No abstract available.
Humans

PURPOSE: It is agreed that tumor stage is the definitive prognostic indicator for patients with renal cell carcinoma. We investigated pathologic grade and cell subtype as another prognostic in each tumor stage. MATERIALS AND METHODS: We reviewed the medical records of 206 patients who underwent partial or radical nephrectomy for renal cell carcinoma between January 1991 and June 1998. Renal cell carcinoma grade, stage and cell subtype (conventional [clear cell], papillary, chromophobe, sarcomatoid type) were evaluated using the 1997 Union International Contre Ie cancer (UICC) and the American Joint Committee on Cancer (AJCC) grading, TNM staging criteria and renal cell carcinoma classification. Kaplan -Meier survival curves were used to determine 5-year survival for all patient groups. Univariate analysis using log rank test was performed to evaluate the prognostic significance of TNM stage, Fuhrman nuclear grade, cell subtype and tumor size. We investigated pathologic grade and cell subtype with log rank teat whether those were another significant prognostic factors in each tumor stage. Multivariate analysis was performed to determine which factors had an independent impact on survival of patients with renal cell carcinoma. RESULTS: Univariate analysis revealed that TNM stage (p<0.001), pathologic grad (p<0.001) were the important prognostic indicators for renal cell carcinoma. Survival was affected significantly by tumor size when cutoff diameter for localized T1 lesions was 7cm but not 2.5cm. Pathologic grade had a significant impact on patient survival (p<0.0001). In the cell subtype chromophobe type had the best survival and sarcomatoid type had the worst survival though cell subtype did not appear to affect survival significantly (p=0.0583). Multivariate analysis revealed that N classification (p=0.009) and M classification (p=0.018) were the most important prognostic indicators for cell subtype (p=0.841) were not shown to have any independent impact on patient survival. In the group of localized disease(TXN0M0 stage) at the diagnosis, cell subtype had a significant impact on survival in T1(p<0.001), T2(p=0.01) and T3(p=0.029) and grade in T1(p=0.0016) and T3(p=0.0054). CONCLUSIONS: Pathologic grade and cell subtype were significant predictors of survival in each T stage of localized disease though they didn't have independent impact on the patient survival.
Carcinoma, Renal Cell* ; Classification* ; Diagnosis ; Humans ; Joints ; Medical Records ; Multivariate Analysis ; Neoplasm Staging ; Nephrectomy

No abstract available.
Biopsy* ; Salivary Glands* ; Sjogren's Syndrome*

The 56-kilodalton protein genes of Orientia tsutsugamushi TA678, TA686, TA716, TA763 strains were amplified by PCR. The amplified products were sequenced and cloned into pIH821 vector. The recombinant proteins were expressed in Escherichia coli as fusion proteins with maltose binding protein. The recombinant proteins were purified and used for the sensitization of sheep RBCs and the reactivity of the recombinant 56-kDa proteins of Orientia tsutsugamushi TA 678, TA686, TA716 strains were analyzed with 40 sera from scrub typhus patients in Korea, 40 sera from scrub typhus in Thailand, Malaysia and Philippines. The 56-kDa protein coding DNA sequence of Orientia tsutsugamushi TA678, TA686, TA716 show 70 to 88% homology with other known strains and four variable regions are also observed. 39 of 40 sera from scrub typhus patients in Korea showed the strongest reactivity to the recombinant protein of Boryong strain and one sera showed the strongest reactivity to the recombinant protein of Gilliam strain. 14 of 40 sera from patients in Thailand, Malaysia and Philippines showed the strongest reactivity to the recombinant protein of TA686 strain and 12 sera showed the strongest reactivity to the recombinant protein of TA716 strain. No serum from patients in Thailand, Malaysia and Philippines showed the strongest reactivity to the recombinant protein of Boryong strain.
Asian Continental Ancestry Group* ; Base Sequence ; Chungcheongnam-do ; Clinical Coding ; Clone Cells ; Cloning, Molecular* ; Escherichia coli ; Hemagglutination Tests* ; Hemagglutination* ; Humans ; Korea ; Malaysia ; Maltose-Binding Proteins ; Orientia tsutsugamushi* ; Philippines ; Polymerase Chain Reaction ; Recombinant Proteins ; Scrub Typhus ; Sheep ; Thailand

No abstract available.
Humans ; Tracheostomy* ; Ventilators, Mechanical*

No abstract available.
Nose* ; Paranasal Sinuses*

Trigeminal neuralgia has been treated in many ways, both medical and surgical. We wished to determine the efficancy of low frequency electrical acupuncture therapy for nine patients suffering from trigeminal neuralgia with Model 6,26 and G6805 Electrotherapeutic Apparatus. The results were as follows: (1)Initisl.beneficial during 1aw frequency electrical acupuncture therapy was recognized in a11 cases (2) Longterm.baneficial effect was seen in 77%, excluding 3 cases with no improvement. (3) Low frequency elactrical acupuncture therapy seemed to be valuable, preceding medical and .surgical treatment for acute trigemieal neuralgia.
Acupuncture Therapy ; Acupuncture* ; Humans ; Neuralgia ; Trigeminal Neuralgia*

