Diabetic and nondiabetic vascular diseases cause significant foot problems and it frequently progress to osteomyelitis and amputation. Advances in vascular surgical techniques, including distal arterial bypass via synthetic grafts or autogenous vein grafting have opened the way for higher rate of limb salvage. We have experienced patients with ischemic vascular foot disease and combined skin ulceration and varing degree of soft tissue defect. In three patient with major vessel obstruction, we could preserve limb and avoid major amputation using greater saphenous vein graft with or without microvascular free tissue transfer.
Amputation ; Extremities ; Foot Diseases ; Foot* ; Humans ; Limb Salvage ; Osteomyelitis ; Saphenous Vein ; Skin Ulcer ; Transplants ; Vascular Diseases ; Veins

PURPOSE: The variety of outcomes in patients with stage II colorectal carcinomas might be due to understaging caused by an inadequate number of lymph nodes (LNs) being examined. The aim of this study was to determine if any number of examined LNs reflects a reliable node-negative staging for colorectal carcinomas (CRCs). METHODS: Data on 241 patients (132 males) who underwent potentially curative resections for pT3 and pT4 CRC were reviewed. The patients ranged in age from 21 to 87 (mean: 58.2) years with a median follow-up of 43 (range: 7~96) months. The relationship between the number of LNs harvested and both the 5-year disease-free survival (DFS) and the overall survival (OS) rates were assessed for stage II CRCs. RESULTS: A median of 15 LNs (range: 3~104) was harvested per tumor specimen, and lymph-node metastases were present in 107 cases (44.4%). The proportion of lymph-node metastases increased as a function of the number of LNs harvested (P=0.0002; 95% confidence interval, 0.3333~0.8138). The number of LNs revealed to be the best number for dividing stage II patients into subgroups with different DFS and OS rates was ten. The 5-year DFS and OS rates of the 48 patients (35.8%) with nine or fewer LNs harvested were 68.6% and 76.8%, respectively, whereas those of the 86 patients (64.2%) with ten or more LNs harvested were 87.2% and 91.9%, respectively (DFS, P=0.0082; OS, P=0.0303). Moreover, there were no statistical differences between the node-negative patients with nine or fewer LNs harvested and the 67 stage III patients with N1 in respect to the DFS (68.6% vs. 56.7%; P= 0.2031) and the OS (76.8% vs. 68.3%; P=0.2772) rates. CONCLUSIONS: This study suggests that examining a greater number of lymph nodes increases the likelihood of accurate nodal staging and that a minimum of ten LNs per surgical specimen should be harvested and examined to label a pT3 or pT4 CRC as node-negative.
Colorectal Neoplasms* ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Lymph Nodes* ; Neoplasm Metastasis ; Prognosis

PURPOSE: To evaluate the early ERG (electroretinogram) changes in N-methyl-N-nitrosourea (MNU)-induced retinal degeneration in rats. METHODS: Thirty-six 6-week-old male rats were injected intraperitoneally with 60mg/kg MNU and divided into 6 groups. Histology and ERG were recorded for the rats of each group before treatment and at 3, 6, 12, 18, and 24 hours after MNU injection. Promptly after the ERG recording, rats were sacrificed and the eyeballs prepared for histologic sectioning. The Tdt-mediated dUTP-digoxigenin nick end labeling (TUNEL) method was used to detect photoreceptor cell death. RESULTS: The first decreases of ERG responses were noticed maximally at 3 hours after the treatment. Thereafter, the amplitude of the responses was partially recovered at 12 hours post-treatment. The second decrease of ERG amplitudes was observed in the 18-hour recordings, and those changes progressed to 24 hours after the treatment. In the histologic findings, TUNEL (+) cells in the Outer Nuclear Layer (ONL) were not detected at 3 hours after MNU injection, but were initially noticed at 6 hours post-injection. CONCLUSIONS: The first decreases of ERG amplitudes proceeded the appearance of TUNEL (+) cells in ONL, and these electrophysiological changes seemed to not be related to photoreceptor cell death. We propose that electrophysiological changes observed might be related to the MNU-induced activity enhancement of guanylate cyclase in the phototransduction pathway. We also show that photoreceptor cell death in the MNU-induced retinal degeneration model occurs at 6 hours after the treatment, which is earlier than the results of previous reports.
Animals ; Guanylate Cyclase ; Humans ; In Situ Nick-End Labeling ; Light Signal Transduction ; Male ; Methylnitrosourea ; Photoreceptor Cells ; Rats* ; Retinal Degeneration* ; Retinaldehyde*

the ineidence of abdominal subcutaneous endometriosis is quite rare we have experienced one case of subcutaneous endometriosis. The typical clinical bistory and local findings of endometriasis enabk us to make the conect diagnosis. the treatment of choice is complete surgical excision of endometrial tissue and post operative medical therapy. This case was reported with a brief review of the comcemed literatures.
Diagnosis ; Endometriosis* ; Female ; Subcutaneous Tissue*

