No abstract available.
Laurence-Moon Syndrome*

No abstract available.
Laurence-Moon Syndrome*

The incidence of diabetes mellitus is in increasing tendency because of expension of medical care, economic development and increasing of the population of the aged person recently. The diabetic foot is one of serious complication of diabetes. With the advancement of the method of treatment of diabetes the other acute metabolic complications are decreased, but the development of diabetic gangrene encounteres at any age of adult life with increasing of incidence according to the duration of diabetes. The most of them requires operation, and its treatment is difficult frequently because of high incidence of wound problem in healing. So it is important to educate and prevent for lowering its incidence. From January 1978 to December 1984, 38 patients with diabetic foot were treated and analysed at Department of Orthopaedic Surgery of Presbyterian Medical Center. The results obtained are as follow. 1. The average of annual incidence of diabetic gangrene was 2.85%. There was increasing tendency of incidence to 1981, thereafter decreasing tendency. 2. 71% of patients with gangrene were in over-50 year age group. 3.72% of patients were in duration of diabetes more than 5 years. 4.79% of patiens were in inadequate treatment before admisson. 5. There was no relationship between fasting blood sugar level and development of gangrence. 6. The most common site of the lesion was big toe. 7. The most common predisposing fector was local pressure (39%), then minor trauma, and burn injury. 8. The primary wound healing rate was 53% after operation. 9. There was no relationship between the lowest palpable artery and primary wound healing. 10. The most common combined complication of diabetes was retinopathy (47%), then neuropathy and hypertension. 11. The rate of bacterial infection was 66%, and the most common organism was staphylococcus aureus (36%).
Adult ; Arteries ; Bacterial Infections ; Blood Glucose ; Burns ; Clinical Study ; Diabetes Mellitus ; Diabetic Foot ; Economic Development ; Fasting ; Gangrene ; Hallux ; Humans ; Hypertension ; Incidence ; Methods ; Protestantism ; Staphylococcus aureus ; Wound Healing ; Wounds and Injuries

PURPOSE: L-arginine is a precursor of nitric oxide(NO). It was reported that administration of L-arginine increases immune reaction in some studies. Also it is known that NO was involved in antitumor effect of BCG therapy on bladder carcinoma. So we tried to know if antitumor effect of intravesical BCG instillation on murine bladder cancer could be potentiated by oral L-arginine administration. MATERIALS AND METHODS: N-butyl-N-(4-hydroxybutyl) nitrosamine(BBN) was fed to Fisher 344 rats for 20 weeks to induce bladder carcinoma. We instilled intravesically normal saline in group I, BCG in group II, and BCG together with oral ingestion of L-arginine in group III once a week from the 8th week to the 19th week, respectively. Urinary NO secretion was measured. The rats were sacrificed at the 20th week. The expression of inducible nitric oxide synthase(iNOS) as well as the incidence, size and number of bladder tumor was evaluated in the murine bladder. RESULTS: Urinary NO secretion increased significantly in group II and III compared to group I. The incidence of carcinoma showed no difference among the three groups. The tumors in group II and III were smaller and fewer than those in group I. iNOS was more strongly expressed in group II and III than that in group I. But there was no statistical difference between group II and III on the urinary secretion of NO, the incidence, size and number of the tumor, and the expression of iNOS. CONCLUSIONS: Our results suggest that ingestion of L-arginine neither enhances production of NO nor potentiates antitumor effect of BCG immunotherapy against bladder carcinoma in this animal model study.
Animals ; Arginine* ; Eating* ; Immunotherapy ; Incidence ; Models, Animal ; Mycobacterium bovis* ; Nitric Oxide ; Rats* ; Urinary Bladder Neoplasms ; Urinary Bladder*

PURPOSE: A retrospective analysis was performed to investigate the factors that affect stone recurrence in patients who were stone-free after extracorporeal shock wave lithotripsy(SWL). MATERIALS AND METHODS: From February 1990 to December 1992, 1039 patients were treated by SWL with EDAP LT-01+ lithotriptor. Among them 200 patients were followed up at 60 months. Fifty eight(29.0%) of 200 patients had recurrent stone after SWL. We analysed the patients according to patient age, sex, location, multiplicity and size of the original stones, serum calcium and uric acid level, urinary calcium and uric acid level at presentation, anatomical abnormality and pyuria after SWL as possible factors affecting stone recurrence. RESULTS: Mean age of the patients was 43.6 years(range 7 to 81) and there were 115 male and 85 female patients with sex ratio 1.35:1. Age and sex did not affect stone recurrence. The recurrence rates according to the stone location were 100%(1/1) for staghorn calculi, 28.6%(2/7) for pelvic stones, 26.2%(16/61) for single calyceal stone, 47.8%(11/23) for multiple calyceal stones and 29.7%(41/138) for ureteral stones. Stone location did not affect stone recurrence. 16(47.0%) of 34 renal units with multiple stones had recurrent stones, whereas 55(28.1%) of 196 renal units with single stone recurred. Multiplicity of the stone was the risk factor for stone recurrence(p<0.05). The stone size(renal unit) of less than 20mm were identified in 213 and 64(30.0%) of them had recurrent stones, whereas stone size(renal unit) of more than 20mm were identified in 17 and 7(41.2%) of them had recurrent stones. More than 20mm of the stone size was the risk factor for stone recurrence(p<0.05). Hypercalcemia, hyperuricemia, hypercalciuria, and hyperuricosuria did not affect stone recurrence. 14(28.6%) of 49 patients who had pyuria after SWL had recurrent stones, whereas sterile urine after SWL were noted in 151 and 44(29.1%) of them had recurrent stones. Pyuria after SWL did not affect stone recurrence. Anatomical abnormality was noted in 5 patients and 4(80%) of them showed recurrence, but there was no statistical significance due to small populations. CONCLUSIONS: Multiplicity and size of the stones were the risk factor for stone recurrence. But patient age, sex, location of the original stones, serum calcium and uric acid level, urinary calcium and uric acid level at presentation and pyuria after SWL did not affect stone recurrence.
Calcium ; Calculi ; Female ; Humans ; Hypercalcemia ; Hypercalciuria ; Hyperuricemia ; Lithotripsy* ; Male ; Pyuria ; Recurrence* ; Retrospective Studies ; Risk Factors ; Sex Ratio ; Shock* ; Ureter ; Uric Acid

PURPOSE: Through our previous studies on the antitumor mechanism of BCG therapy for bladder carcinoma, we become to consider a nitric oxide(NO)-mediated process as one of its mechanisms. Briefly describing, intravesical BCG stimulates T helper cells to secrete INF-gammaand also stimulates macrophages to secrete TNF-alpha and IL-1. The cytokines induce expression of inducible NO synthase(iNOS) in the macrophages, the epithelium, and the tumor cells of the bladder , which results in longstanding abundant secretion of NO in those cells and results in apoptosis of tumor cells. Our theory of NO-mediated antitumor mechanism confronts a question; Can E. coli replace BCG because E. coli also induce NO production To reply to the question this study was done. MATERIALS AND METHODS: N-butyl-(4-hydroxybutyl) nitrosamine was fed in rats. Normal saline in group I, E. coli in group II, and BCG in group III were intravesically instilled weekly for 12 times, respectively. Urinary nitrite concentration was measured in the 3 groups. Observed were histological findings including iNOS expression ,incidence ,size and number of the tumors in the excised bladder at the 20th week. RESULTS: Urinary nitrite concentration in group III was significantly higher than that in group I and II. iNOS expression was relatively strong in the epithelium and the tumor of group II and III, but weak in those of group I. No statistically significant difference was found in the incidence of tumor among the three groups. Induced tumors were fewer in group II and III than in group I. And the tumors were smaller in group III than in group II. CONCLUSIONS: Intravesical E. coli instillation showed less significant secretion of NO in the bladder than BCG instillation. Intravesical E. coli might weakly suppress tumor growth in the rats. On the other hand, intravesical BCG instillation induces strong iNOS expression and significant NO production in the bladder tissue and seems to suppress tumor growth.
Animals ; Apoptosis ; Cytokines ; Epithelium ; Hand ; Incidence ; Interleukin-1 ; Macrophages ; Mycobacterium bovis* ; Nitric Oxide ; Rats* ; T-Lymphocytes, Helper-Inducer ; Tumor Necrosis Factor-alpha ; Urinary Bladder Neoplasms* ; Urinary Bladder*

No abstract available.
Arthritis, Infectious* ; Hip Joint* ; Hip*

PURPOSE: Mutations of the p53 gene are currently the most commonly recognized genetic mutations in human cancer. In some tumors, p53 gene mutations are associated with aggressiveness of the tumor and poor prognosis. There is wide variation in the reported incidence of p53 mutation in renal cell carcinoma, and little is known about its prognostic significance. To detect whether the expression of p53 could be correlated with clinical characteristics, we perfomed immunohistochemical stain on renal cell cancer samples. MATERIALS AND METHODS: Paraffin-embedded nephrectomized specimens collected from 25 patients were immunostained for p53 using the DO-1 monoclonal antibody. We evaluated the relation between p53 staining and known prognostic factors such as tumor size, pathologic stage, lymph nodal involvement, presence of metastasis, nuclear grade and cell types. RESULTS: Positive staining for p53 was detected in 32%(8/25). The staining for p53 was not statistically significant in relation with the prognostic factors such as pathologic stage(stageI&II; positive staining 6/18, 33%, stage III&IV; 2/7, 29%), lymph nodal involvement(positive 1/3, 33%, negative 7/22, 32%), distant metastasis(positive 2/6, 33%, negative 6/19, 32%), nuclear grade(nuclear gradeI&II; positive 5/18, 28%, nuclear grade III&IV; 3/7, 43%) and cell types(p>0.05). CONCLUSIONS: p53 gene mutations of the renal cell carcinoma are infrequent and show no relation to tumor size, pathologic stage, lymph nodal involvement, presence of metastasis, nuclear grade and tumor cell type in this study.
Carcinoma, Renal Cell* ; Genes, p53 ; Humans ; Incidence ; Neoplasm Metastasis ; Prognosis

PURPOSE: We designed this study to find out the risk factors affecting the patency rate after creation of an arteriovenous fistula (AVF) for hemodialysis. METHODS: Between March 1997 and December 2001, a total of 397 AVF operations in 314 patients were performed by a single surgeon using the same surgical technique and principles. One hundred and forty cases (35.3%) were reoperations due to previous AVF failure. Artificial vessels (=PTFE, polytetrafluoroethylene) were used for the AVF in 39 cases (9.8%). The sex, age, diabetes mellitus, previous operation history and type of dialysis center were considered as a possible risk factors affecting the patency rate. RESULTS: After a mean follow-up of 18.3 months, there were 63 cases of patient death, 15 of kidney transplantation, and 104 of AVF failure identified. The overall patency rates of 1, 2 and 3 year were 76.2, 70.9, and 66.9%, respectively. From the multivariate analysis, the previous operation history was the only significant factor affecting the patency rate of AVF (P=0.001, odd ratio=2.58). Although the diabetic patient (odd ratio=1.43) and artificial vessel groups (odd ratio=1.678) showed high odd ratios, these factors were not statistically significant (P>0.05). From the univariate analysis, the reoperation cases also showed a significantly inferior patency rate compared to the first operation cases (1 year patency rate was 65.2% and 83.7%, P=0.001). However, the diabetes and types of vessel showed no significant differences in patency rates. CONCLUSION: A reoperation of an AVF creation was the most significant risk factor affecting the patency rate after its original creation. The first attempt AVF creations showed-favorable patency rates. To improve the overall patency rate of an AVF creation, a more delicate preoperative study and accurate surgical technique will be required at the time of the first AVF operation.
Arteriovenous Fistula* ; Diabetes Mellitus ; Dialysis ; Follow-Up Studies ; Humans ; Kidney Transplantation ; Multivariate Analysis ; Renal Dialysis* ; Reoperation* ; Risk Factors

Spontaneous dissections of visceral arteries without aortic involvement are very rare. The etiologies of these entities are unclear and their clinical managements remain controversial. We report a case of spontaneous multiple dissections affecting 4 visceral arteries including the superior mesenteric artery, the celiac artery and the bilateral renal arteries. The patient was managed conservatively and endovascularly. The clinical manifestation markedly improved and laboratory tests returned to normal limits within 1 week. The regular follow-up suggested a good clinical and radiological outcome until 84 months.
Arteries* ; Celiac Artery ; Endovascular Procedures ; Follow-Up Studies ; Humans ; Mesenteric Artery, Superior ; Renal Artery