Randomized Comparison of Actual and Ideal Body Weight for Size Selection of the Laryngeal Mask Airway Classic in Overweight Patients

Size selection of the laryngeal mask airway (LMA) Classic based on actual body weight remains a common practice. However, ideal body weight might allow for a better size selection in obese patients. The purpose of our study was to compare the utility of ideal body weight and actual body weight when choosing the appropriate size of the LMA Classic by a randomized clinical trial. One hundred patients with age 20 to 70 yr, body mass index > or =25 kg/m2, and the difference between LMA sizes based on actual weight and ideal weight were allocated to insert the LMA Classic using either actual body weight or ideal body weight in a weight-based formula for size selection. After insertion of the device, several variables including insertion parameters, sealing function, fiberoptic imaging, and complications were investigated. The insertion success rate at the first attempt was lower in the actual weight group (82%) than in the ideal weight group (96%), even it did not show significant difference. The ideal weight group had significantly shorter insertion time and easier placement. However, fiberoptic views were significantly better in the actual weight group. Intraoperative complications, sore throat in the recovery room, and dysphonia at postoperative 24 hr occurred significantly less often in the ideal weight group than in the actual weight group. It is suggested that the ideal body weight may be beneficial to the size selection of the LMA Classic in overweight patients (Clinical Trial Registry, NCT 01843270).

Clinical and Radiographic Features of Adult-onset Ankylosing Spondylitis in Korean Patients: Comparisons between Males and Females

The objective of this study was to investigate clinical and radiographic features and gender differences in Korean patients with adult-onset ankylosing spondylitis. Multicenter cross-sectional studies were conducted in the rheumatology clinics of 13 Korean tertiary referral hospitals. All patients had a confirmed diagnosis of ankylosing spondylitis according to the modified New York criteria. Clinical, laboratory, and radiographic features were evaluated and disease activities were assessed using the Bath ankylosing spondylitis disease activity index. Five hundred and five patients were recruited. The male to female ratio was 6.1:1. Average age at symptom onset was 25.4+/-8.9 yr and average disease duration was 9.6+/-6.8 yr. Males manifested symptoms at a significantly earlier age. HLA-B27 was more frequently positive in males. Hips were more commonly affected in males, and knees in females. When spinal mobility was measured using tragus-to-wall distance and the modified Schober's test, females had significantly better results. Radiographic spinal changes, including bamboo spine and syndesmophytes, were more common in males after adjustment of confounding factors. In conclusion, we observed significant gender differences in radiographic spinal involvement as well as other clinical manifestations among Korea patients with adult-onset ankylosing spondylitis. These findings may influence the timing of the diagnosis and the choice of treatment.

Rapidly Progressive Interstitial Lung Disease Associated with Dermatomyositis; A Case Report / 대한류마티스학회지

A previously healthy 44-year-old woman who was diagnosed as having dermatomyositis suddenly developed severe dyspnea while being in the state of improved condition of muscle weakness. Interstitial lung disease was found on high resolution computed tomography (HRCT). In spite of the treatment with the immune-modulating agent (high dose steroid, cyclophosphamide, immunoglubulin and cyclosporine), her condition deteriorated further and rapidly, leading to death. More intensive agent such as FK506 would be necessary in those cases of dermatomyositis-related interstitial lung disease that have poor prognostic factors.

Correlation between Sonographic Severity and Biochemical Markers of Synovium and Cartilage in Knee Osteoarthritis Patients / 대한류마티스학회지

OBJECTIVE: Ultrasonography has benefit in detecting soft tissue abnormalities within the joints, which cannot be assessed by conventional X-ray. In this study, we investigated the relationship between soft tissue and/or bony abnormalities on ultrasonography and biochemical markers of synovium and cartilage in knee osteoarthritis (OA) patients METHODS: Fifty-one knee OA patients who fulfilled the ACR criteria were enrolled in this study. Knee ultrasonography was performed in affected knee joints with a 12 MHz linear probe to assess the presence of effusion, synovial proliferation, capsular distension, length of osteophytes, and thickness of cartilage. At the same time, the serum levels of hyaluronic acid (HA) and cartilage oligomeric protein (COMP) were measured by ELISA and serum osteocalcin levels were determined by RIA. RESULTS: The patients with longer medial osteophytes showed higher levels of serum HA and COMP than those with shorter ones. Serum HA levels were significantly higher in patients with larger amount of effusion and/or synovial proliferation, suggesting inflammatory changes within the joint, than those without. In addition, the severity of capsular distention was also correlated well with serum HA and COMP levels. However, the length of lateral osteophytes and thickness of femoral cartilage were not correlated with serum HA or COMP levels. Serum osteocalcin levels did not show any association with above ultrasonographic parameters, either. CONCLUSIONS: Using knee ultrasonography, we demonstrated that serum HA and COMP levels were elevated in more severe OA patients than less severe patients. This result suggests that detailed pathologic changes in the soft tissue and/or bone of OA joints on ultrasonography are being directly reflected to biochemical markers measured in the peripheral blood.

