No abstract available.
Animals ; Babesiosis* ; Clindamycin ; Humans ; Male* ; Quinine

No abstract available.
Animals ; Babesiosis* ; Clindamycin ; Humans ; Male* ; Quinine

A soft tissue defect of the lower leg or foot presents a challenging problem. Reconstructive surgeon should be armed at all points of wound site, tendon and bone exposure, injury of major vessel and so on in the lower limb. We reconstructed the defects of lower legs and feet of 25 patients between February, 1997 and December, 2003. Applying reversed adipofascial flap with skin graft on a soft tissue defect of the lower leg or foot is challenging. We did a comparative study of 25 reversed adipofascial flaps with 51 free flaps. All 25 cases of reverse adpofascial flap reconstruction were successful except for a partial loss of skin graft in 3 occasions. The reversed adipofascial flap had a merit of a short operation time and hositalization, a high success rate and minimum complications. Besides major vessels in the lower leg are better preserved and donor morbidity is minimal. However, the flap is unmerited in reconstructing a hug hallowed defect and in the leg with poor blood circulation and once previous surgery. The operators may consider the feasible substitution of reversed adipofascial flap for free flap before applying in the lower leg.
Arm ; Blood Circulation ; Foot ; Free Tissue Flaps* ; Humans ; Leg* ; Lower Extremity ; Skin ; Tendons ; Tissue Donors ; Transplants ; Wounds and Injuries

BACKGROUND: Several studies have indicated that lumbar epidural anesthesia may decrease the incidence of deep vein thrombosis and pulmonary embolism, particulary after total hip replacement. Moreover venous thromboembolism also occurs after the release of a tourniquet in orthopedic surgery. The d-dimer test has been reported to be useful for predicting lower limb DVT and PE. Of the d-dimer test methods, the latex agglutination method shows excellent sensitivity and specificity. METHODS: We compared the quantity of d-dimer for General (n = 21) and Epidural (n = 20) anesthesia after tourniquet release in patients undergoing arthroscopic knee surgery. RESULTS: D-dimer significantly increased after tourniquet release in both groups, whereas the increase of d-dimer in the Epidural group was no smaller than that in the General group. Epidural group showed a correlation between tourniquet application and d-dimer. CONCLUSIONS: The present data suggest that DVT and PE after tourniquet release could occur during arthroscopic knee surgery and that epidural anesthesia may increase the fibrinolysis of a tourniquet induced thrombus.
Agglutination ; Anesthesia ; Anesthesia, Epidural* ; Anesthesia, General* ; Arthroplasty, Replacement, Hip ; Fibrinolysis ; Humans ; Incidence ; Knee* ; Latex ; Lower Extremity ; Orthopedics ; Pulmonary Embolism ; Sensitivity and Specificity ; Thromboembolism ; Thrombosis ; Tourniquets* ; Venous Thromboembolism ; Venous Thrombosis

BACKGROUND: Propofol is a good induction agent. but it has a disadvantage of pain on intravenous injection. Pretreatment of metoclopramide or lidocaine have been reported to reduce pain on injection. thus, we have evaluated the quantity and quality of anagesic effect of metoclopramide and lidocaine. We observed differences in quality of pain according to venous cannula sizes and intravenous injection sites as well as nausea and vomiting in the postoperative state. METHODS: Eighty patients scheduled for an elective operation by general anesthesia were chosen according to ASA (I or II) and divided into four groups randomly. Each group was injected through venous cannulas with normal saline (control group), metoclopramide 5 mg (group 1), metoclopramide 10 mg (group 2), or 2% lidocaine 40 mg (group 3) respectively. Then, propofol was injected of a 2 mg/kg dose with 0.5 ml/sec to all groups and we asked questions about injection pain after 10 seconds. RESULTS: Pain relief was shown in all groups compared with the control. but metoclopramide 10 mg and lidocaine 40 mg pretreatment groups showed significant pain reief. Pain was relieved significantly when the drug was injected in the antecubital area. Postoperative nausea and vomiting were not observed. CONCLUSIONS: Metoclopramide 10 mg or lidocaine 40 mg pretreatment to induction by propofol revealed a good analgesic effect for propofol injection pain.
Anesthesia, General ; Anesthetics ; Catheters ; Humans ; Injections, Intravenous ; Lidocaine ; Metoclopramide* ; Nausea ; Postoperative Nausea and Vomiting ; Propofol* ; Vomiting

Systemic lupus erythematosus (SLE) which is thought to be autoimmune in nature affects multiple organs and produces a diversity of signs and symptoms. However, cardiovascular manifestations of SLE are manifested more frequently by autopsy. Recently, with the prolonged survival and improvement of diagnostic methods in SLE including echocardiography, the morbidity and mortality associated with cardiovascular manifestations of SLE became more apparent and increased. Simultaneous involvement of the pulmonary artery and the myopericardium in SLE is known to be rare. Pulmonary hypertension is known to be associated with poor prognosis. We report a 27 year-old female patient of SLE with pulmonary hypertension, pericarditis and left ventricular systolic dysfunction.
Adult ; Autopsy ; Echocardiography ; Female ; Humans ; Hypertension, Pulmonary* ; Lupus Erythematosus, Systemic* ; Mortality ; Pericarditis* ; Prognosis ; Pulmonary Artery

