Stasis dermatitis is one of the important skin manifestations of venous stasis. Therefore, the searching for the cause of venous stasis is importrnt. Two cases of stasis dermatitis with inferior vena caval obstruction are reported and possible etiologic factor is discussed. Case I The patient, 38-year-old carpenter, was admitted at Choong Buk Medical Center in April, 1974 with superficial venous engorgement of the lower extremities which had begun to appear two years after severe blunt trauma to both legs in 1962. 5 years prior to admission, abdomial venous engorgement and abdominal fullness developed and was exaggerated gradually. Since 2 years prior to admission, he has been suffered from the recurrent exudative ulcer on the right lower leg The physical examination revealed mild icteric sclera, hepatomegaly, abdominal distension, tortuous venous engorgement on the abdomen, the lateral chest wall and the lower extremities, and edematous scaly brawny pigmentation of the lower legs. Esphagogram showed no esphageal varices. Inferior vena cavogram showed complete obstruction at the level of upper border of 2nd lumbar vertebra and well developed collateral circulation, Findings of skin biopsy on the right lower leg showed moderate acanthosis, increased pigmentation of bosal cell layer in the epidermis, capillary proliferation, diffuse inflammatory cell infiltration with increased fibrosis and hemosiderin granules in the dermis. Case II The patient. 36-year-old farmer, was admitted at Dept. of Dermatology, St. Mary's Hospital, Catholic Medical College in Sept., 1973.The physical examination revealed hepatomegaly, abdominal distension, superficial venous engorgement on the abdomen, the neck and the lower extrcmities, severe edema and pigmentation of the lower legs, and the multiplc. Exudative ulcers on the left lower leg. Liver scanning showed somewhat general enlargement with some mottlings along the margin and relative prominance of the left lobe. Liver biopsy revealed findings of non specific chrcnic hepatitis. Inferior vena cavogram through the left femoral vein showed complete obstruction at the level between 11th and 12th thoracic vertebrae.His peripheral edema and ascites was much subsided after adequate bed rest and the skin lesion improved with scar formation.
Abdomen ; Adult ; Ascites ; Bed Rest ; Biopsy ; Capillaries ; Cicatrix ; Collateral Circulation ; Dermatitis* ; Dermatology ; Dermis ; Edema ; Epidermis ; Femoral Vein ; Fibrinogen ; Fibrosis ; Hemosiderin ; Hepatitis ; Hepatomegaly ; Humans ; Hyperemia ; Leg ; Liver ; Lower Extremity ; Neck ; Physical Examination ; Pigmentation ; Sclera ; Skin ; Skin Manifestations ; Spine ; Thoracic Wall ; Ulcer ; Varicose Veins

No abstract available.
Cervix Uteri* ; Conization* ; Female

PURPOSE: We wanted to determine and report on the outcome of combined gemcitabine/cisplatin chemotherapy for patients suffering with locally advanced or metastatic urothelial cancer. MATERIALS AND METHODS: Between July 1999 and December 2004, 43 selected patients were enrolled in this study. Group 1 (the adjuvant chemotherapy group) had undergone radical surgery with removal of evident tumor from the following primary sites: bladder (n=8), renal pelvis (n=7) and ureter (n=3). Group 2 (the salvage chemotherapy group) had undergone palliative surgery with a remnant tumor at the following primary sites; bladder (n=23) and renal pelvis (n=2). All the patients were given gemcitabine/ciplatin and they evaluated for the therapeutic effect and toxicity. The patients were initially treated with gemcitabine 1000 mg/m2 intravenously for 30 minutes on days 1, 8 and 15 of a 28-day cycle, and cisplatin 70 mg/m2 was administered intravenously on day 1 using prehydration measures. RESULTS: Group 1: The median follow-up period was 16.5 months. The mean age was 63 years (males: 15 cases, females: 3 cases), and eleven patients (61%) remained alive. The estimated median relapse-free survival period and 2-year survival rate were 24 months and 63%, respectively. Group 2: the median follow-up period was 20 months, the mean patient age was 63.8 years (males: 22 cases, females: 3 cases), and nine patients (36%) remained alive. The overall response and 2-year survival rates were 36% and 43%, respectively. Toxicities: Grade 3 toxicities developed in 14 cycles during the total 232 cycles. Grade 4 toxicity did not occur. CONCLUSIONS: The results of this study confirm that adjuvant and salvage chemotherapy with using gemcitabine and cisplatin is tolerable and safe.
Chemotherapy, Adjuvant ; Cisplatin ; Drug Therapy* ; Female ; Follow-Up Studies ; Humans ; Kidney Pelvis ; Palliative Care ; Survival Rate ; Ureter ; Urinary Bladder ; Urologic Neoplasms

No abstract available.
Abortion, Induced* ; Female ; Patient Acceptance of Health Care*

No abstract available.
Abortion, