PURPOSE: To evaluate the clinical manifestations, the patterns and the functional outcome of the amputations due to the diabetic foot complications. MATERIALS AND METHODS: Fifty patients (50 feet) of diabetic foot amputations were followed for more than 1 year. The mean age was 62.5 years, and the mean follow-up period was 46 months. Retrospective analysis was performed using chart review and interview with the patients. The outcome was assessed with modified AOFAS scale. RESULTS: The diabetic foot lesions were infection in 45 feet, gangrene in 35 feet and ulcer in 15 feet. Toe amputation was most commonly performed procedure (23 cases) followed by below knee and ray amputation. Postoperative modified AOFAS score was average 51.5 points, and 94% were satisfied with outcome. Minor amputations showed better outcome than the major amputations. CONCLUSION: Overall postoperative functional outcome was encouraging with high patient satisfaction rate (94%). Better outcome was obtained with the minor amputations.
Amputation* ; Diabetic Foot* ; Follow-Up Studies ; Foot ; Gangrene ; Humans ; Knee ; Lower Extremity* ; Patient Satisfaction ; Retrospective Studies ; Toes ; Ulcer

PURPOSE: Survival outcome of locally advanced pancreatic cancer has been poor and little is known about prognostic factors of the disease, especially in locally advanced cases treated with concurrent chemoradiation. This study was to analyze overall survival and prognostic factors of patients treated with concurrent chemoradiotherapy (CCRT) in locally advanced pancreatic cancer. MATERIALS AND METHODS: Medical records of 34 patients diagnosed with unresectable pancreatic cancer and treated with definitive CCRT, from December 2003 to December 2012, were reviewed. Median prescribed radiation dose was 50.4 Gy (range, 41.4 to 55.8 Gy), once daily, five times per week, 1.8 to 3 Gy per fraction. RESULTS: With a mean follow-up of 10 months (range, 0 to 49 months), median overall survival was 9 months. The 1- and 2-year survival rates were 40% and 10%, respectively. Median and mean time to progression were 5 and 7 months, respectively. Prognostic parameters related to overall survival were post-CCRT CA19-9 (p = 0.02), the Eastern Cooperative Oncology Group (ECOG) status (p < 0.01), and radiation dose (p = 0.04) according to univariate analysis. In multivariate analysis, post-CCRT CA19-9 value below 180 U/mL and ECOG status 0 or 1 were statistically significant independent prognostic factors associated with improved overall survival (p < 0.01 and p = 0.02, respectively). CONCLUSION: Overall treatment results in locally advanced pancreatic cancer are relatively poor and few improvements have been accomplished in the past decades. Post-treatment CA19-9 below 180 U/mL and ECOG performance status 0 and 1 were significantly associated with an improved overall survival.
Chemoradiotherapy* ; Follow-Up Studies ; Humans ; Medical Records ; Multivariate Analysis ; Pancreatic Neoplasms* ; Survival Rate

Animals ; Horns ; Myelin Sheath ; Neurons ; Patch-Clamp Techniques ; Potassium ; Pronase ; Rats ; Sensation ; Sodium ; Thermolysin ; Trigeminal Nucleus, Spinal

Paraganglioma is an unusual neoplasm that is embryologically derived from neural crest cells. The most common location of this neoplasm is the adrenal medulla, where these tumors are known as pheochromocytoma. It is extremely rare that paragangliomas occur in the liver. There are only 7 reports of primary hepatic paraganglioma. A 56-year-old man was referred to XX Medical Center. Hypertension was not found. He had suffered from jaundice, headache and weight loss for the 4 previous weeks, but hypertension was not present. The total bilirubin was 7.7 mg/dl and the CA19-9 level was 56.3 U/dl. The tumor was diagnosed as intrahepatic cholangiocarcinoma on the computed tomography image. After biliary drainage via endoscopic nasobiliary drainage, surgical exploration was carried out; right trisectionectomy with caudate lobectomy, portal vein resection and anastomosis were then done. The final pathological diagnosis was primary hepatic malignant paraganglioma of the intrahepatic duct. There has been no evidence of recurrence on the follow up CT images during the 24 month follow up period.
Adrenal Medulla ; Bilirubin ; Cholangiocarcinoma ; Drainage ; Follow-Up Studies ; Headache ; Humans ; Hypertension ; Jaundice ; Liver ; Liver Neoplasms ; Middle Aged ; Neural Crest ; Paraganglioma ; Pheochromocytoma ; Portal Vein ; Recurrence ; Weight Loss

