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

No abstract available.
Animals ; Cats* ; Reflex*

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

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

OBJECTIVE: To analyse neonatal outcomes of the very low birthweight infants born to women who underwent an indicated preterm delivery and spontaneous preterm delivery. METHODS: We performed an observational study of 150 very low birthweight(<1500 grams) infants delivered at Samsung Medical Center. The study population was limited to singleton infants without major congenital anomalies. The primary reason for delivery was categorized as indicated preterm delivery or spontaneous preterm delivery. Selected neonatal outcomes were compared between infants born to women in each of these groups. RESULTS: Univariate analyses showed some survival benefits in infants born to women who underwent indicated preterm delivery. Selected neonatal outcomes, however, did not differ between the groups in the multiple logistic regression analysis. CONCLUSION: There was no survival advantage to the very low birthweight infants born to women who underwent an indicated preterm delivery compared to those born to women with spontaneous preterm delivery.
Female ; Humans ; Infant* ; Logistic Models ; Observational Study

OBJECTIVE: The purpose of this study was to examine the pharmacological treatment patterns and clinical responses in inpatients and/or outpatients with obsessive compulsive disorder (OCD) at a university hospital. METHODS: A total of 71 OCD patients were included and followed during the first 4 months, first year and second year from 1998. The patterns of medication use and clinical responses according to the Yale-Brown obsessive-compulsive scale (Y-BOCS) were analyzed descriptively in this period. RESULTS: During the first 4 months, 26.7% of the patients underwent monotherapy in which most of the drugs were serotonin reuptake inhibitors (SRIs). Therapy with two or more drugs was administered in 66.6% of the patients and combination drugs with SRIs were atypical antipsychotics and clonazepam. The clinical response rate using Y-BOCS was 24.0% compared with baseline score. During the first year, the frequency of the monotherapy decreased to 6.5%, while that of therapy with two or more drugs increased to 80.6% (two and three drug frequencies were 35.3%, and 32.3%, respectively). The clinical response rate was 26.4% during this period. During the second year, the frequency of the monotherapy was 25% and that of multidrug therapy was 70.8% (two and three drug frequencies were 20.8%, and 45.8%, respectively). The clinical response rate was 39.3% compared with baseline score. CONCLUSIONS: In this study, the frequency of the combination therapy was relatively high compared with SRI monotherapy during the first 4 months and it increased further during the first year. The combination therapy was maintained without change of SRI dosage during the second year. Most of the drugs used in the combination therapy were atypical antipsychotics and clonazepam.
Antipsychotic Agents ; Clonazepam ; Drug Therapy* ; Humans ; Inpatients ; Obsessive-Compulsive Disorder* ; Outpatients ; Serotonin Uptake Inhibitors

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*

PURPOSE: To evaluate the usefulness and the accuracy of CT-discography in lumbar disc disease by analyzing the findings of CT-discogram and types of evoked pain during the procedure. MATERIALS AND METHODS: CT-discograms were retrospectively evaluated in 47 intervertebral discs of 20 patients with multilevel involvement of lumbardisc diseases. In 28 herniated discs confirmed at surgery, the findings of CT-discogram (28 disc levels/20 patients), MRI(23/16) and CT(21/15) were comparatively analysed. The type of pain after infusion of contrast mediaduring CT-discography was compared with that prior to the procedure. RESULTS: The accuracy for determining typesof the herniated lumbar disc when compared with postoperative results was 96.4%(27 discs/28 discs) in the CT-discogram, 82.6%(19 discs/23 discs) in MRI and 71.4%(15 discs/21 discs) in the CT scan. Pains encountered during discography were radiating pain in 12 discs and back pain in 24 discs. CT-discography was especially helpful in 10 patients with multilevel involvement of the lumbar disc diseases to evaluate the exact location of diseased disc(s) that provoked the pain. CONCLUSION: CT-discography is a highly accurate method in diagnosis ofthe herniated lumbar intervertebral discs and is very useful in determining the precise location related to the development of pain in such cases.
Back Pain ; Diagnosis ; Humans ; Intervertebral Disc ; Intervertebral Disc Displacement ; Magnetic Resonance Imaging ; Retrospective Studies ; Spine ; Tomography, X-Ray Computed

