No abstract available.
Hepatic Encephalopathy*

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

INTRODUCTION: The fixation strength of transpedicular screw system in the vertebral hody relied on bone quality and anatomical characteristics of vertebral pedicle, designs of screw and types of connection(rod or plate) with screw. The purpose of this study is to verify the biomechanical nature of the transpedicular fixation in spine under various conditions with porcine vertebrae. MATERIAL AND METHOD: Fresh porcine vertebrae and the custom-made screws were used in this experiment. To reduce the errors caused by vertebral bodies of different size and quality, vertebral bodies having regular range of pedicular width(10.0 to 11.5mm) and hone density(more than 1.0 gm/cm2) were used. The pedicle screws were inserted in the same procedure and axial pull out test was performed with using the Material Testing System(lntron8511, Canton, USA). The experiments were performed in four types to assess the difference of strength accroding to designs of the screw hy using two group of screws. The first group of screw was designed according to the outer and inner diameter and the second group was designed according to the shape, pitch, and thread profile of screw. Experiment I was perfomed to evaluate the effect of screw diameters on the biomechanical pull-out strength hy using the first group of custom-made pedicle screw which fixed all other factors except the diameter of screw. Experiment I was to verify the effect of screw shape, experiment III to verify the effect of pitch and experiment IV to verify the effect of thread profile. RESULTS: The results of experiments were summarized as follows: Experiment I showed that the screw of larger outer diameter had greater holding strength. Experiment II showed that the holding strength of cylindrical shaped screw is superior to that of conical shaped screw. Experiment III showed that there is no statistical significance between different modes of pitch. Experiment IV showed that the holding strength of buttress shape of thread profile is superior to that of V-shape. CONCLUSION: It seemed that the fixation strength of the screw was more powerful with 1 mm increment of outer diameter in 4-7mm of outer diameter, 3mm of pitch and buttress shape of thread of the screw with the same operation technique.
Spine

BACKGROUND: Although there is a controversy on the optimal timing for active infective endocarditis(IE), recently good results of early surgical intervention have been published. Herein, we analyzed the results of surgery for active IE according to the duration of preoperative antibiotic treatment. MATERIAL AND METHOD: Retrospectively, we analyzed 51 patients who underwent operation for active IE at the department of thoracic and cardiovascular surgery of Samsung medical center from Mar. 1995 to Oct. 2001. Male to female ratio was 39:12, mean age of the patients was 44.5+/-17.8 years(range : 13~74). Infected valves were mitral valve in 17(33.3%), aortic valve in 15(29.4%), mitral and aortic valve in 12(23.5), and tricuspid valve in 5(9.8%) cases. Among them, prosthetic valve endocarditis was present in 10(19.6%) cases. Infecting organism was Staphylococcus in 19 (37.3%), Streptococcus in 17(33.3%), Enterococcus in 3(5.9%), fungus in 3(5.9%), and other bacteria in 5(9.8%) cases. Organism was not isolated in 6(11.8%) cases, and two organisms were isolated in 4(7.8%) cases. Dividing these patients into two groups according to the duration of preoperative antibiotic treatment(A: less than 7 days, B: more than 8 days), we compared the surgical results between the two groups. RESULT: There were 16 cases in group A and 35 in group B. Annular reconstruction was performed in 10(62.5%) cases in group A and 10(28.6%) cases in group B, which has statistically significance(p<0.05). There was one early death in group B. Forty nine patients(96.1%) except two were followed up with mean follow-up duration of 28.7+/-23.6 months. Endocarditis was recurred in one in group A, and two in group B. Three late deaths occurred in group B. Recurrence rate and survival were not statistically different between the two groups. CONCLUSION: Early surgery for active IE showed good results as the result of that which was performed after prolonged antibiotic treatment; therefore, we believe that early surgery for active IE could effectively eradicate the infection.
Aortic Valve ; Bacteria ; Endocarditis* ; Enterococcus ; Female ; Follow-Up Studies ; Fungi ; Humans ; Male ; Mitral Valve ; Recurrence ; Retrospective Studies ; Staphylococcus ; Streptococcus ; Tricuspid Valve

BACKGROUND: Lipoprotein(a)[Lp(a)] is a subspecies of low-density lipoprotein and has been shown to be associated with pathogenesis of thrombosis-related disease. It is already known that patients with diabetic nephropathy are usually complicated by vascular complications such as coronary artery diseases and cerebrovascular accidents. According to the recent data, Lp(a) level tends to be increased as the proteinuria is increased and renal function are decreased. We evaluated the Lp(a) level to know whether its level is correlated to the severity of diabetic nephropathy. METHODS: We investigated Lp(a) levels in eighty-one patients with Type 2 (non-insulin-dependent) diabetic patients. They were divided into four groups according to the level of urinary albumin excretion and serum creatinine level: Group 1 (n=30): normal renal function + urine microalbumin or=1.5mg/dL. Blood samples were obtained during the morning in the fasting state and separated serum from the it and reserved at -70degrees C. Lp(a) concentration was checked by one-step sandwich ELISA test. All grouped data were expressed as mean+/-SD. ANOVA and unpaired t-test was used to assess the statistical difference between any two means. RESULTS: Lp(a) levels were 30.2+/-4.6mg/dL in Group 1, 42.7+/-8.2mg/dL in group 2, 73.4+/-19.7mg/dL in group 3, and 80.7+/-14.8mg/dL in group 4. The level of Lp(a) in group4, group 3, and group 2 was significantly higher than that of group 1 respectively (P=0.009, 0.001, 0.038). However, no significant correlation was observed between the level of Lp(a) and that of total cholesterol, triglyceride and total lipid in all groups. CONCLUSIONS: these results indicate that Lp(a) concentrations are increased in the patients with diabetic nephropathy with microalbuminuria or overt proteinuria. So, the presence of albuminuria may be the important determinant for the elevated Lp(a) level in diabetic nephropathy.
Albuminuria ; Cholesterol ; Coronary Artery Disease ; Creatinine ; Diabetic Nephropathies* ; Enzyme-Linked Immunosorbent Assay ; Fasting ; Humans ; Lipoprotein(a)* ; Lipoproteins* ; Proteinuria ; Stroke ; Triglycerides ; Urinalysis