PURPOSE: Metastasis to the pancreas is rare, and the benefit of resection for pancreatic metastasis is poorly defined. The aim of this study was to review our experiences of the operative management of metastasis to the pancreas. METHODS: Between 1995 and 2009, 11 patients (8 men and 3 women; median age, 54 years) were admitted to our institution with a metachronously metastatic lesion to the pancreas and later underwent pancreatic resection. The clinical features and outcomes of treatments were examined. RESULTS: The primary cancers were renal cell carcinoma (RCC, n = 7), carcinoid tumor (n = 2), rectal cancer and leiomyosarcoma. Six patients underwent distal pancreatectosplenectomy, 3 pancreaticoduodenectomy and 2 patients underwent enucleation for small RCC. One patient died of metastatic RCC at 53 months after surgery and ten patients remain alive; four patients without disease at 7 to 69 months postoperatively, and the other six with disease at 11 to 68 months. Median postoperative survival of all patients was 34 months. CONCLUSION: Patients with a low surgical risk should be considered for pancreatic metastasectomy if curative resection is possible. Primary cancer type, which is associated with survival benefit, would be the best candidate for surgical resection of metastases to the pancreas.
Carcinoid Tumor ; Carcinoma, Renal Cell ; Humans ; Leiomyosarcoma ; Male ; Metastasectomy ; Neoplasm Metastasis ; Pancreas ; Pancreaticoduodenectomy ; Rectal Neoplasms

PURPOSE: Pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) are treatments used for pancreatic benign neoplasms even though both of these treatments result in significant loss of normal pancreatic parenchyma; this leads to subsequent impairment of exocrine and endocrine pancreatic function. The purpose of this study is to provide short-and long-term result of limited resection (LR) in a single center. METHODS: Two-hundred thirty patients who had undergone pancreatic resection between April 1998 and September 2008 for benign neoplasms were reviewed retrospectively. DP was performed in 102 patients, LR in 77, PD in 51 patients. The definitions of the International Study Group of Pancreatic Fistula (ISGPF) were applied to postoperative pancreatic fistulas (POPF), perioperative endocrine function was evaluated through oral glucose tolerance test. RESULTS: LR includes 42 enucleation, 24 central pancreatectomy, and 11 uncinate process resection. No deaths occurred to patients during the study review period; POPF was detected in 50 patients (65%), 37 patients with grade A and 13 patients with grade B or C. POPF occurred 65% of the time after LR, more frequently compared to the occurrance after PD or DP (58%), but this was not statistically significant (P =.322). After LR, there were 2 patients with new onset diabetes (3%), while 26 (17%) patients developed diabetes after DP or PD (P = .002). CONCLUSION: LR may preserve endocrine and exocrine function. While mortality is low with the use of LR, it is associated with a higher pancreatic-leakage rate. The precise management of benign pancreatic lesions remains in evolution.
Glucose Tolerance Test ; Humans ; Pancreatectomy ; Pancreatic Fistula ; Pancreaticoduodenectomy ; Retrospective Studies

Metastases of malignant tumors to the oral region from distant sites are uncommon. A 45-year-old man with painless gingival swelling was diagnosed with adenocarcinoma of the lung. On cytology, clusters of tumor cells on mucous background revealed enlarged nuclei, indistinct cell borders, and irregular nuclear membranes. Some cells showed nuclear inclusions, nuclear grooves and small nucleoli. These findings are indicative of metastatic adenocarcinoma. We present a case of gingival metastasis from a lung adenocarcinoma.
Adenocarcinoma ; Biopsy, Fine-Needle ; Gingiva ; Humans ; Intranuclear Inclusion Bodies ; Lung ; Lung Neoplasms ; Middle Aged ; Neoplasm Metastasis ; Nuclear Envelope

