Diabetic gangrene is a common complication of diabetes mellitus, and its an incidence which has an increasing tendency. And its treatment is very difficult because of the high incidence of delayed wound healing. The diagnostic method to determine the level of amputation for treatment of ischemic limb was reported by many authors, but it still has many controversies. From January 1973 to December 1982, 60 cases in 55 patient of diabetic gangrene were treated at the Department of Orthopedic Surgery Severance Hospital. The result of treatment of diabetic gangrene according to the level of amputation, primary healing rates, and complication were studied. The results obtained are as follow; l. Among 55 patients, 34 male and 21 female, 50 patients(90.9%) were older than 51 years. 2. There was no correlation between primary healing and palpating arterial pulsation at the amputation level, also there was no correlation between primary healing and obstruction of proximal artery in arteriography. 3. It wasrecommended to correct hemoglobin level above 12.1gm% before treatment for primary healing at the operation site. 4. Debriment and skin graft were indicated with the grade I lesion. Whenever they amputate and attempt to do primary healing at the operation site, the ideal level is the site where the skin temperature is between 33.1℃ to 34℃. 5. High delayed healing rate(71.4%) was anticipated in below knee amputation with grade IV lesion with low skin temperature(below 32℃). 6. Among 12 patients who took Pylon prosthesis and started early weight bearing walking after major amputation, 10 patients(83.3%) were healed orimarily. 7. Operative mortality was 5.4% and 5 year mortality after operation due to diabetic gangrene was 16.9%.
Amputation ; Angiography ; Arteries ; Clinical Study ; Diabetes Mellitus ; Extremities ; Female ; Gangrene ; Humans ; Incidence ; Knee ; Male ; Methods ; Mortality ; Orthopedics ; Prostheses and Implants ; Skin ; Skin Temperature ; Transplants ; Walking ; Weight-Bearing ; Wound Healing

No abstract available.
Heart* ; Thoracic Surgery*

No abstract available.
Female ; Pregnancy ; Pregnancy, Ectopic*

Surgical intervention during the pregnancy is not rare and the impact of anesthesia and surgery during the pregnancy is doublefold, because the mother and the fetus in uterus are concerned. The anesthesiologist must know the progressive' maternal changes during the pregnancy and drug action on the fetus. The authors have experienced 50 cases of pregnant women undergoing various kinds of operation and have analyzed those cases according to the type of disease, the duration of gestation, physical status, premedication, anesthetic technics and agent used, and the outcome of the fetus and the patient during the period between March 1972 to August 1978 The results were as follows: 1) The most of patient, 32 cases were operated for the obstetric and gynecological :reason s. 2) 27 cases (54%) had undergone the operation during the second trimester. 3) Physical status class 2 including 28 cases (56%) was the most commonly found physical status of the patients. 4) Halothane was the main anesthetic agent for 39 cases (78%) and there were 3 cases of spinal anesthesia. 5) We could follow 27 cases among 50 cases about the outcome of the fetus. 17 spontaneous vaginal delivery, 8 Cesarean sections, 1 fetal death in uterus and 1 wanted D&C. 6) Among 5 premature deliveries, 2 premature infants died during the hospitalization. 7) The only maternal motality was the case of intrahepatic stone who expired 11 days postoperatively and delivered a 1,300 gm premature 7 days postoperatively.
Anesthesia ; Anesthesia, Spinal ; Cesarean Section ; Dilatation and Curettage ; Female ; Fetal Death ; Fetus ; Halothane ; Hospitalization ; Humans ; Infant, Newborn ; Infant, Premature ; Mothers ; Pregnancy ; Pregnancy Trimester, Second ; Pregnant Women ; Premedication ; Uterus

No abstract available.
Angiofibroma ; Carbon ; Carbon Dioxide ; Lasers, Gas

Severe recurrent attacks of acute febrile neutrophilic dermatosis shortly followed multiple keratoacanthoma in a 43-year-old man with myelodysplastic syndrome. Besides the typical clinicopathological findings of the syndrome(fever, leukocytosis and neutrophilic erythematous plaques of the skin), the patient showed orolingual and conjunctival ulceration and severe cutaneous pathergic reactions. Moreover, to the best of our knowledge, multiple keratoacanthoma has not yet been reported with relation to the acute febrile neutrophilic dermatosis.
Adult ; Humans ; Keratoacanthoma* ; Leukocytosis ; Myelodysplastic Syndromes ; Neutrophils ; Sweet Syndrome* ; Ulcer

