Results of the Use of Bioabsorbable Magnesium Screws for Surgical Treatment of Mason Type II Radial Head Fractures

Background@#In Mason classification type II radial head fractures, compared to plate fixation, fixation with cannulated headless screws and absorbable pins has been reported to provide more favorable postoperative outcomes, including less postoperative limitation in range of motion. The fact that radial head fractures are less prone to weight-bearing during fracture union further supports the use of absorbable screws as a suitable alternative treatment option in radial head fractures. This study aimed to perform fixation through open reduction using bioabsorbable magnesium screws for Mason type II radial head fractures and to report radiographic and clinical results. @*Methods@#Among patients who visited the orthopedic department from April 2017 to August 2021, 22 with surgical indications were selected for participation. Radiographic tests were conducted at 2 weeks, 4 weeks, 8 weeks, 12 weeks, 6 months, and over 1 year after surgery to confirm the degree of bone union, reduction loss, and degree of H 2 gas production. The Disabilities of the Arm, Shoulder and Hand (DASH) score, Mayo Elbow Performance Score (MEPS), hand grip power, and range of joint motion were measured at the 6-month follow-up to evaluate the clinical efficacy of the operation. @*Results@#Bone union was confirmed in all 22 cases, and the mean time to union was 10.2 weeks. DASH score was 22.27 on average and no patients complained of significant discomfort after the surgery. The mean MEPS was 91.1. The hand grip power of the affected hand was similar to that of the unaffected hand, being 1.19% weaker on average. These differences reached statistical significance (p = 0.002). The range of elbow joint motion was measured: mean flexion, 146.1°; mean extension, 1.4°; mean pronation, 88.2°; and mean supination, 87.9°. @*Conclusions@#In treating Mason type II radial head fractures, the use of bioabsorbable screws made of magnesium showed satisfactory results in radiographic and clinical evaluations. Magnesium bioabsorbable screws can maintain sufficient stability at the fracture site and have the advantage of avoiding secondary operation for the removal of internal fixation devices.

Effectiveness and Causes of Early Cessation of Intravenous Patient-Controlled Analgesia in Orthopedic Surgery / 대한정형외과학회잡지

Purpose@#This study examined the frequency of early cessation of intravenous patient-controlled analgesia (IV-PCA) after orthopedic surgery, and the difference in frequency according to the surgical site and type to determine the factors affecting the early cessation of IVPCA. @*Materials and Methods@#Based on the medical records of 2,915 patients using PCA after orthopedic surgery from October 2018 to February 2020, sex, age, smoking status, surgical site, operation name, anesthesia method, PCA usage time, satisfaction, side effects, early discontinuation and the reason of early discontinuation were assessed. Orthopedic surgery was classified into major surgery and minor surgery, and the surgical site was classified into the upper limb, lower limb, and spine. The reasons for discontinuation were side effects, patient rejection, and discharge. The factors affecting early discontinuation were identified by univariate analysis, and the degree of each factor affecting early discontinuation was confirmed by logistic regression analysis. @*Results@#The early discontinuation rate of IV-PCA was 6% (upper limb: 8.3%, lower limb: 5.7%). Univariate analysis identified, age, surgical site, surgical classification, anesthesia method, PCA usage time, satisfaction, and side effects as factors affecting early discontinuation. Logistic regression analysis showed that early discontinuation of the upper limb surgery was higher than the lower extremity surgery (p=0.005, odds ratio [OR]=1.78). Moreover, that the early discontinuation of minority surgery was higher than that of major surgery (p=0.002, OR=2.029). The most common reason for early discontinuation in lower extremity surgery is the side effects (71.5%), whereas patient rejection was the major reason in upper limb surgery (41.7%). @*Conclusion@#Early cessation of IV-PCA for postoperative pain control was more frequent in upper extremity surgery than lower extremity surgery. The rate of early discontinuation due to simple rejection or discharge of patients was higher in the upper extremity surgery than lower extremity surgery. Therefore, methods such as neuroaxial anesthesia should be considered for pain control after upper limb surgery rather than IV-PCA.