BACKGROUND/AIMS: Acute hemorrhagic rectal ulcers (AHRUs) are rare and have not been thoroughly studied. This study aimed to assess the clinical and endoscopic characteristics of AHRUs and to determine the risk factors for rebleeding after the initial management. METHODS: Thirty patients who underwent colonoscopy within 48 hours of the onset of hematochezia were consecutively enrolled between January 2004 and December 2007. The patients were divided into a rebleeding group and a non-rebleeding group according to presence of recurrent bleeding after initial management. We analyzed the clinical features, including the underlying disorder, the Karnofsky performance status (PS), the use of anticoagulant or antiplatelet agents, the endoscopic findings, and the methods used for hemostasis. RESULTS: All of the patients were elderly, in a bedridden status, and all had experienced the sudden onset of massive, fresh rectal bleeding without pain. The characteristics of the lesions on colonoscopy included solitary or multiple rectal ulcers, or Dieulafoy lesions located in the distal rectum. There were no differences between the two groups based on mean age, gender, use of anticoagulant or antiplatelet agents, PS, methods of hemostasis, and clinical outcomes. The PT (INR) and endoscopic findings (Dieulafoy types), however, differed significantly between the two groups (p=0.024 and p=0.013, respectively). CONCLUSIONS: When massive hematochezia occurs in bedridden patients with severe comorbid illnesses, AHRUs should be considered in the differential diagnosis. It is advisable to be vigilant for rebleeding in patients with prolongation of the PT (INR) and Dieulafoy-type ulcers on colonoscopy.
Aged ; Colonoscopy ; Diagnosis, Differential ; Gastrointestinal Hemorrhage ; Hemorrhage ; Hemostasis ; Humans ; Karnofsky Performance Status ; Platelet Aggregation Inhibitors ; Rectum ; Risk Factors ; Ulcer

Addison's disease is a rare chronic endocrine disorder which results from progressive destruction of the adrenal glands. It is kind of autoimmune polyendocrine syndrome type 2 with autoimmune thyroiditis, and can lead to fatal outcomes when complicated in pregnancy. We report on an anesthetic experience with 38-year-old primigravida with Addison's disease and hypothyroidism who was followed up from the early stage of pregnancy to delivery by a multidisciplinary medical board. Great attention was given to steroid replacement therapy as well as fetal surveillance in order to lower the risk of maternal and fetal mortality. This report describes our experience of the spinal anesthetic management for Cesarean section of a patient with Addison's disease and hypothyroidism.
Addison Disease* ; Adrenal Glands ; Adult ; Anesthesia, Spinal ; Cesarean Section* ; Fatal Outcome ; Female ; Fetal Mortality ; Humans ; Hypothyroidism ; Pregnancy ; Thyroiditis, Autoimmune*

Addison's disease is a rare chronic endocrine disorder which results from progressive destruction of the adrenal glands. It is kind of autoimmune polyendocrine syndrome type 2 with autoimmune thyroiditis, and can lead to fatal outcomes when complicated in pregnancy. We report on an anesthetic experience with 38-year-old primigravida with Addison's disease and hypothyroidism who was followed up from the early stage of pregnancy to delivery by a multidisciplinary medical board. Great attention was given to steroid replacement therapy as well as fetal surveillance in order to lower the risk of maternal and fetal mortality. This report describes our experience of the spinal anesthetic management for Cesarean section of a patient with Addison's disease and hypothyroidism.
Addison Disease* ; Adrenal Glands ; Adult ; Anesthesia, Spinal ; Cesarean Section* ; Fatal Outcome ; Female ; Fetal Mortality ; Humans ; Hypothyroidism ; Pregnancy ; Thyroiditis, Autoimmune*