branch lines, the coupler can be designed to have an arbitrary power-split ratio between the through and coupled ports, while its structural simplicity is preserved. Moreover, the practical range of power-split ratio is relatively wider than previous dual-band branch-line couplers. A detailed design procedure is presented. Experimental results for dual-band couplers centered at 1 and 2.5 GHz with ±3-dB power-split ratios show great agreement with theoretical results. The power-split ratio remains within 0.5 dB from the specified, in as much as 230 MHz bandwidths at both 1 and 2.5 GHz.

39. Comparison of the predictive value of computed tomography with myelography versus MRI using exercise treadmill exam in lumbar spinal stenosis

imaging was used to identify at least one radiologically normal disc from the middle thoracic (T6-7 or T7-8) and lower thoracic (T9-10 or T10-11) regions in each volunteer for IDP measurement. Pressure measurements were taken with a needle-mounted thin film metal diaphragm pressure transducer (Gaeltec, Isle of Skye, Scotland). Local anesthetic was administered, and the needle was placed into the nucleus pulposa under fluoroscopic guidance. Nuclear pressure was measured while the subjects performed a sequence of maneuvers in the prone, sitting, and standing positions. In the prone, sitting upright, and standing upright positions, readings were taken with the needle oriented horizontally and vertically to assess the directional dependence of the sensor, while the rest of the positions were recorded with the needle orientated vertically. Global position and disc level comparisons were made using a two-way ANOVA, and pairwise comparisons were made using the Student-Newman-Keuls method. RESULTS: Intradiscal pressure measurements from one middle and one lower thoracic disc were taken in all but one of the participants; due to the inability to access a middle disc in one subject, two discs from the lower region were measured. Globally, different maneuvers had a statistically significant effect on IDP (p 0.0001). The highest pressures recorded were while the subject was sitting and holding 20 kg with arms flexed (mean SEM, 2.77 0.07 MPa), while the lowest pressures were observed while in the prone position (0.21 0.07). The thoracic level (middle or lower) from which the measurements were taken did not show an overall significant pressure difference (p 0.681). There was no significant difference between pressures takenwith needle oriented vertically versus horizontally (p 0.755). DISCUSSION: This study used a minimally invasive technique to measure IDP of the middle and lower thoracic discs in various body positions. Interestingly, there was not a significant difference in pressures recorded from the middle and lower levels of the thoracic spine despite apparently different mechanical environments. Comparison of pressures from the lumbar spine reportedbyNachemson in1970 to thoseof themiddle and lower thoracic spine show the magnitudes of the thoracic pressures to be similar to those reported in the lumbar spinebutwerenot consistentlyhigheror lower. CONCLUSIONS: The information presented here will aid in understanding intervertebral disc biomechanics, and its relationship to spine pathology and treatment. DISCLOSURES: No disclosures. CONFLICT OF INTEREST: No conflicts.

484 Diversity of clinical manifestations of patients with acute heart failure

484 Diversity of clinical manifestations of patients with acute heart failure K.H. Ryu1, M.M. Lee2, S.C. Chae3, M.C. Cho4, E.S. Jeon5, D.J. Choi6, J.J. Kim7, J.W. Ha8 on behalf of Korean Acute Heart Failure Registry 1Konkuk University Hospital, Cardiology Dept., Seoul: 2Dongguk Univ Hospital, Goyang: 3Gyungbuk Natl. Univ Hospital, Daegu; 4Chungbuk Natl. Univ Hospital, Cheongju; 5Samsung Medical Center, Seoul; 6Seoul Natl Univ Bundang Hospital; 7Asan Medical Center, Seoul, Korea; 8Yonsei Medical Center, Seoul, Korea, Republic of