The Relationship between Left Ventricle Diastolic Dysfunction and Carotid Plaques in Elderly Patients with Ischemic Stroke

BACKGROUND: Atherosclerotic plaques in the carotid artery have been considered a potential source of cerebrovas- cular events. Carotid plaques are associated with an increased risk of ischemic stroke. We performed this study to evaluate the relationship between atherosclerotic carotid plaques and cardiac function measured by echocardiography in elderly patients with ischemic stroke. METHODS: A total of 415 patients aged >60 yrs with acute ischemic stroke were divided into two groups according to the presence(groups I, n=195, 140 males) or absence(group II, n=220, 112 males) of carotid plaques. We evaluated the asso ciation of the presence of plaques with age, sex, potential vascular risk factors, other carotid images, and cardiac function by echocardiography. RESULTS: Of the 415 patients, carotid plaques were found in 195 cases. Mean plaque size was 2.44+/-0.7mm on the right side and 2.32+/-0.75mm on the left. Plaques were located more frequently in the carotid bulb(68%) than in the common carotid artery(32%). 57% were calcified plaques and 72%, multiple plaques. Group I(with carotid plaques) had a significantly higher percentage of males(73.6%, p<0.001), hypertension(68.5%, p=0.043), diabetes(28.7%, p=0.029), and dyslipidemia(60.1%, p=0.008). In addition, group I had thicker carotid IMT than group II(Right: 0.86 vs. 0.70mm, p<0.001, Left: 0.90 vs. 0.73mm, p<0.001), lower common carotid artery end diastolic flow velocity(Right: 13.37 vs. 15.73m/s, p=0.002, Left: 14.46 vs.17.24m/s, p=0.004), and higher E/E'level(11.57 vs. 9.36, p=0.001). Old age, dyslipidemia, and diastolic dysfunction were independently associated with carotid plaques. CONCLUSION: Our results indicated that old age, male gender, diabetes, hypertension, and dyslipidemia are more com- mon in patients with carotid plaques than in those without. Old age, male gender, dyslipidemia, and diastolic dysfunc- tion are independent risk factors of carotid plaques in elderly patients with ischemic stroke. We further concluded that though left ventricle systolic function is not associated with carotid plaques in elderly patients with ischemic stroke, left ventricle diastolic dysfunction is.

Phosphodiesterase 4D Gene and Risk of Noncardiogenic Ischemic Stroke in a Korean Population

Recently published studies from different populations provide apparently conflicting evidence on the association between the phosphodiesterase 4D (PDE4D) gene and ischemic stroke. The relationship between a representative PDE4D genotype and ischemic stroke was explored in a case-control study of 205 consecutive Korean patients with noncardiogenic ischemic stroke and 103 healthy controls who were neurologically and radiologically proven to be stroke-free. We selected and genotyped a PDE4D single nucleotide polymorphism (SNP 41, rs152312) as a candidate marker for susceptibility to ischemic stroke because SNP 41 has shown the most significant association with stroke in both a meta-analysis and the original Icelandic study of the PDE4D gene. No significant difference was observed between the cases and controls in the distribution of the PDE4D SNP 41 genotypes. The results from the adjusted conditional logistic regression analysis (adjusted for age, hypertension, diabetes and smoking status) showed no significant association between PDE4D SNP 41 genotypes and an increased risk of noncardiogenic ischemic stroke. The PDE4D gene is not a major risk factor for noncardiogenic ischemic stroke in a Korean population, which supports the recent evidence suggesting that the causative genetic variants of ischemic stroke may differ across populations.

Alteration of Antioxidant Enzyme Gene Expression with Aging and Exercise in Fisher Rats

BACKGROUND: It has been reported that radical oxygen species(ROS) production increased drastically during ageing. This increase in ROS had negative effects on many age-related diseases. In this study, we investigated the effects of ageing and exercise on antioxidant gene expression in Fisher rats and the mechanism of chronic exercise on ROS generation related to ageing. METHODS: After a standard diet, young and old male Fischer rats were assigned to sedentary control groups(young control group: YC, old control group: OC) and exercise training groups(young exercised group: YE, old exercised group: OE). After a 12-week treadmill exercise training in the exercise training groups, antioxidant gene expre- ssion(catalase, glutathione peroxidase) in the liver and muscle was measured by RT-PCR(reverse transcription- polymerase chain reaction). RESULTS: Liver catalase mRNA expression was lower in the old group compared with that in the young group. However, this remained unchanged post-exercise. Liver glutathione peroxidase mRNA expression was not different between the young and old groups and remained unchanged in both these groups. The expression of catalase mRNA in the soleus muscle was significantly lower in the old control rats compared with that in the young rats. Exercise sig- nificantly increased catalase mRNA expression in the soleus in both the young and old rats. The expression of gluta- thione peroxidase mRNA in the soleus was lower in the old control rats than in the young. Exercise significantly increased glutathione peroxidase mRNA expression in both young and old rats. CONCLUSION: This study showed that chronic exercise could be an important contributor to the recovery in the decline of certain antioxidant gene expressions in both young and aged rats. Long-term exercise may posi- tively affect metabolic diseases by modulating antioxidant gene expression.

One-stage Reconstruction of Soft-tissue Defect including Achilles Tendon: A Case Report / 대한정형외과학회잡지

Open defect of the Achilles tendon with loss of overlying skin is very difficult to treat. This condition poses problems of combating infection, providing soft-tissue cover and bridging the gap in the tendon. This has been generally managed in multi-staged procedures. Once the infection is brought under control with debridement and antibiotics, skin cover is provided by the flap. The tendon itself is reconstructed later by a conventional technique. More recently, composite free-tissue transfers repairing the skin and tendon in a single stage have been reported. We describe a simple and very reliable one-stage procedure, using a lateral supramalleolar island flap, a fascia lata autograft and a peroneus brevis tendon transfer, which helps tendon units bridge the gap in the Achilles tendon, and thin and mobile skin to cover the defect in the skin. Our patient showed good result, so we report this case with a review of the literature.

Patellar Tendon Rupture associated with Rupture of Anterior Cruciate Ligament, Both Collateral Ligoments, and Lateral Meniscus: A Case Report / 대한정형외과학회잡지

Combined rupture of the medial collateral ligament, medial meniscus, and anterior cruciate ligament is common. Since O Donoghue described this combined injury in 1950, it has been referred to as O Donoghue's triad. But the rupture of the patellar tendon is a relatively uncommon form of injury, particularly in a young, well-conditioned athlete. Baker (1980) presented a case of O' Donoghue' s triad with a rupture of the patellar tendon. We present an unusual case of patellar tendon rupture associated with rupture of anterior cruciate ligament, medial collateral ligament, lateral collateral ligament and lateral meniscus. This case differs from Baker's case and has not yet been reported in the literature. The senior author performed arthroscopic partial menisectomy, patellar tendon repair by Matava's method and arthroscopic anterior cruciate ligament reconstruction, using the autogenous bone-patellar tendon-bone graft from the controlateral knee. The clinical results were good, and as far as the authors have reviewed, no report has been published about this rare injury. So we report this case with a review of the literature.

Fracture of the Body of the hamate: A case report / 대한정형외과학회잡지

The hamate fracture is very rare condition. The mechanism of fracture may be attributed to direct trauma by rolling down. We have experienced a case of fracture of the body of the hamate bone. It was treated by conservative method. The result was satisfactory with conservative treatment without traumatic arthritis, nonunion, ulnar nerve palsy, flexor digitorum profundus tendinitis & limitation of motion. A case of fracture of the body of the hamate bone is reported with brief review of literature.