Journal of Yeungnam Medical Science

Original article

Endocrinology, Diabetes, and Metabolism
Risk factors affecting amputation in diabetic foot: Jun Ho Lee, Ji Sung Yoon, Hyoung Woo Lee, Kyu Chang Won, Jun Sung Moon, Seung Min Chung, Yin Young Lee; Yeungnam Univ J Med. 2020;37(4):314-320. Published online May 6, 2020; DOI: https://doi.org/10.12701/yujm.2020.00129

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Background
A diabetic foot is the most common cause of non-traumatic lower extremity amputations (LEA). The study seeks to assess the risk factors of amputation in patients with diabetic foot ulcers (DFU).
Methods
The study was conducted on 351 patients with DFUs from January 2010 to December 2018. Their demographic characteristics, disease history, laboratory data, ankle-brachial index, Wagner classification, osteomyelitis, sarcopenia index, and ulcer sizes were considered as variables to predict outcome. A chi-square test and multivariate logistic regression analysis were performed to test the relationship of the data gathered. Additionally, the subjects were divided into two groups based on their amputation surgery.
Results
Out of the 351 subjects, 170 required LEA. The mean age of the subjects was 61 years and the mean duration of diabetes was 15 years; there was no significant difference between the two groups in terms of these averages. Osteomyelitis (hazard ratio [HR], 6.164; 95% confidence interval [CI], 3.561−10.671), lesion on percutaneous transluminal angioplasty (HR, 2.494; 95% CI, 1.087−5.721), estimated glomerular filtration rate (eGFR; HR, 0.99; 95% CI, 0.981−0.999), ulcer size (HR, 1.247; 95% CI, 1.107−1.405), and forefoot ulcer location (HR, 2.475; 95% CI, 0.224−0.73) were associated with risk of amputation.
Conclusion
Osteomyelitis, peripheral artery disease, chronic kidney disease, ulcer size, and forefoot ulcer location were risk factors for amputation in diabetic foot patients. Further investigation would contribute to the establishment of a diabetic foot risk stratification system for Koreans, allowing for optimal individualized treatment.

Citations

Citations to this article as recorded by

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Case Reports

Pulmonary and Respiratory Medicine
Partial spontaneous remission of small cell lung carcinoma with neurologic symptom: Kyung Hyun Yun, Sung Heon Song, Chung Hyoun Kim, Chan Hee Hwang, Jun Ho Lee, Je Hyoung Choi, Sun Young Kim; Yeungnam Univ J Med. 2017;34(2):275-278. Published online December 31, 2017; DOI: https://doi.org/10.12701/yujm.2017.34.2.275

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Abstract PDF: Small cell lung carcinoma (SCLC) is a cancer that shows aggressive behavior, early spread to distant sites, and frequent association with distinct paraneoplastic syndromes. Spontaneous remission of cancer, particularly of SCLC, is a rare biological event. Cases involving spontaneous regression of SCLC were reported, and were associated with paraneoplastic syndromes of the nervous system. This article reports on a 78-year-old man with SCLC in remission, with neurological symptoms. The patient visited the hospital because of generalized weakness, and imaging studies revealed a mass in the lower lobe of the left lung, pathological evaluation showed SCLC. The patient refused oncologic treatment and was treated only with conservative care. In follow-up study the diameter of the mass had decreased from initial 32 mm, 9 months after admission to 20 mm, 17 months after admission to 13 mm. The patient kept complaining of generalized weakness, dizziness, and paresthesia of limbs. We assumed that, in this case, the spontaneous remission of lung cancer was related to the immunologic response directed against the tumor, which is believed to be an important factor in the pathogenesis of paraneoplastic neurologic syndromes.

Gastroenterology and Hepatology
Ileal epithelioid leiomyosarcoma with omental and peritoneal seeding: Chung Hyoun Kim, Sun Young Kim, Chang Kil Jung, Jung Pil Choi, Keum Soo Seo, Jun Ho Lee, Jae Hyung Choi; Yeungnam Univ J Med. 2017;34(1):132-136. Published online June 30, 2017; DOI: https://doi.org/10.12701/yujm.2017.34.1.132

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Abstract PDF: Leiomyosarcoma (LMS) of the small intestine is a rare tumor, accounting for about 1% of all malignant mesenchymal lesions in the gastrointestinal tract. Since small bowel tumors are initially asymptomatic and nonspecific, delayed diagnosis and treatment are common. We found that a 44-year-old male patient who came in for lower abdominal pain had partial obstruction in the small bowel. Multiple ascites and ileal tumors involving peritoneal seeding were observed from his abdominal computed tomography. He was diagnosed as epithelioid LMS involving peritoneal transition after surgical resection, and the outpatient department has planned for a conservative therapy with observation. To the best of our knowledge, ileal epithelioid LMS accompanying a huge omental mass, with a size of 18 cm in dimension, and peritoneal seeding has not yet been reported in Korea. We report this rare case with literature review.

Review Article

Plastic and Reconstructive Surgery
Various Abdominal Flaps for Breast Reconstruction: Pedicled TRAM, Free TRAM, Muscle-sparing TRAM, DIEP, and SIEA Flaps.: Jun Ho Lee; Yeungnam Univ J Med. 2011;28(2):116-123. Published online December 31, 2011; DOI: https://doi.org/10.12701/yujm.2011.28.2.116

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Abstract PDF: The incidence of breast cancer, the second most prevalent cancer type in South Korea, has increased by 6.8% annually in the lastsix years.The higher number of breast cancer patients has led to an increase in the cases of skin-sparing mastectomies, thereby increasing the need for reconstructive procedures. The reconstruction options include alloplastic techniques such as implant or autologous reconstruction with numerous flaps. The abdominal area is the preferred donorsite for the harvest of autologous tissue for breast reconstruction. Breast reconstruction using abdonimal tissue is commonly accomplished using the transverse rectus abdominis myocutaneous (TRAM) flap. The establishment of microvascular surgery led to the development of the free TRAM flap because of its increased vascularity and decreased rectus abdominis sacrifice. The muscle-sparing TRAM, DIEP, and SIEA flap techniques were later developed in an effort to decrease the abdominal-donor-site morbidity by decreasing the injury to the rectus abdominis muscle and fascia. This article summarizes the various abdominal flaps for breast reconstruction.

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