PURPOSE: Since the introduction of short vein bypass (SVB), many have reported its feasibility when long vein bypass (LVB) cannot be performed due to limited vein conduit. However, the presence of inflow-vessel disease may affect graft patency and thus require endovascular treatment prior to surgery. Our study aims to analyze the results between SVB and LVB. MATERIALS AND METHODS: From 2009 to 2013, 27 bypass procedures were reviewed retrospectively. Outcomes such as patency rate, postoperative ankle brachial index (ABI) and limb salvage rate between SVB and LVB were compared. Wound healing time and primary patency rate were analyzed and the former was also analyzed according to the respective angiosome and revascularization type. RESULTS: There were 11 males and 16 females and the mean age was 66.6+/-12.3 years. Twenty four patients had TransAtlantic Inter-Society Consensus (TASC) D and 3 patients had TASC C lesions below knee. The 1-year cumulative patency rate between SVB and LVB were 63% and 66%, P=0.627. The limb salvage rate (100% vs. 73%; P=0.280) and postoperative ABI (0.592 vs. 0.508; P=0.620) were higher in the SVB group than in the LVB group, although the differences were not significant. There was no difference in wound healing time by angiosomal revascularization type. In situ vein graft showed higher patency rate than reversed greater saphenous vein (75% vs. 61%; P=0.00) CONCLUSION: The results of SVB were similar to those of LVB. SVB is feasible in the setting of limited conduit availability, in combination with endovascular treatment in the presence of proximal lesions.
Ankle Brachial Index ; Consensus ; Extremities* ; Female ; Humans ; Ischemia* ; Knee ; Limb Salvage ; Male ; Retrospective Studies ; Saphenous Vein ; Transplants* ; Veins* ; Wound Healing

Femur neck fracture is well known as one of the major death cause after trauma in elderly patients, and unsolved fracture due to its frequent association with complications such as avascular necrosis and nonunion. Through meticulous evaluation of the patient, hip and surgeon's experiences, reduction of mortality and morbidity as well as rapid recovery of the patient to the preinjury social and ambulatory status without local complications and revision after treatment is urgently needed. Many factors about this fracture in itself were noted, but we have analyzed 18 femur neck fracture of the patients older than 50 years preliminarily according to age, fracture pattern, osteoporosis, etiology and method of treatment with its delay in association with major complications especially avascular necrosis and nonunion. The results are as follows; 1. Of these 18 fractures, 11 were in females, 8 were caused by minor trauma such as slipdown accident and 4 were associated with definite osteoporosis according to the Sing's classification. 2. Fracture pattern of these 18 are undisplaced in 4, displaced subcapital in 11, displaced transcervical in 3. 11 fractures in the patients older than 60 year are composed of 3 undisplaced or impacted fractures and 8 displaced subcapital fractures. 3. These 18 fractures were treated by closed reduction and internal fixation with multiple pins in 13, and hemiarthroplasty in 4, but one was not treated to die after discharge from hospital. 4. Undisplaced or impacted fractures and 3 displaced transcervical fractures were not associated with any complications such as avascular necrosis or nonunion. But 4 of 6 displaced subcapital fractures were complicated by avascular necrosis, 3 of which were reduced in the varus position within 1 week, and the other was reduced in the good position on 1 week after trauma. There was no complication in 2 displaced subcapital fractures reduced in valgus position within 3 days after trauma. According to the above results, the prognosis of the femur neck fracture is dependent upon the fracture pattern and delay in its treatment. So it is inevitable to reduce the fracture in anatomical or valgus position as early as possible. But the arthroplasty may be needed in displaced subcapital fractures delayed for several days, with its reluction in extreme varus position or impossible and with preexisting disease in the same hip joint (total hip replacement).
Aged* ; Arthroplasty ; Cause of Death ; Classification ; Female ; Femoral Neck Fractures* ; Femur Neck* ; Femur* ; Hemiarthroplasty ; Hip ; Hip Joint ; Humans ; Methods ; Mortality ; Necrosis ; Osteoporosis ; Preexisting Condition Coverage ; Prognosis

