PURPOSE: To evaluate the role of MRI in the management of cervical cancer treated by conventional four-field whole pelvic irradiation. METHOD AND MATERIAL: Between 1993-march and 1994-february, 20 patients(4 Stage I B, 3 Stage U A, 13 Stage U B) with invasive cervical cancer were eligible for evaluation of accuracy of conventionally designed lateral treatment field without MRI determination. RESULTS: 5 out of 20 Patients had inadequate margin without MRI. The position of uterine fundus was more important than cervix in correction of field size and the center of treatment field. CONCLUSION: This Preliminary date show MRI determination of uterine position prior to radiotherapy planning is essential in the case of four-field whole pelvic irradiation technique.
Cervix Uteri ; Female ; Humans ; Magnetic Resonance Imaging* ; Radiotherapy* ; Uterine Cervical Neoplasms*

All authors would like to withdraw the article because they have found a mistake in selecting subjects for this study.

BACKGROUND: The afferent and efferent pathways of fentanyl cough response (FCR) and central organization are poorly understood at present. The aim of this study was to investigate the pretreatment effects of morphine, propofol, atropine, and midazolam on FCR. METHOD: The 120 healthy patients were randomly assigned to six equal pretreatment groups. They received 2ug/kg fentanyl rapidly through a peripheral venous catheter. The patients in each group were pretreated before the time necessary for peak plasma levels with different drugs as follows: group 1, no premedication; group 2, morphine 0.05 mg/kg iv; group 3, morphine 0.05 mg/kg iv naloxone 0.01mg/kg iv; group 4, propofol 0.5 mg/kg iv; group 5, atropine 0.01 mg/kg iv; group 6, midazolam 0.05 mg/kg iv. The patients were observed for any coughing or side effects, including oxygen desaturation, bronchoconstriction, chest wall rigidity and seizure. RESULT: 40% of patients in group 1 (control) had a cough response to fentanyl. Group 2 (morphine) and group 3 (morphine naloxone) showed a reduced FCR of 10%. The incidence of coughing was 60% of the patients in group 4 (propofol), 30% in group 5 (atropine), and 40% in group 6 (midazolam). These were not statistically significant. CONCLUSION: FCR is not altered by pretreatment with propofol, atropine, or midazolam, but morphine inhibits cough response and this antitussive effect was not antagonized by naloxone.
Atropine* ; Bronchoconstriction ; Catheters ; Cough* ; Efferent Pathways ; Fentanyl* ; Humans ; Incidence ; Midazolam* ; Morphine* ; Naloxone ; Oxygen ; Plasma ; Premedication ; Propofol* ; Seizures ; Thoracic Wall

No abstract available.

PURPOSE: To determine the magnetic resonance (MR) imaging findings of tuberculous arthritis, and the frequency-in such cases-with which tuberculoma occurs. MATERIALS AND METHODS: MR images of 26 patients (M:F, 14:12; mean age, 46.2 years) with pathologically proven tuberculous arthritis were retrospectively reviewed. The presence of joint effusion, subchondral erosion, synovial proliferation and soft tissue abscess, and whether the inner wall of this abscess was smooth, were assessed. In particular, we determined whether a nodular lesion which showed low SI on T1WI, central low SI with peripheral high SI on T2WI, and rim enhancement on contrast study, was a tuberculoma. RESULTS: The joints involved were those of the knee (n=7), hip (n=7), shoulder (n=4), sacroiliac region (n=3), elbow (n=3), and ankle (n=2). Joint effusion was noted in 15 cases (58%), and subchondral erosion in 24(92%). synovial proliferation was found in 23 cases (88%), and soft tissue abscess in 24 (92%). The inner wall of this abscess was irregular in 17 cases (71%). A tuberculoma was present in intra- or extra-articular soft tissue in 18 cases (69%). CONCLUSION: The MR findings of tuberculous arthritis were subchondral erosion, synovial proliferation, and soft tissue abscess. The presence of a tuberculoma in intra- or extra-articular soft tissue, a specific finding in tuberculous arthritis, was noted in 69% of our cases.
Abscess ; Ankle ; Arthritis* ; Elbow ; Hip ; Humans ; Joints ; Knee ; Retrospective Studies ; Shoulder ; Tuberculoma*

BACKGROUND: Because of wide individual variations in response to sedative and the level of sedation desired by different patients, inadequate sedation is frequent during surgery. Patient-controlled sedation is a logical extension of patient-controlled analgesia to find and maintain their own steady-state of sedation by self-administration of sedatives during surgery. The purpose of this study was to evaluate the feasibility of patient-controlled sedation compared with anesthesiologist-controlled sedation during surgical spinal anesthesia. METHODS: Unpremedicated forty adult patients who received spinal anesthesia for lower extremity surgery were randomly allocated into two groups (n=20 for each group). After selection of target state of sedation according to sedation scale, patient-controlled sedation (PCS) group self-administered 0.5 mg (1 ml) intravenous midazolam in increments using a Walkmed PCA infusor and anesthesiologist- controlled sedation (ACS) group administered by the anesthesiologist as the same manner to achieve previously selected sedation state. Sedation score, vital signs, SpO2 were checked 5, 10, 20, 30, 40min after start of drug injection. RESULTS: The sedation scores patient desired were 4.4 +/- 0.8 in PCS group and 4.3 +/- 0.7 in ACS group. These scores were achieved 20min after start of injection in PCS group and 40 min in ACS grou p (p<0.05). Degree of satisfaction was higher in PCS group compared with ACS group (1.5 +/- 0.6 vs 2.1 +/- 0.8, p<0.05). No complications were detected in two groups. CONCLUSIONS: PCS using midazolam was better than ACS in terms of early achievement of sedation state patient desired and degree of satisfaction.
Adult ; Analgesia, Patient-Controlled ; Anesthesia, Spinal ; Humans ; Hypnotics and Sedatives ; Infusion Pumps ; Logic ; Lower Extremity ; Midazolam* ; Passive Cutaneous Anaphylaxis ; Vital Signs