No abstract available.
Sarcoma*

The combination of intra-articular morphine and bupivacaine has been suggested as an ideal analgesic after arthroscopy. We performed a randomized double-blind controlled study in patients undergoing elective knee arthroscopy to investigate the analgesic effect of intra-articular morphine and bupivacaine. Sixty ASA physical status 1~2 patients were randomized into one of three treatment groups. All patients received general anesthesia with N2O, O2 and inhalational agents. The drugs were given by intra-articular injection by the surgeon before tourniquet release at the end of the operation. According to the mode of the drugs administered, the patients were divided into three groups; 1) Groupl (n=20) received 0.25% bupivacaine 2) Group2 (n=20) received morphine 1 mg in saline 3) Group3 (n=20) received morphine 1 mg in 0.25% bupivacaine. The injected volume was 25 ml, and all solutions contained 1:250,000 epinephrine. Additional postoperative analgesia was provided with intramuscular diclofenac sodium. The visual analogue pain scores in the recovery room(0.5 h) and 2, 4, 8, 12 and 24 h after surgery, time to first analgesic use, and total 24 h additional analgesic requirements were recorded. The results were as follows; 1) Visual analogue pain scores were lower in group 1 and 3 at 1~8 h. 2) Visual analogue pain scores were lower in group 2 and 3 at 24 h. 3) Additional analgesic requirements were lower for the first 12 h in group 1 and 3, but no difference was seen between groups over the 24 h study period. We conclude that, after elective knee arthroscopy, intra-articular morphine 1 mg in 0.25% bupivacaine 25 ml, with 1: 250,000 epinephine, may provide superior postoperative analgesia up to 24 h than bupivacaine or morphine alone.
Analgesia ; Anesthesia, General ; Arthroscopy* ; Bupivacaine* ; Diclofenac ; Epinephrine ; Humans ; Injections, Intra-Articular ; Knee* ; Morphine* ; Tourniquets

We present the cytologic features of small cell neuroendocrine carcinoma of the liver metastasized from the uterine cervix. Cytologically, tumor cells were arranged in a pat- tern of solid sheet in necrotic background. The tumor cells were characterized by uniform, small cells, round hyperchromatic nuclei, and high nuclear cytoplasmic ratio. The smears showed frequent mitotic figures and rosette formation, These findings were identified with the previous histologic sections of uterine cervix. To make a diagnosis of metastatic small cell neuroendocrine carcinoma on the Papanicolaou smear, a high index of suspicion and careful review of clinical history are needed
Animals ; Carcinoma, Neuroendocrine ; Cervix Uteri ; Charadriiformes ; Cytoplasm ; Diagnosis ; Familial Hypophosphatemic Rickets* ; Female ; Fibrous Dysplasia, Polyostotic* ; Liver ; Papanicolaou Test ; Rosette Formation ; Vitamin D* ; Vitamins*

OBJECTIVE: The ovarian cycle is characterized by repeating patterns of cellular proliferation and differentiation that accompany follicular development and the formation and regression of the corpus luteum (CL). That angiogenesis may play an important role in this process. Angiogenesis is supposed to be regulated by vascular endothelial growth factor (VEGF). The goal of the present investigation, therefore, was to determine whether the expression of VEGF was changed in the normally cycling human ovary. We also investigated VEGF expression in the regressed CL (ie, nonfunctiong CL) of normal term pregnancy to define the association with steroidogenic activity. To our knowledge there is no report available on VEGF expression in the CL of term pregnancy. METHODS: We assessed VEGF expression in ovaries obtained from, 26-42 yr of age, and from patients undergoing hysterectomy and salpingo-oophorectomy for nonendocrinological or nonovarian disorders. Tissue samples from premenopausal women included specimens from follicular (n=4) and luteal (n 4) phases. In addition, we studied ovarian specimens from pregnant women (n=3). Immunohistochemical analysis for VEGF was performed using a rabbit polyclonal antibody directed against human VEGF. RESULTS: These data demonstrate a development-related VEGF expression in the follicle and indirectly show that VEGF expression may be up to the existence of LH-receptor. And also, VEGF was overexpressed in the regressed CL of pregnant women compared with the functioning CL of nonpregnant cycles CONCLUSION: This study suggests that the intensity of VEGF expression is not correlated with steroidogenic activity, although both of them are stimulated by LH.
Cell Proliferation ; Corpus Luteum ; Female ; Humans* ; Hysterectomy ; Menstrual Cycle ; Ovarian Follicle ; Ovary* ; Pregnancy ; Pregnant Women ; Vascular Endothelial Growth Factor A*