Squamous cell carcinoma has occasionally been encountered in orthopedic practice as a complication of chronic osteomyelitis, burn scar and other lesions. The possible occurrence of this secondary change impose difficulty in the diagnosis and management of chronic orthopedic diseases. During 11 years from 1966 to 1976, 16 cases of squamous cell carcinoma were confirmed by histopathological examination and the results of clinical observation on them are summarized here. l. Of 16 patients, men were 15 and woman one. Their average age was 51.3 years 2. The primary lesions in which this malignancy developed were osteomyelitis (5 cases), and scar (5 cases), and scar after extensive laceration (2 cases). In one case no primary lesion was present. 3. Average duration of symptomatology of the primary lesion was 35.4 years in osteomyelitis and 31.2 yeary in burnscar. 4. Location of the lesion was in lower extremity in 15 cases, eight of which were in the leg. 5. Methods of treatment undertaken were; amputation (10 cases), chemotherapy (2 cases), chemotherapy and irradation (1 case). In three no treatment was done because of refusal. 6. The follow-up study was possible in five of them. Of four cases amputated, one was well alive for two years after ablation with no evidence of metastasis, the others two showed spread, to inguinal nodes in one and ribs in the other, after two years and the fourth died of unknown disease after two years. The fifth died, after initial remission with chemotherpy and irradation, of lung cancer after two years.
Amputation ; Burns ; Carcinoma, Squamous Cell ; Cicatrix ; Diagnosis ; Drug Therapy ; Epithelial Cells ; Female ; Follow-Up Studies ; Humans ; Lacerations ; Leg ; Lower Extremity ; Lung Neoplasms ; Male ; Neoplasm Metastasis ; Orthopedics ; Osteomyelitis ; Ribs

Defect of the radius should be managed with either fusion of radius and ulna forming “one-bone forearm”, or restoration of its continuity by bone graft. Reported hereia are two cases in which the radius developed defect following sequestrectomy and treatment of open infected fructure respectively. Reconstruction of the radius was tried with bone graft; utilizing the ulnar end resected from the same side in one case and fibula in other. Both Sowed sound bony union of the graft about four months postoperatively.
Fibula ; Radius ; Transplants ; Ulna

Correction of alveolar cleft with bone grafting has become a well-established step in the integral management of cleft lip and palate patients. Secondary bone graft at mixed dentition is a widely accepted protocol and iliac bone graft is recommended as the gold standard by a multitude of cleft centers. However, grave morbidities of the iliac donor site have discouraged cleft surgeons from adopting this reliable method. In this study, percutaneous bone biopsy set was used to avoid the morbidities of conventional iliac bone graft. Iliac bone graft was performed on 20 patients with alveolar cleft during the period from January 1995 to February 1999. The tube saw of the bone biopsy set was introduced through a small incision of less than 1 cm, and cancellous bone cores were harvested from the iliac crest. After the pericoronal incision, a wide gingival mucoperiosteal flap was elevated at both sides of the cleft. A soft tissue pocket that was created by closure of the nasal and palatal lining was filled with harvested bone cores. Medial transposition and water-tight closure of both gingival mucoperiosteal flaps provided coverage of the bone graft. During the follow-up period from 5 to 50 months (mean, 29 months), completion of the goals of the alveolar bone graft was observed. There was no serious complication except for one case the exposure of the bone graft, and this was resolved spontaneously. Bone harvest with a percutaneous bone biopsy set enables early ambulation by reducing postoperative pain, and it may be faster and simpler than any other method introduced so far. Furthermore, blood loss was minimal, while the scar was small and acceptable. Iliac bone graft with percutaneous bone biopsy is a reliable method for correction of the alveolar cleft and it has many advantages over conventional iliac bone graft and other sources of bone.
Biopsy* ; Bone Transplantation ; Cicatrix ; Cleft Lip ; Dentition, Mixed ; Early Ambulation ; Follow-Up Studies ; Humans ; Pain, Postoperative ; Palate ; Tissue Donors ; Transplants

