Raynaud's phenomenon manifests as triphasic color change episodes of blanching, cyanosis, and reddening of the digits, induced by exposure to low temperature or emotional stress. It is a relatively common disorder, estimated to affect 5-10% of the general population and 20-30% of otherwise healthy women. Most cases of primary Raynaud's phenomenon also called Raynaud's disease, are mild and self-limited. Secondary Raynaud's phenomenon presents as a secondary manifestation of an underlying disease and are complicated by ulcerations and tissue necrosis. From March 1996 to August 1998, we experienced 4 patients with Raynaud's phenomenon. Two patients were diagnosed Raynaud's disease and the other two were secondary. Raynaud's disease responded to drug therapy and sympatetic ganglion block. Secondary Raynaud's syndrome was treated with vein graft and free tissue transfer. During postoperative follow-up of 33-49 months, both severity and symptomatic intervals were improved.
Cyanosis ; Drug Therapy ; Female ; Follow-Up Studies ; Ganglion Cysts ; Humans ; Necrosis ; Raynaud Disease ; Stress, Psychological ; Transplants ; Ulcer ; Veins

No abstract available.
Blister ; Humans ; Necrosis ; Rhabdomyolysis

No abstract available.
Hemoptysis*

Coronary artery ectasia (CAE) is a rare condition defined as the dilatation of coronary artery to at least 1.5 times larger than the normal adjacent coronary artery. Clinical manifestations of CAE vary, ranging from asymptomatic to ST-segment elevation myocardial infarction (STEMI). Because of its rarity and clinical diversity, the best treatment strategy and prognosis for CAE remain unclear. We describe a case of STEMI caused by intracoronary thrombus formation within an ectatic area in a patient with liver cirrhosis (LC). The patient was successfully managed by thrombus aspiration only, without balloon angioplasty or stent implantation, and maintained by dual antiplatelet therapy with aspirin and ticagrelor, a potent new P2Y12 inhibitor.
Angioplasty, Balloon ; Aspirin ; Coronary Vessels* ; Dilatation ; Dilatation, Pathologic ; Humans ; Liver Cirrhosis* ; Liver* ; Myocardial Infarction* ; Platelet Aggregation Inhibitors ; Prognosis ; Stents ; Thrombosis*

Dysphagia is a common symptom in elderly individuals, and anterior cervical osteophytes have been implicated as a rare, but surgically correctible cause of dysphagia. In previous studies, surgical treatment of such cases has been associated with immediate symptomatic relief. The surgical outcome of three cases was reviewed retrospectively. A 74-year-old male with progressive dysphagia and aspiration pneumonia attributed to diffuse ossification of anterior longitudinal ligaments (OALL) from C3 to T1 was treated by standard anterior approach and subtotal resection was done. The second case was a 64-year-old male with dysphagia due to diffuse idiopathic skeletal hyperostosis (DISH) underwent anterior DISH resection. The last was a 79-year-old male with progressive dysphagia and aspiration pneumonia due to OALL treated with osteophyte resection. Symptomatic relief was achieved immediately in the first two cases, however, recurrence occurred after seven years in the first case and osteophyte regrowth without symptom in the second case after 33 months follow up. The last case did not have any symptomatic improvement and mechanical obstruction was noted intraoperatively within esophagus. Surgical complication resulting emergency hematoma evacuation and tracheostomy occurred in the second case with complete recovery. Surgical complications, reossification with symptomatic recurrence, and possible plural or mixed causes of dysphagia are all reasons for caution prior to the decision to intervene surgically in such cases.
Aged ; Cervical Vertebrae ; Deglutition Disorders ; Emergencies ; Esophagus ; Female ; Follow-Up Studies ; Hematoma ; Humans ; Hyperostosis, Diffuse Idiopathic Skeletal ; Longitudinal Ligaments ; Male ; Middle Aged ; Osteophyte ; Pneumonia, Aspiration ; Recurrence ; Retrospective Studies ; Tracheostomy

