ABSTRACT
PURPOSE: Buerger's disease (Thromboangiitis obliterans, TAO) is characterized by non- atheromatous inflammatory disease, and segmental inflammatory thrombotic occlusions of the small & middle-sized arteries and veins of the upper or lower extremities. Any epidemiological study of Buerger's disease in Korea has not been carried out until now. This study was undertaken to investigate the incidence of Buerger's disease in Korea among the patients suffering with arterial disease. METHODS: We collected and analyzed the data on 11,128 patients who were admitted to or visited the participating 22 hospitals for chronic arterial diseases throughout the major region of the South Korea from January 1986 to December 2003. The clinical diagnostic inclusion criteria for Buerger's disease were the followings: (1) a history of smoking or tobacco abuse; (2) an age of onset less than 50 years; (3) infrapopliteal, segmental arterial occlusions with sparing of the proximal vasculature; (4) frequent distal upper extremity arterial involvement (Raynaud's syndrome or digital ulceration) or-superficial phlebitis; and (5) the absence of arteriosclerotic risk factors other than smoking. RESULTS: The incidence rate of Buerger's disease among the arterial disease (11,128 patients) was 93 patients (0.83%) when the strict criteria of Shionoya was applied. 699 male-patients (6.55%) and 30 female patients (4.12%) who met the less strict criteria (the extended clinical diagnostic criteria group) were also reviewed. The 4th and 5th decades were the most common ages with-249 patients (34.2%) and 222 patients (30.5%) respectively, being found at these ages. The mean age was 40.4+/-1.6 years (age range: 16~83 years) and this was similar in both the strict criteria group and the less strict criteria group. CONCLUSIONS: This study suggests there was a low incidence of Buerger's disease in Korea among the patients who visited the participating hospitals when the strict diagnostic criteria were used. The incidence was lower than expected even when the less strict criteria were used. The more accurate incidence of Buerger's disease among the general population can be obtained by performing careful prospective study that is participated in by not only vascular surgeons, but also the other medical specialists with utilizing the strict diagnostic criteria.
Subject(s)
Female , Humans , Age of Onset , Arteries , Epidemiologic Studies , Incidence , Korea , Lower Extremity , Phlebitis , Risk Factors , Smoke , Smoking , Specialization , Thromboangiitis Obliterans , Nicotiana , Upper Extremity , VeinsABSTRACT
Acute mesenteric infarction due to mesenteric venous thrombosis was first reported by Elliot in 1895. In 1925 Warren and Eberhard characterized mesenteric venous thrombosis as an unique disease. PURPOSE: Mesenteric venous thrombosis is responsible for 5~15% of causes in acute mesenteric infarction. There are idiopathic thrombosis that has no specific causative disease and secondary thrombosis due to intraabdominal infection, tumor, portal hypertension, hematologic disorders and trauma to portal venous system etc. A diagnosis is made by Duplex scan, CT, MRA and angiography. CT has a 90% sensitivity rate. Bowel wall thickening and ascites are observed in advanced state. Angiographay can be used when the diagnosis is uncertain. Mortality is reported as high as 13~50% and major complications include short bowel syndrome, wound infection and sepsis etc. METHOD: We exprienced two patients (male 36 year old, male 47 year old) presented with acute abdominal pain who proved to have small bowel infarction due to mesenteric thrombosis. RESULT: Both patients showed signs of panperitonitis. CT examination showed portal-superior mesenteric venous thrombosis, small bowel infarction and large amout of ascites in either case. Small bowel resection and thrombectomy in one case and only small bowel resection in the other case were carried. Progressive postoperative fever and abdominal pain developed in one patient and intraabdominal absecess showed on CT examination. We performed secondary operation in the 9th postoperative date. CONCLUSION: The diagnosis of mesenteric venous thrombosis is difficult and small bowel resection should be performed when necrotic small bowel was encountered on exploration. Postoperative anti-coagulation therapy is reported to reduce recurrence and mortalty rate.
Subject(s)
Adult , Humans , Male , Abdominal Pain , Angiography , Ascites , Diagnosis , Fever , Hypertension, Portal , Infarction , Intraabdominal Infections , Mortality , Necrosis , Recurrence , Sepsis , Short Bowel Syndrome , Thrombectomy , Thrombosis , Veins , Venous Thrombosis , Wound InfectionABSTRACT
BACKGROUND: Bispectral index (BIS) has been designed to measure objectively the degree of sedation and hypnosis for several anesthetics. It is predicted that sedation and hypnosis during nitrous oxide inhalation affect BIS in an unusual manner due to a different mechanism compared to usual hypnotics. The aim of this study was to evaluate the effect of different concentration of nitrous oxide inhalation on BIS and sedation score. METHODS: Forty unpremedicated ASA physical status I or II patients scheduled for lower extremity surgery were studied. After performing epidural anesthesia, patients inhaled gradually increasing concentrations of nitrous oxide from 0 to 67% (15 minutes for each concentration) via a tightly sealed face mask. At the end of each inhalation, BIS and OAA/S scale (Observers's Assessment of Alertness/ Sedation scale) were assessed. RESULTS: The increasing concentrations of inhaled nitrous oxide resulted in significant reduction of the OAA/S scale but in no change of BIS. Concentrations of nitrous oxide exceeding 50% affected behavior or emotion of the patients. CONCLUSIONS: Following increasing concentrations of inhaled nitrous oxide, sedation score was reduced significantly but BIS was not affected.
Subject(s)
Humans , Anesthesia, Epidural , Anesthetics , Hypnosis , Hypnotics and Sedatives , Inhalation , Lower Extremity , Masks , Nitrous OxideABSTRACT
PURPOSE: There are several well-established prognostic factors to predict the course of breast cancer. Recently, a new category of genes that control the process of programmed cell death, also called apoptosis, has been identified. It includes the bcl-2 proto-oncogene which actively blocks apoptosis. The purpose of this retrospective study is to investigate the relationship between Bcl-2 protein expression in primary breast cancers and other markers of prognostic value. MATERIALS AND METHODS: We analyzed 43 cases of invasive ductal carcinoma of breast cancer, which were consecutively operated in the period from January 1990 to December 1994. Analysis of Bcl-2 protein, ER and PgR expression was carried out using immunohistochemistry on the paraffin-embedded tissue section. The following indices were measured.; size of the tumor, number of axillary metastasis, histological grade, menopausal status, ER, PgR, and Bcl-2 status. RESULTS: Expression of the bcl-2 proto-oncogene was found in 28 cases of 43 patients (65.1%). No relationship could be observed between Bcl-2 status and tumor grade, TNM staging and menopausal status. A strong positive relationship was demonstrated between Bcl-2 immunoreactivity and ER status (P 0.001) and PgR status (P=0.014). A favorable prognostic value was demonstrated for Bcl-2 expression on overall survival (P=0.0427), but no prognostic value was demonstrated on disease-free survival (P=0.1587). CONCLUSION: Our results suggest that the Bcl-2 expression may be a favorable prognostic marker and its important role may be a modulator of response to adjuvant therapy in breast cancer.