Transcatheter arterial chemoembolization(TACE) was performed in a 61 year old male patient with hepatocellular carcinoma with 10 cc of Lipiodol and 50 mg of doxorubicin. Three days later, he complained of dyspnea and dry cough. The arterial blood gas study revealed moderate hypoxemia and hypocarbia. The chest PA showed acute pulmonary edema with bilateral pleural effusion. To rule out the possibilities of acute respiratory failure caused by infection, pulmonary embolism or congestive heart failure, we performed several laboratory studies. The blood and sputum culture studies revealed negative results for bacterial growth. The echocardiogram was normal. The abdominal CT scan and MR imaging revealed no thrombus or mass lesion in the inferior vena cava. So we concluded pulmonary oil embolism induced by lipiodol as the cause of acute lung injury. Four weeks later, clinical symptoms and chest x-ray were markedly improved with conservative care. We report a case of acute lung injury after TACE with lipiodol and doxorubicin, with review of literatures.
Acute Lung Injury* ; Anoxia ; Carcinoma, Hepatocellular* ; Cough ; Doxorubicin ; Dyspnea ; Embolism ; Ethiodized Oil ; Heart Failure ; Humans ; Magnetic Resonance Imaging ; Male ; Pleural Effusion ; Pulmonary Edema ; Pulmonary Embolism ; Respiratory Insufficiency ; Sputum ; Thorax ; Thrombosis ; Tomography, X-Ray Computed ; Vena Cava, Inferior

PURPOSE: This study was aimed to evaluate the effect of time of surgery for acute appendicitis on surgical outcomes to optimize the timing of appendectomies. METHODS: Medical records of patients who underwent an appendectomy were reviewed to obtain data on time of symptom onset, time of hospital presentation, and start times of surgery. Surgical findings were used to define appendicitis as either uncomplicated or complicated. The uncomplicated group included patients with simple, focal, or suppurative appendicitis, and the complicated group included patients with gangrenous, perforated appendicitis or periappendiceal abscess formation. The 2 groups were analyzed by age, sex, and time. RESULTS: A total of 192 patients were analyzed. The mean time from symptom onset to start of operation showed a significant difference between both groups (1,652.9 minutes vs. 3,383.8 minutes, P < 0.001). The mean time from hospital visit to start of operation showed no difference between both groups (398.7 minutes vs. 402.0 minutes, P = 0.895). Operating within 24 hours of symptom onset had a relative risk of 1.738 (95% confidence interval, 1.319-2.425) for complications. Operating more than 36 hours after symptom onset was associated with an increased risk of postoperative ileus and a longer hospital stay. CONCLUSION: Complicated appendicitis is associated with a delay in surgery from symptom onset rather than a delay at hospital arrival. Surgeons should take into account the time from symptom onset when deciding on the timing of appendectomy. We recommend that appendectomy be performed within 36 hours from symptom onset.
Abscess ; Appendectomy ; Appendicitis* ; Humans ; Ileus ; Length of Stay ; Medical Records ; Surgeons ; Treatment Outcome

OBJECTIVE: Sural nerve conduction study is known to be one of the sensitive tests for detecting neuropathies. In peripheral neuropathy, the distal sural nerve, lateral dorsal cutaneous branch of sural nerve (LDCBSN), may be more easily affected than proximal portion of the sural nerve. To evaluate the clinical application of LDCBSN conduction study and amplitude comparison between sural nerve and LDCBSN in peripheral neuropathy. METHOD: Antidromic conduction studies were performed for sural nerve and LDCBSN and amplitude between two nerve responses were obtained in 30 controls (mean age, 46) and 30 patients with diabetic neuropathy (mean age, 54), but obtainable sural sensory response. The active recording electrodes were placed were placed over the dorsolateral surface at the midpoint of the fifth metatarsal for LDCBSN and posterior aspect of lateral malleolus for sural nerve. The stimulating electrodes were placed 12 cm proximal to the active electrodes in both nerves. RESULTS: LDCBSN response was obtainable in all controls and not obtainable in 7 diabetic patients in whom the amplitude of sural response was less than 5 uV. The amplitude of LDCBSN to sural nerve was approximately 35% in controls and 22% in diabetic patients, which was statistically significant (p=0.00). CONCLUSION: LDCBSN conduction study is sensitive test to detect peripheral neuropathies and amplitude ratio of LDCBSN to sural nerve can be used in the evaluation of peripheral neuropathies.
Diabetic Neuropathies* ; Electrodes ; Humans ; Metatarsal Bones ; Peripheral Nervous System Diseases ; Sural Nerve*

