PURPOSE: This treatment planning study was undertaken to evaluate the impact of beam angle configuration of intensity-modulated radiotherapy (IMRT) on the dose of the normal liver in hepatocellular carcinoma (HCC). MATERIALS AND METHODS: The computed tomography datasets of 25 patients treated with IMRT for HCC were selected. Two IMRT plans using five beams were made in each patient; beams with equidistance of 72degrees (Plan I), and beams with a 30degrees angle of separation entering the body near the tumor (Plan II). Both plans were generated using the same constraints in each patient. Conformity index (CI), homogeneity index (HI), gamma index, mean dose of the normal liver (Dmean_NL), Dmean_NL difference between the two plans, and percentage normal liver volumes receiving at least 10, 20, and 30 Gy (V10, V20, and V30) were evaluated and compared. RESULTS: Dmean_NL, V10, and V20 were significantly better for Plan II. The Dmean_NL was significantly lower for peripheral (p = 0.001) and central tumors (p = 0.034). Dmean_NL differences between the two plans increased in proportion to gross tumor volume to normal liver volume ratios (p = 0.002). CI, HI, and gamma indices were not significantly different for the two plans. CONCLUSION: The IMRT plan based on beams with narrow separations reduced the irradiated dose of the normal liver, which would allow radiation dose escalation for HCC.
Carcinoma, Hepatocellular ; Humans ; Liver ; Radiotherapy, Intensity-Modulated ; Tumor Burden

OBJECTIVES: The aim of this study was to know differences of characteristics between presenile and senile patients who were consulted to the department of psychiatry during medical-surgical admission. METHODS: The demographic and clinical data obtained from the medical records of psychiatric consultation in the presenile inpatients with age 50 to 64 years(N=162) and those of the senile inpatients with age over 65 years(N=171) were reviewed and compared. RESULTS: 1) The most common chief complaints for psychiatric consultation in presenile patients were somatic symptoms, anxiety and sleep disturbance in order, while cognitive decline, clouded consciousness and depressed mood were most common in senile patients with statistical significance. 2) The most frequent psychiatric diagnoses after consultation in presenile patients were delirium, mood disorder and substance use disorder in order, while delirium, mood disorder and major neurocognitive disorder were most frequent in senile patients with statistical significance. 3) There were no significant difference in numbers of physical illnesses, while numbers of therapeutic drugs for them were more in senile patients. CONCLUSIONS: Our study found significant differences between presenile and senile patients on psychiatric symptoms and diagnoses in geropsychiatric consultation. Therefore, more subdivided age-specific approach seems to be needed for the geropsychiatric consultation activities.
Anxiety ; Consciousness ; Delirium ; Diagnosis ; Humans ; Inpatients* ; Medical Records ; Mood Disorders ; Substance-Related Disorders

BACKGROUND: Critical illness polyneuropathy(CIP) is a recognized cause of muscle weakness and failure of weaning from a ventilator during the course of sepsis and multi-organ failure. We experienced seven patients of polyneuropathy associated with critical illness, and reviewed the cases in order to characterize the clinical features of CIP. METHODS: We evaluated seven patients who developed polyneuropathy for the first time during intensive care at the Asan Medical Center from Feb, 1998 to Mar, 1999. RESULTS: CIP occurred usually 2-8 weeks after admission to the intensive care unit. All patients received ventilator care due to severe pulmonary problems, which included pneumonia, ARDS, and empyema. Five of them had sepsis. All patients had quadriparesis prominently in the distal area, muscle atrophy, decreased tendon reflexes, and distal hypoesthesia. Electrophysiological and pathologic studies were compatible with axonal polyneuropathy. Five patients recovered from the underlying critical illness and regained their muscle power with improved findings on follow-up nerve conduction studies. CONCLUSIONS: Critical illness should be considered as a cause of polyneuropathy in severely ill patients, especially if associated with sepsis. After recovery from illness, motor weakness as well as electrophysiological findings improved. Failure of weaning from a ventilator may be more affected by pre-existing cardiopulmonary problems than CIP.
Axons ; Chungcheongnam-do ; Critical Illness* ; Empyema ; Follow-Up Studies ; Humans ; Hypesthesia ; Critical Care ; Intensive Care Units ; Muscle Weakness ; Muscular Atrophy ; Neural Conduction ; Pneumonia ; Polyneuropathies* ; Quadriplegia ; Reflex, Stretch ; Sepsis ; Ventilator Weaning ; Ventilators, Mechanical ; Weaning