Epidermolytic keratosis palmaris is a rare disease which shows clinical findings of Unna Thost keratoderma and histopathologic of epidermolytic hyperkeratosis. We report herein a case of epidermolytic keratosis palmaris et plantaris in a 16-month-old female baby. Light microscopy shows marked hyperkeratosis, large irregular keratohyalin granules, and large clear spaces in the granular and upper spinous layers. Eletron microscopic findings shows that the clear spaces are areas of cytoplasm filled with a fibrillar material and cellular organelles. Abnormal clumping of tonofilament and keratohyalin is also present.
Cytoplasm ; Female ; Humans ; Hyperkeratosis, Epidermolytic ; Infant ; Intermediate Filaments ; Keratoderma, Palmoplantar* ; Keratosis* ; Microscopy ; Organelles ; Rare Diseases

PURPOSE: The Pediatric Risk of Mortality(PRISM) III score was developed from the Physiologic Stability Index(PSI) to assess pediatric ICU mortality and Provide an objective data as a severity index. Although the PRISM score has been applied to many comparisions and analyses in previous studies, there are few reports applied to pediatric intensive care patients in Korea. To evaluate the effectiveness of the PRISM III score as a severity index for expecting mortality and find important variables influencing mortality, we applied this scoring scale to pediatric neurologic patients admitted to the ICU and analyzed the data statistically. METHODS: Data collection was done by careful review of medical records and scored each clinical variable. The outcome at discharge was determined as non-survival, survival, and hopeless discharge. Determination of mortality in the hopeless discharge group was done within 48 hours after discharge by telephone interview. The study populations were classified into four groups; CNS infection(26 patients), acute encephalopathy(31 patients), status epilepticus(35 patients) and cerebrovascular disorder(4 patients). The difference of the PRISM III score between the survival group and non-survival group was compared by using the nonparametric Mann~Whitney test in the entire study population and for each diagnostic group. To confirm the degree of fitness between the actual mortality and Predicted mortality, the Hosmer-Lemeshow goodness-of-fit test, a multiple logistic regression model was used. All clinical variables used for scoring were compared for survivals and non-survivals by the Chi-square test. f values <0.05 were considered significant. RESULTS: The PRISM III score was significantly higher in the non-survival groups than in the survival group. Predicted mortality from the PRISM III score has fitted to actual mortality According to the results of analyses in each diagnostic groups, the PRISM III score was higher in non-survivals of the acute encephalopathy and CNS infection groups, but statistically insignificant in the cerebrovascular disorders and status epilepticus groups. The important variables of the PRISM III score associated with mortality were mental state, Pupil reflex, systolic blood pressure, acidosis, blood sodium level blood creatinine level, blood glucose level, and PT/PTT. , CONCLUSION: The PRISM III score is helpful in predicting mortality in pediatric intensive care neurologic patients, especially those in the acute encephalopathy or the CNS infection groups. However, this score was not useful in the status epilepticus group, and insignificant in cerebrovascular group. Due to the smallness of the study group, more massive and comprehensive studies are needed as a follow up to this study.
Acidosis ; Blood Glucose ; Blood Pressure ; Cerebrovascular Disorders ; Creatinine ; Data Collection ; Follow-Up Studies ; Humans ; Critical Care* ; Interviews as Topic ; Korea ; Logistic Models ; Medical Records ; Mortality* ; Pupil ; Reflex ; Sodium ; Status Epilepticus

Trauma is one of the causes of lymphedema. However, we usually do not consider it as a cause of the lymphedema, thus, we often fail to take care of the patients properly. We report a patient with post traumatic lymphedema and the result of complex decongestive therapy, and reviewed the clinical, lymphoscintigraphic findings and treatment.
Humans ; Lymphedema*

Hepatolithiasis is common in east Asia, but rare in the Western world. Recently, epidemiologic study on Korea gallstone disease showed that the portion of patients with hepatolithiasis among total gallstone patients is 14.1%. Hepatolithiasis is the cause of recurrent cholangitis and it is that risk factor of liver abscess, hepatic failure, or sepsis. Also, biliary cirrhosis and cholangiocarcinoma were developed from hepatolithiasis. The incidence of cholangiocarcinoma associated with hepatolithiasis is about 2.4~10% . We present three cases of unresectable cholangiocarcinoma diagnosed after removal of hepatolithiases by percutaneous transhepatic cholangioscopy.
Cholangiocarcinoma* ; Cholangitis ; Far East ; Gallstones ; Humans ; Incidence ; Korea ; Liver Abscess ; Liver Cirrhosis, Biliary ; Liver Failure ; Risk Factors ; Sepsis ; Western World

