We experienced a case of a primary aortoduodenal fistula, which was successfully diagnosed and repaired. This diagnosis must be considered in cases of gastrointestinal bleeding with an abdominal aortic aneurysm. If the correct diagnosis can be made promptly, surgical repair of the fistula is possible.
Aortic Aneurysm, Abdominal ; Diagnosis ; Fistula* ; Hemorrhage

A total of 33 patients with infective endocarditis were observed in the Guro and Hye Hwa Hospitals of Korea University Between September, 1981 and Feb, 1987. Among thses patients four patients presented with heart murmur and heart failure and had vegetation like findings observed on the two dimensional echocardiography. But these patients did not have any fever or leukocytosis in the peripheral blood and the repeated blood cultures were negative. They showed the immunologic phenomena of infective endocarditis such as microscopic hematuria in 4 patients, rheumatoid factor in 3 patients, false positive VDRL in one patient. The serum complement was decreased in 2 patients in whom it was checked. We report these 4 patients because we think these patients might be in the clinical stage in which the infecting organism is spontaneously cleared but the immunologic sequelae are remained.
Complement System Proteins ; Echocardiography ; Endocarditis* ; Fever ; Heart Failure ; Heart Murmurs ; Hematuria ; Humans ; Korea ; Leukocytosis ; Rheumatoid Factor

Lichen planopilaris is believed to be a variant of lichen planus which is occasionally accompanied by classical lichen planus. A 68-year old male had asymptomatic skin colored or light violet colored papules and nodules on the occipital area followed by hair loss for 2 months. He had also violaceous pea to bean sized whitish scaly papules on the right lower extremity. Histopathological examination revealed the dilated follicles to be filled with horny material. There were also intense infiltrations of monocytes which were most prominent at the lower pole of the hair follicles on the scalp lesion. There was also hyperkeratosis, focal hypergranulosis and band-like infiltrations of lymphocytes at the dermo-epidermal junction on the lesion of the lower extremity. Direct immunofluorescence examination showed linear deposition of fibrin at the dermo-epidermal junction in the hair follicles. We had an opportunity to observe a man with lichen planopilaris who had loss of scalp hair which was accompanied by classical lichen planus on the lower extremity.
Aged ; Fibrin ; Fluorescent Antibody Technique, Direct ; Hair ; Hair Follicle ; Humans ; Lichen Planus ; Lichens* ; Lower Extremity ; Lymphocytes ; Male ; Monocytes ; Peas ; Scalp ; Skin ; Viola

PURPOSE: The purpose of this study is to evaluate the cost effectiveness of Computed Tomography (CT) in diagnosis of leg swelling, Now that the public health insurance became applicable since last year. METHOD: Nineteen patients who had difficulty in diagnosing the causes of leg swelling in physical examination and two patients for follow up underwent CT according to the protocol used since November 1999. RESULT: Eight patients showed deep vein thrombosis including two patients for follow up. Three patients showed compatible findings with lymphedema. Other causes appear to be originated from soft tissue; intramuscular hematoma in two, popliteal cyst rupture in two, multiple abscess in three and unknown origin in one patient. CONCLLUSION: The value of CT screening in the diagnosis of swollen leg should be reconsidered with the lowered cost to the patients.
Abscess ; Cost-Benefit Analysis ; Diagnosis* ; Follow-Up Studies ; Hematoma ; Humans ; Insurance* ; Leg* ; Lymphedema ; Mass Screening ; Physical Examination ; Popliteal Cyst ; Public Health* ; Rupture ; Venous Thrombosis

The thromboembolic complications of nephrotic syndrome are common especially in the renal vein. However peripheral arterial thrombosis has been reported much less frequently and results in a high rate of limb loss and death. We report one case of femoropopliteal artery thrombosis and also one of deep vein thrombosis, along with a review of the literature. We conclude that interventional treatment is also an important modality even in the hypercoagulable state. Furthermore strict anticoagulation is critical to prevent recurrence during the early stage.
Arteries ; Extremities ; Nephrotic Syndrome* ; Recurrence ; Renal Veins ; Thrombosis ; Venous Thrombosis