BACKGROUND: Critical illness polyneuropathy(CIP) is a recognized cause of muscle weakness and failure of weaning from a ventilator during the course of sepsis and multi-organ failure. We experienced seven patients of polyneuropathy associated with critical illness, and reviewed the cases in order to characterize the clinical features of CIP. METHODS: We evaluated seven patients who developed polyneuropathy for the first time during intensive care at the Asan Medical Center from Feb, 1998 to Mar, 1999. RESULTS: CIP occurred usually 2-8 weeks after admission to the intensive care unit. All patients received ventilator care due to severe pulmonary problems, which included pneumonia, ARDS, and empyema. Five of them had sepsis. All patients had quadriparesis prominently in the distal area, muscle atrophy, decreased tendon reflexes, and distal hypoesthesia. Electrophysiological and pathologic studies were compatible with axonal polyneuropathy. Five patients recovered from the underlying critical illness and regained their muscle power with improved findings on follow-up nerve conduction studies. CONCLUSIONS: Critical illness should be considered as a cause of polyneuropathy in severely ill patients, especially if associated with sepsis. After recovery from illness, motor weakness as well as electrophysiological findings improved. Failure of weaning from a ventilator may be more affected by pre-existing cardiopulmonary problems than CIP.
Axons ; Chungcheongnam-do ; Critical Illness* ; Empyema ; Follow-Up Studies ; Humans ; Hypesthesia ; Critical Care ; Intensive Care Units ; Muscle Weakness ; Muscular Atrophy ; Neural Conduction ; Pneumonia ; Polyneuropathies* ; Quadriplegia ; Reflex, Stretch ; Sepsis ; Ventilator Weaning ; Ventilators, Mechanical ; Weaning

Arsenic trioxide (As2O3) has been found to be remarkably effective in the treatment of patients with acute promyelocytic leukemia (APL). Although evidences for the proapoptotic activity of As2O3 have been suggested in leukemic and other solid cancer cells, the nature of intracellular mechanisms is far from clear. In the present study, we investigated As2O3 affect on the stress-responsive signaling pathways and pretreatment with antioxidants using HepG2 cells. When treated with micromolar concentrations of As2O3, HepG2 cells became highly apoptotic paralleled with activation of caspase-3 and members of mitogen-activated protein kinases (MAPKs) including extracellular signal-regulated kinase (ERK) and c-jun NH2-terminal kinase (JNK) but not p38 MAP kinase. However, inhibition of each kinase activity failed to inhibit apoptosis by As2O3. Addition of n-acetyl cysteine (NAC) or diphenyleneiodonium (DPI) effectively protected cells from apoptosis and significantly lowered As2O3-induced activation of caspase-3. However, neither NAC nor DPI was able to effect ERK or JNK activation induced by As2O3. Guanidinoethyldisulfide dihydrochloride (GED) and 2-ethyl- 2-thiopseudourea (ETU), known inhibitors of the inducible nitric oxide synthase (iNOS), also suppressed the apoptotic activity of As2O3. These results suggest that As2O3 induces caspase-mediated apoptosis involving a mechanism generating oxidative stress. However, activation of some stress- responsive signaling pathways by As2O3 may not be the major determinant in the course of apoptotic processes.
Antioxidants/administration & dosage/pharmacology ; Apoptosis/*drug effects ; Arsenicals/administration & dosage/*pharmacology ; Cell Line, Tumor ; Dose-Response Relationship, Drug ; Enzyme Activation/drug effects ; Enzyme Inhibitors/*pharmacology ; Human ; Nitric-Oxide Synthase/*antagonists & inhibitors/metabolism ; *Oxidative Stress/drug effects ; Oxides/administration & dosage/*pharmacology ; *Signal Transduction/drug effects

