BACKGROUND: The afferent and efferent pathways of fentanyl cough response (FCR) and central organization are poorly understood at present. The aim of this study was to investigate the pretreatment effects of morphine, propofol, atropine, and midazolam on FCR. METHOD: The 120 healthy patients were randomly assigned to six equal pretreatment groups. They received 2ug/kg fentanyl rapidly through a peripheral venous catheter. The patients in each group were pretreated before the time necessary for peak plasma levels with different drugs as follows: group 1, no premedication; group 2, morphine 0.05 mg/kg iv; group 3, morphine 0.05 mg/kg iv naloxone 0.01mg/kg iv; group 4, propofol 0.5 mg/kg iv; group 5, atropine 0.01 mg/kg iv; group 6, midazolam 0.05 mg/kg iv. The patients were observed for any coughing or side effects, including oxygen desaturation, bronchoconstriction, chest wall rigidity and seizure. RESULT: 40% of patients in group 1 (control) had a cough response to fentanyl. Group 2 (morphine) and group 3 (morphine naloxone) showed a reduced FCR of 10%. The incidence of coughing was 60% of the patients in group 4 (propofol), 30% in group 5 (atropine), and 40% in group 6 (midazolam). These were not statistically significant. CONCLUSION: FCR is not altered by pretreatment with propofol, atropine, or midazolam, but morphine inhibits cough response and this antitussive effect was not antagonized by naloxone.
Atropine* ; Bronchoconstriction ; Catheters ; Cough* ; Efferent Pathways ; Fentanyl* ; Humans ; Incidence ; Midazolam* ; Morphine* ; Naloxone ; Oxygen ; Plasma ; Premedication ; Propofol* ; Seizures ; Thoracic Wall

No abstract available.
Glomerulonephritis, IGA* ; Hodgkin Disease* ; Immunoglobulin A*

Many methods are available for monitoring spinal cord conductian during operation. It is essential for the anesthesiologist to the know potential interactions between the drugs used during the operation and the neurophysiologic response. The purpose of the present study was to experimentally examine the effects of ketamine and fentanyl used in the operating room. Twenty-three patients, 23 to 68 years of age, ASA I-II, free of neurologic disease and scheduled for elective operations were randomly selected for the study. Averaged somatosensory evoked potentials to stimulation of the posterior tibial nerve at the ankle were recorded. After baseline recording of the somatosensory evoked potential, ketamine (1.5 mg/kg) or fentanyl (3u/kg) was administered by bolus injection in each patient. Additional somatosensory evoked potential after the drug injection was recorded. ECG, blood pressure and heart rate were monitored throughout the measuring procedure. 1) The mean values of latency (Pl, Nl, P2) and amplitude (Pl-N1, Nl-P2) were 39.58, 48.36 and 60. 74 msec and 7.88 and 10.30uV respectively. Those values were changed to 38.54, 46.67 and 60.50 msec and 6.55 and 9.85uV in patients in the ketamine injected group. 2) The mean values of latency and amplitude were 37.90, 45.93 and 61.01 msec and 7.35 and 7.21uV respectively in the baseline state. Each value changed to 38.10, 47.06 and 61.88 msec and 6.67 and 8.49uV respectively after fentanyl injection. There was no statistical difference in latencies and amplitudes between the pre-injection state and post-injection state in both the ketamine and fentanyl groups. Therefore, we suggested that the use of ketamine or fentanyl could be administered successfully during intraoperative somatosensory evoked potential monitoring without much influence on tibial nerve stimulation.
Ankle ; Blood Pressure ; Electrocardiography ; Evoked Potentials, Somatosensory* ; Fentanyl* ; Heart Rate ; Humans* ; Ketamine ; Operating Rooms ; Spinal Cord ; Tibial Nerve

PURPOSE: This study was designed to demonstrate the potential therapeutic advantage of 3-dimensional (3-D) treatment planning over the conventional 2-dimensional (2-D) approach in patients with carcinoma of the nasopharynx. MATERIAL AND METHODS: The two techniques were compared both qualitatively and quantitatively for the boost portion of the treatment (19.8 Gy of a total 70.2 Gy treatment schedule) in patient with T4. The comparisons between 2-D and 3-D plans were made using dose statistics, dose-volume histogram, tumor control probabilities, and normal tissue complication probabilities. RESULTS: The 3-D treatment planning improved the dose homogeneity in the planning target volume. In addition, it caused the mean dose of the planning target volume to increase by 15.2% over 2-D planning. The mean dose to normal structures such as the temporal lobe, brain stem, parotid gland, and temporomandibular joint was reduced with the 3-D plan. The probability of tumor control was increased by 6% with 3-D treatment planning compared to the 2-D planning, while the probability of normal tissue complication was reduced. CONCLUSION: This study demonstrated the potential advantage of increasing the tumor control by using 3-D planning, but prospective studies are required to define the true clinical benefit.
Brain Stem ; Humans ; Nasopharynx* ; Parotid Gland ; Temporal Lobe ; Temporomandibular Joint