Various vascularized flaps have been used for oral reconstruction after ablative cancer surgery. Among these, the radial forearm flap, rectus abdominis flap and anterolateral thigh perforator flap are the most popular options. In cases of tongue and mouth floor reconstruction, radial forearm fasciocutaneous flap has been the empirical choice for many years. However, it often carries cosmetic and functional problems on the donor site and limitations in flap size and volume. Considering these drawbacks, the anterolateral thigh perforator flap could be a good alternative. Generally, anterolateral thigh perforator flap has been used for tongue reconstruction due to the favorable flap thickness compared to the radial forearm flap. Furthermore, if a thin flap should be required solely for lining purpose, the flap thickness can be controlled through thinning procedures without circulatory compromise. For large composite tissue defects after cancer ablation surgery, the flap can be designed in a 3-dimensional plane and used for volumetric reconstruction as well as for adequate lining. Between September 2002 and September 2003, the authors used 15 anterolateral thigh perforator flaps for reconstruction of oropharyngeal defects after cancer ablation surgery in 15 patieints and analyzed the clinical data acquired retrospectively. Based on the results, we propose the indications and drawbacks of the anterolateral thigh flap in oropharyngeal reconstruction.
Forearm ; Humans ; Mouth Floor ; Mouth* ; Perforator Flap* ; Rectus Abdominis ; Retrospective Studies ; Thigh* ; Tissue Donors ; Tongue

BACKGROUND: Pleural eosinophilia is rare and commonly considered to be an indicator of good prognosis. The diagnostic significance of eosinophilic pleural effusions remains controversial despite a century of observation and discussion. This study was conducted to assess the prevalence of eosinophilia in 446 consecutive samples of pleural fluid, to review the cause of eosinophilic pleural effusion and to determine whether the presence of eosinophils increases the likehood of benign conditions. METHOD: A retrospective analysis was performed upon patients that underwent first thoracentesis due to pleural effusion between January 1999 and December 1999. RESULTS: Eosinophilic pleural effusions were identified in 24 of the 446 patients (5.4%). Malignancy, parapneumonic effusion and tuberculosis were determined the major causes of pleural effusion (80.6%). Malignancy was diagnosed as frequently in eosinophilic effusions as in non-eosinophilic effusions (54.2% vs 50.5%, p=0.725). No difference was found in the prevalence of eosinophilic and non-eosinophilic effusion according to the etiology. The mean blood eosinophil ratio in patients with eosinophilic pleural effusion was 5.4% and no significant correlation existed between the blood and pleural eosinophilic count. CONCLUSION: Pleural eosinophilia is not helpful for differentiating benign and malignant etiology and is not related with blood eosinophilia or repeated tapping.
Eosinophilia ; Eosinophils* ; Humans ; Pleural Effusion* ; Prevalence ; Prognosis ; Retrospective Studies ; Tuberculosis

OBJECTIVES: Cardiovascular disease is the leading cause of death and a major source of workers' compensation claims in Korea. Since 2000 the Korea Occupational Safety and Health Agency (KOSHA), working through local occupational health institutions, has supported cardiovascular disease prevention programs at a number of companies in Korea. The purpose of this study was to assess the short-term effects of this effort. METHODS: A total of 11,077 workers at risk were enrolled in the workplace cardiovascular disease prevention program and 5,902 workers (53.3%) completed the 1-year course during 2007. The program consisted of a medical checkup and health counseling for the workers by occupational health nurses. The guidelines for this prevention program were adopted from KOSHA Code H-11-2004. To determine the program's effectiveness, the workers' risks for cardiovascular disease were assessed before and one year after completion of the program. RESULTS: The intervention led to significant reductions in the mean systolic and diastolic blood pressures of 4.9 mmHg and 3.1 mmHg, respectively. Mean total cholesterol and BMI were also reduced significantly by 8.4 g/dl and 0.1 kg/m2. The rate of smoking was decreased by 6.0% and the percentage of workers engaging in regular exercise was increased by 23.1%. Of the 3,530 workers with the low risk and above, the overall cardiovascular risk was improved in 1,734 (49.1%) of them. CONCLUSIONS: The cardiovascular disease prevention program supported by the Korea Occupational Safety and Health Agency reduces cardiovascular diseases risks among workers and may improve the health status of workers in Korea.
Cardiovascular Diseases ; Cause of Death ; Cholesterol ; Counseling ; Government Programs ; Health Promotion ; Korea ; Occupational Health ; Smoke ; Smoking ; Workers' Compensation