No abstract available.
Cytomegalovirus Infections* ; Cytomegalovirus*

The goal of fracture treatment is to restore the patient to pre-injury function level. But the outcome assessment after orthopedic interventions has usually focused on physician-defined parameters of technical success, such as fracture union, alignment and range of motion rather than patient function and quality of life. However, the correlation among improvements in these parameters and functional status, psychosocial well being is inconsistent and weak in the elderly. Therefore authors assessed the functional status after surgical intervention of hip fractures in the elderly with functional recovery score(FRS). Independence in basic activities of daily living, in instrumental activities of daily living, in mobility, freedom from pain and intact memory were assessed in 133 hip fractures in the elderly. The hip fractures in the elderly resulted in 24.8% loss of function after the first year. The older the age, the more the loss of function after surgery of hip fractures. The more functional loss was observed in female patients and in patients with poor postoperative radiological results, but statistically insignificant (P>0.05). The more functional loss was observed in patients with underlying medical disease preoperatively and it was statistically significant (P<0.05). We recommend the evaluation of functional status in the elderly after hip fractures.
Activities of Daily Living ; Aged* ; Female ; Freedom ; Hip Fractures* ; Hip* ; Humans ; Memory ; Orthopedics ; Quality of Life ; Range of Motion, Articular

OBJECTIVE: Surgically removed herniated lumbar disc specimen are immunostained to evaluate the production of MMPs(Matrix metalloproteinases) -1, 2, 3 for the investigation of the possible correlation of MMPs in lumbar disc herniation depending on the types of disc herniation. METHODS: The study population consists of 30 patients with lumbar disc herniation. There were 18 men and 12 women with patient age averaging 43.4 years(19-68years). The types of disc herniation identified at the time of surgery were classified as follow ; protruded type(Group 1, 10cases), extruded type(Group 2, 10cases), sequestrated type(Group 3, 10cases). Immunohistochemical study for the MMPs of the herniated disc tissue was performed and results of staining were graded to examine differences in histology among three types of disc herniation . RESULTS: The MMPs immunopositive cells were increased in old patients but statistically it was not significant(p=0.074). A significantly increased incidence of positive cells for MMP-1, 2 was found in the herniated lumbar disc tissue than the control group(p=0.02) but there were no significant differences among the three types of disc herniation. The MMP-3 positive cells were predominantly detected in the sequestrated disc tissue group(p=0.037) more than other groups. CONCLUSION: These results suggest that the MMP-1, 2, 3 may play important roles in the process of degeneration, herniation, and resorption of the lumbar intervertebral discs and that the MMP-3 may express the severity of lumbar disc herniation and play a role in resorption of the sequestrated disc tissue.
Female ; Humans ; Immunohistochemistry ; Incidence ; Intervertebral Disc ; Intervertebral Disc Displacement ; Male ; Matrix Metalloproteinases*

The purpose of this study was undertaken to test if alteration of calcium flux across the sarcolemma or sarcoplasmic reticulum change subsequent relaxation of rat aorta in tissue model of ischemia. Thoracic aorta ring segments(2-3mm wide) were studied with solution that mimicked real ischemia condition(hypoxia, acidosis, elevated lactate levels and zero sub strate). During ischemic condition, the effect of treatments thought to decrease cytosolic cal cium were tested. Half time(t(1/2)) and degree of stabilized relaxation were 2.4+/-0.9 minutes and 17.6+/-12.1%(NE 10-7 M precontraction as 100%) for verapamil(10-6 M), 3.3+/-0.7 min- utes, 22.2+/-3.9% for low Ca2+(0.75mM) in ischemic solution. Interventions aimed to elevat- ing cytosolic calcium were also tested. 3.8+/-0.9 minutes and 68.6+/-8.1% for high (10.0 mM) Ca2+ in ischemic solution, 3.7+/-0.7 minutes, 72.8+/-3.9/. for ryanodine(3X10-9 M). 3.8+/-0.5 minutes, 53.4+/-2.6% for isoproterenol. Without any treatment or agents during ischemia, hlaf time and degree of relaxation were 4.0+/-1.7 minutes, 74.6+/-13.2%, enothelium and time independent. These data support that treatment or agent thought to reduce influx of cytosolic calcium levels exaggerated the severity of relaxation. The mechanism of relaxation in ischsmia is not completely clear, but it is suggested that a reduction of calcium influx may involved and directly related.
Acidosis ; Animals ; Anoxia ; Aorta ; Aorta, Thoracic ; Calcium ; Cytosol ; Ischemia* ; Isoproterenol ; Lactic Acid ; Rats* ; Relaxation* ; Sarcolemma ; Sarcoplasmic Reticulum