BACKGROUND: High-frequency jet ventilaion is considered a reliable technique for anesthesia and critical care including respiratory failure but there are adverse reactions such as carbon dioxide retension and dry of respiratory mucosa. The purpose of this study was to confirm the effects of combined high- frequency jet ventilation (HFJV) and converntional mechanical ventilation (CMV) on the cardiovascular system, arterial blood gases tension and mean airway pressure in 9 Korea mongrel dogs with pulmonary edema induced by oleic acid. METHODS: During CMV with 20 breaths/minute, 10 ml/kg of tidal volume and F1O2 1.0, parameers were evaluated (base line value). When pulmonary edema was developed, HFJV was applied initially with 120 breaths/minute, inspiratory time 30% and driving pressure 40 psi F1O2 1.0 for 60 minutes (control value) and thereafter simultaneous use of CMV was applied with the tidal volume of 10 ml/kg and each respiratory rate 8, 4, 2, 1, 0.5 per minute for 30 minutes. RESULTS: Combined application of HFJV and CMV (above repiratory rate 1 per minute) achieved the improvement of oxygenation and carbon dioxide elimination, and Paw was decreased without undesirable effects on cardiovascular system in case of the induced pulmonary edema. CONCUSIONS: From above results we recommanded that HFJV combined with CMV may be a useful method of treatment for respiratory failure.
Anesthesia ; Animals ; Carbon Dioxide ; Cardiovascular System ; Critical Care ; Dogs* ; Gases ; High-Frequency Jet Ventilation* ; Korea ; Oleic Acid* ; Oxygen ; Pulmonary Edema* ; Respiration, Artificial* ; Respiratory Insufficiency ; Respiratory Mucosa ; Respiratory Rate ; Tidal Volume ; Ventilation

Carcinoid tumors originate from the neuroendocrine cells throughout the body and occur most frequently (74%) in the gastrointestinal tract. The clinical course is often indolent but can also be aggressive and resistant to therapy. Clinical manifestations are often vague or absent. Nevertheless, in approximately 10% of patients, the tumors secrete bioactive mediators which may engender various elements of characteristic carcinoid syndrome. In many instances, the neoplasms are detected incidentally at the time of surgery for other gastrointestinal disorders. The tendency for metastatic spread correlates with tumor size, and is substantially higher in lesions larger than 2.0 cm. Management of patients with carcinoid tumors requires an understanding of the disease process and a multimodality approach. Treatment consists of radical surgical excision of the tumor, although gastric (type I and II) and rectal carcinoids may be managed with local excision. However, advanced carcinoid tumor remains incurable.
*Carcinoid Tumor/diagnosis/therapy ; English Abstract ; *Gastrointestinal Neoplasms/diagnosis/therapy ; Humans

In the paget's disease involving the vertebra, the symptom and sign of compression come from encroachment on the spinal cord due to the enlarging vertebral bodies, pedicles and laminae. The cord compression appears to be preceded by a long insidious period of noncharacteristic clinical symptoms with minor neurologic dysfunction. The lumbar syndrome of Paget's disease is classified according to its severity, clinical findings, biochemical factors and radiologic patterns. The severity of neurologic complication in Paget's disease involving the vertebra varies according to the level involved. The outcome depends on the suddeness of symptom onset and the effectiveness of decompression. We have experienced a case of Paget's disease involving long bones and lumbar spine in 56 year old male patient, in which surgical decompression produced improvement. We report a case of spinal stenosis in paget's disease with brief review of literature.
Decompression ; Decompression, Surgical ; Humans ; Male ; Neurologic Manifestations ; Spinal Cord ; Spinal Stenosis ; Spine

Adjuvant therapy for completely resected esophageal squamous cell carcinoma is lesscommonly applied in clinical practice than neoadjuvant therapy, but it plays a substantialrole in improving survival for esophageal cancer patients. This article presents a concise reviewof the evidence regarding adjuvant therapy for esophageal squamous cell carcinomaand future directions, particularly immunotherapy.

