Pain from cancer is a major problem of managing the oral cancer patients in terminal stage. Overall, pain is reported by about 50% of patients at all stages of cancer and by over 70% with advanced neoplasms. Unrelieved pain can be incapaciting and preclude a satisfying quality of life. But, pain is often poorly assessed, and many clinicians lack sufficient knowledge to optimize cancer pain treatment. There are three basic approaches to the control of pain : modifying the source of pain, altering the central perception of pain, and blocking the transmission of pain to the central nervous system. The optimal use of these approaches and an individualized plan for pain control can maximize both quality and duration of life in dying patients. Opioid analgesics are are the mainstay of pharmacologic treatment. Practical opioid therapy include selection of both drug and route, dose titration, and management of side effects. We present our experienced pharmacologic treatment protocol for cancer pain management that collaborated by Dept. of Hospice, Catholic Medical Center. It will acts as a guideline for our colleague to facilitate the translation of current knowlegde into the clinical practice.
Analgesics, Opioid ; Central Nervous System ; Clinical Protocols ; Hospices ; Humans ; Mouth Neoplasms* ; Pain Management ; Quality of Life

No abstract available.
Adult* ; Esophageal Atresia* ; Fistula* ; Humans

Ventriculoperitoneal shunt (VP shunt) for hydrocephalus is thought to inhibit the closure of processus vaginalis by increasing intraabdominal pressure, thus it promotes the inguinal hernia. We reviewed the incidence and characteristics of the inguinal hernia in VP shunted patients, and tried to estimate the patency rate of processus vaginalis in early childhood. A reprospective review of patients undergone insertion of VP shunt between January 1980 and May 1998 at Seoul National University Children Hospital was done. 262 patients were included in this study. Among them, 28 patients developed inguinal hernia (10.7%). Six patients developed inguinal hernia before the insertion of VP shunt. According to the age of VP shunt, the inguinal hernia developed in 16.2% (12/74) of patients who had undergone VP shunt before 6 months old, 12.4% (11/89) between 6 months and 2 years old and 5.1% (5/99) after 2 years old. Among 22 patients excluding 6 patients who developed hernia before VP shunt, the incidence of inguinal hernia after VP shunt was 8.6% (22/256) with male predominance (M:F=18:4). 8 patients developed inguinal hernia bilaterally (36.4%). It is suggested that at least 14% of processus vaginalis is patent until 2 years old.
Child ; Child, Preschool ; Hernia ; Hernia, Inguinal* ; Humans ; Hydrocephalus ; Incidence ; Infant ; Male ; Seoul ; Ventriculoperitoneal Shunt*

No abstract available.
Humans ; Inpatients*

Two cases of glioblastoma multiforme in children are reported. In one case, 2-year and 11 month-old female with the complaints of vomiting and the left hemiparesis for one month, the huge supra-Sylvian cystic tumor was associated with arteriovenous malformation originating from tumor and draining into the superior sagittal sinus. In the other case, 14-year-old male presenting seizure for 6 months, headache and the right hemiparesis for one month, the cystic frontal soft tumor infiltrated to the wall of the lateral ventricle. Wide internal decompression was performed as possible and pathologic reports were proved glioblastoma multiforme.
Adolescent ; Arteriovenous Malformations ; Child* ; Decompression ; Female ; Glioblastoma* ; Headache ; Humans ; Infant ; Lateral Ventricles ; Male ; Paresis ; Seizures ; Superior Sagittal Sinus ; Vomiting

PURPOSE: Proximal subclavian artery stenosis is relatively uncommon and usually asymptomatic. It is well known that the retrograde flow through ipsilateral vertebral artery is not related with onset of clinical symptom and not a definite indication of treatment. METHOD: We reviewed six patients including four patients who underwent percutaneous transluminal angioplasty to correct the difference of blood pressure between arms. RESULT: Nobody shows marked clinical improvement even though there was definite technical success. CONCLLUSION: It is considered that angioplasty could be done for the treatment in most of subclavian artery stenosis.
Angioplasty* ; Arm ; Blood Pressure ; Humans ; Subclavian Artery* ; Subclavian Steal Syndrome* ; Vertebral Artery