Rhabdomyosarcoma is the most common soft tissue sarcoma in children, accounting for 4.5% of all cases of cancer in childhood. Although the head and neck are the most common sites of rhabdomyosarcoma, oral lesions are relatively rare and account for only 10% to 12% of head and neck rhabdomyosarcoma cases. This is a case report of a girl aged 2 years and 1 month who initially presented with an upper lip mass that invaded the oral mucosa, oral skin, and nostril skin, causing narrowing of the airway. Through our case, we show that rapidly growing small round cell malignancies, especially rhabdomyosarcoma, can be effectively diagnosed and treated at the same time using primary resection with intraoperative frozen section biopsy and that the time spent waiting for the results of preoperative biopsy can be saved in this way, particularly when the patient’s symptoms are intensifying rapidly and require immediate operation.

Thoracolumbar paraspinal myonecrosis can be developed with various etiologies. It can induce compartment syndrome of spinal muscles and cause elevated pressure on back muscles, resulting in severe back pain. Thoracolumbar paraspinal myonecrosis is a very rare disease. There are only a few studies about paraspinal myonecrosis. Here we report a case of a spontaneous thoracolumbar paraspinal myonecrosis in a patient who had asymptomatic abdominal aortic dissection. Through this case, etiologies, clinical features, radiologic findings, and treatment options for thoracolumbar paraspinal myonecrosis are discussed.
Back Muscles ; Back Pain ; Compartment Syndromes ; Humans ; Muscles ; Rare Diseases

Bacillus Calmette-Guerin(BCG) has been widely used for the prophylaxis of superficial bladder tumor recurrence and for the treatment of bladder carcinoma in situ. More than 95% of patients who receive BCG instillation tolerate the treatment well and side reactions have been reported in less than 5% of patients. Most side effects are minor and self-limiting. However, a rear occurrence of severe systemic reactions have been reported. Among the severe systemic reactions, hypersensitivity pneumonitis should be considered in patients with pneumonic complications after BCG instillation in cases where the culture for mycobacteria is negative in the sputum, brochoalveolar lavage and blood specimen. In addition, a fiberoptic bronchoscopy with transbronchial lung biopsy demonstrates a fibrosis of the alveolar septums, where there is and an increased lymphocyte count without tuberculous inflammatory changes, the and CD4:CD8 ratio is increased and no symptomatic response to antituberculosis chemotherapy is observed. Here we report a 68 years old man with interstitial pneumonitis following intravesical BCG instillation.
Administration, Intravesical* ; Alveolitis, Extrinsic Allergic ; Bacillus ; Biopsy ; Bronchoscopy ; Carcinoma in Situ ; Drug Therapy ; Fibrosis ; Humans ; Lung ; Lung Diseases, Interstitial* ; Lymphocyte Count ; Mycobacterium bovis* ; Recurrence ; Sputum ; Therapeutic Irrigation ; Urinary Bladder Neoplasms* ; Urinary Bladder*

No abstract available.
Acute Lung Injury* ; Oxygen* ; Sus scrofa*

Nonspecific immune parameters such as natural killer(NK) activity, antibody-dependent cellular cytotoxicity(ADCC), production of leukocyte migration inhibitory factor(LlF) and levels of immune complex(IC) were assessed in 47 patients with rheumatoid arthritis (RA) 20 with degenerative arthritis (DA) and 40 healthy controls. Peripheral blood (PB) as well as synovial fluid (SF) were collected from both RA and DA patients before treatment. Mononuclear cell suspensions and sera were prepared and submitted for the in vitro tests; 4-hr chromium-release assays using human K562 and mouse L1210 cells as targets for NK and ADCC assays respectively, 2-step agarose assay for LIF and platelet aggregation test for IC. Results revealed that 1) LIF activity of PB lymphocytes (PBL) from both RA and DA patients showed a significant (P < 0.05) decrease as compared with that from healthy controls. 2) PB-NK activity from RA patients showed an insignificant decrease as compared with that from DA or healthy controls. However, mononuclear cells isolated from SF (SFL) of RA patients exhibited significantly(P < 0.02) lower NK activity than PBL from the same patients. 3) In ADCC assays with PBL no significant differencies were observed among the 3 groups. 4) Higher titers of IC were detected in both PB and SF from RA patients than DA, and a negative correlation was found between serum IC levels and PB-NK activity. These data are discussed in light of previous reports, and a hypothesis regarding a decreased nonspecific cell-mediated immunity in conjunction with an increased humoral immune response, particularly in local sites, is proposed as one of the mechanisms underlying the pathogenesis of RA.
Adult ; Antibody-Dependent Cell Cytotoxicity ; Antigen-Antibody Complex/immunology ; Arthritis, Rheumatoid/immunology* ; Female ; Human ; Killer Cells, Natural/immunology ; Leukocyte Migration-Inhibitory Factors/biosynthesis ; Male ; Middle Age ; Synovial Fluid/immunology