There is an increasing number of reports that the lesion site in isolated cranial neuropathies may be the brainstem. The authors describe a diabetic patient with peripheral type facial palsy and concurrent trochlear palsy. Magnetic resonance imaging showed only a small pontine infarction responsible for the facial palsy. Multiple cranial nerve palsies seen in this patient might be a manifestation of multiple acute small infarcts involving both the brainstem and its cranial nerve root simultaneously.
Brain Stem ; Brain Stem Infarctions ; Cranial Nerve Diseases ; Cranial Nerves ; Diabetes Mellitus* ; Facial Paralysis ; Humans ; Infarction ; Magnetic Resonance Imaging ; Paralysis ; Trochlear Nerve Diseases* ; Trochlear Nerve*

Pancreatic encephalopathy is a rare complication of acute pancreatitis. We report a 80-year-old woman who, after an acute episode of pancreatitis, developed a fluctuating confusion and clouded consciousness. She experienced two relapses with alternating encephalopathic features. Serum amylase was highly increased and symptoms were relieved in accord with normalized amylase value. We suggest that this encephalopathic features may be related with pancreatitis.
Aged, 80 and over ; Amylases ; Consciousness ; Female ; Humans ; Pancreatitis* ; Recurrence

Bilateral striopallidodentate calcinosis involves calcification of the basal ganglia and dentate nuclei of the cerebellum. On occasion it may be associated with either hypoparathyroidism or pseudohypoparathyroidism. We report a 52-year-old woman with enduring dysarthria. She had bilateral calcification of the basal ganglia, thalamus, and dentate nuclei on a brain CT. She also had hypothyroidism. Familial study including her son and daughter was negative. We emphasize the need to evaluate the thyroid function in patients with specific intracranial calcifications.
Basal Ganglia ; Brain ; Calcinosis* ; Cerebellum ; Dysarthria ; Female ; Humans ; Hypoparathyroidism ; Hypothyroidism* ; Middle Aged ; Nuclear Family ; Pseudohypoparathyroidism ; Thalamus ; Thyroid Gland

Hypertensive encephalopathy is a medical emergency whose clinical manifestations are usually associated with bilateral parieto-occipital lesions. Predominant brainstem edema without accompanying occipital lesions is rare in hypertensive encephalopathy and usually occurs in patients with secondary hypertension. We describe the clinical and radiological features of two patients with reversible hypertensive brainstem encephalopathy. Both patients had chronic renal failure, but the extensive neuroimaging abnormalities revealed few clinical features of brainstem involvement. The clinical findings and neuroimaging abnormalities resolved once the hypertension was treated.
Brain Stem* ; Edema ; Emergencies ; Humans ; Hypertension ; Hypertensive Encephalopathy* ; Kidney Failure, Chronic ; Neuroimaging

BACKGROUND: The terminal latency index (TLI) is a calculated value that adjusts the distal motor latency for the terminal distance and the proximal motor nerve conduction velocity. The purpose of this study is to evaluate the sensitivity of the median TLI in the diagnosis of carpal tunnel syndrome (CTS) and compare it with other electrophysiological parameters. METHODS: We prospectively studied 32 patients with nerve conduction studies using a conventional surface technique in the median and ulnar nerves. The distal distance for the CMAP was measured in 5 cm using Oh's techniques. Based on the clinical diagnosis, 32 patients (59 hands) were judged to have CTS. Control data were obtained from 40 healthy hands utilizing identical techniques. RESULTS: The mean TLI was 0.24 +/- 0.04 in the CTS group and 0.30 +/- 0.02 in the control group (P<0.01). The 32 patients had a mean age of 57 years (SD +/- 13 years; 73% women). Twenty subjects with an average age of 46 years (SD +/- 15 years; 65% women) were evaluated for control data. The calculated lower limit of normal from the control group (mean-2SD) was 0.26. The sensitivity of the TLI was 73%. The TLI was statistically better than the median motor distal latency and sensory nerve conduction velocity in the second digit-wrist segment. In four patients from the CTS group, the TLI was the only abnormal electrophysiological parameter. CONCLUSIONS: The median TLI is an easy, inexpensive, highly informative test and is therefore extremely useful in the diagnostic work-up of patients with CTS.
Carpal Tunnel Syndrome* ; Diagnosis ; Hand ; Humans ; Median Nerve* ; Neural Conduction ; Prospective Studies ; Reference Values* ; Ulnar Nerve