J Formos Med Assoc
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This study evaluates the prognostic factors and causes associated with mortality in Chinese diabetic patients after lower extremity amputations. Medical records of all diabetic patients admitted to the National Taiwan University Hospital for leg amputations from 1982 to 1991 were reviewed. Demographic data, medical history, amputation levels and admission routines, including fasting plasma glucose, cholesterol, triglycerides, blood urea nitrogen, creatinine, urine protein and electrocardiograms, and bacterial culture done during the admission period were recorded. ⋯ A history of hypertension and coronary heart disease were found to be the best indicators for predicting a fatal outcome with rate ratios of over two-fold. This study shows that post-amputational mortality is high in diabetic patients and that the major cause of death is cerebral infarction. The major cause of death in this study differs from that reported for Caucasians, for whom cardiovascular disease is the most important cause of death.
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Case Reports
Fracture of the posterior process of the talus associated with subtalar dislocation: report of a case.
Although subtalar dislocation is not common in foot trauma, fracture of the entire posterior process of the talus is even rarer. The concomitant injury of a subtalar dislocation associated with a fracture of the posterior process of the talus has not yet been reported in the medical literature. A 52-year-old woman involved in a traffic accident had her right foot twisted into an inversion deformity. ⋯ The subtalar dislocation was treated with a closed reduction. The fracture of the posterior process was treated with an open reduction and internal fixation. After the anatomic reduction of both injuries, the patient recovered and returned to her previous activities.
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We report a 49-year-old man with acute intermittent perioral and distal hand sensory dysfunction on the left side (cheiro-oral syndrome). The responsible lesion was confirmed by magnetic resonance imaging to be bilateral subdural hematomas with the larger side compressing the middle and lower thirds of the right postcentral gyrus. We emphasize that subdural hematoma should be considered in the differential diagnosis of cheiro-oral syndrome.
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The surgical treatment of acute type A aortic dissection remains a great challenge to all cardiac surgeons. From January 1991 to June 1993, 21 consecutive patients (13 men and eight women, aged 34 to 74 years) underwent emergency operations to repair acute type A aortic dissection, with the aid of hypothermic circulatory arrest. The intima tear was located in the ascending aorta in 13 patients, in the aortic arch in five patients, and in the descending aorta in three patients. ⋯ Post-treatment follow-ups (mean, 18.2 months) were completed in all patients except one, who died 12 months after the operation as a result of a traffic accident. All of the surviving patients are doing well without any further aortic operations. Our experience suggests that surgical repair of the acute type A aortic dissection can be a simple and safe procedure if sutureless intraluminal grafts are used and hypothermic circulatory arrest and retrograde cerebral perfusion are utilized.
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A 54-year-old male suddenly developed cramping abdominal pain followed by diarrhea. A segmental narrowing with multiple mucosal ulcers of the colon near the splenic flexure was noted on both barium enema and fiberoptic colonoscopy. Cramping abdominal pain and diarrhea persisted, associated with a body weight loss of 13 kg. ⋯ The artery showed an eccentric organized hematoma between the outer media and the adventitia. The lumen was occluded by organized thrombi. The pathologic findings were those of an organized dissecting hematoma (aneurysm), probably caused by segmental mediolytic arteriopathy.