There are many methods for postoperative pain relief. For example,intramusoular or in- travenous administration of analgesics,nerve block,wound infiltration or intravenous injaction with local anesthetics, epidural or intrathecal injection of opioids or local anesthetics, TENS, cryoanalgesia, psychological support are available, We managed postoperative pain by means of intrathecal morphine injection or epidural morphine with bupivacaine mixture administration. In the group 1, morphine 0.2mg was injected intrathecally just after the operation. In the group 2, the mixture of morphine with bupivacaine was infused into epidural space continuously for 3days. The results were as follows; 1. The pain score was significantly decreased in group 2 compared to group 1.(P<0.05) 2. In group 1,there was signficantly more itehing sensation than in group 2.(P<0.05), but there were no significst differences in other complications 3. There was no significant difference in gas passing time. 4. The feeling of satisfaction was high in both groups,and there was no significant difference. 5. It was technically more difficult and the cost was higher in group 2.
Analgesics, Opioid ; Anesthetics, Local ; Bupivacaine* ; Epidural Space ; Injections, Spinal ; Morphine* ; Pain, Postoperative ; Sensation ; Transcutaneous Electric Nerve Stimulation

Teaching both English in medical field and bioethics to medical students in Korea is becoming more and more important. We have investigated the present status of medical English and bioethics lectures in medical schools in Korea. We have taught bioethics in medical English class and investigated its effect through questionnaire. Less than two thirds of the 35 medical schools in Korea have medical English and /or bioethics lectures. Mainly English medical terms were taught in premedical course in most of the school which needs to be improved. Evaluation of the bioethics lecture in medical English class was responded favorably by the students. In conclusion, teaching bioethics in medical English class in English appears to be an effective way of teaching both English and bioethics in medical field at the same time and a good way of saving time by teaching both simultaneously.
Bioethics* ; Humans ; Korea ; Lectures ; Schools, Medical ; Students, Medical ; Surveys and Questionnaires

Uterine adenomyosis is a common benign pelvic tumor in women. One of the complications that may be infrequently associated with the huge pelvic mass is venous stasis of the lower extremities and may develop thrombophlebitis secondary to pelvic compression. Intravascular thrombosis in the deep vein of the legs is a serious illness that sometimes cause death due to acute pulmonary thromboembolism. Deep vein thrombosis (DVT) has been reported to be closely related to pregnancy, surgical procedure, long term bedrest, obesity, and oral contraceptives. However, there is few report about deep vein thrombosis caused by huge uterine adenomyosisWe report a case of deep vein thrombosis caused by huge adenomyosis was treated by hysterectomy, thrombectomy, and thrombolysis with a brief review of the literature.
Adenomyosis* ; Bed Rest ; Contraceptives, Oral ; Female ; Humans ; Hysterectomy ; Leg* ; Lower Extremity ; Obesity ; Pregnancy ; Pulmonary Embolism ; Thrombectomy ; Thrombophlebitis ; Thrombosis ; Veins ; Venous Thrombosis*

OBJECTIVE: To evaluate the clinical effectiveness of minilaparotomy total hysterectomy compared with other methods of hysterectomy ever used. METHODS: Data of 300 women who had been done hysterectomy due to benign gynecologic disease were used for this thesis. Minilaparotomy hysterectomy was done for 40 women, classical transabdominal hysterectomy for 186 women, laparoscopic assisted vaginal total hysterectomy for 28 women and vaginal total hysterectomy for 46 women. Women's clinical data and clinical outcome were compared using Excel and SPSS. RESULTS: Minilaparotomy hysterectomy has no limitation in choosing patient and adnexal surgery like classical transabdominal hysterectomy, and postoperative clinical course is so rapid similar with laparosocopic assisted vaginal total hysterectomy. CONCLUSION: Minilaparotomy hysterecomy is good choice for treatment of benign gynecologic disease.
Female ; Genital Diseases, Female* ; Humans ; Hysterectomy* ; Laparotomy

