No abstract available.
Diagnosis ; Venous Thrombosis

PURPOSE & METHOD: To evaluate clinical pattern and operative outcome of the ischemic lower extremity, 142 patients who were admitted to Yeungnam University Hospital between January 1996 to December 1998 were analyzed. RESULTS: The patients were 125 males and 17 females ranging from 21 to 88 years of age. The mean age was 59, with the highest incidence among people in their 60s, followed by those in their 70s and then in their 50s. The causes of arterial occlusive disease were artherosclerotic obliterans (ASO) in 87 cases (61.2%), thromboangitis obliterans (TAO) in 44 cases (30.9%), thromboembolism in 10 cases and superficial femoral aneurysm in 1 case. Associated diseases in ASO were hypertension in 37 cases (42.5%), diabetes mellitus in 17 cases (30.9%), cardiac disease in 24 cases (27.5%) and cerebrovascular disease in 7 cases (8.0%). History of smoking was noted in 77.4% of the cases. The major arterial occlusive site of ASO were femoral artery in 36 cases (41.3%), aortoiliac artery in 26 cases (29.8%), iliofemoral artery in 9 cases (10.3%), popliteal artery in 5 cases (5.7%), tibial artery in 6 cases (6.8%) and multi-level occlusion in 5 cases (5.7%). The major arterial occlusive site of TAO were tibial artery in 35 cases (79.5%), pedal artery in 8 cases (18.1%) and popliteal artery in 1 case. According to the Fontaine classification of clinical symptoms, the distribution was as follows: Grade 0 0 case, Grade I 48 cases (33.8%), Grade II 46 cases (32.3%) and Grade III 48 cases (33.8%). The operative procedures of arterial occlusive disease were bypass graft operation in 72 cases, thromboembolectomy in 12 cases, endarterectomy in 2 cases and percutaneous transluminal angioplasty (PTA) was performed in 9 cases. Arterial bypass operation with autogenous or artificial prosthesis were done in 72 cases, which included aortobifemoral or aortobipopliteal bypass in 12 cases, iliofemoral bypass in 5 cases, femoropopliteal bypass in 26 cases, femorotibial bypass in 5 cases, popliteotibial bypass in 8 cases. axillobifemoral bypass in 4 cases and femorofemoral bypass in 12 cases. In over 90% of the operative cases, the early outcome was good with 3+ to 2+ rating according to Rutherford criteria. Mortality for 114 cases was 2.6% (3 cases), including 2 resulting from associated cardiac condition and 1 resulting from ARDS. CONCLUSION: Strategies for successful revascularization and long term patency may be made by consideration of the extent of diseases, associated diseases, clinical symptoms and status of distal perfusion.
Aneurysm ; Angioplasty ; Arterial Occlusive Diseases ; Arteries ; Classification ; Diabetes Mellitus ; Endarterectomy ; Female ; Femoral Artery ; Heart Diseases ; Humans ; Hypertension ; Incidence ; Ischemia* ; Lower Extremity* ; Male ; Mortality ; Perfusion ; Popliteal Artery ; Prostheses and Implants ; Smoke ; Smoking ; Surgical Procedures, Operative ; Thromboangiitis Obliterans ; Thromboembolism ; Tibial Arteries ; Transplants ; Troleandomycin

PURPOSE: Whereas cyclosporine is increasingly used not only in transplantation but also in autoimmune disorders, it may be associated with several side effects. Gingival hyperpalsia is one of the most frequent side effects and has been estimated to occur in 21-30% of all patients receiving the drug and may require surgical correction. Azithromycin is a macrolide antibiotics reported to coincidentally reduce gingival hyperplasia in renal transplant recipients treated for respiratory infections. To confirm the effect of azithromycin in cyclosporine induced gingival hyperplasia we tried clinical use of azithromycin in renal transplant patients with severe gingival hyperplasia. METHODS: Patients (n=9) with cyclosporine induced gingival hyperplasia were selected and took azithromycin for 5 days. Follow-up visits were conducted at week 4 and week 8. Changes in gingival hyperplasia were evaluated by measuring the ratio of clinical crown height and width in each of the four central incisors. RESULTS: Significant improvements were observed in periodontal measurement. The pre-treatment ratio of clinical crown height and width was 1.04+/-0.14 and it was increased to 1.17+/-0.16 in 4 weeks and 1.22+/-0.15 in 8 weeks. 88.9% (8/9) of patients reported an improvement in clinical symptoms. Azithromycin was tolerated and 77.8% (7/9) of patients reported that the treatment was at least somewhat useful. CONCLUSION: Azithromycin treatment for cyclosporine induced gingival hyperplasia is efficacious, cost effective, and has less morbidity compared with gingivectomy.
Anti-Bacterial Agents ; Azithromycin* ; Crowns ; Cyclosporine ; Follow-Up Studies ; Gingival Hyperplasia* ; Gingivectomy ; Humans ; Incisor ; Respiratory Tract Infections ; Transplantation*

