No abstract available.
Peptic Ulcer*

No abstract available.
Facial Nerve* ; Paralysis* ; Temporal Bone*

Intrathecal and epidural narcotics have been widely used since 1979 to relieve pain and provide postoperative analgesia. Ketamine hydrochloride, a potent analgesic and anesthetic, has also been studied to its usefulness in epidural administration for postoperative pain relief devoid of the respiratory depression caused by morphine. This study was performed to evaluate whether a large dose of ketamine is effective for postoperative pain relief and the results were compared with those of epidural morphine. Forty patients undergoing lower abdominal and extremity surgery were randomly assigned in two groups of twenty. No patient was receiving narcotics or analgesic at the time of study. The operative anesthesia was provided by continuous epidural anesthesia with 27 ml of 1.5% lidocaine with 1:200,000 epinephrine. Ketamine 30mg or morphine 3-4 mg was administered about 30 minutes before the end of operation through the epidural catheter respectively. Patients were monitored every 15 minutes during the first hour and every hour during first 24 hours. Pain complaint, respiratory rate, heart rate, blood pressure, SaO2 and potential side effects were recorded. The results were as follows; 1) Two cases in the ketamine group and nine cases in the morphine group did not need the additional analgesics after operation. The duration of pain relief in the ketamine group varied from 1.83 hour to over 48 hours (less than 3 hours in 50% of patients). Mean analgesic time in the morphine group was 28.3+/-5.6 hours. 2) Dissociative anesthesia with hypotension (one), sedation (fifteen), dizziness (seven), nausea (six) and vomiting (six) in the ketamine group, whereas nausea (nine), and vomiting (five) in the morphine group were developed. We conclude that ketamine 30 mg administered epidurally, which had a more central actions and less analgesic effect than morphine, is inadequate for postoperative pain relief after lower abdomimal and extremity surgery.
Analgesia ; Analgesics ; Anesthesia ; Anesthesia, Epidural ; Blood Pressure ; Catheters ; Dizziness ; Epinephrine ; Extremities ; Heart Rate ; Humans ; Hypotension ; Ketamine* ; Lidocaine ; Morphine ; Narcotics ; Nausea ; Pain, Postoperative* ; Respiratory Insufficiency ; Respiratory Rate ; Vomiting

PURPOSE: The aim of this study was to identify clinical predictive factors for tumor response after preoperative chemoradiotherapy (CRT) in rectal cancer. MATERIALS AND METHODS: The study involved 51 patients who underwent preoperative CRT followed by surgery between January 2005 and February 2012. Radiotherapy was delivered to the whole pelvis at a dose of 45 Gy in 25 fractions, followed by a boost of 5.4 Gy in 3 fractions to the primary tumor with 5 fractions per week. Three different chemotherapy regimens were used (5-fluorouracil and leucovorin, capecitabine, or tegafur/uracil). Tumor responses to preoperative CRT were assessed in terms of tumor downstaging and pathologic complete response (ypCR). Statistical analyses were performed to identify clinical factors associated with pathologic tumor response. RESULTS: Tumor downstaging was observed in 28 patients (54.9%), whereas ypCR was observed in 6 patients (11.8%). Multivariate analysis found that predictors of downstaging was pretreatment relative lymphocyte count (p = 0.023) and that none of clinical factors was significantly associated with ypCR. CONCLUSION: Pretreatment relative lymphocyte count (%) has a significant impact on the pathologic tumor response (tumor downstaging) after preoperative CRT for locally advanced rectal cancer. Enhancement of lymphocyte-mediated immune reactions may improve the effect of preoperative CRT for rectal cancer.
Chemoradiotherapy ; Deoxycytidine ; Fluorouracil ; Humans ; Leucovorin ; Lymphocyte Count ; Multivariate Analysis ; Pelvis ; Rectal Neoplasms ; Capecitabine

PURPOSE: Iliac vein compression syndrome (IVCS), first characterized by Cockett and Thomas in 1965, is the development of iliofemoral deep venous thrombosis due to compression of the left common iliac vein against the spine and pelvic brim by the right common iliac artery. Thrombectomy treatment of the underlying compression is essential if significant long-term sequelae are to be avoided. Surgical treatment options include venous reconstruction or venous bypass, but treatment using endovascular techniques have recently been described. This study was conducted to evaluate the usability of endovascular treatment (esp. thrombolysis with stent insertion) in a venous outflow obstruction resulting from IVCS. METHOD: During a 2-year period, 20 patients (17 women, 3 men; mean age, 60 years) presented with clinical and imaging findings consistent with IVCS. All patients presented with leg edema or pain. The mean duration of symptom onset was 6.6+/-4.4 days, ranging from 1 to 15 days. All patients were evaluated using a Duplex scan, computerized tomography and venography. After the ascending venography had been performed, an infusion catheter system was placed, and urokinase infused locally into the thrombus burden. After near complete clot dissolution, the residual left common iliac vein stenosis was treated by means of angioplasty and the placement of a Wallstent. All patients continued to receive oral warfarin. Patients were followed-up by means of clinical visits, and the stent patency was assessed by means of a Duplex scan or computerized tomography. RESULT: The total dose of urokinase used and the duration of infusion were 2.28+/-0.93 million unit, ranging from 1.00 to 5.20 and 46.8+/-14.8 hours, ranging from 14 to 72 hours, respectively. Grade III (complete lysis) thrombolysis was achieved in 17 patients. All 17 patients successfully received a Wallstent. The initial clinical success was 100%, with complete resolution of symptoms in all patients. One patient, with combined ovarian cancer, had a recurrent symptomatic deep vein thrombosis and complete occlusion of the stent due to thrombosis 2 months after treatment. However, no other patients showed evidence of deep vein thrombosis after treatment. The overall patency rate of the stenting at 18 months was 94.1%. There were no deaths, pulmonary embolism, cerebral hemorrhage or major bleeding complications. CONCLUSION: These results suggested that the treatment of iliac vein compression syndrome, using catheter directed thrombolytic therapy and venous stent insertion, was a safe and effective method at the mid term evaluation. These patients will continue to be followed up with screening tests to further define the long-term patency.
Angioplasty ; Catheters ; Cerebral Hemorrhage ; Constriction, Pathologic ; Edema ; Endovascular Procedures ; Female ; Hemorrhage ; Humans ; Iliac Artery ; Iliac Vein* ; Leg ; Male ; Mass Screening ; May-Thurner Syndrome* ; Ovarian Neoplasms ; Phlebography ; Pulmonary Embolism ; Spine ; Stents ; Thrombectomy ; Thrombolytic Therapy ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Venous Thrombosis ; Warfarin

