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: 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

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

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

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

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

A 6-year-old-man with a severe pectus excavatum and marfanoid feature was admitted for the correction of pectus excavatum. Nuss procedure was recently introduced, because of its excellent effect from the cosmetic point of view. This method is that convex steel bar is inserted under the sternum through small bilateral thoracic incisions, and when it is in position, the bar is turn over, thereby correction the deformity. We experienced a case of the cardiac arrest during the rotation of a stainless steel bar. After the injection of atropine, epinephrine and the closed cardiac massage, sinus rhythm was restored. A vasovagal reflex due to the operation could be considered the possible etiology.
Atropine ; Congenital Abnormalities ; Epinephrine ; Funnel Chest* ; Heart Arrest* ; Heart Massage ; Humans ; Reflex ; Stainless Steel* ; Steel ; Sternum

No abstract available.
Coronary Vessels* ; Spasm*