No abstract available.

PURPOSE: The aim of this prospective study was to evaluate whether additional intraoperative injection of Tarasyn (ketorolac tromethamine) provided a preemptive analgesic effect that improved postoperative pain. METHODS: Sixty patients scheduled for hemorrhoidectomy were randomly assigned to the study and control groups. For the control group (n=32), patients were treated with standard intravenous injections of Nubain (Nalbuphine hydrochloride; Jeil Pharmaceuticals Co, Seoul) per 8 hours for three times postoperatively for pain relief. In the study group (Tarasyn group, n=28), 60 mg of Tarasyn (ketorolac tromethamine; Roche Korea, Seoul) was injected into the internal sphincter muscle and around the operative wound at the time of hemorrhoidectomy as well as standard intravenous injections of Nubain . Parameters were measured of pain score from 0 (no pain) to 10 (agonizing pain), painless sound sleep, additional analgesic requirements, time to first bowel movement, and postoperative urinary retention. RESULTS: Rate of painless sound sleep was 75.0% and 53.1% in the Tarasyn and the control groups, respectively, which was significant statically between two groups (P<0.05). Time to first bowel movement was 2 and 3.2 days in Tarasyn and the control groups, respectively, which was also significant statistically (P<0.05). Voiding difficulty developed in one case (3.5%) in the Tarasyn group and he needed catheterization. In the control group, however, the number (15 cases, 46.9%; P<0.001) was much higher requiring more catherization (13 cases, 40.9%; P<0.001). Mean pain scores was significant statically between two groups (P<0.001). CONCLUSION: The data suggest that the use of intraoperative injection of Tarasyn is associated with a significant decrease in pain and urinary complications after hemorrhoidectomy.
Catheterization ; Catheters ; Hemorrhoidectomy* ; Humans ; Injections, Intravenous ; Korea ; Nalbuphine ; Pain, Postoperative ; Prospective Studies* ; Tromethamine ; Urinary Retention ; Wounds and Injuries

No abstract available.

Although optimal treatment of tumors at mid and distal rectum continues to be a matter of great debate to oncologic surgeons, a surgical goal of sphincter preservation should be considered in all patients with an intact sphincter. There are growing evidences and indications that sphincter-preserving procedure might be a valid alternative to conventional modality in tumors of the mid or lower rectum. Traditionally, an abdominoperineal resection with permanent colostomy would be the sole surgical option. Recently, a variety of sphincter-preserving procedures are performed in majority of distal rectal cancers with acceptable oncologic and optimal functional results. Several recent advances may further influence future treatment strategies and many issues are, at present, under evaluation. Here, some of the most relevant topics regarding current methods of sphincter-preserving procedures with their oncologic and functional results are discussed to establish the guideline of surgical treatment in rectal cancer.
Anal Canal ; Digestive System Surgical Procedures/*methods ; Humans ; Rectal Neoplasms/*surgery

We report a case of congenital giant pigmented nevus with malignant melanoma of brain in a 14-year-old male patient. He had giant pigmented nevus on the back and neck, and multiple satellite lesions over the whole body since birth. One year prior to visit to our hospital, the patient suffered from various neurologie symptoms including headache, nausea, vomiting, seizure and right side motor weakness. Flistologic findings of skin lesions were benign nevocytic nevi. Computed tomogram of brain demonstrated increased densities in the both fronto-parietal leptameninges and brain parenchyme. Histologic findings of brain parenchyme by stereotaxic long needle biopsy showed the infiltration of melanin containing atypical melanocytes. There was no evidence of malignant melanoma at other organs. All of these findings suggested that origin of malignant melanoma of brain parenchyme was leptomeninges rather than skin.
Adolescent ; Biopsy, Needle ; Brain* ; Headache ; Humans ; Male ; Melanins ; Melanocytes ; Melanoma* ; Nausea ; Neck ; Nevus ; Nevus, Pigmented* ; Parturition ; Seizures ; Skin ; Vomiting

No abstract available.
Colon* ; Humans* ; Morphine* ; Naloxone* ; Perfusion*

In patients with symptomatic incurable metastatic colorectal cancer (mCRC), the goal of resection of the primary lesion is to palliate cancer-related morbidity, including obstruction, bleeding, or perforation. In patients with asymptomatic primary tumors and incurable metastatic disease, however, the necessity of primary tumor resection is less clear. Although several retrospective analyses suggest survival benefit in patients who undergo resection of the primary tumor, applying this older evidence to modern patients is out of date for several reasons. Modern chemotherapy regimens incorporating the novel cytotoxic agents oxaliplatin and irinotecan, as well as the target agents bevacizumab and cetuximab, have improved median survival from less than 1 year with the only available single-agent 5-fluorouracil until the mid-1990s to over 2 years. In addition to significant prolongation of overall survival, combinations of novel chemotherapeutic and target agents have allowed improved local and distant tumor control, decreasing the likelihood of local tumor-related complications requiring surgical resection. Resection of an asymptomatic primary tumor risks surgical complications and may postpone the administration of chemotherapy that may offer both systemic and local control. In conclusion, the morbidity and the mortality of unnecessary surgery or surgery that does not improve quality of life or survival in patients with mCRC of a limited life expectancy should be carefully evaluated. With the availability of effective combinations of chemotherapy and target agents, systemic therapy for the treatment of life-threatening metastases would be a preferable treatment strategy for unresectable asymptomatic patients with mCRC.
Antibodies, Monoclonal, Humanized ; Bevacizumab ; Camptothecin ; Cetuximab ; Colorectal Neoplasms ; Cytotoxins ; Fluorouracil ; Hemorrhage ; Humans ; Life Expectancy ; Neoplasm Metastasis ; Organoplatinum Compounds ; Palliative Care ; Quality of Life ; Retrospective Studies ; Unnecessary Procedures