Correlation of Sonographic Findings with Knee Joint Pain in Knee Osteoarthritis Patients / 대한류마티스학회지

OBJECTIVE: To investigate the ultrasonographic findings in knee OA patients and to examine the possible causes of pain in osteoarthritis by ultrasonography. METHODS: Ultrasonography was performed with 7.5 MHz linear probe in 64 knee OA patients who fulfilled the ACR criteria. All patients were graded according to the Kellgren-Lawrence grades and then classified into group 1 (K/L I and II) and Group 2 (K/L III and IV). Also WOMAC score, BMI, laboratory finding (ESR, CRP) were checked. Ultrasonographic findings was examined; effusion, thickening of synovium, vertical length of medial and lateral osteophyte (longitudinal view), length of capsular distension (medial longitudinal view), evidence of bursitis and articular cartilage. RESULTS: 50.0% of patients had effusion, among whom 68.7% patients also had synovial thickening. In all patients, the severity of pain was correlated with 4 variables; the presence of effusion, disease duration, the length of medial osteophyte, the length of capsular distension (r=0.279, r=0.415, r=0.537, r=0.608, respectively, p<0.05). The length of medial osteophyte, the degree of capsular distension and disease duration were significantly correlated with WOMAC pain score in Group 1 (p<0.05). After multiple regression analysis, the length of medial osteophyte alone had correlation with the pain severity in Group 1 (r2= 0.396 p<0.05) and the only length of capsular distension was significantly correlated with WOMAC pain score in Group 2 (r=0.609, p<0.05). CONCLUSION: The length of osteophyte may be more related with pain severity in mild cases (K/L score I and II) while capsular distension could be an important factor causing knee pain in more advanced knee OA (K/L score III and IV).

Serum Levels of Zinc and Copper are Associated with Disease Activity in Patients with Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: To investigate the relationship between serum trace element levels with disease activity in Korean patients with rheumatoid arthritis (RA). METHODS: The serum levels of zinc, copper and ceruloplasmin were measured by inductively coupled plasma atomic emission spectrometers in 80 patients th , 26 osteoarthritis (OA), and 30 healthy controls (HC). We also measured the levels of zinc and copper in the synovial fluid (SF) of patients with RA. We nvestigated the clinical parameters simultaneously obtained at sampling of serum and analyzed correlation between serum levels of trace elements and disease activity in RA. RESULTS: In RA, the levels of serum zinc were significantly lower than that of HC, and thelevels of serum copper and ceruloplasmin were significantly higher than those of HC. In active RA, the levels of serum zinc were more decreased , and the levels of serum copper and ceruloplasmin were more increased than those of inactive group of RA. The levels of both copper and ceruloplasmin showed positive correlation with the levels of serum ESR and CRP. On the other hand, the levels of serum zinc showed negative correlation with the levels of serum ESR and CRP. CONCLUSION: Serum zinc levels are significantly lower and serum copper levels significantly higher in patients with active RA and these trace elements were useful parameter of disease activity in RA.