Results of a Bioabsorbable Magnesium Screw and K-Wire for the Surgical Treatment of an Upper Extremity Fracture / 대한정형외과학회잡지

Purpose@#The treatment of fractures has shown excellent safety enabling solid fixation and early exercise treatment with the development of internal metal fixtures and fixation techniques. On the other hand, complications remain, such as secondary surgery for implant removal and, discomfort caused by internally fixed metal materials. Recently, a bioabsorbable magnesium implant with relatively high strength and low decomposition, manufactured using only body components, was developed in the form of screws and K-wire for use in orthopedic surgery. This study aimed to apply bioabsorbable magnesium screws and K-wires to upper extremity fracture surgery and investigate the results. @*Materials and Methods@#From May 2019 to September 2019, 46 cases (clavicle 11, humerus 4, olecranon 2, radial head 4, coronoid process 3, radius 4, ulna 1, phalanx 8, metacarpals 8, and hamate 1) in 44 patients who agreed to use a bioabsorbable magnesium implant among patients requiring internal fixation using screws and K-wires for upper extremity fractures at the author’s orthopedic surgery department were enrolled. The U&I Corporation commissioned this study, and a prospective study was conducted. The radiological findings and The Disabilities of the Arm, Shoulder, and Hand (DASH) score, hydrogen gas generation, and complications were evaluated. In comminuted fractures, the magnesium screws and K-wires were used for additional interfragmentary fixation with a conventional metal plate and screws in 22 cases. There were 24 cases of exclusive usage. The most common surgical method was intramedullary fixation of bioabsorbable magnesium K-wires in 10 cases. @*Results@#In all cases, bone union was achieved on average 16 weeks (4–28 weeks) after surgery, and the mean DASH score at the last follow-up was 45.0 (30–116). A hydrogen gas cavity produced around the absorbable magnesium implant was observed at an average of two weeks and six days, and the largest was noted at an average of 12 weeks. There were no interactive reactions with drugs, infection, osteolysis, tendon rupture and swelling with hydrogen gas. There were two cases of the loss of reduction, one case of implant breakage, two cases of urticaria. @*Conclusion@#Bioabsorbable magnesium screws and K-wires can be applied for upper extremity fractures, but caution is required.

Paratricipital Approach for AO/OTA Type C2 Intra-Articular Fracture of Distal Humerus

PURPOSE: The aim of this study was to determine the outcomes of fixation of AO/OTA type C2 fractures among intra-articular fractures of the distal humerus using the paratricipital approach (side to side retraction of the triceps). MATERIALS AND METHODS: From June 2008 to January 2018, 12 patients underwent an open reduction and internal fixation with the paratricipital approach and were followed-up for more than 10 months after surgery. According to the AO/OTA classification, type C2 fractures were chosen among the intraarticular distal humerus fractures. An extended posterior incision was used over the olecranon in the prone position, preserving the insertion site of the triceps brachii muscle. The fracture site was exposed by retracting the muscle side-to side through a dissection of the medial and lateral intermuscular septum of the triceps brachii muscle. The therapeutic results were assessed by the anatomical reduction of the articular surface and integrity of the metaphyseal contour in postoperative simple radiographs, complications, such as neuropathy or non-union, and the Mayo elbow performance score (MEPS) were checked to estimate the functional outcome. RESULTS: In the postoperative simple radiographs, no case showed more than 1 mm step-off and the disrupted contour of the distal humerus was recovered to normal alignment in most cases. The range of elbow joint motion in the last follow-up was 133.8° on average with a mean flexion contracture of 5.0°. The clinical results depending on the MEPS were excellent, except for two cases, which were good. Neuropathy of the ulnar nerve was observed in one patient, which was resolved after metal removal. CONCLUSION: The paratricipital approach is useful technique in AO/OTA type C2 intra-articular distal humerus fractures that provides sufficient exposure of the surgical field, without injury to the triceps brachii muscle and postoperative complications associated with the trans-olecranon approach.

