A case of a reflex sympathetic dystrophy syndrome (RSD) asscciated with the internal iliac arterio-venous fistula was reported. The patient was a 36-year old woman, and had the left oophorectomy at 21-year old and the lumbar laminectomy at 36-year-old. She complained of coldness and paresthesia of the right lower extremity 14 days after the lumbar laminectomy. A stenosis or occlusion of the arteries in both legs were not demonstrated by arteriogram. The coldness and paresthesia disappeard after the epi-dural block. RSD of the right leg was diagnosed which occurred at the lumbar laminectomy. Lumbar sympathectomy (L2∼L4) was performed simultaneously with closure of the internal iliac arteriovenous fistula. Postoperative clinical course was uneventful. Symptoms we were immediately disappeared. Sympathetic ganglion block has same efficiency as lumbar sympathectomy. Therefore sympathetic ganglion block is more suitable if patient has RSD only.

The degree of intermittent claudication is difficult to evaluate objectively; therefore, the therapeutic efficiency of a drug is difficult to test in patients suffering from intermittent claudication. The purpose of this paper is to know whether treadmill test is useful to evaluate objectively the degree of intermittent claudication. 20 patients suffering from a peripheral arterial occlusive disease with intermittent claudication (Stage II) were investigated. PGE₁ incorporated in lipid microspheres (Lipo PGE₁) was infused (10μg/day) with one shot on 7 consecutive days into the forearm vein of patients. Painfree walking distance and maximum walking distance were measured on treadmill (3.0km/h, 5% incline). Brachial systolic pressure and ankle pressures were measured before and after exercise, and ankle/arm pressure ratio and ankle pressure difference between the pre-exercise and post-exercise values were calculated. All measurements were performed before and 7 days after beginning of treatment. Painfree walking distance was prolonged from 72.5±41.4m before treatment to 92.0±53.7m after treatment, with significant difference (p<0.01). However, no significant changes of ankle/arm pressure ratio, ankle pressure difference and maximum walking distance were observed. It is concluded that measurement of painfree walking distance on treadmill was useful to evaluate objectively the degree of intermittent claudication.

During the period between January 1975 and April 1991, 37 patients with acute arterial occulusion of the extremities were admitted to our department and were classified into 2 groups according to their causative factors, including thrombosis and embolism. Among 16 thrombosis patients with involvement of 17 limbs, 4 patients died and 6 limbs were amputated at the time of discharge. On the contrary, among 21 embolism patients with involvement of 25 limbs, 2 patients died and only one limb was amputated. Sixteen of 17 limbs with thrombosis were operated on. Arterial reconstruction was carried out initially on 5 limbs, resulting in successful limb salvage; 3 of 6 limbs which had undergone thrombectomy initially were occluded again soon after the procedure. In the end, 1 limb had to be amputated. On the other hand, 22 of 25 limbs were operated on. Three arterial reconstructions, 18 embolectomies and 1 amputation were carried out initially. All arterial reconstructions and embolectomies were successful. From these results, it was concluded that arterial reconstruction must be done initially for thrombosis patients. For the embolism patients, embolectomy is preferable.

No abstract available.
Lymph Nodes* ; Melanoma* ; Neoplasm Metastasis*