PURPOSE: Early hypopharyngeal squamous cell carcinoma (HPSCC) is a rarely diagnosed disease, for which the optimal treatment has not been defined yet. We assessed patterns of failure and outcomes in early HPSCC treated with various therapeutic approaches to identify its optimal treatment. MATERIALS AND METHODS: Thirty-six patients with stage I (n = 10) and II (n = 26) treated between January 1992 and March 2014 were reviewed. Patients received definitive radiotherapy (RT) (R group, n = 10), surgery only (S group, n = 19), or postoperative RT (PORT group, n = 7). All patients in both the R and PORT groups received elective bilateral neck irradiation. In the S group, 7 patients had ipsilateral and 8 had bilateral dissection, while 4 patients had no elective dissection. RESULTS: At a median follow-up of 48 months, the 5-year locoregional control (LRC) rate was 65%. Six patients had local failure, 1 regional failure (RF), 3 combined locoregional failures, and 2 distant failures. There was no difference in 5-year LRC among the R, S, and PORT groups (p = 0.17). The presence with a pyriform sinus apex extension was a prognosticator related to LRC (p = 0.01) in the multivariate analysis. Patients with a bilaterally treated neck showed a trend toward a lower RF rate (p = 0.08). CONCLUSION: This study shows that patients with early stage HPSCC involving the pyriform sinus apex might need a tailored approach to improve LRC. Additionally, our study confirms elective neck treatment might have an efficacious role in regional control.
Carcinoma, Squamous Cell ; Cohort Studies* ; Follow-Up Studies ; Humans ; Hypopharyngeal Neoplasms* ; Multivariate Analysis ; Neck ; Pyriform Sinus ; Radiotherapy ; Treatment Failure

PURPOSE: The aim of this study was to analyze the patterns of care and treatment outcomes in patients with primary thyroid lymphoma (PTL) in a single institution. MATERIALS AND METHODS: Medical records of 29 patients with PTL treated between April 1994 and February 2012 were retrospectively reviewed. Diagnosis was confirmed by biopsy (n = 17) or thyroidectomy (n = 12). Treatment modality and outcome were analyzed according to lymphoma grade. RESULTS: The median follow-up was 43.2 months (range, 3.8 to 220.8 months). The median age at diagnosis was 57 years (range, 21 to 83 years) and 24 (82.8%) patients were female. Twenty-five (86.2%) patients had PTL with stage IEA and IIEA. There were 8 (27.6%) patients with mucosa-associated lymphoid tissue (MALT) lymphoma and the remaining patients had high-grade lymphoma. Patients were treated with surgery (n = 2), chemotherapy (n = 7), radiotherapy (n = 3) alone, or a combination of these methods (n = 17). Treatment modalities evolved over time and a combination of modalities was preferred, especially for the treatment of high-grade lymphoma in recent years. There was no death or relapse among MALT lymphoma patients. Among high-grade lymphoma patients, 5-year overall survival (OS) and 5-year progression-free survival (PFS) were 75.6% and 73.9%, respectively. Complete remission after initial treatment was the only significant prognostic factor for OS (p = 0.037) and PFS (p = 0.003). CONCLUSION: Patients with PTL showed a favorable outcome, especially with MALT lymphoma. Radiotherapy alone for MALT lymphoma and chemotherapy followed by radiotherapy for high-grade lymphoma can be effective treatment options for PTL.
Biopsy ; Diagnosis ; Disease-Free Survival ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Lymphoid Tissue ; Lymphoma* ; Lymphoma, B-Cell, Marginal Zone ; Lymphoma, Non-Hodgkin ; Medical Records ; Methods ; Physician's Practice Patterns ; Radiotherapy ; Recurrence ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroidectomy ; Treatment Outcome