Ultrasound-Guided Axillary Brachial Plexus Block, Performed by Orthopedic Surgeons / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to assess the effectiveness and complications of an ultrasound-guided axillary brachial plexus block performed by orthopedic surgeons. MATERIALS AND METHODS: From March to May 2017, an ultrasound-guided axillary brachial plexus block was performed on a total of 103 cases of surgery. A VF13-5 transducer from Siemens Acuson X300 was used. The surgical site was included in the range of the anatomic sensory distribution of the blocked nerve, except for the case where an operation time of more than 2 hours was expected due to multiple injuries and the operation of the upper arm. The procedure was performed by 2 orthopedic surgeons in the same method using 50 ml of solution (20 ml of lidocaine HCl in 2%, 20 ml of ropivacaine in 0.75%, 10 ml of normal saline in 0.9%). The success rate of anesthesia induction during surgery, anesthetic induction time, anatomical range of operation, duration of postoperative analgesia and complications were investigated. RESULTS: The results from the 2 practices were similar. The anesthesia was successful in 100 out of 103 patients (97.1%). In these patients, the average needling time was 5.5 minutes (2.5–13.2 minutes), the average induction time to complete anesthesia was 18.4 minutes (5–40 minutes), and the average duration of postoperative analgesia was 402.8 minutes (141–540 minutes). The post-anesthesia immediate complications were dizziness in 1 case, nausea and vomiting in 4 cases, and peri-oral numbness in 2 cases, but surgery was performed without problems. All these 7 cases with complications recovered on the same day. A total of 3 cases failed with anesthesia, and they were treated by an injection with local anesthesia in the operation room in 2 cases and switched to general anesthesia in 1 case. CONCLUSION: An ultrasound-guided axillary brachial plexus block, which was performed by orthopedic surgeons allows anesthesia in a brief period and the high success rates of anesthesia for certain surgeries of the elbow and surgeries on forearm, wrist and hand. Therefore, it can reduce the waiting time to the operating room. This technique is a relatively safe procedure and dose selective anesthesia is possible.

Usefulness of intraopertive ultrasonography during directional atherectomy using SilverHawk/TurboHawk system

PURPOSE: Directional atherectomy (DA) was introduced for the management of infrainguinal arterial stenosis or occlusive lesions. The procedure success rate in the DEFINITIVE LE study was determined using radiologic imaging. The aim of our study was to determine the usefulness of intraoperative ultrasonography (USG) during DA for evaluating the early results of this procedure. METHODS: Patients who underwent DA from January to December 2014 were reviewed retrospectively. Twenty lesions from 14 patients with femoral artery stenosis (>70% stenosis) with short segment occlusive lesions (<2 cm in length) were treated. Among 20 lesions, 3 were treated with the TurboHawk system with a protective device due to lesion calcification. The percentage of stenosis during and after DA was determined with USG. RESULTS: Median follow-up was 5.1 months, and the procedural success rate (<30% stenosis at the end of the procedure) was 100% on angiography, but only 30% on intraoperative USG. On USG, median residual stenosis was 40% (range, 28%–42%) at the end of DA, 40% (range, 30%–55%) at 1 month, 55% (range, 35%–85%) at 6 months, and 64% (range, 60%–100%) at 1 year. There was one dissection, but no cases of perforation, pseudoaneurysm, or thrombosis. Primary patency, which was defined as a peak systolic velocity ratio ≤3.5 with no reintervention at 6 months, was found in 18 lesions (90%), and 11 of 14 patients (78.6%) were free of ischemic symptoms such as claudication at 6 months. CONCLUSION: Our results demonstrated that DA with intraoperative USG is an effective treatment option for short segment occlusive lesions of the femoral artery.

An Anterior Approach to Entire Length of Humerus and to Distal Shaft for Fracture Fixation

BACKGROUND: The aim of study was to confirm the clinical effectiveness and results of wide and single anterior approach for fractures occurring along length of humerus. METHODS: A total of 23 patients with humeral fracture were enrolled into our study who were able to participate in at least one year of follow-up. Seven patients had segmental comminuted humeral fractures and 16 patients had distal humeral fractures. We made various tractions of the muscles to expose the proximal and the middle third humerus between the biceps and brachialis and the distal humerus by partial splitting of lateral side of biceps through a single incision. Postoperatively, we measured the Mayo elbow performance index (MEPI). RESULTS: we achieved bone union in all 23 patients. Solid union of the bone was achieved at an average 13.9 weeks. Postoperatively, two complications were observed screw loosening and nonunion. Revision surgery was performed in both patients. The patient with bone nonunion was treated using bone grafts. No postoperative infections or peripheral neuropathies were observed. At the final follow-up (average 20 months), we found that the average MEPI functional score of the patients was 91.7 points regardless of the fracture site. CONCLUSIONS: Our whole humerus with a single incision was effective for the treatment of segmental comminuted and distal fractures. we believe it is a useful alternative to preexisting methods of fracture fixation.

