Diabetic foot wounds in haemodialysis patients: 2-year outcome after percutaneous transluminal angioplasty and minor amputation.

Critical limb ischaemia (CLI) is known to be associated with high mortality. In some patients, surgery cannot be performed due to high risk of perioperative death and complications. In other cases, there is only pain at rest but no wound. Therefore, it is difficult to accurately predict the prognosis of individual patients. We examined the prognosis of CLI cases in which therapeutic footwear was made for ambulation after wounds healed. The subjects were 31 haemodialysis patients with diabetic foot wounds, which were treated with percutaneous transluminal angioplasty and minor amputation. The subjects were 22 men and 9 women. Female patients were significantly older than male patients (P = 0.046). Two-year postoperative outcomes were survival in 19 patients and death in 12 patients. Eight of twelve deceased patients had a history of coronary intervention. There were 8 deaths among 13 patients with such history, indicating a marginally significant increase in the mortality rate (P = 0.060). Re-amputation was performed in 6 of 19 patients who survived. Two years postoperatively, 41.9% of patients overall survived without re-amputation. It is important to increase the number of cases for further study to improve the well-being of CLI patients and to examine medical economics.

Physiological incidents during 39 years of hypobaric chamber training in Japan.

BACKGROUND: Hypobaric chamber training for military aircrew is very important for flight safety. Since we began hypobaric training in our laboratory in 1960, some trainees have suffered physiological incidents. This study will characterize the physiological incidents during hypobaric chamber training at the Japan Air Self-Defense Force (JASDF). METHODS: All available training records from 1960-1998 were reviewed and the frequency of physiological incidents counted and analyzed. RESULTS: There were 29,677 trainees and 58,454 exposures. Overall frequency of physiological incidents was 6.3%. Physiological incidents included ear pain, paranasal sinus pain, abdominal pain, hypoxia, hyperventilation, joint pain, and toothache. Decompression sickness (DCS-I, simple joint pain only) was rare. In cases of DCS-I, joint pain was easily relieved with controlled descent. During the last three decades, overall prevalence of physiological incidents has gradually increased from 5.3 to approximately 6.1% before 1991, to 6.8-9.9% after 1991. However, prevalence rate showed no change through out the period when ear pain was factored out. The increase in prevalence was entirely due to an increased frequency of ear pain: 3.6 to approximately 4.6% before 1991, and 5.4 to approximately 7.2% after 1991. CONCLUSIONS: DCS has not been a problem in the JASDF hypobaric chamber training experience. The majority of physiological incidents during hypobaric chamber training in JASDF have been ear pain, a minor but frequent obstacle to hypobaric training. The exact cause of the observed increase in frequency of Eustachian tube dysfunction currently remains unclear.

[Acute myocardial infarction with variable clinical manifestations: probable catastrophic primary antiphospholipid antibody syndrome: a case report].

A 62-year-old diabetic man was admitted to our hospital because of acute myocardial infarction. Emergent coronary angiography showed multiple thromboembolic occlusions in the distal circumflex and anterior descending arteries. For the first 2 weeks of hospitalization, he suffered multiple organ manifestations including the gastrointestinal, central nervous, renal and respiratory systems. The anticardiolipin beta2GP1 complex antibody titer on the 15th day was as high as 27.2 U/l (normal value < 3.5). These clinical manifestations and laboratory findings suggested catastrophic antiphospholipid antibody syndrome. He was discharged on the 83rd day with anticoagulant therapy and regular hemodialysis. Acute myocardial infarction is rare as the initial manifestation of catastrophic antiphospholipid antibody syndrome.

[Right coronary air embolism secondary to bowel infarction: a case report].

An 81-year-old man with broad cerebral infarction presented with coronary air embolism secondary to bowel infarction and developed cardiogenic shock. Electrocardiography revealed ST elevation in the inferior leads and complete atrioventricular block with atrial fibrillation. Emergent angiography showed total occlusion of the right coronary artery without apparent thrombi. A multifunctional probe catheter was inserted into the right coronary artery for selective angiography. A moderate amount of air was aspirated from the catheter. The diagnosis was coronary air embolism. Coronary flow was restored after aspiration and normal saline flushing. Computed tomography showed massive portal venous gas. Emergent laparotomy disclosed broad bowel necrosis. The coronary air emboli may have originated from the portal vein and passed through the intrahepatic (portal to hepatic) shunt and patent foramen ovale(paradoxical embolization).