Spontaneous rupture of the quadriceps tendon has heen rarely reported. We experienced four knees of 3 patients. Two patients with chronic renal failure(CRF) had been treated with peritoneal dialysis and the other patient was healthy without significant medical problem. In the CRF patients, laboratory studies were coincided with secondary hyperparathyoidism. Radiologic and operative findings suggested that the repeated minor trauma caused avulsion fracture of the bone near the insertion site of the tendon. Histologic findings revealed no elastosis of the tendon and no deposit of amyloid in the quadriceps tendon. In the non-CRF case, there was normal lahoratory data, and the rupture occurred at the musculotendinous junction, suggesting sudden contracture of the muscle causing failure without trauma history. All cases were treated successfully with open repair of the quadriceps tendon. It could be summarized that the site of spontaneous rupture in the CRF and normal patient were different.
Amyloid ; Contracture ; Humans ; Kidney Failure, Chronic ; Knee* ; Peritoneal Dialysis ; Rupture ; Rupture, Spontaneous* ; Tendons*

Efforts from various approaches have been made to anesthetize myasthenic patients associated with thymoma and, on a ehoice of kinds and dosage of the muscle relaxants, there were considerable solicitude of the anesthesiologist. In recent years, intermediate aeting none depolarizing muscle relaxants were developed and its use tends to increase. we used with the divided dose administration of small amount vecuronium and observed the degree of relaxation using peripheral nerve stimulator for endotracheal intubation and maintenance of anesthesia. On the basis of our experience, we would like to recommand techniques that administrate the divided dose of small amount vecuronium as a musde relaxant and use peripheral nerve stimulator during general anesthesia.
Anesthesia ; Anesthesia, General ; beta-Aminoethyl Isothiourea ; Humans ; Intubation, Intratracheal ; Myasthenia Gravis* ; Neuromuscular Depolarizing Agents ; Peripheral Nerves ; Relaxation ; Thymectomy* ; Thymoma* ; Vecuronium Bromide

The purpose of this study was to define the optimum dose of lidocaine required to reduced pain on injection of diazepam. We conducted a prospective, randomized trial on l20 patients undergoing anesthesia. patients were allocated to four groups according to the lidocaine do sage: group A(control), no lidocaine; group B, lidocaine 0.1 mg/kg; group C, lidocaine 0.2 mg/kg; group D, lidocaine 0.4 mg/kg. our results sbowed that a dose of lidocaine 0.4 mg/kg significa ntly reduced the incidence of pain.
Anesthesia ; Diazepam* ; Humans ; Incidence ; Lidocaine* ; Prospective Studies

The development of endotracheal tubes with high-volume and low-pressure cuffs has decreas ed the incidence of associated tracheal injury. If room air used for inflation of the cuff during general anesthesia using N2O-O2, mixtures, however, endotracheal tube cuff result in distention and potential pressure changes. Therefore, tracheal pressure injury may occur during long general anesthesia(especially, head and neck surgery). For the prevention of this problems and the determination of proper methods, we performed this study relating to nitrous oxide diffusion into a gas filled endotracheal tube cuff.
Anesthesia, General ; Diffusion ; Head ; Incidence ; Inflation, Economic ; Neck ; Nitrous Oxide*

Teratogenic effects of a diphenylhydantoin on the neurulation of the explanted early chick embryos were studied using the punched-out filter paper explantation technique. The 6th to 9th Hamburger and Hamilton staged chick embryos were explanted and cultured in the Ham's F-10 media treated with 15 microgram/ml, 30 microgram/ml, 60 microgram/ml, 90 microgram/ml, 120 microgram/ml of diphenylhydantoin in the CO2 incubator for 6-9 hours. The morphological chracteristics and the ultrastructural changes of the neuroepithelium of early chick embryos were compared with the control and experimental group using the stereomicroscope and the electron microscope. Of th 40 chick embryos cultured in the Ham's F-10 media without drug, 37 embryos(92.5%) developed normally and 3 embryos(7.5%) developed abnormally in 94 embryos(61.4%). The frequent anomalous features of the embryos were deformities of the neural folds in the cranial regions, failure of neural tube closure, dispersion of somites and developmental arrest. The scanning electron microscopic findings of neuropithelial cells of abnormally developed embryos were diminished surface blebs and microvilli, flattened and smooth cellular surfaces, and irregular size of cells. The transmission electron microscopic findings of neuroepithelial cells of abnormally developed embryos showed no significant changes of the development of intracellular organelles except the smooth cellular surface and mild underdevelopment of microfilaments.
Actin Cytoskeleton ; Animals ; Blister ; Chick Embryo* ; Congenital Abnormalities ; Embryonic Structures ; Incubators ; Microvilli ; Neural Crest ; Neural Tube ; Neuroepithelial Cells ; Neurulation* ; Organelles ; Phenytoin* ; Somites

BACKGROUND: Since postoperative cognitive impairement is common in elderly patients and normal cognitive function is important for proper use of patient controlled analgesia (PCA), we compared the efficacy, adverse effect and postoperative cognitive impairment among postoperative elderly patients given the PCA morphine, fentanyl and meperidine. METHODS: Forty-five elderly patients were randomly allocated to receive patient-controlled analgesia with either morphine, fentanyl or meperidine following upper abdominal surgery. Patients were evaluated for used doses, adverse effects, visual analogue scale, the satisfaction for analgesia during postoperative 2 days and the Mini Mental Status Examination (MMSE) and the Short Portable Mental Status Questionnaire (SPMSQ) at posoperative 1 day. RESULTS: Patients receiving the PCA fentanyl used more opioid based on a dose expressed as morphine equivalents using the putative potency ratios of 1:10:0.01 (morphine/meperidine/fentanyl). But adverse effects, visual analogue scale, and the satisfaction for analgesia were not statistically different between groups. The decrease in MMSE in the PCA-meperidine group was significantly greater than that seen in the PCA-fentanyl group and the PCA-morphine group. SPMSQ were not statistically different between groups. CONCLUSION: The present result suggest that PCA is effective method in posterative elderly without serious complications. But PCA meperidine may be avoided in the elderly because it can contribute to decrease postoperative cognitive function.
Aged* ; Analgesia ; Analgesia, Patient-Controlled* ; Fentanyl ; Humans ; Meperidine ; Morphine ; Passive Cutaneous Anaphylaxis