OBJECTIVE: To determine the therapeutic effect of paratendinous injection of aprotinin, a polyvalent inhibitor of inflammatory proteolytic enzyme, in patients with shoulder tendinitis. METHOD: Thirty patients with shoulder tendinitis diagnosed with ultrasonography were included. Patients were assigned to one of two groups at random to receive paratendinous injection. One group received a paratendinous aprotinin 1.5 ml and 1% lidocaine 2 ml injection of shoulder2~5 times at 1 week apart. The other group received a paratendinous injection one time with mixture of triamcinolone 40 mg and 1% lidocaine 2.5 ml. The effect of treatment was assessed with the visual analogue scale (VAS), and the patients' life activities were assessed with the Western Ontario rotator cuff(WORC) index. RESULTS: The VAS of the two groups showed improvement at 1 week (aprotinin group: 2.9+/-0.7, triamcinolone group: 3.7+/-1.2) and 4 weeks (aprotinin group: 2.1+/-1.0, triamcinolone group: 2.4+/-1.0) after injection compared with pre- injection status (aprotinin group: 8.6+/-1.3, triamcinolone group: 8.2+/-1.3)(p<0.01) and the WORC index of the two groups showed improvement at 1 week (aprotinin group: 36.5+/-7.8, triamcinolone group: 53.2+/-12.3) and 4 weeks (aprotinin group: 33.4+/-6.2, triamcinolone group: 31.4+/-8.8) after injection compared with pre-injection status (aprotinin group: 116.2+/-29.1, triamcinolone group: 123.5+/-37.0)(p< 0.01). There was no significant difference in the improvement of the VAS scores and WORC index between the two groups. CONCLUSION: The short term effect of paratendinous aprotinin injection in patients with shoulder tendinitis was as good as triamcinolone injection, although more frequent injection was necessary.
Aprotinin ; Humans ; Lidocaine ; Ontario ; Rotator Cuff ; Shoulder ; Tendinopathy ; Triamcinolone

BACKGROUND: It is known that there is a pronounced circardian periodicity for the time of onset of acute myocardial infarction(AMI), with prominent increase in incidence of onset in the morning hours. However, the characteristic circardian variability in AMI is blunted in patients receiving beta-blockers or aspirin therapy before their presentation with AMI. These findings are attributed to the increase in platelet aggregability, blood coagulability, and plasma catecholamine that change coronary tone and myocardial oxygen demand. We hypothesize that, in addition to above physiologic and biochemical parameters, morphologic patterns of the coronary artery lesions are related to the development of circardian variation in AMI. METHOD: Subjects were 160 patients with AMI(male 92, female 68, mean age 56.9 +/-10.5 years old). Patients were classified by the time of onset of typical chest pain(AMI) by 6-hour interval from mid-night. Circardian variability of onset of AMI was compared with clinical findings and coronary angiographic findings. RESULTS: Incidence of onset of AMI was most frequent in the morning hours(6AM-noon,42.5%). There was no difference in degree of stenosis, lesion length, incidence of intraluminal thrombus, among 3 subgroups of AMI according to time of attack. Morning hour group had more frequent ulceration of coronary lesion than that of other groups(22.4% vs. 5.4%, p<0.01), and less frequent calcified lesion than that of other groups(3.0% vs 5.4%, p<0.05). Normal or minimal coronary artery lesion, that is Iess than 25% stenosis, was more frequent in the morning hour group comparing to that of other groups(11.9% vs. 9.78%). Eccentric stenosis(15.7% vs, 11,1%) and diffuse irregular lesion(25.5% vs. 16.7%) tended to be more frequent in the morning hour group. There were no differences in sex, age, incidence of hypertension, cigarette smoking, diabetes, degree of alcohol ingestion, ejection fraction, maximal CK value, preinfarction angina duration, past history of MI, and in incidence of arrhythmia. CONCLUSIONS: There were more ulcerative coronary atherosclerotic lesions, but fewer calcified coronary lesions in the morning group than in afternoon and night group. These findings indicate that morphology of coronary artery lesions may play a role in causing circardian variation in AMI.
Angina, Unstable ; Arrhythmias, Cardiac ; Aspirin ; Blood Platelets ; Constriction, Pathologic ; Coronary Vessels* ; Eating ; Female ; Humans ; Hypertension ; Incidence ; Myocardial Infarction* ; Oxygen ; Periodicity ; Plasma ; Smoking ; Thorax ; Thrombosis ; Ulcer

