PURPOSE: Critical limb ischemia (CLI) is equated with a need for limb salvage. We studied whether measurement of skin perfusion pressure (SPP) can be used to accurately identify the ampuation level of those patients with CLI who require major amputation and predict the patients whose foot ischemic ulcer would heal or not after vasodilator treatment for over 4 weeks. METHODS: Fifty-one patients with a nonhealing foot ulcer were studied prospectively at Yeungnam university hospital. Age range was 46 to 78 years old with average 68 years old and male to female ratio was 3.3:1. Patients were included in the study if informed consent for medication of vasodilators was obtained, and patients were excluded if there was uncontrolled sepsis or if they required imminent amputation. We used PGE1 (Opalmon(R), 6 tablets/day #3 for 6 weeks, 100 mg/tablet) in 20 cases, PGI2 (Beraprost(R), 6 tablets/day, #3 for 6 weeks, 20 mg/tablet) in 16 cases and Argatroban (antithrombin: Novastan(R) 2 amples/day #2 IV for 4 weeks, 10 mg/ample) in 15 cases. The ankle pressure was checked for each limb. Measurements of SPP were made with photoplethysmography (Life Sciences MVL Modulab(R)) at the metatarsal level which were mostly located at the proximal site of ulcer in viable tissue. The SPP measuements were compaired with the clnical results of therapy (group I: stop medication and major amputation in 7 cases, group II: failed to heal in 18 cases, group III: ulcer healed in 26 cases) in group II & III. We calculated overall acuracy of SPP measurement for prediction of limb ischemic ulcer healing. RESULTS: The ankle pressure or Ankle Brachial Index (ABI) was not predictive of the need for the outcome of drugs therapy. Average SPPs were 12+/-6 mmHg in group I,27+/8 mmHg in group II and 45+/-7 mmHg in group III. The overall predictive accuracy of SPP over 40 mmHg for ulcer healing was 80%. CONCLUSIONS: SPP measurement with PPG is an objective, easy and effective noninvasive method that can be used to predict ischemic ulcer healing.
Aged ; Alprostadil ; Amputation ; Ankle ; Ankle Brachial Index ; Epoprostenol ; Extremities ; Female ; Foot ; Foot Ulcer ; Humans ; Informed Consent ; Ischemia ; Limb Salvage ; Male ; Metatarsal Bones ; Perfusion ; Photoplethysmography ; Prospective Studies ; Sepsis ; Skin ; Ulcer ; Vasodilator Agents

OBJECTIVES: To evaluate the urinary concentrations of hydroxyridinium crosslinks of collagen in patients with osteoarthritis(OA) or rheumatoid arthritis(RA), and to compare its clinical correlation with the classic indices of the disease activity of RA. METHODS: Concentrations of urinary pyridinoline (Pyd) and deoxypyridinoline(Dpd) were measured in urinary samples collected from 18 control patients, 35 patients with OA, 45 patients with RA by competitive enzyme immunoassay using microplate coated with monoclonal antibody. RESULTS: 1) Mean urinary concentrations of Pyd in OA patients were 33.5nmol/mmol creatinine, in RA patients were 50.0nmol/mmol creatinine which were higher than the values in controls (25.1 nmol/mmol creatinine). Also, mean concentrations of Dpd in OA patients were 9.2nmol/mmol creatinine, in RA patients were 10.1nmol/mmol creatinine which were higher than the values in controls(5.6nmol/mmol creatinine)(p<0.01). 2) Mean urinary concentration of Pyd was 50.0 nmol/mmol creatinine in RA patients, which was significantly higher than the values in OA(33.5 nnmol/mmol creatinine)(p<0.05), but the mean Dpd concentratians were not significantly different between the two groups. 3) The concentrations of urinary Pyd in RA patients was significantly correlated with the biologic markers indicating inflammatory activity such as ESR(r=0.68, p<0.001), CRP(r=0.72, p<0.001) and the number of tender joint(r=0.66, p<0.01) CONCLUSION: Urinary concentrations of Pyd and Dpd were significantly higher in OA and RA patients than in controls, Especially urinary Pyd concentrations were significantly increased in RA patients than in OA patients, and strongly correlated with disease activity index of rheumatoid arthritis. The mean Dpd concentration, bone specific analogue, in RA patients was not significantly different from that of OA patients and it was not correlated with disease activity index Thus measurement of urinary Pyd might provide a sensitive, noninvasive biochemical marker for studying activity of RA.
Arthritis, Rheumatoid ; Biomarkers ; Collagen ; Creatinine ; Humans ; Immunoenzyme Techniques ; Osteoarthritis