An Anterior Approach to Entire Length of Humerus and to Distal Shaft for Fracture Fixation

BACKGROUND: The aim of study was to confirm the clinical effectiveness and results of wide and single anterior approach for fractures occurring along length of humerus. METHODS: A total of 23 patients with humeral fracture were enrolled into our study who were able to participate in at least one year of follow-up. Seven patients had segmental comminuted humeral fractures and 16 patients had distal humeral fractures. We made various tractions of the muscles to expose the proximal and the middle third humerus between the biceps and brachialis and the distal humerus by partial splitting of lateral side of biceps through a single incision. Postoperatively, we measured the Mayo elbow performance index (MEPI). RESULTS: we achieved bone union in all 23 patients. Solid union of the bone was achieved at an average 13.9 weeks. Postoperatively, two complications were observed screw loosening and nonunion. Revision surgery was performed in both patients. The patient with bone nonunion was treated using bone grafts. No postoperative infections or peripheral neuropathies were observed. At the final follow-up (average 20 months), we found that the average MEPI functional score of the patients was 91.7 points regardless of the fracture site. CONCLUSIONS: Our whole humerus with a single incision was effective for the treatment of segmental comminuted and distal fractures. we believe it is a useful alternative to preexisting methods of fracture fixation.

Clinical Features and Treatments of Carpal Bone Cysts

PURPOSE: A total of 27 carpal bone cysts were analyzed for their sites, relations of other wrist soft tissue ganglions and their results of treatment were evaluated. METHODS: Twenty-seven carpal bone cysts in 20 patients (bilateral 5, multiple 2) from February 2002 to June 2013 were evaluated. Mean follow-up period was 16.6 months. We investigated etiological classification, the site of carpal bone cyst, and their relationship with soft tissue ganglion in same wrist. Pain, range of motion, radiographic changes, and their satisfaction after treatment were assessed postoperatively. RESULTS: The carpal bone cysts occurred mainly at the radial wrist axial ray on the lunate (12 cases), scaphoid (6 cases), and triquetrum (5 cases), trapezium (2 cases), and capitate (2 cases). Based on the magnetic resonance imaging (MRI) findings in 25 cases, we classified carpal bone cysts into 4 distinct types; type I with purely intraosseous lesion (16 cases), type II with bone cyst associated cortical perforations (6 cases), type III with coexisting soft tissue ganglion communicating with intra-osseous lesion (2 cases), and type IV with coexisting soft tissue ganglion non-communicating intraosseous lesions (1 case). CONCLUSION: The carpal bone cysts can be classified by MRI into 4 distinct types. The purely intraosseous type is most common, suggesting the intrinsic cause in the development of carpal bone cyst.

Results of Arthroscopic Partial Meniscectomy for Lateral Discoid Meniscus Tears Associated with New Technique

PURPOSE: To introduce and evaluate the clinical results of a new arthroscopic technique for partial meniscectomy of symptomatic lateral discoid meniscus using a knife. MATERIALS AND METHODS: From March 2005 to October 2010, 60 knees of 58 patients underwent arthroscopic partial meniscectomies for lateral discoid meniscus. The average age was 28.9 years (range, 12 to 63 years), and average follow-up was 26 months (range, 8 to 72 years). In this procedure, using a No. 11 knife holder inserted through the high far anteromedial portal, a stab incision on the anterior meniscal horn and following piecemeal meniscal excision were made. Clinical results were assessed using the scale of Ikeuchi and Lysholm score. RESULTS: Meniscus shape was complete in 32 knees (53.3%) and incomplete in 28 knees (46.6%). The shape of tears in complete type lesions was horizontal cleavage in 17 knees (53.1%), flap or complex degenerated tears in 10 knees (31.2%) and radial tears in 5 knees (15.6%). Clinical results assessed using the scale of Ikeuchi were excellent in 38 (63.3%), good in 13 (21.6%), fair in 8 (13.3%) and poor in 1 knee (1.6%). The average Lysholm score was improved from 82.8 preoperatively to 95.4 postoperatively. CONCLUSIONS: Our new arthroscopic technique in lateral discoid partial meniscectomy suggests convenient methods and successful clinical results.