Relapsing polychondritis is an uncommon disease associated with inflammation in cartilaginous tissues throughout the body, particularly affecting the cartilaginous structures of ears, nose, joints, and respiratory tract. Several autoimmune diseases, including vasculitis, are associated with the concurrent relapsing polychondritis. However, ankylosing spondylitis primarily affecting the sacroiliac joints and spine is rare in patients with relapsing polychondritis. We report on a 54-year-old man with concurrently relapsing polychondritis and ankylosing spondylitis.
Autoimmune Diseases ; Ear ; Humans ; Inflammation ; Joints ; Middle Aged ; Nose ; Polychondritis, Relapsing* ; Respiratory System ; Sacroiliac Joint ; Spine ; Spondylitis, Ankylosing* ; Vasculitis

No abstract available.
Embolism, Air* ; Humans ; Infant, Newborn*

No abstract available.
Embolism, Air* ; Humans ; Infant, Newborn*

PURPOSE: Some controversies exist over the prognostic values of lymphatic, venous, and neural invasion in patients with gastric cancer. This study was conducted to confirm the prognostic values of these histopathologic factors in gastric cancer patients who received a gastrectomy. MATERIALS AND METHODS: Data for clinicopathologic factors and clinical outcomes were collected retrospectively from the medical records of 1,018 gastric cancer patients who received a gastrectomy at Yeungnam University Medical Center between January 1995 and December 1999. A statistical analysis was done using the SPSS program for Windows (Version 10.0, SPSS Inc., USA). The Kaplan-Meier method was used for the survival analysis. Prognostic factors were analyzed by using a multivariate analysis with Cox proportional hazard regression model. RESULTS: Ages ranged from 21 to 79 (median age, 56). A univariate analysis revealed that age, tumor size, location, gross type, depth of invasion, extent of gastrectomy or lymph node dissection, lymph node metastasis, distant metastasis, lymphatic invasion, venous invasion, neural invasion, pathologic stage, histologic type, and curability of surgery had statistical significance. Among these factors, lymph node metastasis, curability of surgery, neural invasion, lymphatic invasion, and depth of invasion were found to be independent prognostic factors by using a multivariate analysis. Venous invasion showed no prognostic value in the multivariate analysis. CONCLUSION: Neural invasion and lymphatic invasion are useful parameters in determining a prognosis for gastric cancer patients.
Academic Medical Centers ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Metastasis ; Medical Records ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Stomach Neoplasms*

PURPOSE: Some controversies exist over the prognostic values of lymphatic, venous, and neural invasion in patients with gastric cancer. This study was conducted to confirm the prognostic values of these histopathologic factors in gastric cancer patients who received a gastrectomy. MATERIALS AND METHODS: Data for clinicopathologic factors and clinical outcomes were collected retrospectively from the medical records of 1,018 gastric cancer patients who received a gastrectomy at Yeungnam University Medical Center between January 1995 and December 1999. A statistical analysis was done using the SPSS program for Windows (Version 10.0, SPSS Inc., USA). The Kaplan-Meier method was used for the survival analysis. Prognostic factors were analyzed by using a multivariate analysis with Cox proportional hazard regression model. RESULTS: Ages ranged from 21 to 79 (median age, 56). A univariate analysis revealed that age, tumor size, location, gross type, depth of invasion, extent of gastrectomy or lymph node dissection, lymph node metastasis, distant metastasis, lymphatic invasion, venous invasion, neural invasion, pathologic stage, histologic type, and curability of surgery had statistical significance. Among these factors, lymph node metastasis, curability of surgery, neural invasion, lymphatic invasion, and depth of invasion were found to be independent prognostic factors by using a multivariate analysis. Venous invasion showed no prognostic value in the multivariate analysis. CONCLUSION: Neural invasion and lymphatic invasion are useful parameters in determining a prognosis for gastric cancer patients.
Academic Medical Centers ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Metastasis ; Medical Records ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Stomach Neoplasms*