Glioblastomas (GBMs) are the most common and aggressive primary brain tumors, and despite advances in treatment, prognosis remains poor. The extent of resection has been widely recognized as a key factor affecting survival outcomes in GBM patients. The surgical principle of “maximal safe resection” has been widely applied to balance tumor removal and neurological function preservation. Historically, T1-contrast enhanced (T1CE) extent of resection has been the focus of research; however, the “supramaximal resection” concept has emerged, advocating for even greater tumor resection while maintaining neurological function. Recent studies have demonstrated potential survival benefits associated with resection beyond T1CE extent in GBMs. This review explores the developing consensus and newly established criteria for “supramaximal resection” in GBMs, with a focus on T2-extent of resection. Systematic reviews and meta-analyses on supramaximal resection are summarized, and the Response Assessment in Neuro-Oncology (RANO) resect group classification for extent of resection is introduced. The evolving understanding of the role of supramaximal resection in GBMs may lead to improved patient outcomes and more objective criteria for evaluating the extent of tumor resection.

OBJECTIVE: Obesity is considered a potential cause of several malignancies including endometrical cancer and breast cancer. We analyzed the relationship between obesity and cervical cancer to examine the role of obesity in developing cervical cancer and to prevent the cervical cancer. METHODS: A retrospective analysis was performed on 203 cervical carcinomas including 87 cervical adenocarcinoma and 116 cervical squamous cell carcinoma patients and as control group, 279 patients visiting severance hospital for PAP smear in the period 1994-2003. We analyzed medical records for patient characteristics and body mass index. The obtained data were analyzed using t-test, chi square test and logistic regression analysis by SPSS. RESULTS: There was no statistically significant risk factor in patient characteristics including body mass index between adenocarcinoma and control group. Between cervical squamous cell carcinoma and control group, patients age (odds ratio=0.952, p=0.06) and menopause status (odds ratio=2.420, p=0.02) were statistically significant risk factors. Body mass index was not significantly different among three groups (adenocarcinoma vs. control group, 23.0 +/- 3.4 vs. 22.4 +/- 3.2; squamous cell carcinoma vs. control group, 23.9 +/- 3.5 vs. 22.4 +/- 3.2). CONCLUSION: Our results were consistent with the concept that obesity was not a risk factor for cervical carcinoma. However menopause might be a potential risk factor in developing squamous cell carcinoma of the uterine cervix.
Adenocarcinoma ; Body Mass Index ; Breast Neoplasms ; Carcinoma, Squamous Cell ; Cervix Uteri ; Female ; Humans ; Logistic Models ; Medical Records ; Menopause ; Obesity* ; Retrospective Studies ; Risk Factors* ; Uterine Cervical Neoplasms*

OBJECTIVE: This study was carried out to investigate the relationship between DNA ploidy, S-phase fraction (SPF), expression of cyclin A and clinical prognostic factors including stage, grade, CA-125 and residual tumor size in epithelial ovarian cancer, and to evaluate the association between DNA ploidy, SPF, expression of cyclin A and 3-year survival. METHODS: Study group consisted of 31 cases of epithelial ovarian cancer, 10 of borderline ovarian tumor and 5 of benign ovarian tumor diagnosed at the department of Obstet. and Gynecol. in Yonsei University College of Medicine, Seoul, Korea from Feb. 2000 to Jan. 2003. All patients underwent staging-laparotomy and postoperative chemotherapy. The level of CA-125 was assessed after 6th postoperative chemotherapy with cut-off value of 35 U/mL. DNA ploidy and SPF were evaluated by flow-cytometry of fresh ovarian tissue obtained at the operative field. The expression of cyclin A was evaluated by immuno-histochemical stain. Expression of 5% was considered as positive. Statistical analysis was done by two-sample t-test, chi-square test, and Kaplan-Meier survival curve using SPSS ver 11.0 software. RESULTS: In 46 ovarian tumors aneuploidy, SPF and expression of cyclin A were significantly higher in epithelial ovarian cancer as compared with benign and borderline tumors (p=0.004, 0.001, 0.001, respectively). Number of aneuploidy, SPF and expression of cyclin A were significantly higher in patients with higher grade, more advanced stage, higher level of CA-125 (more than 35 U/mL) and more than 2 cm of residual tumor size (p=0.004, 0.009, 0.05, 0.002 in aneuploidy; p=0.06, 0.01, 0.04, 0.007 in SPF; p=0.03, 0.004, 0.06, 0.02 in cyclin A). Aneuploidy and expressions of more than 10% of SPF and cyclin A were also associated with poorer overall survival (p=0.02, 0.02, <0.0001, respectively). Significantly positive correlations were observed among these factors. CONCLUSION: Number of aneuploidy, percentage of SPF and expression of cyclin A were higher in more advanced stage, higher grade, higher CA-125 and more than 2 cm of residual tumor size and associated with poorer overall survival. Thus DNA flow-cytometry and estimation of expression of cyclin A may provide major information about prognosis of disease in epithelial ovarian cancer patients.
Aneuploidy ; Cyclin A* ; Cyclins* ; DNA* ; Drug Therapy ; Humans ; Korea ; Neoplasm, Residual ; Ovarian Neoplasms* ; Ploidies ; Prognosis ; Seoul