PURPOSE: The aim of this study was to review the outcome of local control after the local excision for T1/T2 rectal cancers and, thus, to assess its effectiveness as an alternative to a more radical resection. METHODS: This retrospective study analyzed 23 patients with T1/T2 rectal cancer treated by local excision (LE), and their results were compared with the results for 22 patients with rectal cancer of the same stage treated by a radical resection (RR). All patients with pT2 lesions in the LE group received postoperative adjuvant chemoradiation. The outcomes were defined as 5-year local-recurrence-free survival (LRFS). The median follow-up was 72 (range, 40~92) months. RESULTS: Recurrence occurred in 4 patients (pT1, 1; pT2, 3) in the LE group and in 3 patients (all pT2) in the the RR group. One patient with vascular invasion (T2N1M0) in the RR group showed multiple liver metastases at 23 months postoperatively. The difference in 5-year LRFS was not statistically significant between the two groups. In the LE group, the 5-year LRFS for pT2 lesions was significantly less favorable than that for pT1 lesions (40% vs. 94%; P= 0.005). The 5-year LRFS for pT2 in the RR group was more favorable than that in the LE group, although the difference was not statistically significant (76.9% vs. 40%, P=0.138). CONSLUSIONS: Local excision provides a favorable local control for pT1 rectal cancers. A more radical resection, however, remains an effective surgical option for pT2 lesions because local excision, even combined with adjuvant chemoradiation, showed substantial local recurrences.
Follow-Up Studies ; Humans ; Liver ; Neoplasm Metastasis ; Rectal Neoplasms* ; Recurrence ; Retrospective Studies

BACKGROUND: Interleukin-1alpha is interesting lymphokine to cardiologists because it has been implicated as a regulatory protein in the development and clinical sequale of atherosclerosis, including the modulation of low density lipoprotein metabolism, the regulation of vascular smooth muscle cell mitogenesis, the stimulation of leukocyte adherence to endothelium, and procoagulant activity. But most interleukin-1alpha remains in the cytosol of cells in its precursor form, and is transported to cell surface. and associated with cell membrane. Therefore considerable amount of interleukin-1alpha, contrast to interleukin-1beta, is not released by cells into the extracellular space and the circulation. Despite of increased production of interleukin-1alpha, circulating level may not be elevated because of autocrine and paracrine action of that. In order to elucidate whether interleukin-1alpha is systematically elevated or not in patients with coronary artery disease who are complaining of chest pain, we undertook this study. METHODS: We isolated lymphocytes from peripheral blood in patients and control group. After the peripheral lymphocytes were cultured in the presence or absence of phytohemmagglutinin in RPMI-1640 media for 24 hours, we measured the content of interleukin-1alpha in supernatant by radioimmunoassay. RESULTS: 1) In the absence of phytohemagglutinin, the mean value of Interleukin-1alpha in the supernatant was 29.13+/-17.42 pmol/ml in control group and 27.28+/-18.80 pmol/ml in patients group(p=NS). 2) In the presence of phytohemagglutinin, the mean value of Interleukin-1alpha in the supernantant was 36.53+/-20.72 pmol/ml in control group and 152.13+/-91.85 pmol/ml in patient group(p<0.0001). CONCLUSION: Significant increase of interleukin-1alpha in the presence of phytohemagglutinin in the patient group means that the peripheral lymphocytes in patients with coronary artery disease are activated to produce interleukin-1alpha.
Atherosclerosis ; Cell Membrane ; Chest Pain ; Coronary Artery Disease* ; Coronary Vessels* ; Cytosol ; Endothelium ; Extracellular Space ; Humans ; Interleukin-1alpha* ; Interleukin-1beta ; Leukocytes ; Lipoproteins ; Lymphocytes* ; Metabolism ; Muscle, Smooth, Vascular ; Radioimmunoassay

Torticollis is an usual symptom that can be the result of various disorders, such as sternocleidomastoid muscle pathology, bony abnormalities of the cervical spine, disorders of the central or peripheral nervous system, various ocular diseases, and brain tumors, especially in children. A 12-month-old male visited our hospital because of torticollis. He was normal on systemic examination, with no neurological abnormality, and his cervical spine CT was also normal. About 4 weeks later, he revisited the emergency department due to vomiting with altered mental status, and was diagnosed with a cerebellar tumor with hemorrhage. Although torticollis is known to be an important sign of a posterior fossa tumor, associated neurological or ocular symptoms are usually present. We report here a patient with posterior fossa tumor where torticollis was the only initial presenting symptom.