Congenitally corrected transposition of the great arteries is a rate congenital heart disease. In this discase, there is discordance between both the atria and ventricles and the ventricles and great vessels. The anatomic left ventricle lies on the rightside and is connected to the pulmonic trunk, whereas the anatomic right ventricles lies on the left side and functions as the systemic ventricle. Most patients have associated another cardiac anomalies and conduction disturbance.Less commonly, ventricular extrasystoles, paroxismal supraventricular tachycardia, WPW preexitaion and atrial fibrillation may be obserced. We report an adult case of congenitally corrected transposition of great arteries associated with paroxysmal atrial fibrillation and heart failure.
Adult* ; Arteries* ; Atrial Fibrillation* ; Chymopapain ; Heart Defects, Congenital ; Heart Failure* ; Heart Ventricles ; Heart* ; Humans ; Tachycardia, Supraventricular ; Transposition of Great Vessels ; Ventricular Premature Complexes

Especially in design of automobile, there are many professional softwares based finite element or multi-body like Madymo, Pam-Crash, Ansys. These program have been released almost every car maker and university. Also in accident reconstruction fields, there are some softwares like PC-Crash, HVE was developed. Unfortunately these programs for accident reconstruction are so general and its input data are so limited, it is very difficult or even impossible to analyze some special cases. In this study, we reconstruct two crime scenes using Madymo program. Although this program was developed for design of car, we apply to crime scene reconstruction. First case is regarding traffic accident. A car was fell under 5m from the road and turn over and then move about 40m. Finally the driver eject from the car. Second case is regarding suicide by hanging. When the police investigate the crime scene at first time, they assume that this crime is a murder case but we carried out autopsy and investigated the crime scene again and analyzed by computer simulation and finally find out this crime is suicide case not murder.
Accidents, Traffic ; Automobiles ; Autopsy ; Computer Simulation* ; Crime* ; Homicide ; Humans ; Police ; Suicide

BACKGROUND: High-dose cytarabine (HDAC) and etoposide, two of the most active drugs in relapsed acute myeloid leukemia (AML), have shown synergistic activity with platinum analogues in both preclinical and clinical studies. The present study was undertaken to assess the efficacy and toxicity of a combination regimen of HDAC, etoposide and cisplatin (HAEP) in adult patients with relapsed AML. METHODS: Between 1990 and 1998, 16 patients with relapsed AML were treated with HAEP salvage therapy, which consisted of HDAC (2.0g/m2, q12hr x2/d), etoposide (100mg/m2/d) and cisplatin (20mg/m2/d, 2-hr infusion) for 5 days. RESULTS: Ten of 16 patients (62.5%) achieved a complete remission (CR). Six patients who could not attain CR died either of infection (5 patients) or CNS hemorrhage (1 patient). The median overall survival (OS) for all patients was 63 (range, 6~253) weeks. Median disease free survival (DFS) for those who achieved CR was 57 weeks. At the time of analysis, 6 patients were alive with a median follow-up of 68 (range, 22~152) months. All patients experienced fever in the setting of grade IV neutropenia. The median length of neutropenia and thrombocytopenia was 36 and 41 days, respectively. The median period of neutropenic fever in complete responders was 20 days. The main non-hematologic grade III~IV toxicities were mucositis(25%) and hepatic dysfunction (40%). CONCLUSIONS: The HAEP salvage regimen appears highly effective in obtaining high CR rate and possibly long-term survival in relapsed AML. The results suggest that the addition of cisplatin may enhance the activity of HDAC and etoposide. Hematologic toxicity was high, but there was no excessive or cumulative non-hematologic toxicity. Further evaluation of this novel combination in AML is indicated.
Adult* ; Cisplatin* ; Cytarabine* ; Disease-Free Survival ; Drug Therapy* ; Etoposide* ; Fever ; Follow-Up Studies ; Hemorrhage ; Humans ; Leukemia, Myeloid, Acute* ; Neutropenia ; Platinum ; Salvage Therapy ; Thrombocytopenia