Human Fasciola hepatica infection is a rare entity involving infestation of the liver and biliary tree with adult flukes, which can result in hepatitis, cirrhos is and biliary tract inflammation, obstruction and lithiasis. The patient had the typical diagnostic tetrad of fever, eosinophilic leukocytosis, tender hepatomegaly and fluke ova in the stools. Treatment consists of Emetine hydrochloride hydrochloride administration for hepatic involvement and common bile duct exploration for removal of flukes, with cholecystectomy for associated cholelithiasis. The combination of medical and surgical therapy can be expected to produce an arrest of this infection. The removed liver revealed eggs of the fasciola species in the intrahepatic bile duct. The clinical history, pathological findings and treatment of this case were described.
Adult ; Bile Ducts, Intrahepatic ; Biliary Tract ; Cholecystectomy ; Cholelithiasis ; Common Bile Duct ; Eggs ; Emetine ; Eosinophils ; Fasciola ; Fasciola hepatica ; Fascioliasis* ; Fever ; Hepatitis ; Hepatomegaly ; Humans* ; Inflammation ; Korea* ; Leukocytosis ; Lithiasis ; Liver* ; Ovum ; Trematoda

BACKGROUND: Recurrent aphthous stomatitis (RAS) is usually the earliest sign of Behcet's disease. Hyperhomocysteinemia can damage endothelial cells and progress to obstructive vascular disease. It has been reported that hyperhomocysteinemia is a marker of activation in Behcet's disease. Enzyme 5,10-methylenetetrahydrofolate reductase may be one of the main factors that regulates plasma homocysteine levels. Homozygosity for the C677T (MTHFR C677T) mutation is associated with reduced activity of this enzyme and considered the most common genetic cause of elevated serum homocyteine levels. However its relationship to vascular injury in Behcet's disease remains controversial, and its relationship to RAS is unknown. Apolipoprotein E (Apo E) has both immunoregulatory and anti-infective features. Search for Apo E polymorphism and lipid composition in RAS patients might be a clue to pathogenesis of RAS. OBJECTIVE: To analyze the relationship of MTHFR gene C677T polymorphism, several epidemiologic factors such as age and sex, smoking, lipid composition and Apo E polymorphism to vasculitis in RAS, we assessed the MTHFR gene C677T polymorphism, Apo E polymorphism and lipid composition in RAS and normal population. METHODS: We analyzed data from the General Health survey conducted on 1,243 participants (M:F=281:962) over a 20 year-old in Incheon city. Medical interview and laboratory test for methylenetetrahydrofolate reductase (MTHFR) C677T gene polymorphism, apolipoprotein E polymorphism were completed. Statistical significance was analyzed by chi-square test and multistep logistic regression analysis. RESULTS: Among normal population over the age of twenty, a total of 34.2% (426/1,243) had RAS. Female predominance (4.5:1, p=0.003) was noted. The incidence of RAS in age group 20 to 39 year old is higher than the over 40 age group. The incidence is higher in smoking group compared to the nonsmoking group in multistepwise logistic regression analysis. Frequency of the MTHFR C677T genotypes was highest at CT compared to CC and TT homozygous genotype in normal and RAS patients group. There was no significant statistical differences in MTHFR genotypes in RAS patients compared to the control group. Similarly, Apo E genotype analysis revealed no significant statistical differences either. Apo E genotype and total cholesterol, HDL-cholesterol, triglyceride level didn't show any associations. CONCLUSION: This study revealed insignificant association between the MTHFR C677T mutation and RAS. Apo E genotype didn't show a significant statistical difference in RAS patients compared to normal controls.
Apolipoproteins ; Apolipoproteins E ; Cholesterol ; Endothelial Cells ; Epidemiologic Factors ; Female ; Genotype ; Health Surveys ; Homocysteine ; Humans ; Hyperhomocysteinemia ; Incidence ; Logistic Models ; Methylenetetrahydrofolate Reductase (NADPH2) ; Oxidoreductases ; Plasma ; Smoke ; Smoking ; Stomatitis, Aphthous ; Tetrahydrofolates ; Vascular Diseases ; Vascular System Injuries ; Vasculitis