PURPOSE: We performed the retrospective analysis to find the outcome of external beam radiotherapy alone in advanced esophageal cancer patients. METHODS AND MATERIALS: One hundred and six patients treated with external beam radiotherapy alone between July 1990 and December 1996 were analyzed retrospectively. We limited the site of the lesions to the thoracic esophagus and cell type to the squamous cell carcinoma. Follow-up was completed in 100 patients (9 4%) and ranged from 1 month to 92 months (median; 6 months). RESULTS: The median age was 62 years old and male to female ratio was 104:2. Fifty-three percent was the middle thorax lesion and curative radiotherapy was performed in 83%. Mean tumor dose delivered with curative aim was 58.6 Gy (55-70.8 Gy) and median duration o f the radiation therapy was 53 days. The median survival of all patients was 6 months and 1-year and 2-year overall survival rte was 27% and 12%, respectively. Improvement of dysphagia was obtained in most patients except fo 7 patients who underwent feeding gastrostomy. The complete response rate immediately after radiation therapy was 32% (34/106). The median survival and 2-year survival rate of the complete responder was 14 months and 30% respectively, while those of the nonresponder was 4 months and 0% respectively (p=0.000). The median survival and 2-year survival rate of the patients who could tolerate regular diet was 9 rnonths and 16% while those of the patients who could not tolerate regular diet was 3 months and 0%, respectively (p=0.004). The survival difference between the patients with 5 cm or less turnor length and those with more than 5 cm tumor length was rnarginally statistically significant (p=0.06). However, the survival difference according to the periesophageal invasion or mediastinal lymphadenopathy in the chest CT imaging study was not statistically significant in this study. In a multivariate analysis, the statistically significant covariates to the survival were complete response to radiotherapy, tumor length, and initial degree of dysphagia in a decreasing order. The complication was observed in 10 patients (9%). CONCLUSION: The survival outcome for advanced esophageal cancer patients treated by external be am radiotherapy alone was very poor, In the treatment of these patients, the brachytherapy and chemotherapy should be added to improve the treatment outcome.
Brachytherapy ; Carcinoma, Squamous Cell ; Deglutition Disorders ; Diet ; Drug Therapy ; Esophageal Neoplasms* ; Esophagus ; Female ; Follow-Up Studies ; Gastrostomy ; Humans ; Lymphatic Diseases ; Male ; Middle Aged ; Multivariate Analysis ; Radiotherapy* ; Retrospective Studies ; Survival Rate ; Thorax ; Tomography, X-Ray Computed ; Treatment Outcome

Generalized sterile pustular eruptions occur in various dermatoses including pustular psoriasis, erythema multiforme, Sneddon-Wilkinsan disease and others. Recentlr, acute eruptions of disseminated sterile pustules have been reported. The etiology is not related to a gepetic predisposition to psoriasis but to drug ingestion or viral infections, thus termed toxic pustuloderm; (T. P.). In this report, we present a typical case of T. P. observed iu our department. Our patient, an 18-year-old male, with no personal or family history of psoriasis, was given drug medication including amoxicillin for fever and chilling sensation. Pustilar eruptions first, appeared on his face about two days aft.er the medication and gradually spread to the trunk and limbs. The skin examination revealed numerous small pustules on an erythematous base. Laboratory examination revealed neutrophilic leukocytosis and an elevated sedimentation rate skin biopsy showed subeorneal and spongiform neutrophilic pustules Upon interruption of the amoxicillin, the pustules cleared rapidly in 3 days and there has been ri.o recui rence of any rash over a 7-month follow-up period.
Adolescent ; Amoxicillin ; Biopsy ; Eating ; Erythema Multiforme ; Exanthema ; Extremities ; Fever ; Follow-Up Studies ; Giant Cell Tumors ; Humans ; Leukocytosis ; Male ; Neutrophils ; Psoriasis ; Sensation ; Skin ; Skin Diseases

Gastric cancer is the second most common cause of cancer-related death in the world. A growing body of evidence indicates that inflammation is closely associated with the initiation, progression, and metastasis of many tumors, including those of gastric cancer. In addition, approximately 60% of the world's population is colonized by Helicobacter pylori, which accounts for more than 50% of gastric cancers. While the role of inflammation in intestinal and colonic cancers is relatively well defined, its role in stomach neoplasia is still unclear because of the limited access of pathogens to the acidic environment and the technical difficulties isolating and characterizing immune cells in the stomach, especially in animal models. In this review, we will provide recent updates addressing how inflammation is involved in gastric malignancies, and what immune characteristics regulate the pathogenesis of stomach cancer. Also, we will discuss potential therapeutics that target the immune system for the efficient treatment of gastric cancer.
Adaptive Immunity/*immunology ; B-Lymphocytes/immunology ; Cytokines/immunology ; Gastritis/immunology ; Helicobacter Infections/immunology ; Helicobacter pylori/immunology ; Humans ; Immunity, Innate/*immunology ; Immunotherapy/methods ; Receptors, Cytokine/immunology ; Stomach Neoplasms/diagnosis/*immunology/therapy ; T-Lymphocytes/immunology ; Tumor Microenvironment/*immunology

