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

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*

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*

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.

Purpose: This study aimed to investigate whether levetiracetam (LEV), the most used antiepileptic drug, influences survival in patients with glioblastoma (GBM), using a national database. Materials and Methods: This study used data from the Korea Health Insurance Review and Assessment database. Patients diagnosed with GBM between 2007-2018 treated with standard therapy were included. The study population was divided into long-term (≥ 60 days) and short-term (< 30 days) LEV groups. A separate long-term valproic acid (VPA) group (≥ 60 days) was identified for comparison. Demographics, disease characteristics, and treatment parameters were collected. Kaplan-Meier method and Cox regression were used to compare survival outcomes between the groups. Results: Overall, 2,971 patients were included, with 1,319 and 1,652 in the short-term and long-term LEV groups, respectively. The median overall survival (OS) for the entire population was 19.15 months post-surgery. Kaplan-Meier analysis revealed a significantly longer median OS in the long-term LEV group versus the short-term LEV group. After adjusting for confounders, Cox proportional hazard analysis revealed an association of long-term LEV use with improved survival, which was also observed in a subgroup analysis of patients without preoperative seizure history. The long-term LEV group demonstrated longer median OS, compared with the long-term VPA group. Conclusion Our nationwide population-based study found an association between long-term LEV use and improved survival in patients with GBM, regardless of preoperative seizure history. Prospective studies are needed to validate these findings and investigate the potential impact of LEV on the survival outcomes of patients with GBM.

Purpose: This study aimed to investigate whether levetiracetam (LEV), the most used antiepileptic drug, influences survival in patients with glioblastoma (GBM), using a national database. Materials and Methods: This study used data from the Korea Health Insurance Review and Assessment database. Patients diagnosed with GBM between 2007-2018 treated with standard therapy were included. The study population was divided into long-term (≥ 60 days) and short-term (< 30 days) LEV groups. A separate long-term valproic acid (VPA) group (≥ 60 days) was identified for comparison. Demographics, disease characteristics, and treatment parameters were collected. Kaplan-Meier method and Cox regression were used to compare survival outcomes between the groups. Results: Overall, 2,971 patients were included, with 1,319 and 1,652 in the short-term and long-term LEV groups, respectively. The median overall survival (OS) for the entire population was 19.15 months post-surgery. Kaplan-Meier analysis revealed a significantly longer median OS in the long-term LEV group versus the short-term LEV group. After adjusting for confounders, Cox proportional hazard analysis revealed an association of long-term LEV use with improved survival, which was also observed in a subgroup analysis of patients without preoperative seizure history. The long-term LEV group demonstrated longer median OS, compared with the long-term VPA group. Conclusion Our nationwide population-based study found an association between long-term LEV use and improved survival in patients with GBM, regardless of preoperative seizure history. Prospective studies are needed to validate these findings and investigate the potential impact of LEV on the survival outcomes of patients with GBM.

Purpose: This study aimed to investigate whether levetiracetam (LEV), the most used antiepileptic drug, influences survival in patients with glioblastoma (GBM), using a national database. Materials and Methods: This study used data from the Korea Health Insurance Review and Assessment database. Patients diagnosed with GBM between 2007-2018 treated with standard therapy were included. The study population was divided into long-term (≥ 60 days) and short-term (< 30 days) LEV groups. A separate long-term valproic acid (VPA) group (≥ 60 days) was identified for comparison. Demographics, disease characteristics, and treatment parameters were collected. Kaplan-Meier method and Cox regression were used to compare survival outcomes between the groups. Results: Overall, 2,971 patients were included, with 1,319 and 1,652 in the short-term and long-term LEV groups, respectively. The median overall survival (OS) for the entire population was 19.15 months post-surgery. Kaplan-Meier analysis revealed a significantly longer median OS in the long-term LEV group versus the short-term LEV group. After adjusting for confounders, Cox proportional hazard analysis revealed an association of long-term LEV use with improved survival, which was also observed in a subgroup analysis of patients without preoperative seizure history. The long-term LEV group demonstrated longer median OS, compared with the long-term VPA group. Conclusion Our nationwide population-based study found an association between long-term LEV use and improved survival in patients with GBM, regardless of preoperative seizure history. Prospective studies are needed to validate these findings and investigate the potential impact of LEV on the survival outcomes of patients with GBM.

Background: For treating recurrent glioblastoma, for which there is no established treatment, the antiangiogenic antibody, bevacizumab, is used alone or with irinotecan. This study was aimed at comparing the survival of patients with recurrent glioblastoma receiving bevacizumab monotherapy and those receiving bevacizumab plus irinotecan combination therapy (B+I) by using a nationwide population-based dataset. Methods: Patients matching the International Classification of Diseases code C71.x were screened from the Health Insurance Review and Assessment Service database. From January 2008 to November 2021, patients who underwent surgery or biopsy and subsequent standard concurrent chemoradiation with temozolomide were included. Among them, those who received bevacizumab monotherapy or B+I were selected. Demographic characteristics, inpatient stay, prescription frequency, survival outcomes, and steroid prescription duration were compared between these two groups. Results: Eight hundred and forty-six patients who underwent surgery or biopsy and received concurrent chemoradiotherapy with temozolomide were included. Of these, 450 and 396 received bevacizumab monotherapy and B+I, respectively. The corresponding median overall survival from the initial surgery was 22.60 months (95% confidence interval [CI], 20.50– 24.21) and 20.44 months (95% CI, 18.55–22.60; P = 0.508, log-rank test). The B+I group had significantly more bevacizumab prescriptions (median 5 times; BEV group: median 3 times).Cox analysis, based on the postsurgery period, revealed that male sex (hazard ratio [HR], 1.28;P = 0.002), older age (HR, 1.01; P = 0.042), and undergoing biopsy instead of surgery (HR, 1.79; P < 0.0001) were significantly associated with decreased survival. Fewer radiotherapy cycles correlated with improved survival outcomes (HR, 0.63; P = 0.001). Cox analysis, conducted from the start of chemotherapy including bevacizumab, showed that male sex was the only variable significantly associated with decreased survival (HR, 1.18; P = 0.044). Conclusion We found no significant difference in overall survival between the bevacizumab monotherapy and B+I groups. Considering the additional potential toxicity associated with irinotecan, bevacizumab monotherapy could be a suitable treatment option for treating recurrent glioblastoma.

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