Minimum 1 Year Results of Arthroscopic Pull-out Repair for Posterior Root Tear of Medial Meniscus / 대한스포츠의학회지

This study is to evaluate clinical and arthroscopic second-look results of arthroscopic repairs of posterior root tears of medial meniscus which may cause loss of circumferential hoop tension and extrusion of meniscus. From October 2006 to May 2009, fifty-eight patients (59 knees) underwent arthroscopic pull-out repairs. Clinical results were evaluated using Hospital for Special Surgery (HSS) score and International Knee Documentation Committee (IKDC) score for 12-month follow-up. Second-look arthroscopy was done to evaluate meniscal healing in 21 cases. Magnetic resonance imaging (MRI) was performed to assess status of repaired meniscus and tibial tunnel position in 9 patients. Average preoperative HSS score and IKDC score of 59 cases were 69.5 and 36.0, respectively. Average postoperative HSS score and IKDC score of 59 cases had been changed into 90.3 (p<0.001) and 66.8 (p<0.001), respectively. Second-look arthroscopies revealed complete or incomplete healing except one case. Two patients showed increased one grade according to the Kellgren-Lawrence radiologic classification system and others showed no change. Of 9 patients who performed MRI, six patients showed complete healing. The average position of tibial tunnel was 4.8 mm anterior and 5.7 mm medial to center of posterior cruciate ligament. Arthroscopic pull-out repair technique using transtibial tunnel seems to be simple and effective procedure for posterior root tear of medial meniscus. Further evaluation of arthroscopic repair of posterior root tear of medial meniscus should be needed to prove the effectiveness on the prevention of osteoarthritis of knee.

Incomplete Reduction that Influence Reduction of Sesamoid as a Cause for Recurrence of Hallux Valgus / 대한족부족관절학회지

PURPOSE: The incomplete reduction of the sesamoid has lately been issued as cause for recurrence. In this study, we analysed factors that may influence reduction of sesamoid. MATERIALS AND METHODS: The study consists of 50 cases operated by single surgeon. Eighteen cases were done by proximal chevron osteotomy, and 32 cases were done by scarf osteotomy. Hallux valgus (HV) angle and intermetatarsal (IM) angle were measured before and three months after the surgery. Sesamoid position (SP) was classified according to Hardy and Clapham grade system. RESULTS: After the proximal chevron osteotomy, the correction of the mean HV angle was 19.5degrees, and IM angle was 6.2degrees. SP was changed from 5.6 to 3.4 grade. After the Scarf osteotomy, the correction of the mean HV angle was 25 degree, and IM angle was 9degrees. SP was changed from 5.5 to 2.8 grade. There was difference of sesamoid's correction between two different method of surgery (p=0.127). However, better correction of sesamoid was witnessed with bigger correction angle regardless of method of surgery (p=0.002, 0.001). CONCLUSION: We believe surgical method do not effect sesamoid's correction but more correction angle can result in better correction of sesamoid position.

Incomplete Reduction that Influence Reduction of Sesamoid as a Cause for Recurrence of Hallux Valgus / 대한족부족관절학회지

PURPOSE: The incomplete reduction of the sesamoid has lately been issued as cause for recurrence. In this study, we analysed factors that may influence reduction of sesamoid. MATERIALS AND METHODS: The study consists of 50 cases operated by single surgeon. Eighteen cases were done by proximal chevron osteotomy, and 32 cases were done by scarf osteotomy. Hallux valgus (HV) angle and intermetatarsal (IM) angle were measured before and three months after the surgery. Sesamoid position (SP) was classified according to Hardy and Clapham grade system. RESULTS: After the proximal chevron osteotomy, the correction of the mean HV angle was 19.5degrees, and IM angle was 6.2degrees. SP was changed from 5.6 to 3.4 grade. After the Scarf osteotomy, the correction of the mean HV angle was 25 degree, and IM angle was 9degrees. SP was changed from 5.5 to 2.8 grade. There was difference of sesamoid's correction between two different method of surgery (p=0.127). However, better correction of sesamoid was witnessed with bigger correction angle regardless of method of surgery (p=0.002, 0.001). CONCLUSION: We believe surgical method do not effect sesamoid's correction but more correction angle can result in better correction of sesamoid position.