An inferior vena cava (IVC) filter is a useful treatment to prevent a pulmonary embolism (PE) in patients with DVT. Since the introduction of IVC filters more than 30 years ago, there has been a steady improvement in the design, ease and safety of the delivery system. The use of a temporary filter has also increased as performing thrombolysis and thrombectomy has increased. Today all of the commonly used filters can be placed via a peripheral vein by using the standard percutaneous Seldinger (Ed note: check the spelling) technique. However this typically requires fluoroscopy, intravenous contrast agents, radiation exposure and transport of the patient to the interventional or operating suite. As the multiple trauma injured or critically-ill intensive care unit patients often require inotropic and ventilator support, transporting these patients to these facilities can be hazardous. The following report describes two cases of VTE patients who underwent percutaneous placement of an IVC filter with using duplex ultrasound guidance. Identification of the renal vein and artery is important to decide the infrarenal level. The first case was an 84 years female with right ilio-femoral DVT and pulmonary embolism. To prevent recurrence of PE, we decided to insert an IVC filter. The second case was a 47 years female with right femoral DVT together with left pulmonary embolism and infarction. She also had thrombocytopenia, which is a contraindication for anticoagulation. IVC filter insertion can be safely performed under ultrasound guidance. This technique will reduce the risk and complexity of inserting an IVC filter in selected multiple injured trauma patients.
Arteries ; Contrast Media ; Female ; Fluoroscopy ; Humans ; Infarction ; Intensive Care Units ; Multiple Trauma ; Pulmonary Embolism ; Recurrence ; Renal Veins ; Thrombectomy ; Thrombocytopenia ; Veins ; Vena Cava Filters ; Vena Cava, Inferior ; Ventilators, Mechanical

The obturator bypass operation is not a common procedure. In 1963, Shaw and Baue first described performing bypass surgery through the obturator foramen as a technique to deal with infected arterial prostheses in the groin. This operation has been used to reconstruct patients with groin infection, irradiation ulcer, mycotic aneurysm, trauma and excessive scar tissue in the femoral region. We experienced one case of transobturator foramen bypass surgery from a Dacron iliac limb to the popliteal artery.
Aneurysm, Infected ; Cicatrix ; Extremities ; Groin ; Humans ; Polyethylene Terephthalates ; Popliteal Artery ; Prostheses and Implants ; Ulcer

OBJECTIVE: The objective of this study is to evaluate the clinical and angiographic outcomes after primary balloon angioplasty in patients with symptomatic middle cerebral artery (MCA, M1 segment) stenosis refractory to medical therapy. MATERIALS AND METHODS: Eleven patients with intracranial stenosis were treated with primary balloon angioplasty. All patients had MCA stenosis with recurrent transient ischemic attack (TIA). The indication for balloon angioplasty was patients with significant MCA stenosis: 1) age older than 18 years with recurrent or progressive TIA or infarction despite optimal medical therapy, including anti-coagulation, dual anti-platelet, and anti-lipid medication; 2) previous ischemic events or asymptomatic severe stenosis (more than 50%) with poor collateral cerebral circulation, or diminished cerebral perfusion on single photon emission computed tomography before and after administration of the intravenous dosage of acetazolamide. RESULTS: The median age of patients was 53 years (range 44-79). The technical success rate was 100%. Mean pretreatment stenosis degree was 83.63 +/- 9.53% and 29.1 +/- 15.4% before and after angioplasty, respectively. Procedural-related complications occurred in four of 11 patients (36%), but none of the patients had permanent neurological deficit. All patients were available for an average follow-up period of 19.4 +/- 5.1 months. One patient had a stroke in the territory of angioplasty at two months after angioplasty. The stroke free survival rate at 30 days and 12 months was 100% and 91%, respectively. Restenosis over 50% was observed in three of 11 patients (27%); all were asymptomatic. CONCLUSION: Intracranial angioplasty for symptomatic MCA stenosis refractory to medical therapy can be a treatment option to reduce the risk of further TIA or stroke.
Acetazolamide ; Angioplasty* ; Angioplasty, Balloon ; Atherosclerosis ; Constriction, Pathologic* ; Follow-Up Studies ; Humans ; Infarction ; Ischemic Attack, Transient ; Middle Cerebral Artery* ; Perfusion ; Stroke ; Survival Rate ; Tomography, Emission-Computed, Single-Photon

No abstract available.
Adult* ; Evoked Potentials, Auditory, Brain Stem* ; Humans*