BACKGROUND: Since postoperative cognitive impairement is common in elderly patients and normal cognitive function is important for proper use of patient controlled analgesia (PCA), we compared the efficacy, adverse effect and postoperative cognitive impairment among postoperative elderly patients given the PCA morphine, fentanyl and meperidine. METHODS: Forty-five elderly patients were randomly allocated to receive patient-controlled analgesia with either morphine, fentanyl or meperidine following upper abdominal surgery. Patients were evaluated for used doses, adverse effects, visual analogue scale, the satisfaction for analgesia during postoperative 2 days and the Mini Mental Status Examination (MMSE) and the Short Portable Mental Status Questionnaire (SPMSQ) at posoperative 1 day. RESULTS: Patients receiving the PCA fentanyl used more opioid based on a dose expressed as morphine equivalents using the putative potency ratios of 1:10:0.01 (morphine/meperidine/fentanyl). But adverse effects, visual analogue scale, and the satisfaction for analgesia were not statistically different between groups. The decrease in MMSE in the PCA-meperidine group was significantly greater than that seen in the PCA-fentanyl group and the PCA-morphine group. SPMSQ were not statistically different between groups. CONCLUSION: The present result suggest that PCA is effective method in posterative elderly without serious complications. But PCA meperidine may be avoided in the elderly because it can contribute to decrease postoperative cognitive function.
Aged* ; Analgesia ; Analgesia, Patient-Controlled* ; Fentanyl ; Humans ; Meperidine ; Morphine ; Passive Cutaneous Anaphylaxis

Gastric cancer imposes a global health burden. Although multimodal therapies have proven to benefit patients with advanced diseases after curative surgery, the prognosis of most advanced cancer patients still needs to be improved. Surgical extirpation is the mainstay of gastric cancer treatment. Indeed, without curative surgery, variations and combinations of chemotherapy and/or radiation cannot bring clinically meaningful success. Centered around D2 surgery, adjuvant and peri-operative multimodal therapies have improved survival in a certain group of gastric cancer patients. Moving toward a personalized cancer therapy era, molecular targeted strategies have been tested in clinical trials for gastric cancer. With some success and failures, we have learned valuable lessons regarding the biology of gastric cancer and the clinical relevance of biological therapies in addition to conventional treatments. Future treatment of gastric cancer will be shifted to molecularly tailored and genome information-based personalized therapy. Collaboration across disciplines and actively adopting emerging anti-cancer strategies, along with in-depth understanding of molecular and genetic underpinnings of tumor development and progression, are imperative to realizing personalized therapy for gastric cancer. Although many challenges remain to be overcome, we envision that the era of precision cancer medicine for gastric cancer has already arrived and anticipate that current knowledge and discoveries will be transformed into near-future clinical practice for managing gastric cancer patients.
Combined Modality Therapy ; Female ; Gastrectomy ; Humans ; *Precision Medicine ; Prognosis ; Stomach Neoplasms/*surgery

We had experienced anesthetic management of two patients with bilateral pheochromocytoma. They had been treated with phenoxybenzamine for 4 weeks preoperatively. Anesthesia was managed with thiopental sodium for induction,enflurane-N2O-O2 for maintenance, vecuronium for muscle relaxation, and sodium nitroprusside for controlling severe hypertension. After tumor resection, severe hypotension was controlled by rapid transfusion, fluid and dopamine infusion. A tolerable blood pressure and pulse rate were maintained throughout the procedure. Preoperative preparation, sufficient sedation, smooth anesthetic induction, complete analgesia, good muscle relaxation, adequate ventilation and proper cardiovascular control are required in resection of pheochromocytoma.
Analgesia ; Anesthesia ; Blood Pressure ; Dopamine ; Heart Rate ; Humans ; Hypertension ; Hypotension ; Muscle Relaxation ; Nitroprusside ; Phenoxybenzamine ; Pheochromocytoma* ; Thiopental ; Vecuronium Bromide ; Ventilation

Gastric cancer is a global health burden and has the highest incidence in East Asia. This disease is complex in nature because it arises from multiple interactions of genetic, local environmental, and host factors, resulting in biological heterogeneity. This genetic intricacy converges on molecular characteristics reflecting the pathophysiology, tumor biology, and clinical outcome. Therefore, understanding the molecular characteristics at a genomic level is pivotal to improving the clinical care of patients with gastric cancer. A recent landmark study, The Cancer Genome Atlas (TCGA) project, showed the molecular landscape of gastric cancer through a comprehensive molecular evaluation of 295 primary gastric cancers. The proposed molecular classification divided gastric cancer into four subtypes: Epstein-Barr virus-positive, microsatellite unstable, genomic stable, and chromosomal instability. This information will be taken into account in future clinical trials and will be translated into clinical therapeutic decisions. To fully realize the clinical benefit, many challenges must be overcome. Rapid growth of high-throughput biology and functional validation of molecular targets will further deepen our knowledge of molecular dimensions of this cancer, allowing for personalized precision medicine.
Biology ; Chromosomal Instability ; Classification ; Far East ; Genome ; Humans ; Incidence ; Microsatellite Repeats ; Population Characteristics ; Stomach Neoplasms* ; Translational Medical Research