BACKGROUND: Propofol inhibits postoperative bronchospasm. Ketamine prevents bronchospasm in asthmatic patients. The present study was designed to evaluate the effects and mechanisms of propofol and ketamine on tracheal smooth muscles. METHODS: After isolating guinea-pig tracheal preparations, the maximal tracheal tones were induced by smooth muscle constrictors(2 10 7 M carbachol, 10 5 M histamine, 30 mM K+ Krebs solution, 124 mM K+ Krebs solution). When tracheal tones stabilized, propofol or ketamine was added cumulatively to obtain the concentration-relaxation curves, and calculated the ED50 and ED95. RESULTS: Propofol and ketamine decreased maximal tracheal tones in the concentration-dependent manners. The ED50 and ED95 of propofol were lowest in the histamine group, highest in the 30 mM K+ Krebs solution group. The ED50 and ED95 of ketamine were lowest in the 124 mM K+ Krebs solution group, highest in the histamine group. CONCLUSIONS: The relaxant effects of propofol and ketamine involve with all receptors in nonspecific way. However, propofol may inhibit more strongly the histamine mediated mechanism of tracheal contraction and ketamine may involve more strongly with Ca++ channel.
Bronchial Spasm ; Carbachol ; Histamine ; Humans ; Ketamine* ; Muscle, Smooth* ; Propofol*

BACKGROUND: Bag and mask devices are used frequently to provide patients with positive-pressure-assisted ventilation. One of the disadvantages is the fact that they do not deliver high concentrations of oxygen without special adaptors or attention to technique. In order to investigate the variables affecting oxygen delivery, we designed a study to determine the fractions of delivered oxygen (FDO2) under varying ventilating techniques and conditions. METHODS: We designed special wooden box, in which the Laerdal resuscitator bag had been. We measured the fractions of delivered oxygen with or without reservoir bag in various tidal volumes, respiration rates and oxygen flows. RESULTS: Without reservoir bag, the fractions of delivered oxygen were increased up to only 73% in spite of 15 l/min oxygen flow. With reservoir bag, the fractions of delivered oxygen were increased up to nearly 96% in 5-7.5 l/min oxygen flow. CONCLUSIONS: While using the Laerdal resuscitator bag, it is desirable to adapt reservoir bag and supply 5 l/min oxygen in conventional ventilation and 7.5 l/min in hyperventilation minimally for higher fraction of delivered oxygen.
Humans ; Hyperventilation ; Masks ; Oxygen* ; Respiratory Rate ; Tidal Volume ; Ventilation

Cortical blindness means visual loss caused by bilateral destruction of visual cortex. Cortical blindness can develop after cerebral angiography due to hypertonic contrast medium which open the blood-brain barrier and then alternate the function of visual cortex transiently. About 30 minutes after injection of contrast medium (Ultravist 370(R)) during cerebral angiography, the patient complained of decrease of visual acuity. And 3 hours later, evaluation revealed that she could not see even the light. But her vision began to improve after 19 hours and recovered completely after 7 days. MRI taken at 12 hours after cerebral angiography showed high signal intensities in the both occipital lobes. But in repeated MRI study, which was taken after 3 days, previously noted high densities were completely disappeared. So we diagnosed this case as cortical blindness caused by hypertonic contrast medium.
Blindness, Cortical* ; Blood-Brain Barrier ; Cerebral Angiography* ; Humans ; Magnetic Resonance Imaging ; Occipital Lobe ; Visual Acuity ; Visual Cortex

Cortical blindness means visual loss caused by bilateral destruction of visual cortex. Cortical blindness can develop after cerebral angiography due to hypertonic contrast medium which open the blood-brain barrier and then alternate the function of visual cortex transiently. About 30 minutes after injection of contrast medium (Ultravist 370(R)) during cerebral angiography, the patient complained of decrease of visual acuity. And 3 hours later, evaluation revealed that she could not see even the light. But her vision began to improve after 19 hours and recovered completely after 7 days. MRI taken at 12 hours after cerebral angiography showed high signal intensities in the both occipital lobes. But in repeated MRI study, which was taken after 3 days, previously noted high densities were completely disappeared. So we diagnosed this case as cortical blindness caused by hypertonic contrast medium.
Blindness, Cortical* ; Blood-Brain Barrier ; Cerebral Angiography* ; Humans ; Magnetic Resonance Imaging ; Occipital Lobe ; Visual Acuity ; Visual Cortex