Effects on Changes in Femoral Vein Blood Flow Velocity with the Use of Lower Extremity Compression for Critical Patients with Brain injury

PURPOSE: This study was done to evaluate the mean venous velocity (MVV) response with knee and thigh length compression stockings (CS) versus intermittent pneumatic compression (IPC) devices in immobile patients with brain injuries. METHODS: We carried out a randomized controlled study. We analyzed both legs of a randomly chosen sample of 43 patients assigned to one of 4 groups (86 legs). The patients were sequentially hospitalized in the intensive care unit (ICU) in "S hospital" from November 2005 to December 2006. The base line and augmented venous velocity was measured at the level of the common femoral vein. We applied leg compression 42 times over 7 days (for 2 hours at a time at 2 hour intervals). RESULTS: There was a statistical difference among the 4 groups. The difference for the "IPC" group was more significant than the "CS" group. CONCLUSION: These results indicate that the application of IPC can be considered as an effective method to prevent deep vein thrombosis for immobile patients with brain injury.

ACL Reconstruction with a Minimally Invasive Physeal Plate in Adolescence: Technical Note

Substantial ACL ruptures are not common in adolescence or childhood. During this period, ACL tibia avulsion fractures are more common than substantial ACL ruptures are. However, recent advancements in MRI and increases in adolescent sports activity have led to increased diagnosis of substantial ACL ruptures. Many physeal-sparing ACL reconstruction methods have been reported. However, some physeal-sparing ACL reconstructions are associated with poor outcomes because of laxity in the reconstructed ligament and discordance in the isometric point. We report a 14-year-old male patient with a chronic substantial ACL rupture and a longitudinal medial meniscus tear who was treated with ACL reconstruction and all-inside meniscal repair, which spares the femoral physis and reduces tibia physeal injury with an Achilles allograft.

Prevalence and Risk Factors of Asymptomatic Carotid Stenosis in Healthy Korean Population

PURPOSE: To investigate the prevalence and risk factors in stenosis of the extracranial carotid artery in a healthy Korean population. METHODS: Seventeen thousand two hundred and eighty one patients, without previous history of transient ischemic attacks, amaurosis of fugax and/or any neurologic deficit, who underwent carotid artery ultrasonography, were evaluated retrospectively. The patients were divided into six groups according to the degree of carotid artery stenosis, using real time B-mode high resolution ultrasonography; Group A-normal, Group B-from 1 to 15% carotid artery stenosis, Group C-from 16 to 49% carotid artery stenosis, Group D-from 50 to 79% carotid artery stenosis, Group E-from 80 to 90% carotid artery stenosis and Group F-carotid artery occlusion (100%). Medical the records of all patients were investigated for the following factors; age, gender, diabetes mellitus, hypertension, smoking, over weight, total cholesterol, HDL- cholesterol, LDL-cholesterol, TG (triglyceride), and HbA-1c (hemoglobinA-1c). RESULTS: There were 950 (5.5%) cases in Group A, 82 (0.5%) in Group B, 710 (4.1%) in Group C, 138 (0.8%) in Group D, 2 (0.01%) in Group E, 18 (0.1%) in Group F. The age, total cholesterol, LDL-cholesterol, and HbA-1c were higher in Groups B, C, D, E and F than in Group A, with statistical significance. Other factors, however, were no different among the groups. CONCLUSION: Asymptomatic carotid stenosis is not uncom mon in Korea. To prevent a stroke caused by carotid stenosis, carotid ultrasonography would be necessary in patients at high risk of atherosclerosis, such as hypertension, diabetes and a high serum cholesterol level.