PURPOSE: The finding of superficial femoral artery lesions is the most prevalent atherosclerotic lesion identified in peripheral arterial diseases, interventions are provided with a variety of modalities. Many prior studies have shown that patients with leg artery occlusion have serious comorbidity risks such as stroke and ischemic heart disease. In this study we evaluated the clinical significance of the presence of coexistent bilateral femoral artery occlusion to determine clinical significance and comorbidities. METHODS: From 1999 to 2005, there were 213 patients undergoing femoro-popliteal artery bypass for superficial femoral artery occlusion at institution. TASC type B, C lesions were included in this study. We retrospectively analyzed the medical records of 193 patients. Comorbidities, long term graft patency, limb salvage and survival rates were compared between two groups: Group I (115 patients with unilateral lesion) and Group II (77 patients with bilateral lesion). In addition, the natural history of the contralateral limb of patients in Group I were studied. RESULTS: The mean age of Group I and II was 70.5+/-9.3 and 73.0+/-8.2. Diabetes, hypertension, cerebrovascular disease, ischemic heart disease in group I., vs II were: 33.0%, vs. 33.8%, 32.2%, vs. 33.8%, 13.9%, vs. 14.3%, 7.0%, vs. 22.1% respectively; the P-values were 0.91, 0.81, 0.94, 0.002 for each condition respectively. The six-year graft patency, limb salvage and survival rate for group I vs. group II was: 71.58% vs. 69.58%, 86.51% vs. 85.92%, 75.98% vs. 70.95% with p-values of 0.35, 0.58, 0.19. For patients in group I 10.4% (12/115) developed contralateral femoral artery occlusion during a seven year follow up period. CONCLUSION: Ischemic heart disease was significantly higher in patients with bilateral femoral artery occlusion which contributed to perioperative risk. However, no significant difference was identified for long term patency, limb salvage or survival between the two groups.
Arteries ; Atherosclerosis* ; Comorbidity ; Extremities ; Femoral Artery* ; Follow-Up Studies ; Humans ; Hypertension ; Leg ; Limb Salvage ; Medical Records ; Myocardial Ischemia ; Natural History ; Peripheral Arterial Disease ; Retrospective Studies ; Stroke ; Survival Rate ; Transplants

PURPOSE: The finding of superficial femoral artery lesions is the most prevalent atherosclerotic lesion identified in peripheral arterial diseases, interventions are provided with a variety of modalities. Many prior studies have shown that patients with leg artery occlusion have serious comorbidity risks such as stroke and ischemic heart disease. In this study we evaluated the clinical significance of the presence of coexistent bilateral femoral artery occlusion to determine clinical significance and comorbidities. METHODS: From 1999 to 2005, there were 213 patients undergoing femoro-popliteal artery bypass for superficial femoral artery occlusion at institution. TASC type B, C lesions were included in this study. We retrospectively analyzed the medical records of 193 patients. Comorbidities, long term graft patency, limb salvage and survival rates were compared between two groups: Group I (115 patients with unilateral lesion) and Group II (77 patients with bilateral lesion). In addition, the natural history of the contralateral limb of patients in Group I were studied. RESULTS: The mean age of Group I and II was 70.5+/-9.3 and 73.0+/-8.2. Diabetes, hypertension, cerebrovascular disease, ischemic heart disease in group I., vs II were: 33.0%, vs. 33.8%, 32.2%, vs. 33.8%, 13.9%, vs. 14.3%, 7.0%, vs. 22.1% respectively; the P-values were 0.91, 0.81, 0.94, 0.002 for each condition respectively. The six-year graft patency, limb salvage and survival rate for group I vs. group II was: 71.58% vs. 69.58%, 86.51% vs. 85.92%, 75.98% vs. 70.95% with p-values of 0.35, 0.58, 0.19. For patients in group I 10.4% (12/115) developed contralateral femoral artery occlusion during a seven year follow up period. CONCLUSION: Ischemic heart disease was significantly higher in patients with bilateral femoral artery occlusion which contributed to perioperative risk. However, no significant difference was identified for long term patency, limb salvage or survival between the two groups.
Arteries ; Atherosclerosis* ; Comorbidity ; Extremities ; Femoral Artery* ; Follow-Up Studies ; Humans ; Hypertension ; Leg ; Limb Salvage ; Medical Records ; Myocardial Ischemia ; Natural History ; Peripheral Arterial Disease ; Retrospective Studies ; Stroke ; Survival Rate ; Transplants