PURPOSE: Refractory small-cell lung cancer (SCLC) has a poor prognosis, and current salvage chemotherapy for refractory SCLC, such as CAV (cyclophosphamide, adriamycin, vincristine) or topotecan, has an unsatisfactory outcome, with a response rate and overall survival of less than 10% and 6 months, respectively. This phase II study evaluated the role of topotecan combined with etoposide in SCLC patients that have progressed, or relapsed, within 3 months following completion of the initial chemotherapy. MATERIALS AND METHODS: Twenty-seven patients were entered into this study. Eligible patients had an ECOG performance status of less than, or equal to, 2, at least one bidimensionally measurable lesion and adequate end organ function. IV topotecan, 1.0 mg/m2/d for 5 consecutive days, and etoposide, 100 mg/m2/d through days 1 to 3, were administered every 3 weeks until disease progression or undue toxicity. RESULTS: The major toxicity was myelosuppression. Grade 3/4 anemia, granulocytopenia, and thrombocy-topenia occurred in 14.2, 34.8, and 27.3% of cycles, respectively. There was no treatment-related death, and other non-hematologic toxicities were generally mild. Four patients achieved partial responses, with a response rate RR of 14.8%. The progression-free survival PFS ranged from 1 to 7 months, with a median of 2.0 months (95% confidence interval 1.22~2.78 months). Twenty-five patients died, with a median overall survival of 5.5 months (ranging from 1 to 21 months, 95% CI 4.32~6.68 months), and the 6-month survival rate was 32.1% (95% confidence interval 14.4~49.8%). CONCLUSION: The combination of topotecan and etoposide chemotherapy showed a modest response rate, but failed to prolong survival of refractory SCLC patients compared to topotecan monotherapy.
Agranulocytosis ; Anemia ; Carcinoma, Small Cell ; Disease Progression ; Disease-Free Survival ; Doxorubicin ; Drug Therapy ; Drug Therapy, Combination ; Etoposide* ; Humans ; Lung Neoplasms* ; Lung* ; Prognosis ; Survival Rate ; Topotecan*

Situs inversus totalis is a rare inherent disease in which the thoracic and abdominal organs are transposed. Symptoms of appendicitis in situs inversus (SI) may appear in the left lower quadrant, and the diagnosis of appendicitis is very difficult. We report a case of left-sided appendicitis diagnosed preoperatively after dextrocardia that was detected by chest X-ray, although the chief complaint of the patient was left lower-quadrant pain. The patient underwent an emergent laparoscopic appendectomy under the diagnosis of appendicitis after abdominal computed tomography (CT). In patients with left lower quadrant pain, if the chest X-ray shows dextrocardia, one should suspect left-sided appendicitis. A strong suspicion of appendicitis and an emergency laparoscopic operation after confirmation of the diagnosis by imaging modalities including abdominal CT or sonography can reduce the likelihood of misdiagnosis and complications including perforation and abscess. Laparoscopic appendectomy in SI was technically more challenging because of the mirror nature of the anatomy.
Abscess ; Appendectomy ; Appendicitis ; Dextrocardia ; Diagnostic Errors ; Emergencies ; Humans ; Situs Inversus ; Thorax