Blue digit syndrome, peripheral atheroembolism, and atheromatous embolization, all refer to microembolization and occlusion of the smaller distal arteries. Despite the longstanding recognition that atheroemboli arise from severely degenerative atherosclerotic plaques in the proximal circulation, many questions remain about the pathophysiology and natural history of this disorder. The threat to the survival of a single digit may not appear to be of great consequence, but repeated episodes of atheroembolism with continued destruction of the collateral circulation may portend disaster for the digit. Diagnostic efforts should be promptly concentrated on the location, stabilization and preferably, eradication of the embolic source. We report 2 cases of blue digit syndrome were managed by endarterectomy and intra-arterial stenting. Case 1: A 61-year-old man was presented with the blue toe syndrome at the third, fourth, fifth toes. The bilateral pedal pulses were normally palpable and ankle-brachial pressure indices (ABI) were within normal range. At the findings of duplex ultrasonography and CT angiography, right common femoral artery showed a focal eccentric stenosis with mural thrombus. The right common femoral artery endarterectomy was performed for the athersclerotic ulcerating plaque. Case 2: A 64-year-old man was presented with 11-month history of his left leg pain and 1-week history of his left third, fourth fingers. He had a history of flap operation for his left fourth finger tip due to necrosis. At the findings of angiography, multiple stenosis of left common iliac and left subclavian arteries were found. The lesion of left subclavian artery lesion was presumed to be the source of blue finger syndrome and treated with intra-arterial stent placement after balloon angioplasty.
Angiography ; Angioplasty, Balloon ; Arteries ; Blue Toe Syndrome ; Collateral Circulation ; Constriction, Pathologic ; Disasters ; Embolism, Cholesterol ; Endarterectomy* ; Femoral Artery ; Fingers ; Humans ; Leg ; Middle Aged ; Natural History ; Necrosis ; Plaque, Atherosclerotic ; Reference Values ; Stents* ; Subclavian Artery ; Thrombosis ; Toes ; Ulcer ; Ultrasonography

PURPOSE: To evaluate the technical feasibility and clinical efficacy of the use of local thrombolysis for below-knee deep vein thrombosis (DVT). MATERIALS AND METHODS: From a population of 41 patients with a lower extremity DVT, the prospective clinical trial included 11 patients (7 female, 4 male, average age 61.4 years) treated with catheter-directed thrombolysis with urokinase for below-knee DVT. After removal of the proximal ilofemoral DVT, additional interventional procedures to remove the residual thrombus and restore the venous flow from the below-knee vein were performed in cases of continuous occlusion of venous flow from the popliteal and tibial veins. Under ultrasound (US) guidance, catheter-directed thrombolysis with urokinase was performed through the ipsilateral popliteal vein. After administration of oral anticoagulation therapy, CT and venography were performed to identify patency and the presence of a recurrent thrombosis. RESULTS: Successful removal of the thrombus and restoration of venous flow were achieved in all of the patients (100%). Restoration of flow with a residual thrombus occurred in one case. Focal venous stenosis was discovered in four cases. The duration of urokinase infusion was 1-4 days (average 2.36 days), which was considered long. For 15.2 months, the venous lumen of all cases was preserved without a recurrent thrombosis. CONCLUSION: Catheter-directed thrombolysis is an effective procedure for recanalization of below-knee DVT in patients with a lower extremity DVT.
Constriction, Pathologic ; Female ; Humans ; Lower Extremity ; Male ; Phlebography ; Popliteal Vein ; Prospective Studies ; Thrombolytic Therapy ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Veins ; Venous Thrombosis