Leprosy is a multisystemic infectious disease showing various cutaneous manifestations by the reaction between Mycobacterium leprae (M. leprae) and host immunity. We de-scribe a 20-year-old woman with clinical multiple papulonecrotic skin eruptions resembling papulonecrotic tuberculid (PNT) and pityriasis lichenoides et varioliformis acuta (PLEVA). This kind of skin eruption is a new manifestation which has not been reported so far in lepromatous leprosy (LL).
Communicable Diseases ; Female ; Humans ; Leprosy ; Leprosy, Lepromatous* ; Mycobacterium leprae ; Pityriasis Lichenoides ; Skin Manifestations* ; Skin* ; Tuberculosis, Cutaneous ; Young Adult

The objective of this paper is to introduce the schematic protocol of radiofrequency (RF) ablation for the treatment of varicose veins. Indication: anatomic or pathophysiologic indication includes venous diameter within 2-20 mm, reflux time > or =0.5 seconds and distance from the skin > or =5 mm or subfascial location. Access: it is recommended to access at or above the knee joint for great saphenous vein and above the mid-calf for small saphenous vein. Catheter placement: the catheter tip should be placed 2.0 cm inferior to the saphenofemoral or saphenopopliteal junction. Endovenous heat-induced thrombosis > or =class III should be treated with low-molecular weight heparin. Tumescent solution: the composition of solution can be variable (e.g., 2% lidocaine 20 mL+500 mL normal saline+bicarbonate 2.5 mL with/without epinephrine). Infiltration can be done from each direction. Ablation: two cycles' ablation for the first proximal segment of saphenous vein and the segment with the incompetent perforators is recommended. The other segments should be ablated one time. During RF energy delivery, it is recommended to apply external compression. Concomitant procedure: It is recommended to do simultaneously ambulatory phlebectomy. For sclerotherapy, it is recommended to defer at least 2 weeks. Post-procedural management: post-procedural ambulation is encouraged to reduce the thrombotic complications. Compression stocking should be applied for at least 7 days. Minor daily activity is not limited, but strenuous activities should be avoided for 2 weeks. It is suggested to take showers after 24 hours and tub baths, swimming, or soaking in water after 2 weeks.
Baths ; Catheter Ablation* ; Catheters ; Consensus* ; Heparin ; Knee Joint ; Lidocaine ; Saphenous Vein ; Sclerotherapy ; Skin ; Stockings, Compression ; Swimming ; Thrombosis ; Varicose Veins* ; Walking

PURPOSE: To compare the perioperative risks and comorbidities between patients with claudication and patients with critical limb ischemia. METHOD: We retrospectively reviewed the data of 162 patients treated for the leg ischemia at the Vascular Surgery Department at Daegu Catholic University. Excluding patients with acute artery occlusion, vasculitis and Buerger's disease, 127 patients including 58 claudication and 69 critical limb ischemia cases (CI) were studied. To compare perioperative risks, patients data including demographics, physical status classification according to American Society of Anesthesiologists (ASA) and comorbities was collected. RESULT: Mean age was 67.8 years in claudication cases and 68.2 in CI. 98 patients (77.1%) had at least one more associated disease, specifically 87.9% (51/58) in patients with claudication and 66.7% (46/69) in CI. Hypertension was the most frequent disease in both group. Cerebrovascular disease (CVD)(14.5% vs. 12.6%), heart disease (17.3% vs. 10.3%), ASA class 3 (seriously limited physical condition) were more frequent in CI than claudication group (24.6% vs. 15.5%) but not statistically different. 6 patients died during early postoperative period in CI and the claudication group had no deaths. CONCLUSION: Patietns with peripheral arterial diseased patients had high rates of comorbidity (77.1%). More serious disease such as CVD, heart disease were found in CI and associated with higher mortality, which ascertains that more careful attention is be needed, even urgent situations.
Arteries ; Classification ; Comorbidity ; Daegu ; Demography ; Extremities* ; Heart Diseases ; Humans ; Hypertension ; Ischemia ; Leg ; Mortality ; Postoperative Period ; Retrospective Studies ; Thromboangiitis Obliterans ; Vasculitis