The strategies of incorporating monoclonal antibodies (MoABs) have now proved efficacy in the first-line treatment of advanced non-small cell lung cancer (NSCLC). These include targeting the vascular endothelial growth factor (VEGF) or epidermal growth factor receptor (EGFR). Bevacizumab is a MoAB targeting the vascular endothelial growth factor (VEGF), an important mediator of new blood vessel formation. Cetuximab is a MoAB directed at EGFR. Binding cetuximab to EGFR blocks signal transduction and promotes receptor internalization and degradation. In this review, we present current data of bevacizumab and cetuximab for the first line treatment of advanced NSCLC. We also refer to their potential for Asian patients with advanced NSCLC in the first-line setting.
Antibodies, Monoclonal/*therapeutic use ; Antineoplastic Agents/*therapeutic use ; Asian Continental Ancestry Group ; Carcinoma, Non-Small-Cell Lung/*drug therapy ; Humans

No abstract available.
Cisplatin*

BACKGROUND: Medical decisions concerning the prolongation of life, the right to die and euthanasia are among the most extensively discussed issues within medicine and law today. The purpose of this study was to evaluate the attitudes of medical students and housestaff toward euthanasia. METHODS: From July 15 to September 15 of the 1998, the responses of 180 medical students and 132 housestaff to a self-administered questionnaire were analyzed to identify attitudes toward euthanasia. Over 312 respondents about attitudes toward euthanasia, the analysis of differences between proportions was made by the Chi-square test. RESULTS: About 69.9% of the respondents thought euthanasia should be legalized. The findings suggest that Buddhists (77.5%) and non-religious groups (88.1%) tend to support euthanasia more than Christians. Futhermore, medical students (74.4%) support euthanasia more than housestaffs(63.6%), male(75.1%) more often than female(57.9%). About 73.1% of the respondents said that active euthanasia is not justifiable, and 79.2% said that they do not like performing active euthanasia. In respect to passive euthanasia, 69.0% said that it is not ethically justifiable, but 63.0% would perform this as if it were legal. Housestaffs of internal medicine (76.9%) were more willing to do euthanasia than pediatrics (70.0%), surgery (63.6%), family practice (53.8%) and Ob/Gyn (33.3%). CONCLUSION: Respondents have positive attitudes toward legalization of euthanasia.. Most considered that passive euthanasia is not morally justifiable. But if it were legalized, they would be willing to do euthanasia, while they would still be disturbed by active euthanasia. The opinions of physician and medical students directly affect patient care and their attitudes must be considered if clear policies are to be developed concerning euthanasia.
Surveys and Questionnaires ; Euthanasia* ; Euthanasia, Active ; Euthanasia, Passive ; Family Practice ; Humans ; Internal Medicine ; Jurisprudence ; Life Support Care ; Patient Care ; Pediatrics ; Right to Die ; Students, Medical*

Eosinophilic enteritis is an uncommon disease that rarely manifests as an acute abdomen. A 50-year-old man visited our hospital and complained of epigastric and periumbilical pain. He reported direct and rebound tenderness over the periumbilical area. Laboratory examinations showed leukocytosis without eosinophilia. Plain abdominal radiography revealed air-fluid levels in the small intestine and computed tomography revealed concentric wall thickening in the small bowel and ascites in the pelvic cavity. We conducted an emergency operation and segmental resection of the jejunum was performed. Histologically, transmural, eosinophilic infiltration was observed. In patients with intestinal obstruction, even when presenting with an acute abdomen with no peripheral eosinophilia, eosinophilic enteritis should be included in the differential diagnosis.
Abdomen, Acute ; Ascites ; Diagnosis, Differential ; Emergencies ; Enteritis ; Eosinophilia ; Eosinophils ; Gastritis ; Gastroenteritis ; Humans ; Intestinal Obstruction ; Intestine, Small ; Jejunum ; Leukocytosis ; Middle Aged ; Radiography, Abdominal

No abstract available.
Breast* ; Lymphoma*