BACKGROUND: It is known that there is a pronounced circardian periodicity for the time of onset of acute myocardial infarction(AMI), with prominent increase in incidence of onset in the morning hours. However, the characteristic circardian variability in AMI is blunted in patients receiving beta-blockers or aspirin therapy before their presentation with AMI. These findings are attributed to the increase in platelet aggregability, blood coagulability, and plasma catecholamine that change coronary tone and myocardial oxygen demand. We hypothesize that, in addition to above physiologic and biochemical parameters, morphologic patterns of the coronary artery lesions are related to the development of circardian variation in AMI. METHOD: Subjects were 160 patients with AMI(male 92, female 68, mean age 56.9 +/-10.5 years old). Patients were classified by the time of onset of typical chest pain(AMI) by 6-hour interval from mid-night. Circardian variability of onset of AMI was compared with clinical findings and coronary angiographic findings. RESULTS: Incidence of onset of AMI was most frequent in the morning hours(6AM-noon,42.5%). There was no difference in degree of stenosis, lesion length, incidence of intraluminal thrombus, among 3 subgroups of AMI according to time of attack. Morning hour group had more frequent ulceration of coronary lesion than that of other groups(22.4% vs. 5.4%, p<0.01), and less frequent calcified lesion than that of other groups(3.0% vs 5.4%, p<0.05). Normal or minimal coronary artery lesion, that is Iess than 25% stenosis, was more frequent in the morning hour group comparing to that of other groups(11.9% vs. 9.78%). Eccentric stenosis(15.7% vs, 11,1%) and diffuse irregular lesion(25.5% vs. 16.7%) tended to be more frequent in the morning hour group. There were no differences in sex, age, incidence of hypertension, cigarette smoking, diabetes, degree of alcohol ingestion, ejection fraction, maximal CK value, preinfarction angina duration, past history of MI, and in incidence of arrhythmia. CONCLUSIONS: There were more ulcerative coronary atherosclerotic lesions, but fewer calcified coronary lesions in the morning group than in afternoon and night group. These findings indicate that morphology of coronary artery lesions may play a role in causing circardian variation in AMI.
Angina, Unstable ; Arrhythmias, Cardiac ; Aspirin ; Blood Platelets ; Constriction, Pathologic ; Coronary Vessels* ; Eating ; Female ; Humans ; Hypertension ; Incidence ; Myocardial Infarction* ; Oxygen ; Periodicity ; Plasma ; Smoking ; Thorax ; Thrombosis ; Ulcer

BACKGROUND AND OBJECTIVES: To examine the chemopreventive effects of Ginkgo biloba extract (EGb 761) on oral cavity cancer, we investigated the apoptosis of oral cavity cancer cells by EGb 761 and the apoptotic pathway involved. MATERIALS AND METHOD: SCC 1483 cancer cell line derived from a human retromolar trigone carcinoma was used. Inhibition of proliferation was examined by proliferation assay. Apoptosis was measured and confirmed by flow cytometry, DNA fragmentation assay and Western blotting with PARP antibodies. The involvement of the caspase cascade was investigated by co-treating with the caspase inhibitor, z-VAD-fmk. RESULTS: The inhibition of SCC 1483 cells was noted from 250 microgram/ml of EGb 761. Apoptosis was observed after 24 hours of incubation with 250 microgram/ml EGb 761 and it occurred in a time-dependent manner. Apoptosis was confirmed by DNA fragmentation and PARP cleavage. Co-treatment with z-VAD-fmk inhibited apoptosis and PARP cleavage by EGb 761. CONCLUSIONS: EGb 761 induces the apoptosis of SCC 1483 cells and the caspase cascade is involved in this apoptosis. Therefore, EGb 761 may be used as a chemopreventive agent in oral cavity cancer. Further studies are required on the clinical use of EGb 761.
Antibodies ; Apoptosis* ; Blotting, Western ; Caspases ; Cell Line ; DNA Fragmentation ; Flow Cytometry ; Ginkgo biloba* ; Humans ; Mouth Neoplasms ; Mouth*