Genetic alterations have been recognized as an important event in the carcinogenesis of gastric cancer (GC). We conducted high resolution bacterial artificial chromosome array-comparative genomic hybridization, to elucidate in more detail the genomic alterations, and to establish a pattern of DNA copy number changes with distinct clinical variables in GC. Our results showed some correlations between novel amplified or deleted regions and clinical status. Copy-number gains were frequently detected at 1p, 5p, 7q, 8q, 11p, 16p, 20p and 20q, and losses at 1p, 2q, 4q, 5q, 7q, 9p, 14q, and 18q. Losses at 4q23, 9p23, 14q31.1, or 18q21.1 as well as a gain at 20q12 were correlated with tumor-node-metastasis tumor stage. Losses at 9p23 or 14q31.1 were associated with lymph node status. Metastasis was determined to be related to losses at 4q23 or 4q28.2, as well as losses at 4q15.2, 4q21.21, 4q 28.2, or 14q31.1, with differentiation. One of the notable aspects of this study was that the losses at 4q or 14q could be employed in the evaluation of the metastatic status of GC. Our results should provide a potential resource for the molecular cytogenetic events in GC, and should also provide clues in the hunt for genes associated with GC.
Stomach Neoplasms/genetics/*pathology ; Reverse Transcriptase Polymerase Chain Reaction/methods ; Receptors, Thyrotropin/genetics ; Nucleic Acid Hybridization/*methods ; Neoplasm Staging ; Middle Aged ; Male ; MafB Transcription Factor/genetics ; Lymphatic Metastasis/genetics ; Humans ; Genome, Human/genetics ; Gene Expression Regulation, Neoplastic ; Female ; Chromosomes, Human, Pair 20/genetics ; Chromosomes, Human, Pair 14/genetics ; *Chromosome Aberrations ; Aged, 80 and over ; Aged ; Adult

Alexander disease (AD) is a rare leukodystrophy of the central nervous system of unknown etiology. AD is characterized by progressive failure of central myelination and the accumulation of Rosenthal fibers in astrocytes, and is inevitably lethal in nature. Symptomatically, AD is associated with leukoencephalopathy with macrocephaly, seizures, and psychomotor retardation in infants, and usually leads to death within the first decade. Its characteristic magnetic resonance imaging (MRI) findings have been described as demyelination predominantly in the frontal lobe. Moreover, dominant mutations in the GFAP gene, coding for glial fibrillary acidic protein (GFAP), a principal astrocytic intermediate filament protein, have been shown to lead to AD. The disease can now be detected by genetic diagnosis. We report the Korean case of an 8-month-old male patient with AD. He was clinically characterized due to the presence of psychomotor retardation, megalencephaly, spasticity, and recurrent seizures including infantile spasms which is a remarkable presentation. Demyelination in the frontal lobe and in a portion of the temporal lobe was demonstrated by brain MRI. Moreover, DNA analysis of peripheral blood showed the presence of a R239L mutation in the GFAP gene, involving the replacement of guanine with thymine.
Spasms, Infantile/*etiology ; *Mutation ; Male ; Magnetic Resonance Imaging ; Infant ; Humans ; Glial Fibrillary Acidic Protein/*genetics ; Electroencephalography ; Alexander Disease/complications/*diagnosis

PURPOSE: We tried to evaluate whether there are any specific features in treatment outcomes of firstline afatinib in patients with epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC), compared with gefitinib or erlotinib. MATERIALS AND METHODS: We analyzed patients treated with first-line afatinib, gefitinib, or erlotinib for advanced EGFR-mutant NSCLC at Samsung Medical Center between 2014 and 2016. RESULTS: In total, 467 patients received first-line afatinib (n=165), gefitinib (n=230), or erlotinib (n=72). Afatinib was used more often in patients with tumors harboring deletion in exon 19 (Del19), whereas the gefitinib group had more elderly, females, and never smokers. The median progression-free survival (PFS) time for afatinib, gefitinib, and erlotinib was 19.1 months, 13.7 months, and 14.0 months, respectively (p=0.001). The superior PFS of afatinib was more remarkable in subgroups of Del19 or uncommon EGFR mutations. Overall toxicity profiles of the three drugs were comparable, though more grade 3 or 4 toxicities were detected in afatinib (7.3%) compared with gefitinib (2.6%) or erlotinib (1.8%). The common grade 3 or 4 toxicities of afatinib included diarrhea (3.0%), paronychia (2.4%), and skin rash (1.8%). Dose modification was more frequently required in patients treated with afatinib (112/165, 68%), compared with gefitinib (5/230, 2%) and erlotinib (4/72, 6%). Interestingly, however, dose reduction in the afatinib group did not impair its efficacy in terms of PFS (dose reduction vs. no reduction group, 23.5 months vs. 12.4 months). CONCLUSION: First-line afatinib showed satisfactory efficacy data and manageable toxicity profiles.
Aged ; Carcinoma, Non-Small-Cell Lung ; Diarrhea ; Disease-Free Survival ; Erlotinib Hydrochloride ; Exanthema ; Exons ; Female ; Humans ; Paronychia ; Receptor, Epidermal Growth Factor