Chronic Aorto-Iliac Occlusive Disease (CAIOD) commonly occurs in conjunction with obstruction in the femoral and popliteal arteries, resulting in ischemia of the lower extremities. To analyze the characteristics of CAIOD among Koreans, we relied on 110 cases of aorto-iliac occlusive disease in-patients who underwent operative treatment at Yeungnam university hospital during the last 15 years. Among the 110 total cases, the mean age was 61, with the highest incidence among people in their 60s, followed by those in their 50 s and then in their 70 s. 88.2% of the cases occurred in males with the remaining 11.8% occurring among females. Co-existing diseases included hypertension 46 cases (41.8% of the cases), coronary arterial diseases 17 cases (15.4%), diabetes mellitus 22 cases (20%), chronic pulmonary diseases 14 cases (12.7%) and cerebrovascular diseases 10 cases (9.1%). 80% of the cases involved patients with a history of smoking. The level of serum total cholesterol was higher than normal in 32.7% of cases. Advanced arteriosclerotic manifestation was found in over two-thirds of the cases, with the anatomical distribution as follows: Type I 5 cases (4.5%), Type II 30 cases (27.3%) and Type III 75 cases (68.2%). According to the Fontaine classification of clinical symptoms, the distribution was as follows: Grade I (0 case), Grade II 52 cases (47.3%), Grade III 36 cases (32.7%) and Grade IV 22 cases (20.0%). Among the 110 cases, 75 received only inflow procedures, 19 received both inflow and outflow procedures at the same time, and 16 received only outflow procedures. Among the 94 cases of inflow procedures, PTA accounted for 11 cases, PTA with stent accounted for 5, endarterectomy for 3, and bypass operations for 75. The breakdown for the 75 cases of bypass operations was as follows: aortofemoral or aortoiliac (21 cases): iliofemoral (12 cases): extraanatomic bypass including axillobifemoral bypass (15 cases): and fem-fem bypass (27 cases). Thirty-five outflow procedures included femoropopliteal and femorotibial bypass (22 cases), thromboembolectomy (6 cases), endarterectomy (5 cases) and profundoplasty (2 cases). 19 out of these 35 outflow procedures were performed in conjunction with inflow procedures at the time of the initial operation, but 16 were used without inflow procedure, mainly for Type III cases with relatively mild aortoiliac pathology. In over 90% of the 110 operative cases, the early outcome was good with 3 to 2 rating according to Rutherford criteria. The early outcome seemed to be related to the extent of disease and preoperative clinical symptoms but not with the surgical procedures used. Among the 110 total cases, 26 (23.6%) required second procedures. Among the 94 cases of inflow procedures, 24 (25.5%) required the second procedures, while among the 16 cases of outflow procedures, 2 (12.5%) required the second procedures. Among the 94 cases of inflow procedures, the need for second operations was higher in cases undergoing both inflow and outflow procedure at the same time (36.8%, 7 out of 19 cases) compared to the cases that underwent inflow procedure only (22.6%, 17 out of 75 cases). Among the inflow procedures, axillofemoral (46.7%) and iliofemoral (41.7%) bypass required the 2nd procedures much more frequently than aorto-fem (23.8%), fem-fem (14.8%) bypass and PTA (18.8%). An overall 5-year cumulative patency rate demonstrated significant statistical differences between procedures (p=0.001 Log Rank test): aortofemoral or aortoiliac: 0.81, fem-fem: 0.77, PTA: 0.74, iliofemoral: 0.56, and axillofemoral: 0.50. A 5-year cumulative patency rate also showed a significant correlation with the extent of disease (p=0.01), preoperative ischemic symptoms (p=0.05) and Ankle Brachial pressure Index (ABI.). Operative mortality for the 110 cases was 3.6% (4 cases), including 3 resulting from associated cardiac conditions and 1 resulting from aortoduodenal fistula.
Ankle ; Cholesterol ; Classification ; Diabetes Mellitus ; Endarterectomy ; Female ; Fistula ; Humans ; Hypertension ; Incidence ; Ischemia ; Lower Extremity ; Lung Diseases ; Male ; Mortality ; Pathology ; Popliteal Artery ; Smoke ; Smoking ; Stents