BACKGROUND AND OBJECTIVES: This study was designed to predict the development of severe mitral regurgitation (MR) following percutaneous mitral valvuloplasty (PMV) in patients with a favorable morphology of the mitral valve (MV). SUBJECTS AND METHODS: We prospectively examined 253 patients with severe mitral stenosis from 1997 to 2000. Echocardiographic evaluation of MV morphology was performed prior to PMV. We proposed commissural calcification, severe relative prolapse, and uneven thickening of MV as predictors of MR following PMV and defined the MR risk group as patients with any of these 3 features. The balloon size was expressed as the value of the effective balloon dilating area divided by the body surface area. The larger balloon group was defined as patients in whom balloon size>3.8 cm 2/m 2 was selected for PMV. The development of severe MR was defined as the presence of MR> or = 3 + on echocardiography following PMV. RESULTS: Severe MR developed in 14 (5.5%) patients. On multiple logistic regression analysis, the MR risk group (p<0.001) and balloon size (p=0.009) were the only significant independent predictors of severe MR following PMV. A sensitivity and specificity of a Padial MR score >8 and MR risk group was 43%, 88% and 71%, 86% respectively. In the MR risk group, severe MR developed in 8 (53.3%) of 15 patients of the larger balloon group as compared with 2 (6.9%) of 29 patients of the smaller balloon group (p=0.001). CONCLUSION: Echocardiography can identify patients with a high risk of developing MR after PMV and the use of a smaller Inoue balloon may prevent severe MR in selected patients.
Body Surface Area ; Echocardiography* ; Humans ; Logistic Models ; Mitral Valve ; Mitral Valve Insufficiency* ; Mitral Valve Stenosis ; Prolapse ; Prospective Studies ; Sensitivity and Specificity

Purpose: The value of the genomic profiling by targeted gene-sequencing on radiation therapy response prediction was evaluated through integrated analysis including clinical information. Radiation response prediction model was constructed based on the analyzed findings. Materials and Methods: Patients who had the tumor sequenced using institutional cancer panel after informed consent and received radiotherapy for the measurable disease served as the target cohort. Patients with irradiated tumor locally controlled for more than 6 months after radiotherapy were defined as the durable local control (DLC) group, otherwise, non-durable local control (NDLC) group. Significant genomic factors and domain knowledge were used to develop the Bayesian Network model to predict radiotherapy response. Results: Altogether, 88 patients were collected for analysis. Of those, 41 (43.6%) and 47 (54.4%) patients were classified as the NDLC and DLC group, respectively. Somatic mutations of NOTCH2 and BCL were enriched in the NDLC group, whereas, mutations of CHEK2, MSH2, and NOTCH1 were more frequently found in the DLC group. Altered DNA repair pathway was associated with better local failure–free survival (hazard ratio, 0.40; 95% confidence interval, 0.19 to 0.86; p=0.014). Smoking somatic signature was found more frequently in the DLC group. Area under the receiver operating characteristic curve of the Bayesian network model predicting probability of 6-month local control was 0.83. Conclusion Durable radiation response was associated with alterations of DNA repair pathway and smoking somatic signature. Bayesian network model could provide helpful insights for high precision radiotherapy. However, these findings should be verified in prospective cohort for further individualization.

A 55-year-old male was admitted to our hospital complaining of chest discomfort, dysphagia and severe pain on swallowing. Esophageal manometry identified the lower esophageal sphincter as having no response to swallow. Barium swallow showed typical esophagograms of double barrelled esophagus or mucosal stripe. An endoscopic examination revealed an appearance as if an esophago-tracheal fistula had been made at the level of the upper thoracic esophagus. Also, two slitlike mucosal tears were seen on the lower esophagus. Subsequent fasting and total parenteral nutrition for several weeks failed to bring about any improvement in his symptoms. So, as a treatment, primary closure of the upper opening of the false channel was performed under general anesthesia. Soon after the surgical procedure, the patients symptoms disappeared except for mild dysphagia. He was discharged after oral intake had been judiciously commenced with fluids and soft diets. During his follow-up in the out-patient department, he was examined and found to have no specific symptoms including fever or dysphagia. Moreover, there was great improvement from the massive dissection of the esophagus on esophagogram.
Anesthesia, General ; Barium ; Deglutition ; Deglutition Disorders ; Diet ; Esophageal Sphincter, Lower ; Esophagus* ; Fasting ; Fever ; Fistula ; Follow-Up Studies ; Humans ; Male ; Manometry ; Middle Aged ; Outpatients ; Parenteral Nutrition, Total ; Thorax