PURPOSE: The purpose of this study was to determine the proton MR spectroscopic features of liver cirrhosis and the different proton MR spectroscopic features between liver cirrhosis and the normal human liver by comparing the two different conditions. MATERIALS AND METHODS: The investigation involved 30 cases of in-vivo proton MR spectra obtained from 15 patients with liver cirrhosis demonstrated on the basis of radiologic and clinical findings, and from 15 normal volunteers without a past or current history of liver disease. MR spectroscopy involved the use of a 1.5T GE Signa Horizon system (GE Medical Systems, Milwaukee, U.S.A.) with body coil. STEAM (STimulated Echo-Aquisition Mode) with 3000/30 msec of TR/TE was used for signal acquisition; patients were in the prone position and respiration was not interrupted. Cases were assigned to either the cirrhosis or normal group, and using the proton MR spectra of cases of in each group, peak changes occurring in lipids (at 1.3ppm), glutamate and glutamine (at 2.4 -2 .5ppm), phosphomonoesters (at 3.0 -3 .1ppm), and glycogen and glucose (at 3.4 -3 .9ppm) were evaluated. Mean and standard deviation of the ratio of glutamate + glutamine/lipids, phospho-monoesters/lipids, glycogen + glucose/lipids were calculated from the area of their peaks. The ratio of various metabolites to lipid content was compared between the normal and cirrhosis group. RESULTS: The main characteristic change in proton MR spectra in cases of liver cirrhosis compared with normal liver was decreased relative intensity of lipid peak. Mean and standard deviation of ratio of glutamate + g-lutamine/ lipids, phosphomonoesters/lipids, glycogen + glucose/lipids calculated from the area of their peaks of normal and cirrhotic liver were 0.0204 +/-0.0067 and 0.0693 +/-0.0371 (p<0.05), 0.0146 +/-0.0090 and 0.0881 +/-0.0276 (p<0.05), 0.0403 +/-0.0267 and 0.2325 +/-0.1071 (p<0.05), respectively. The other character-istic feature of proton MR spectra of liver cirrhosis was the peak detected at 3.9 - 4.1 ppm with unknown nature. Mean and standard deviation of area ratio of the unknown peak to lipid peak in proton MR spectra of liver cirrhosis was 0.1504 +/-0 . 0 3 5 5 . CONCLUSION: Proton MR spectra of liver cirrhosis revealed decreased intensity of lipid with statistical signifi-cance compared with that of normal liver, and peak at 3.9 -4.1 ppm with unknown nature. In conclusion, liver cirrhosis can be diagnosed non-invasively by the analysis of observed proton MR spectroscopic features.
Fibrosis ; Glucose ; Glutamic Acid ; Glutamine ; Glycogen ; Healthy Volunteers ; Humans ; Liver Cirrhosis* ; Liver Diseases ; Liver* ; Magnetic Resonance Spectroscopy ; Prone Position ; Protons* ; Respiration ; Steam

Synovial chondromatosis is a rare, benign, monoarticular arthropathy that is characterized by the development of highly cellular, metaplastic cartilaginous nodules in the synovial membrane. It commonly affects larger joints such as the knee, elbow, wrist, shoulder, and hip. Synovial chondromatosis of the temporomandibular joint(TMJ) is rare. Moreover, the temporal involvement of synovial chondromatosis without connection with joint is greatly rare. A 44-year-old women had experienced pain of the right TMJ area and limitation of mouth opening. MRI and CT revealed multiple calcified loose bodies and widening in right upper joint space of TMJ and osteolytic lesion in right temporal bone. Treatment consisted of removal of multiple loose bodies, resection of the osteolytic lesion through the preauricular approach. She was diagnosed with primary transitional synovial chondromatosis of TMJ with involvement of temporal bone. In spite of remaining of the loose bodies, pain and mouth opening improved and there have been no recurrence of signs and symptoms for 5 years follow up.
Adult ; Chondromatosis ; Chondromatosis, Synovial ; Elbow ; Female ; Follow-Up Studies ; Hip ; Humans ; Joints ; Knee ; Mouth ; Recurrence ; Shoulder ; Synovial Membrane ; Temporal Bone ; Temporomandibular Joint ; Wrist

PURPOSE: Keloid is a clinical term characterized by elevation and extension of scar tissue beyond wound margin. Currently, there is no known treatment that shows consistent effect in all patients. Postoperative radiation therapy is known to prevent recurrence of keloid. METHODS: We reviewed data of patients who had undergone operation or operation followed by radiation therapy at our institute for the last 12 years. Follow up was possible in 39 patients(21 patients treated only by operation and 18 treated by operation and radiation therapy) We then investigated recurrence in both groups by VAS score. By mail, patients were asked to score their current condition on the bar in 4 aspects(itching, pain, mass lesion(by patients and other persons)). Two criteria were used for defining successful treatment. One is the case which total VAS score was 0, and the other is sum of VAS score of mass lesion was 0 to 5. RESULTS: In the former, recurrence rate is 90.5% in operations-only group but 66.7% in operations plus radiation therapy group(p 0.05). In the latter, recurrence rate is 66.7% in operation-only group but 22.2% in operations plus radiation therapy group(p 0.05). CONCLUSION: These results shows postoperative radiation therapy is effective method in keloid treatment.
Cicatrix ; Follow-Up Studies ; Humans ; Keloid* ; Postal Service ; Recurrence ; Retrospective Studies* ; Wounds and Injuries

Transcatheter arterial embolization (TAE) is widely used in the treatment of unresectable hepatocellular carcinoma. Its common complications are right upper quadrant pain, nausea, vomiting, and rare complications include focal pancreatic necrosis, gastric ulcer, renal failure, DIC, biliary tree necrosis and splenic infarction and so on. It has been reported that hepatobronchial fistula could develop as a pleuropulmonary complication of liver abscess. We report a case of hepatobronchial fistula caused by complicating liver abscess in a patient with hepatocellular carcinoma who was treated with TAE.
Biliary Tract ; Carcinoma, Hepatocellular* ; Dacarbazine ; Fistula* ; Humans ; Liver Abscess ; Nausea ; Necrosis ; Renal Insufficiency ; Splenic Infarction ; Stomach Ulcer ; Vomiting