PURPOSE: Deep vein thrombosis and pulmonary embolism are common and potentially fatal complication among hospitalized patients. The first clinical manifestation of venous thromboembolism may be fatal pulmonary embolism. Therefore, some form of prophylaxis is warranted for patients at risk. Prolonged major surgery is well known as high risk factor in development of venous thromboembolism and venous thromboembolism following surgery remains a significant health care problem. But little data are available concerning the changes of venous hemodynamic during prolonged surgery. METHOD: To access the relationship of the lower leg venous congestion that occurred during prolonged and position-fixed surgery to the development of postoperative deep vein thrombosis, the venous pressure of lower leg were measured continuously. A flexible indwelling angiocatheter was inserted into the greater saphenous vein near ankle area and venous pressure was measured by pressure monitor. The data of patients (experimental group:n=10) who performed spinal operation in Jack-Knife position over 180 minutes, healthy volunteers (n=10) and patients (venous hypertension group) who diagnosed as lower leg deep vein thrombosis (n=7), chronic venous insufficiency (n=3) were collected and analyzed. RESULT: The mean age was 34 years old in experimental group and the patients were 7 males and 3 females. The mean lower leg venous pressures of healthy volunteer in Jack-Knife position were 42.89+/-3.52 mmHg at 30 minutes. In acute deep vein thrombosis and chronic venous insufficiency patients, the mean venous pressures were 73.14+/-4.78, 57.33+/-2.52 mmHg at 30 minutes and these data were statistically significant compared with control group (P<0.05). In experimental group, the changes of the mean venous pressures at 30, 60, 90, 120 and 180 minutes were 48.78+/-2.38, 45.89+/-2.09, 45.33+/-2.24, 45.11+/-2.03 and 46.33+/-2.18 mmHg and these data were not statistically significant compared with control group. There was no postoperative development of deep vein thrombosis. CONCLUSION: The surgical factors (prolonged operation time, fixed position) and anesthetic factor may not play a major role in development of postoperative deep vein thrombosis and other postoperative factors will intervene the development of deep vein thrombosis.
Adult ; Ankle ; Delivery of Health Care ; Female ; Healthy Volunteers ; Hemodynamics ; Humans ; Hyperemia ; Hypertension ; Leg* ; Male ; Pulmonary Embolism ; Risk Factors ; Saphenous Vein ; Venous Insufficiency ; Venous Pressure* ; Venous Thromboembolism ; Venous Thrombosis

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

No abstract available.
Adult* ; Humans ; Knee* ; Korea*

No abstract available.
Hip*

No abstract available.
Femur* ; Hip Fractures* ; Hip*

We measured normal range and mean value of the posterior laxity of normal knee which might be reference for objective and accurate diagnosis, decision of operative indication and position of knee during fixation of ligament, and role of quadriceps building in posterior cruciate ligament injury patients. These results were obtained by measurement and analysis of posterior laxity of normal knee by means of KT-2000 Knee Ligament Arthrometer. We measured 184 Korean adults (100 males, 84 females), and their average age, height, weight, and thigh circumference were 29.8 years, 165.8cm, 59.8kg, 41.2cm, respectively. At 25 degrees of knee flexion, mean posterior displacement of normal knee was 21.2mm with 15lb posterior tibial loading, 2.41mm with 20lb posterior tibial loading. And when quadriceps were tense, laxity was 0.79mm and 0.95mm at the same degree of knee flexion. At 75 degrees of knee flexion, the results were 0.57mm, 0.58mm, 0.26mm, and 0.28mm respectively. Right to left difference of posterior displacement with 20lb posterior tibial loading was 0.07mm at 25 degrees of knee flexion and 0.06mm at 75 degrees of knee flexion. We thought that above 75 degrees of knee flexion is suitable for knee position at the time of graft fixation because 75 degrees of knee flexion markedly decreased(75%) posterior displacement compare to 25 degrees of knee flexion. When quadriceps were tense, remarkable decrease of posterior laxity of normal knee was checked(58%), so we noticed quadriceps building is important to management of posterior cruciate ligament injury patients.
Adult ; Diagnosis ; Humans ; Knee ; Ligaments ; Male ; Posterior Cruciate Ligament ; Reference Values ; Thigh ; Transcutaneous Electric Nerve Stimulation ; Transplants