The effects of intravenous Verapamil administration on ventricular function were evaluated using grated radionuclide ventriculography in 15 patients with essential hypertension. Verapamil(0.1mg/kg) was injected as a bolus for 2 minutes followed by an infusion of 0.007mg/kg/min. Heart rate, blood pressure, ejection fraction, peak ejection rate, total filling time, and prak filling rate were assessed before and after Verapamil administration. The results were was as follows ; 1) Verapamil administration increased heart rate from 63+/-5 to 75+/-9 beats/min(p<0.01) and reduced systolic and diastolic blood pressure from 156+/-17/99+/-6mmHg to 139+/-16/88+/-6mmHg(p<0.01). 2) Ejection fraction, peak ejection rate, and total filling time were not changed significantly after Verapamil injection. 3) Right and left ventricular peak filling rate increased significantly only in patients in whom it was subnormal in the basal study) from 1.6+/-0.4 to 2.3+/-1.1 end-diastolic volumes/s, p<0.05 and from 2.5+/-0.6 to 3.1+/-0.8 end-diastolic volumes/s, p<0.05, respectively). In conclusion, it was found that intravenous Verapamil administration enhances ventricular diatolic function in patients with essential hypertension.
Blood Pressure ; Heart Rate ; Humans ; Hypertension* ; Radionuclide Ventriculography ; Ventricular Function ; Ventricular Function, Right* ; Verapamil*

Superior vents lava(SVC) syndrome is mostly related to a malignant process, but many different benign causes haute also been described. We report a case of SVC syndrome caused by Klebsiella pneumonia diagnosed by sputum culture and serial chest X-ray changes. A 27-year-old man had been in stable health until three days before admission, when he complained of pleuritic chest pain, facial flushing, and shortness of breath. Examination of the head and neck disclosed edema of face and both arms, and jugular venous distention to the angle of the jaw. The chest auscultation resealed decreased breath sound without crackle on right upper lung field. The chest roentgenogram showed homogenous air space consolidation on right upper lobe, asociated with downward displacement of minor fissure and contralateral displacement of trachea, but air bronchogram was not seen. We began antibiotic therapy under impression of pneumonia after assailable culture was taken from blood and sputum. SVC scintigraphy showed stasis of drain of right brachiocephalic vein at the proximal portion with reflux into the right internal jugular vein and faintly visible SVC via the collaterals. Sputum culture resealed Klebsiella pneumoniae. Antibiotic therapy resulted in a cure of infection and disappearance of facial swelling. Follow-up SVC scintigraphy after 20 days showed normal finding. We first report a case of SVC syndrome caused by klebsiella pneumonia
Adult ; Arm ; Auscultation ; Brachiocephalic Veins ; Chest Pain ; Dyspnea ; Edema ; Flushing ; Follow-Up Studies ; Head ; Humans ; Jaw ; Jugular Veins ; Klebsiella pneumoniae ; Klebsiella* ; Lung ; Neck ; Pneumonia* ; Radionuclide Imaging ; Respiratory Sounds ; Sputum ; Superior Vena Cava Syndrome* ; Thorax ; Trachea ; Vena Cava, Superior*

PURPOSE: To evaluate the results of iliac artery angioplasty and stent placement as an option for the treatment of aortoiliac occlusive disease. METHOD: The records of 30 patients (mean age, 65.5 years) who underwent iliac artery angioplasty and/or stent placement were reviewed retrospectively. Presenting symptoms included asymptomatic (6.7%), claudication (73.3%), rest pain (10%), ulceration/tissue loss (3.3%), and blue toe syndrome (6.7%). Follow-up included angioplasty, Doppler ultrasound, and clinical examination. Mean follow-up time was 32 months. RESULT: Forty iliac lesions were treated. Thirty-seven percent of patients had hypertension, 33% had diabetes mellitus, 23% had coronary arterial disease, 6.6% had cerebrovascular disease, 3.3% had hyperlipidemia and 3.3% had renal insufficiency. TASC (Trans Atlantic Inter-Society Consensus) A, B, C and D disease types were 11 (36.7%) patients, 5 (16.7%), 10 (33.3%) and 4 (13.3%). Ipsilateral superficial femoral artery occlusion was present in 6 (20%) patients. Concomitant femoral artery bypass surgery was performed in 10 (33.3%) patients. The cumulative primary patency rates were 83.4%, 71.9% and 64.7% at 1, 2, and 3 years, respectively. CONCLUSION: Iliac artery angioplasty and stent placement is a technically safe and effective treatment modality in patients without ipsilateral superficial femoral artery occlusion.
Angioplasty* ; Blue Toe Syndrome ; Diabetes Mellitus ; Femoral Artery ; Follow-Up Studies ; Humans ; Hyperlipidemias ; Hypertension ; Iliac Artery ; Renal Insufficiency ; Retrospective Studies ; Stents* ; Ultrasonography