Effect of Cyclooxygenase-2 Specific Inhibitor (SC-58635) on the Production of Nitric Oxide and Prostaglandin E2 in Lipopolysaccharide-stimulated Macrophage Cells

BACKGROUND: Celecoxib, a COX-2 specific inhibitor, has recently been used for the treatment of rheumatoid arthritis. However, the molecular and cellular mechanisms of celecoxib against RA inflammation remain to be defined. To elucidate the action mechanism of celecoxib on inflammatory cells, we investigated the effect of celecoxib on the production of two important mediators of inflammation, nitric oxide and PGE2 METHODS: RAW 264.7 cells stimulated with LPS were preincubated with various concentrations of celecoxib (from 10(-8) to 10(-5) M) and 10muM hydrocortisone, respectively. The production of NO and PGE2, the end products of iNOS and COX-2 genes, were estimated in culture supernatants by Greiss method and EIA, respectively. The expression of iNOS gene, COX-2 gene, NF-kappaB, and I-kappaB were determined by RT-PCR and western blot analysis. RESULTS: Celecoxib and hydrocortisone inhibited the production of NO and PGE2 in dose dependent manner, when RAW 264.7 cells were stimulated with LPS. The expression of iNOS was also down-regulated by celecoxib and hydrocortisone. Interestingly, COX-2 gene differentially expressed according to the dose of celecoxib, a decrease with lower dose (10(-8) M) but an increase with higher dose (10(-5) M). NF-kappaB binding activity was decreased by lower dose of celecoxib, whereas was not affected by higher dose of it. The expression of I-kappaB was suppressed by higher dose of celecoxib. CONCLUSION: The celecoxib strongly suppressed the production of NO and PGE2 in LPS-stimulated RAW264.7 cells. The decrease of NO seems to be linked to the inhibition of iNOS by celecoxib. The lower and higher dose of celecoxib differentially regulated the COX-2 expression and NF-kappaB activity

Effect of Erythropoietin on Dialyzer Reuse, Dialysis Efficacy and Other Clinical Parameters / 대한신장학회잡지

The use of erythropoietin for correction of anemia in maintenance hemodialysis patients affects dialyzer reuse, dialysis efficacy and other clinical parameters. This study showed the change of Kt/Vurea, nPCR, pre-dialysis BUN, body weight, ultrafiltration volume, pre-dialysis blood pressure, heparin dosage, the number of dialyzer reuse caused by the administration of erythropoietin in reuse(n=11) and first use(n=9) patients who were started erythropoietin since January, 1995. 1) In 20 all patients, hematocrit increased significantly after EPO treatment 20.7+/-0.8%, 27.8+/-0.7%, ultrafiltration volume increased from 2.0+/-0.3L to 2.5+/-0.2L(P1.0/kg/ day) and then pretreatment versus posttreatment nPCR, pre-dialysis BUN and ultrafiltration volume were compared. In low baseline protein intake group, significant increases of ultrafiltration volume, nPCR were observed. However, pre-dialysis BUN were not changed significantly. In high protein intake group, nPCR, pre-dialysis BUN, ultrafiltration volume were changed without significance. In conclusion, EPO treatment did not affect Kt/Vurea, dialyzer reuse, nPCR, predialysis blood pressure, heparin dosage. But ultrafiltration volume increased significantly after EPO treatment. Maybe increased appetite in low baseline protein intake group caused the increased posttreatment ultrafiltration volume.

Circadian Variation of Cardiac Autonomic Function in Hypertensives

BACKGROUND: We addressed the problem of the circadian changes in neural control of the circulation in ambulant hypertensive subjects. With spectral analysis of heart rate variability the tonic sympathetic and vagal activities and their changes are respectively assessed by the power of 0.050 - 0.015Hz(low frequency, LF) and 0.150 - 0.350Hz(respiratory linked, high frequency, HF) components of the spectrum of the beat by beat variability of RR interval. METHODS: Heart rate variability(HRV) and its circadian rhythm were evaluated in 15 patients with hypertension. By using 24-h Holter monitoring, HRV and its spectral components were measured. Finding were compared with 15 age-matched normal controls. RESULTS: The 24-hour plot of the SDs revealed that heart rate variability was significantly lower in the hypertensive patients, and the differences reached statistical significance during hours 2, 3, 9, 13, 16, 18, 19, and 23(p<0.05). Spectral analysis showed that power in the high-frequency range(0.150 to 0.350Hz) was lower among the hypertensive patients than among the normal controls during 22 of 24 hours but that the difference was statistically significant only during 2 hours(p<0.05). Power in the low frequency range(0.050 to 0.150Hz) was low at night, increased in the morning, and high during the day among controls ; this circadian rhythm was absent among hypertensive patients. CONCLUSIONS: Among hypertensive patients, HRV is decreased with a partial withdrawal of parasympathetic tone, and the circadian rhythm of sympathetic/parasympathetic tone is altered.