BACKGROUND: Methylmethacrylate monomer (MMA) bone cement has been associated with sudden systemic hypotension. The present study was aimed to explore the mechanism of direct myocardial depressant actions of MMA. METHODS: The isometric contraction of isolated guinea pig's right ventricular papillary muscle was measured. Normal and slow action potentials were evaluated by a conventional micro-electrode technique. The effects of MMA on sarcoplasmic reticulum (SR) function were evaluated by its effect on: rapid cooling contractures, rested state contraction of rat papillary muscle in normal Tyrode's solution and of guinea pig's papillary muscle in low Na+ Tyrode's solution. To measure the inward calcium currents (ICa), whole cell patch clamp techniques were applied. RESULTS: MMA caused a dose-dependent depression of the peak force (PF) and maximal rate of peak force (dF/dt-max). About a 30% depression of PF was shown at rested state (RS) contraction in rat myocardium and under low Na+ Tyrode's solution in guinea pig myocardium, respectively. In the 26 mM K+ Tyrode's solution, MMA caused dose-dependent depression of late force development without alteration in early force development. MMA depressed rapid cooling contracture accompanied by prolongation of time to peak contracture. MMA did not alter the amplitude or maximum depolarization rate of normal and slow action potentials. Action potential durations were significantly reduced. In patch clamp studies, MMA reduced ICa in a dose-dependent manner. CONCLUSIONS: MMA depressed cardiac contractility in a dose-dependent manner and may be partly related to the depression of Ca2+ influx through the cardiac membrane. SR Ca2+ release seems to be mildly inhibited by MMA. Based on common clinical concentrations, the direct myocardial depressant effect of MMA may not be a main cause of hypotension during an operation.
Action Potentials ; Animals ; Calcium ; Contracture ; Depression ; Guinea ; Guinea Pigs ; Hypotension ; Isometric Contraction ; Membranes ; Methylmethacrylate* ; Myocardium ; Papillary Muscles ; Patch-Clamp Techniques ; Rats ; Sarcoplasmic Reticulum

One of the disadvantages of the Laerdal resuscitator bag is that it does not deliver a high concentration of oxygen without a reservoir and an appropriate technique of ventilation. With a specific device that is able to compress a resuscitator bag mechanically at a regular volume, ventilator rate, and speed, we evaluated the effects of various factors (the tidal volume, the ventilator rate, the oxygen flow rate, the type of reservoir) of the Laerdal resuscitator bag during positive pressure ventilation that affect the delivered oxygen fraction (FDO2) and also whether 250 mL and 500 mL corrugated tubes could be used as substitutes for the reservoir bag. The 250 mL corrugated tube increased the FDO2 to over 96% with an oxygen flow rate of 15 L/min. The 500 mL corrugated tube increased the FDO2 to over 96% with an oxygen flow rate of 10 L/min regardless of the ventilator rate at a fixed tidal volume of 500 mL. At the identical fixed tidal volume of 500 mL, the 1,600 mL reservoir bag increased the FDO2 to over 92% with an oxygen flow rate of 5 L/min and to over 96% at 7.5 L/min regardless of the ventilator rate. We concluded that the FDO2 of the Laerdal resuscitator bag depends on various factors such as tidal volume, ventilator rate, oxygen flow rate, and type of reservoir and both the 250 mL and 500 mL corrugated tubes can be used as substitutes.
Equipment Design ; Human ; Oxygen/therapeutic use ; Oxygen/administration & dosage* ; Positive-Pressure Respiration ; Resuscitation/instrumentation* ; Tidal Volume

BACKGROUND: So many electronic devices have been introduced in the operating room. However, little was known about the hazards of electromagnetic fields (EMF) to the human body. We have studied about how much the anesthesiologists are exposed to EMF. METHODS: In 19 operating rooms of our hospital, the intensity of magnetic fields was measured by an ELF (Extremely low frequency) field strength measurement system. The distances were 30 cm, 50 cm and the anesthesiologist's proximity to the monitoring devices. RESULTS: The average strength of 19 operating rooms were 2.22 +/- 1.13 mG at 30 cm from the monitors, 1.29 +/- 0.84 mG at 50 cm and 1.00 +/- 0.78 mG at the anesthesiologist's stand. CONCLUSIONS: We found that in some of our operating rooms the exposure to EMF was measured above Sweden's TCO limit which has been accepted as the EMF radiation rule for computer monitors. Although the hazards of EMF have not been definitely confirmed yet, the effort not to be exposed to EMF should be considered by anesthesiologists.
Electromagnetic Fields* ; Human Body ; Magnetic Fields ; Magnets* ; Operating Rooms*