We studied 54 normal volunteers and 30 patients with Bell's palsy by magnetically and electrically evoked direct stimulations of facial nerve. A magnetic coil was placed tangentially to the parieto-occipital area and the stylomastoid foramen. Magnetic stimulation (MS) was less painful and able to excite deeper tying neural structures. Magnetically and electrically evoked direct stimulations of facial nerve showed the same characteristics in excitability and nerve conduction, but they could not be evaluated on the basis of the same normative data. We identified a locus of the impulse generation that might be closer to the exit of facial nerve from the brainstem. Compared with normal controls, MS-evoked CMAPS of patients with Bell's palsy had no responses, longer latencies, lower amplitudes, or disperses pattern. This study shown that MS at the stylomastoid foramen can not be used for the evaluation of the facial nerve conduction study in place of electrical stimulation(ES). As the transcranial MS can stimulate intracranial proximal portion of facial nerve directly and noninvasively, it can give additional information on the evaluation of facial nerve. Transcranial MS combined with ES may provide the means for assessing the entire facial nerve.
Bell Palsy ; Brain Stem ; Electric Stimulation* ; Facial Nerve* ; Healthy Volunteers ; Humans ; Neural Conduction

OBJECTIVES: The analysis of heart rate variability (HRV) is a useful non-invasive tool to investigate the autonomic nerve function. Previous studies on the relationship between HRV and depression have been reported controversial results. Similarly, the correlation between the serum lipids and depression is debatable. The purpose of this study is to examine the relationship between heart rate variability, lipid profile and depression. METHODS: A total of 42 patients with major depressive disorder (MDD) and 32 age and sex-matched normal subjects who had no previous history of major medical and mental illnesses were recruited for this study. A structured-interview was used to assess the general characteristics and psychiatric illness. HRV measures were assessed by time-domain and frequency-domain analyses. Psychological symptoms were measured using the Hamilton rating scale for anxiety (HAM-A), Hamilton rating scale for depression (HAM-D). In addition, the evaluation for lipid profile was performed by blood test. RESULTS: In serum lipid profile test, MDD group showed higher cholesterol (197.68+/-42.94 mg/dL vs. 176.85+/-34.68 mg/dL, p=0.044), TG (139.45+/-92.54 mg/dL vs. 91.4+/-65.68 mg/dL, p=0.018), LDL (130.03+/-33.18 vs. 106.62+/-27.08, p=0.004) level than normal control group. In HRV time domain analyses, the standard deviation of the NN interval (SDNN) was decreased in MDD group than normal control group, but was not significant (32.82+/-14.33 ms vs. 40.36+/-21.40ms, p=0.078). ApEn (Approximate Entrophy) was significantly increased in MDD group than normal control group (1.13+/-0.11 vs. 0.91+/-0.18, p<0.001). ApEn was correlated with LDL level (r=0.277, p=0.028), HAM-D scores (r=0.534, p<0.001) and HAM-A scores (r=0.470, p<0.001). CONCLUSION: MDD patients showed increased ApEn, one of the HRV measurement. And this ApEn was correlated with LDL, HAM-D and HAM-A scores. In this study, the analysis of ApEn would be a useful test of MDD.
Anxiety ; Autonomic Pathways ; Cholesterol ; Depression ; Depressive Disorder, Major ; Heart ; Heart Rate ; Humans