We performed combined spondylectomy for 2 patients of malignant tumors invading spinal column and chest wall. For one patient with Pancoast tumor, anterolateral thoracotomy, apical lobectomy, chest wall resection, and hemispondylectomy were performed. For another patient with solitary metastatic tumor from nasopharyngeal cancer, posterolateral thoracotomy, chest wall resection, and total en bloc spondylectomy were performed with anterior and posterior instrumentation. The tumor including invaded chest wall and spinal column werewas removed completely in both patients. No local recurrence was found at 18 months follow-up evaluation in both patients.
Follow-Up Studies ; Humans ; Nasopharyngeal Neoplasms ; Pancoast Syndrome ; Recurrence ; Spine ; Thoracic Wall ; Thoracotomy ; Thorax

OBJECTIVE: The prognosis of gynecologic malignancies was closely related to the nutritional status of patients as well as clinical or surgical staing at the time of diagnosis. The serum prealbumin has relatively short half-life among the nutritional parameters and could be used to detect immediate postoperative change of nutritional state in surgical patients. The purpose of this study was to evaluate the clinical impact of serum prealbumin and the validity of prealbumin in prediction and detection of postoperative complications in high risk patients with gynecologic malignancy. METHODS: 153 gynecologic malignant patients and 68 non-malignant patients operated from January 1999 to May 2003 were studied retrospectively. The serum albumin, total lymphocyte count (TLC), prealbumin were compared between the malignant and non-malignant patients, early and advanced stage cancer group, and complicated and uncomplicated group. Prealbumin was defined as the difference between preoperative and postoperative prealbumin concentrations. The correlation was statistically analyzed by Student's t-test, one way ANOVA test, and x2-test (SPSS ver. 11.0). RESULTS: There was significant difference in prealbumin between non-malignant patients and malignant patients (p=0.049). There was also significant difference in prealbumin between carcinoma in situ of uterine cervix and cervical cancer group (p=0.049). However there were no significant differences in prealbumin between early and advanced stage ovarian cancer and uterine cancer (p=0.48, p=0.67, respectively). There were no significant differneces between complicated and uncomplicated groups in prealbumin and delta prealbumin. CONCLUSION: Serum prealbumin was not useful in prediction and detection of high risk group of postoperative complications in gynecologic cancer patients.
Carcinoma in Situ ; Cervix Uteri ; Diagnosis ; Female ; Half-Life ; Humans ; Lymphocyte Count ; Nutritional Status ; Ovarian Neoplasms ; Postoperative Complications ; Prealbumin* ; Prognosis ; Retrospective Studies ; Serum Albumin ; Uterine Cervical Neoplasms ; Uterine Neoplasms

Several studies have reported the associations between airborne particles and/or ozone and respiratory diseases. This study examined whether such an association could be seen in Seoul, one of the greatest city in Korea. We compiled daily records of hospital visits in Seoul from November 1, 1995 to October 31, 1996. The daily averages of ozone and particle matter whose diameter is 10 micrometer or less(PM10) from all monitoring stations were computed. Daily respiratory hospital visits were regressed on temperature, humidity, day of weak indicators, seasonal variation indicators, and air pollution. Each pollutant was first examined individually and then two pollutant models were fitted. RESULTS : Both PM10 and Ozone were associated with increased risk of respiratory hospital visits. The relative risk of respiratory hospital visits for 50 microgram/m3 increase in PM10(lagged 2 days) was 1.11(95% confidence interval: 1.05-1.18). The PM10 associations was insensitive to alternative methods of control for weather, including exclusion of extreme temperature days and control for temperature on another day. The ozone results were more sensitive to the approach for weather control. The relative risk of respiratory hospital visits for 0.01 ppm increase in O3 was 1.08(95% confidence interval 1.00-1.17). The magnitude of the PM10 effect in Seoul, where SO2 was essential present, was similar to that reported in the Europe and United states. In conclusion, The consistency of investigations of the health effects of air pollution suggest that attention should be paid to the control of air pollution.
Air Pollution* ; Europe ; Humidity ; Korea ; Ozone ; Seasons ; Seoul* ; United States ; Weather