The ALM(acral lentiginous melanoma) on extremities are less common and less well studied. The purpose of the study is to investigate the surgical management for 19 cases of ALM on extremities for last 10 years. When tumor depth was less than 1.5mm on thumb, the lesion was removed with distal periosteum and full skin through degloving procedure and the defect was covered with wrap around procedure. When tumor depth was more than 1.5mm, distal amputation of thumb was performed, and new thumb was reconstructed through bone graft and wrap-around procedure. The ALM on palm was treated with wide excision, and then reconstruction was performed with reversed radial island flap. Because heel was required for weight bearing, the defect of heel after wide tumor resection was reconstructed with volume rich free flap. During 3 years follow-up period, local recurrence and general metastasis was 0% respectively in cases of tumor depth below 1.5mm. In cases of tumor depth more than 1.5mm, local recurrence and general metastasis rate were 0% and 20% respectively. In terms of function, the reconstructed thumb could have ability of pinch and grasp, and the reconstructed heel could be achieved good contour and weight bearing function.
Amputation ; Extremities* ; Follow-Up Studies ; Free Tissue Flaps ; Hand Strength ; Heel ; Melanoma* ; Neoplasm Metastasis ; Periosteum ; Recurrence ; Skin ; Thumb ; Transplants ; Weight-Bearing

PURPOSE: This prospective study has been conducted to assess the value of three dimensional conformal radiation therapy (3DCRT) for lung cancer and to determine its potential advantage over current treatment approaches. Specific aim of this study were to 1) find the most ideal 3DCRT technique 2) establish the maximum tolerance dose that can be delivered with 3DCRT and 3) identify patients at risk for development of radiation pneumonitis. MATERIALS AND METHODS: Beginning in Nov. 1994, 95 patients with inoperable non-small cell lung cancer (stage I; 4, stage II; 1, stage IIIa; 14, stage IIIb; 76) were entered onto this 3D conformal trial. Areas of known disease and elective nodal areas were initially treated to 45 Gy and then using 3DCRT technique 65 to 70 Gy of total dose were delivered to the gross disease. Sixty nine patients received 65 Gy of total dose and 26 received 70 Gy. Seventy eight patients (82.1%) also received concurrent MVP chemotherapy. 3DCRT plans were compared with 2D plans to assess the adequacy of dose delivery to target volume, dose volume histograms for normal tissue, and normal tissue complication probabilities (NTCP). RESULTS: Most of plans (78/95) were composed of non-coplanar multiple (4-8) fields. Coplanar segmented conformal therapy was used in 17 pateints, choosing the proper gantry angle which minimize normal lung exposure in each segment. 3DCRT gave the full dose to nearly 100% of the gross disease target volume in all patients. The mean NTCP for ipsilateral lung with 3DCRT (range ; 0.17-0.43) was 68% of the mean NTCP with 2D treatment planning (range ; 0.27-0.66). DVH analysis for heart showed that irradiated volume of heart could be significantly reduced by non-coplanar 3D approach especially in the case of left lower lobe lesion. Of 95 patients evaluable for response, 75 (79%), showed major response including 25 (26%) with complete responses and 50 (53%) with partial responses. One and two year overall survivals of stage lll patients were 62.6% and 35.2% respectively. Twenty percent (19/95) of patients had pneumonitis ; Eight patients had grade 1 pneumonitis and 11 other patients had grade 2. Comparison of the average of NTCP for lung showed a significant difference between patients with and without radiation pneumonitis. Average NTCP for patients without complication was 62% of those with complications. CONCLUSIONS: This study showed that non-coplanar multiple fields (4-8) may be one of the ideal plans for 3DCRT for lung cancer. It also suggested that 3DCRT may provide superior delivery of high dose radiation with reduced risk to normal tissue and that NTCP can be used as a guideline for the dose escalation.
Carcinoma, Non-Small-Cell Lung* ; Drug Therapy ; Heart ; Humans ; Lung ; Lung Neoplasms ; Pneumonia ; Prospective Studies ; Radiation Pneumonitis

We report a case of nephrotic syndrome with thymic neuroendocrine tumor. A 50-year-old woman was admitted with generalized edema. 24-hour urine collection revealed proteinuria of 20 gram daily and creatinine clearance of 28 mL/min. During examination, a thymic mass was found, which is unresectable due to metastasis to the lung. Biopsy of the thymus and the kidney revealed large cell neuroendocrine carcinoma of thymus origin and minimal change disease, respectively. Despite high dose steroid therapy, massive proteinuria continued for about 30 days. However, when the patient was given a chemotherapy (cyclophosphamide, adriamycin, vincristine), proteinuria began to decrease dramatically. The carcinoma showed the partial response after six cycles of chemotherapy. This is the first report on remission of malignancy-related nephrotic syndrome after chemotherapy, especially for thymic neuroendocrine tumor.
Biopsy ; Carcinoma, Neuroendocrine ; Creatinine ; Doxorubicin ; Edema ; Female ; Humans ; Kidney ; Lung ; Middle Aged ; Neoplasm Metastasis ; Nephrosis, Lipoid ; Nephrotic Syndrome ; Neuroendocrine Tumors ; Proteinuria ; Thymus Gland ; Thymus Neoplasms ; Urine Specimen Collection

Nuss procedure offers excellent outcome effect in the cosmetic point of view, but the complications such as cardiac perforation, pericardial effusion, constrictive pericarditis, hemothorax, pneumothorax and bar displacement sometimes occur. We experienced a 13-year-old-male, who showed the profound hypotension with bradycardia due to the cardiac perforation and the lung laceration during the pericardiectomy and the removal of pectus bar. Emergent partial cardiopulmonary bypass was initiated and then, ruptured right atrium and lung laceration were repaired without the remarkable complications. In anesthetic management of the pectus excavatum. This case reveals that special attention should be paid to those with cardiac perforation and lung laceration.
Bradycardia ; Cardiopulmonary Bypass ; Funnel Chest* ; Heart Atria ; Hemothorax* ; Humans ; Hypotension ; Lacerations ; Lung ; Pericardial Effusion ; Pericardiectomy* ; Pericarditis, Constrictive* ; Pneumothorax