Since the Asia and Oceania region has tremendous variety in cultural and religious background, the author would like to propose the formation of a research committee with representatives from different countries under the Commission on Asian & Oceanean Affairs to study the psychosocial and cultural aspects of epilepsy. A uniform study protocol can be designed to collect data on “public awareness, understanding and attitudes toward epilepsy” and “patients’ perception of having epilepsy.” The survey can be done among the general population, patients with epilepsy, family members, health providers, or school teachers.

Objective To evaluate the effects of dexmedetomidine combined with subanesthetic dose of ketamine on the emergence agitation in the patients undergoing thoracotomy.Methods Eighty ASA physical status Ⅱ or Ⅲ patients,aged 55-75 yr,weighing 50-75 kg,scheduled for elective esophageal cancer resection,were randomly divided into 4 groups (n =20 each) using a random number table:normal saline group (NS group),dexmedetomidine group (group D),subanesthetic dose of ketamine group (group K),and dexmedetomidine combined with ketamine group (group DK).In DK and K groups,ketamine 0.5 mg/kg was injected intravenously (within 1 min) at 10 min before the end of the operation.In DK and D groups,dexmedetomidine 0.5 μg/kg was infused intravenously over 10 min starting from 10 min before the end of operation.In group NS,the equal volume of normal saline was infused intravenously over 10 min starting from l0 min before the end of operation.The emergence time,extubation time,duration of ICU stay,occurrence and degree of agitation,and development of cardiovascular events and hypoxemia within 24 h after operation were recorded.Ramsay sedation scores were recorded before induction of anesthesia (T1),immediately after completion of administration at the end of surgery (T2),and at 0,5,10 and 30 min after extubation (T3-6).Results There was no significant difference in the emergence time,extubation time,and duration of ICU stay between the four groups.Compared with group NS,Ramsay sedation scores were significantly increased at T3-6,the incidence and degree of agitation were decreased,and the incidence of cardiovascular events and hyoxemia was decreased in D,K and DK groups.Compared with D or K group,Ramsay sedation scores were significantly increased at T3-6,the incidence and degree of agitation were decreased,and the incidence of cardiovascular events and hyoxemia was decreased in group DK.Conclusion Dexmedetomidine combined with subanesthetic dose of ketamine can prevent the emergence agitation in the patients undergoing thoracotomy,which provides better efficacy than either alone.

About 20 or more cases of seminal vesicle cyst were reported up to nowadays, but CT findings are not yetdescribed. Seminal visicle cyst is often associated with ipsilateral renal agenesis, and the mechanism ofdevelopment is based on embryogenesis. A 26 year old male was confirmed as seminal vesicle cyst in S.N.U.H. inNov. 1981. CT of the seminal vesicle cyst revealed huge, globular and homogeneous mass with well-circumscribedsmooth margin between urinary bladder and rectum. Adilated tubular structure was also found lateral to the hugecystic mass. The ipsilateral kidney was not found in any level of abdomen from the diaphragmetic dome to thesymphisis pubis.
Abdomen ; Embryonic Development ; Female ; Humans ; Kidney ; Male ; Pregnancy ; Pubic Bone ; Rectum ; Seminal Vesicles ; Urinary Bladder

As an essential amino acid, tryptophan (Trp) has various physiological functions and is of great significance in the metabolic process of tumors. In the human body, tryptophan is mainly transformed through kynurenine metabolic pathway, which not only promotes the inherent malignant properties of tumor cells, but also leads to immune-suppressive tumor microenvironment. Changes in tryptophan metabolism often occur in tumors, accompanied by abnormal gene expression of tryptophan-related enzymes, among which indoleamine 2,3-bioxygenase (IDO)-related gene expression and tryptophan 2,3-dioxygenase (TDO)-related gene changes are the most significant. A large number of clinical trials on IDO inhibitors, TDO inhibitors and combination therapy have been carried out. This paper reviewed the tryptophan metabolic pathway, regulation of IDO (TDO), kynurenine (KYN) and other related genes in tumor cells, and outlined the development of therapeutic schedule targeting tryptophan-related genes. The new progress provides new ideas for the further exploration of tumor treatment options.