Isoimmune hemolytic disease of the newborn due to anti-E is a disease characterized by the progressive neonatal hyperbilimbinemia and anemia which is caused by the IgG antibody transmitted from the mother to the ferns. Authors have experienced two cases of isoimmune hemolytic disease due to anti-E, who presented with jaundice on the first and the second day of life, respectively. The ABO and Rh blood types of their mother and father were B, CcDee and O, ccDEE, respectively. Both babies showed positive direct Coombs test and the mother showed strong positive indirect Coombs test. Antibody identification tests were made only in the first case and the mother, both of which revealed anti-E antibody. The first case was treated with phototherapy for 3 days and two blood transfusions. The second case was treated with phototherapy for 6 days and two exchange transfusions.
Anemia ; Blood Transfusion ; Coombs Test ; Fathers ; Ferns ; Humans ; Immunoglobulin G ; Infant, Newborn ; Jaundice ; Mothers ; Phototherapy ; Siblings*

No abstract available.
Drug Therapy* ; Granulocyte Colony-Stimulating Factor* ; Granulocytes* ; Leukemia, Myeloid, Acute*

The lateral medullary syndrome, I. E. Wallenberg syndrome, presents with several forms of sensory deficits. However, the correlation between the sensory deficits and the MRI findings of the medulla has been rarely attempted. We studied 16 patients with lateral medullary infarction who showed appropriate MRI lesions and correlated their sensory findings with the MRI results. In order to examine the extent of lesion of medulla in the MRI, we divided the medulla into three parts, namely upper, middle, and lower parts. The patients exhibited six types of sensory manifestation. In brain MRI, five patients with uncrossed sensory deficit; three patients with contralateral sensory deficit involving only body; and one patient with contralateral sensory level on trunk showed a diagonal band, lateral, or combined lesion in the medulla. Four patients with crossed sensory deficit and one patient with ipsilateral sensory deficit involving only face showed a large, laterodorsal lesion in the medulla. Two patients without sensory deficit exhibited a dorsal lesion in the medulla. In conclusion, lateral medullary syndrome usually has a characteristic lesion in the MRI according to the sensory deficits.
Brain ; Humans ; Infarction ; Lateral Medullary Syndrome* ; Magnetic Resonance Imaging*

No abstract available.
Hysterectomy*

No abstract available.
Hysterectomy*

PURPOSE: The aim of this study was to analyze the factors related to nonunion in tibiotalar arthrodesis. MATERIALS AND METHODS: Eighty cases of ankle arthritis treated with tibiotalar arthrodesis in our hospital from November 2008 to November 2015 with more than one year follow up were analyzed. Simple anteroposterior and lateral radiographs after 6 and 12 months of surgery were analyzed. Union was defined as more than 50% connection of the trabecular bone at the ankle joint surface in the anteroposterior and lateral radiographs. The nonunion group was defined as no signs of union with persistent pain 9 months after surgery. The surgical approach, type of used screw, preoperative and postoperative ankle alignment, body mass index (BMI), bone mineral density, and patients' prior history were compared between the two groups. RESULTS: There were 69 union cases and 11 nonunion cases. In the patient factors, the gender and BMI was related to nonunion (p<0.05). The mean preoperative and postoperative ankle alignment in the nonunion group was 9.93°±6.92° and 5.43°±3.35° respectively, and 9.80°±7.55° and 5.63°±3.45° in the union group, respectively; the difference was not statistically significant (p>0.05). In the technical factors, the transfibular approach showed a better relationship but the association was not significant (p<0.05). In 40 cases of the transfibular approach, 12 cases used cancellous screws, and 4 cases showed nonunion due to screw breakage. CONCLUSION: Technical factors, such as the surgical approach and the type of screw used can be a risk factor in nonunion. In addition, patients' factors, such as gender and BMI, must be considered to reduce the nonunion rate.
Ankle ; Ankle Joint ; Arthritis ; Arthrodesis* ; Body Mass Index ; Bone Density ; Follow-Up Studies ; Humans ; Risk Factors