PURPOSE: The purpose of this study is to determine the maximum tolerated dose (MTD), safety, pharmacokinetics, and recommended phase II dose of an oral drug composed of paclitaxel and HM30181A, which is an inhibitor of P-glycoprotein, in patients with advanced cancers. MATERIALS AND METHODS: Patients with advanced solid tumors received standard therapy were given the study drug at escalating doses, using a 3+3 design. The study drug was orally administered on days 1, 8, and 15, with a 28-day cycle of administration. The dose of paclitaxel was escalated from 60 to 420 mg/m2, and the dose of HM30181A was escalated from 30-210 mg/m2. RESULTS: A total of twenty-four patients were enrolled. Only one patient experienced a dose-limiting toxicity-a grade 3 neutropenia that persisted for more than 2 weeks, at 240 mg/m2 of paclitaxel. MTD was not reached. The maximum plasma concentration was obtained at a dose level of 300 mg/m2 and the area under the curve of plasma concentration-time from 0 to the most recent plasma concentration measurement of paclitaxel was reached at a dose level of 420 mg/m2. The absorption of paclitaxel tends to be limited at doses that exceed 300 mg/m2. The effective plasma concentration of paclitaxel was achieved at a dose of 120 mg/m2. Responses of 23 patients were evaluated; 8 (34.8%) had stable disease and 15 (65.2%) had progressive disease. CONCLUSION: The study drug appears to be well tolerated, and the effective plasma concentration of paclitaxel was achieved. The recommended phase II dose for oral paclitaxel is 300 mg/m2.
Absorption ; Humans ; Maximum Tolerated Dose ; Neutropenia ; P-Glycoprotein* ; Paclitaxel* ; Pharmacokinetics ; Plasma

PURPOSE: The purpose of this study was to evaluate the outcome of adjuvant chemoradiotherapy (CRT) after distal pancreatectomy (DP) in patients with pancreatic adenocarcinoma, and to identify the prognostic factors for these patients. MATERIALS AND METHODS: We performed a retrospective review of 62 consecutive patients who underwent curative DP followed by adjuvant CRT between 2000 and 2011. There were 31 men and 31 women, and the median age was 64 years (range, 38 to 80 years). Adjuvant radiotherapy was delivered to the tumor bed and regional lymph nodes with a median dose of 50.4 Gy (range, 40 to 55.8 Gy). All patients received concomitant chemotherapy, and 53 patients (85.5%) also received maintenance chemotherapy. The median follow-up period was 24 months. RESULTS: Forty patients (64.5%) experienced relapse. Isolated locoregional recurrence developed in 5 patients (8.1%) and distant metastasis in 35 patients (56.5%), of whom 13 had both locoregional recurrence and distant metastasis. The median overall survival (OS) and disease-free survival (DFS) were 37.5 months and 15.4 months, respectively. On multivariate analysis, splenic artery (SA) invasion (p=0.0186) and resection margin (RM) involvement (p=0.0004) were identified as significant adverse prognosticators for DFS. Also, male gender (p=0.0325) and RM involvement (p=0.0007) were associated with a significantly poor OS. Grade 3 or higher hematologic and gastrointestinal toxicities occurred in 22.6% and 4.8% of patients, respectively. CONCLUSION: Adjuvant CRT may improve survival after DP for pancreatic body or tail adenocarcinoma. Our results indicated that SA invasion was a significant factor predicting inferior DFS, as was RM involvement. When SA invasion is identified preoperatively, neoadjuvant treatment may be considered.
Adenocarcinoma* ; Chemoradiotherapy, Adjuvant* ; Disease-Free Survival ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Lymph Nodes ; Maintenance Chemotherapy ; Male ; Multivariate Analysis ; Neoadjuvant Therapy ; Neoplasm Metastasis ; Pancreatectomy* ; Pancreatic Neoplasms ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies ; Splenic Artery*

An ampulla within a diverticulum is not rare especially in elderly patients with duct stones, but may pose a problem in identifying the papilla and properly orienting this structure for cannulation during endoscopic retrograde cholangiopancreatography. We therefore have used a new technique using the application of an additional catheter to keep the ampulla outside the diverticulum. When we pushed the duodenal fold downward and laterally with the first catheter, the ampulla was everted from the diverticulum and the hidden papilla was brought into view. Once the papilla was visible, the second catheter which was identical to the first, was advanced alongside it and inserted into the papillary orifice without difficulty. Eventually a successful cholangiogram was obtained. With the insertion of a guidewire through the second catheter, sphincterotomy and insertion of endoscopic nasobiliary drainage tube were also performed successfully.
Aged ; Catheterization* ; Catheters ; Cholangiopancreatography, Endoscopic Retrograde ; Diverticulum* ; Drainage ; Humans