No abstract available.
Carcinoma, Squamous Cell* ; Cervix Uteri* ; Female ; Humans ; Biomarkers, Tumor*

This review aims to introduce the Taiwanese Medical Accreditation System: its history, role and future goals. In 1999, the Ministry of Education, Taiwanese Government commissioned the non-profit National Health Research Institutes (NHRI) to develop a new medical accreditation system. According to that policy, the Taiwan Medical Accreditation Council (TMAC) was established in the same year. The council serves a similar function to that of the Liaison Committee on Medical Education (LCME) of the United States and the Australian Medical Council (AMC). The accreditation process consists of a self-assessment plus a four-day site visit by a team of eight medical educators that are headed by one of the council members of the TMAC. The first cycle of initial visits was completed from 2001 to 2004. Subsequent follow-up visits were arranged according to the results of the survey with smaller-sized teams and shorter periods. There is evidence to suggest that the majority (seven of eleven) of the medical schools in Taiwan have made good progress. TMAC's next step will be to monitor the progress and raise the standard of medical education in individual schools with a homogenous, superior standard of medical education.
Academies and Institutes ; Accreditation ; Education, Medical ; Follow-Up Studies ; Head ; Humans ; Organothiophosphorus Compounds ; Schools, Medical ; Self-Assessment ; Taiwan ; United States

No abstract available.
Lipomatosis*

Juvenile hyaline fibromatosis is a rare disorder probably inherited as an autosomal recessive trait. It is characterized by multiple slowly growing subcutaneous nodules, hypertrophy of gingiva, flexion contracture, and radiolucent bone destruction. The histological features of the tumor-like lesions are characterized by the deposition of amorphous hyaline material in which spindle shaped cells are embedded. We report a case of juvenile hyaline fibromatosis in a 26 year-old-woman. She had multiple subcutaneous nodules in scalp, ear, forearms, right knee, and back. Surgical excision of the tumors in the scalp and ear was done. The largest one measured 13 9 6 cm, and had homogeneous, grayish yellow cut surface with calcification. Light microscopic examination showed abundant eosinophilic hyaline material with extensive calcification and metaplastic bone formation. Spindle cells were rarely observed at the periphery of the tumor. Hyaline matrix was PAS positive, diastase resistant, and alcian blue negative. Scattered spindle cells were positive for vimentin but negative for S-100 protein and smooth muscle actin. There were many reports regarding early lesions of juvenile hyaline fibromatosis; however in this patient, tumor existed for more than 20 years and the histology was somewhat different from the early lesions reported in the literature.
Actins ; Adult* ; Alcian Blue ; Amylases ; Contracture ; Ear ; Eosinophils ; Forearm ; Gingiva ; Humans ; Hyalin ; Hyalinosis, Systemic* ; Hypertrophy ; Knee ; Muscle, Smooth ; Osteogenesis ; S100 Proteins ; Scalp ; Vimentin

According to the level of selenium (Se) and methionine (Met) in diet, Wistar rats were randomly divided into 3 groups, group A (normal Se and normal Met); group B (Low Se and normal Met); group C (low Se and low Met). The animals were sacrificed after 8-week feeding. The results showed that the alteration of myocardial ultrastructure was slight in group B. Decreased activities of cytochrome oxidase and succinate dehydrogcnase of myocardial mitochonria and decreased activities of GSH-Px in the blood, heart and liver in group B were observed, as compared with those in group A. But the level of TBA was higher than that of group A.The above mentioned changes in group C were extremely apparent than group A or B, indicating both Se and Met deficiency in diet may concern the etiology of Keshan disease.

Objective To investigate the impact of intermittent porta hepatis occlusion on postoperative intra-hepatic recurrence of hepatocellular carcinoma.Methods We retrospectively reviewed the records of 335 patients who underwent partial hepatectomy.The patients were classified into 2 groups:(1) the study group (n=97):porta hepatis was occluded with intermittent Pringle maneuver with 2-3 cycles of clamp/unclamp time of 15 min/5 min,repeated 2-3cycles; (2) the control group (n=238):including using Pringle maneuver,preconditioning occlusion of porta hepatis and selective occlusion of portal blood inflow.Patients were followed-up in the Outpatient Department once every 2-3 weeks in the 1st year,and once every 3-6 weeks in the 2nd year with US/CT/MRI and serum AFP test.The mean duration of follow-up was 26.5 months.Results The perioperative mortality was 1.8％ (6/335).Tumour recurrence in the study group was 31.6％ and 48.4％ in the 1st and 2nd year,respectively.The recurrence rates were significantly higher,than the 21.4％ and 38.0％ in the control group (P＜0.05).To exclude the miscellaneous factors which were involved in intra-hepatic recurrence of HCC,we set up 3 criteria to include patients for subgroup analysis:tumor ≥5 cm; serum AFP decreased to normal level within 4 weeks; negative intra-operative US scan.The number of patients included were 79 and 155 in the study and the control groups,respectively.There were significant differences in recurrence rate between the study and the control groups in the 1st and 2nd year (29.1％ vs 18.7％,46.8％ vs 35.5％,P＜0.05).There were no significant differences in overall survival rate between the two groups.Conclusions Intermittent porta hepatis occlusion is a risk factor of postoperative intra hepatic recurrence of hepatocellular carcinoma.