Pain is as old as mankind and is one of the physiological defense mechanisms, but when it lasts long, it may be harmful. We decided to conduct an exploratory trial with nerve block and acupuncture for 134 patients referred to this clinic with chronic or intractable pain syndromes. We used Model 6.25 and G6805 Electrotherapeutic Apparatus for acupuncture therapy. The results were as follows: (1) Sex and age distribution: 64 were male, 79 were female and 91 patients were over 40 years of age. (2) Localigation of pain: Scapular and upper extemities in 53 among 143 patients. (3) Method of treatment: Nerve block 84, low frequency electrical acupuncture 92 and combined therapy in 3 patients. (4) Effect of treatment: 92% of various nerve blocks and 88% of low frequency electrical acupuncture therapy gave good results.
Acupuncture ; Acupuncture Therapy ; Age Distribution ; Defense Mechanisms ; Female ; Humans ; Male ; Nerve Block* ; Pain Clinics* ; Pain, Intractable

Since McCarthy et al. (1965) demonstrated that ketamine produced a profound analgesia, preserved the protective pharyngeal reflex and elevated the arterial blood pressure in dogs, this anesthetic agent has been widely used in clinical anesthesia. However, there has still been argument about its psychotomimetic effects such as postanesthetic delirium and occasional hallucinations which appear to be commoner in adults than in children. On the other hand, imerous investigators (Chodoff and Stella, 1966; Little et al., 1971; Jawalekar et al., 1972; Galbert and Gardner, 1973; Akamatsu et al., 1974; Corssen, 1974) reported that ketamine induced contraction of the uterus and recommended this drug as a suitable obstetric anesthetic agent. The present study was undertaken to determine whether or not ketamine excites the myometrium and to elucidate the mechanism of its uterine action. Female albino non-pregnant, pregnant and postpartum rabbits weighing approximately 2.0kg were employed in this experiment. At the end of ten days following bilateral oophrectory, the non-pregnant rabbits were injected intramusculary with estrogen (2000 I.U./kg) or progesterone (5 mg/kg) daily for 4 days. An uterine strip, about 2.0 cm in length, was carefully isolated from the experimental rabbits and suspended in a muscle chamber containing 100 ml of Locke's solution, maintained at a constant temperature of 38degrees C. It was aerated with 100% oxygen bubbling through the bathing fluid by means of a sintered glass plate at the bottom of the muscle chamber. The uterine strip was attached to a Grass force displacement transducer, and the motility and tonus were recorded on a Grass model 7 polygraph. After being washed several times with fresh Locks solution, the uterine strip attained a constant motility and tonus. Ketamine then was added in concentrations ranging from 50 to 2000 r/dl to the muscle chamber. Summary 1. Ketamine produced no appreciable effect on the spontaneous motility and tonus of the uterine strip isolated from the normal non-pregnant rabbits but in a few instances it produced an increase in the amplitude and frequency of contraction. 2. Ketamine showed a tendency to increase the amplitude and frequency of contraction of the uterine strips isolated from pregnant and postpartum rabbits. 3. Uterine strips isolated from bilaterally oophorectomized rabbits showed a very weak but reguIar spontaneous contraction. Ketamine produced neither inhibitory nor stimulatory effects on these uterine strips. 4. Ketamine produced no effect on the motility and tonus of isolated uterine strips from rabbits treated with estrogen for 4 days following bilateral oophorectomy. 5. Ketamine produced, without exception, a marked stimulant action on the motility and tonus of the uterine strips isolated from rabbits treated with progesterone following bilateral oophorectomy. Pretreatment of the uterine strip from progesterone-treated rabbits with an aderenergic alpha blocking agent (dibenzyline) or adrenergic beta blocking agents (dichloroisoproterenol and propranolol) failed to alter the excitatory action of ketamine. 7. Atropine failed to alter the excitatory action of ketamine. 8. Oxytocin and ergonovine produced no effects on the excitatory aetion of ketamine on the isolated uterine strips from the progesterone-treated rabbits. From the above results it may be concluded that ketamine exerted a stimulatory action on the uterus under the influence of progesterone. This progesterone-dependent uterine stimulatory action of ketamine is not concerned with adrenergic and cholinergic mechanisms but appears to be a direct action on the uterine muscle.
Adult ; Analgesia ; Anesthesia ; Animals ; Arterial Pressure ; Atropine ; Baths ; Child ; Delirium ; Dogs ; Ergonovine ; Estrogens ; Female ; Gagging ; Glass ; Hallucinations ; Hand ; Humans ; Ketamine* ; Mice ; Myometrium ; Ovariectomy ; Oxygen ; Oxytocin ; Poaceae ; Postpartum Period ; Progesterone ; Rabbits* ; Research Personnel ; Transducers ; Uterus*

When ventilatory support becomes necessary in patients with acute respiratory failure, there is an associated increase in complications. We reviewed the charts of acute respiratory failure patients with the ventilatory support retrospectively who were admitted to the General Intensive Care Unit, Yonsei University College of Medicine, Seoul, Korea for the 6 months period, from March through August, 1990. The data included incidence of complications, morbidity and mortality, and reasons for and the duration of the ventilatory support. Of 269 patients receiving the ventilatory support, 107 patients (39.8%) developed 159 complications including alveolar hyperventilation (56 times), premature extubation (20 times) and right bronchial intubation (16 times). A single complication was associated with mortality rate of 19.5%, while with two or more complications, mortality rate was 60%, giving an average mortality rate of 29% when the complications were identified. The highest incidence of complications was in patients with multiple organ failure (80%). The highest mortality rate (50%) occurred in patients with heart failure. Patients with the ventilatory support less than one day had 23% incidence of complications and 2.7% mortality, while those with support for more than one month, these figures were 90.0% and 40.0% respectively (p<0.05).
Acute Disease ; Adult ; Female ; Human ; Intensive Care Units ; Male ; Respiration, Artificial/*adverse effects/mortality ; Respiratory Insufficiency/*therapy ; Retrospective Studies