BACKGROUND: Recent studies and case reports have shown that recombinant factor VIIa (rFVIIa) treatment is effective for reversing coagulopathy and reducing blood transfusion requirements in trauma patients with life-threatening hemorrhage. The purpose of this study is to evaluate the effect of rFVIIa treatment on clinical outcomes and cost effectiveness in trauma patients. METHODS: Between January 2007 and December 2010, we reviewed the medical records of patients who were treated with rFVIIa (N=18) or without rFVIIa (N=36) for life-threatening hemorrhage due to multiple traumas at the Emergency Department of Pusan National University Hospital in Busan, Korea. We reviewed patient demographics, baseline characteristics, initial vital signs, laboratory test results, and number of units transfused, and then analyzed clinical outcomes and 24-hr and 30-day mortality rates. Thromboembolic events were monitored in all patients. Transfusion costs and hospital stay costs were also calculated. RESULTS: In the rFVIIa-treated group, laboratory test results and clinical outcomes improved, and the 24-hr mortality rate decreased compared to that in the untreated group; however, 30-day mortality rate did not differ between the groups. Thromboembolic events did not occur in both groups. Transfusion and hospital stay costs in the rFVIIa-treated group were cost effective; however, total treatment costs, including the cost of rFVIIa, were not cost effective. CONCLUSIONS: In our study, rFVIIa treatment was shown to be helpful as a supplementary drug to improve clinical outcomes and reduce the 24-hr mortality rate, transfusion and hospital stay costs, and transfusion requirements in trauma patients with life-threatening hemorrhage.
Adult ; Aged ; Aged, 80 and over ; Factor VIIa/*therapeutic use ; Hemoglobins/analysis ; Hemorrhage/complications/*drug therapy/mortality ; Humans ; Middle Aged ; Multiple Trauma/*complications ; Partial Thromboplastin Time ; Platelet Count ; Prothrombin Time ; Recombinant Proteins/therapeutic use ; Retrospective Studies ; Treatment Outcome

BACKGROUND: The patients with atopic dermatitis (AD) show a defective barrier function of the skin and symptoms such as xerosis, pruritus and erythematous lesions with increased transepidermal water loss (TEWL). The choice of topical moisturizer is very significant for AD patients because these symptoms could be relieved by a local moisturizing agent that strengthens the epidermal barrier function. OBJECTIVE: This study was performed to evaluate the effects of the moisturizer APDDR-0801, which contains physiologic lipid granules (DermaON(R)), for relieving the symptoms associated with AD. METHODS: 128 patients (17.8+/-12.1 years) who were suffering from mild to moderate AD topically applied the test moisturizer twice daily for up to 4 weeks. The treatment efficacy was evaluated by the investigator global assessment (IGA) score, the eczema area and severity index (EASI) score, the transepidermal water loss (TEWL), the visual analogue scale (VAS) for pruritus and sleep disturbance, and the level of inflammatory cytokines in the horny layer of the flexural areas. RESULTS: The test moisturizer was well-tolerated and 58.6% of the patients achieved clinical improvements (over moderate) after the application of the test moisturizer for 4 weeks. The significant relief of AD symptoms was observed from 2 week to 4 week in a time-dependent manner. Significant improvements in the signs and symptoms of AD were observed at 4 week, such as the EASI score (37.8% improvement), the TEWL (20.3% improvement in the antecubital fossa lesion), the VAS score for pruritus (26.2% improvement), and VAS score for insomnia (39.7% improvement). CONCLUSION: The moisturizer APDDR-0801 (Atobarrier Cream(R), which contains physiologic lipid granules, effectively relieved the symptoms associated with AD.
Cytokines ; Dermatitis, Atopic ; Eczema ; Humans ; Pruritus ; Research Personnel ; Skin ; Sleep Initiation and Maintenance Disorders ; Stress, Psychological ; Treatment Outcome