Prevalence of Asymptomatic Carotid Atherosclerosis in Korea

PURPOSE: To investigate the prevalence and risk factors of atherosclerotic disease of the extracranial carotid artery in healthy Korean population. METHODS: Eight hundred twenty-five patients without previous history of transient ischemic attack, amaurosis fugax, and/or any neurologic deficit who underwent carotid artery ultrasonography were evaluated retrospectively. The patients were divided into five groups according to the degree of carotid artery stenosis using real-time B-mode high resolution ultrasonography; Group A-normal carotid artery, Group B-below 30% of carotid artery stenosis, Group C-from 31% to 50% of carotid artery stenosis, Group D-from 51% to 70% of carotid artery stenosis, Group E-above 71% of carotid artery stenosis. Medical Records of all patients were investigated for following factors; sex, age, family history, smoking, hypertension, diabetes mellitus, total cholesterol, HDL- cholesterol, LDL-cholesterol, TG (triglyceride), HbA-1c (hemoglobin A-1c), and folate. RESULTS: 12.5% of asymptomatic patients have carotid stenosis due to atherosclerosis of extracranial carotid artery. The prevalence of extracranial carotid artery stenosis was as follows; Group B: 2.2%, Group C: 7.0%, Group D: 3.0%. The age, total cholesterol, LDL-cholesterol and HbA-1c were significantly higher in Group B, C, D than Group A (P=0.001, 0.016, 0.011, 0.001). The prevalence of diabetes and hypertension were significantly higher in Group B, C, D than Group A. Other factors, however, were not different among the groups. CONCLUSION: Asymptomatic carotid artherosclerosis is not uncommon in Korea. Carotid ultrasonography would be necessary for patients with hypertension, diabetes, and high serum cholesterol level.

Analysis of the Venous Hemodynamic Changes in the Primary Varicose Vein of the Lower Limbs

PURPOSE: To evaluate the changes of venous hemodynamics after the treatment of the primary varicose vein of the lower limbs. METHODS: We retrospectively analyzed 493 lower limbs (221 right and 272 left, 157 male and 336 female) who underwent surgery for the primary varicose veins from September 1994 to May 1999. All patients were evaluated using air-plethysmography (APG) pre-and post-operatively. RESULTS: The prevalent age was 40 to 49-year-old and the male to female ratio was 1:2. Presumed etiological factors included occupations requiring long periods of standing in 94 cases, and pregnancy in 188 female cases. The average duration of illness was 12.9+/-8.2 years. 232 limbs were treated with a method of the greater saphenous vein high ligation (GSV HL) and above knee (AK) stripping with varicosectomy (VS), 38 limbs with GSV HL and total stripping and VS, 101 with short saphenous vein HL and VS, 100 with external banding valvuloplasty of GSV and VS, 5 with external banding valvuloplasty of GSV only, 10 with Linton's operation, 6 with GSV branch ligation and VS, and sclerotherapy in 9. The reduction rate of venous volume (VV) were 13.9+/-6.6 % in GSV stripping group and 20.4+/-18.2% in GSV valvuloplasty group. The reduction rate of venous filling index (VFI) were 53.6+/-31.0% in GSV stripping group and 58.9+/-33.7% in GSV valvuloplasty group. The increasing rate of ejection fraction (EF) were 26.9+/-41.1% in GSV stripping group and 21.1+/- 32.2% in GSV valvuloplasty group. The reduction rate of ambulatory venous pressure (AVP) were 4.4+/-128% in GSV stripping group and 22.7+/-73.3% in GSV valvuloplasty group. CONCLUSION: In patients with primary varicose vein of the lower limbs, APG could be a useful method for the documentation of hemodynamic improvement by showing decrease in VV, VFI, AVP and increase in EF.

Characteristics of Vascular Anatomy and Hemodynamics in Korean Population

The value of the noninvasive diagnostic methods for vascular disease is worthy of emphasis. In many studies, the diagnostic abnormal findings of the vascular disease were reported. But there were a few studies for normal human vasculatures measuring with noninvasive diagnostic methods. And more, there is few data for vasculature of Oriental people, especially of the Korean population. The authors examed 20 healthy persons without any vascular disease by using the noninvasive vascular diagnostic tool-duplex scan and air plethysmography. The knowledge of the normal data of human vasculature, especially Korean population, will improve the sensitivity and specificity of the noninvasive vascular diagnostic methods. It is not appropriate to presume that this report with analysis of only 20 cases represent the normal data of Korean population. Further collection of the data is needed to define the normal data of vasculature of Korean population.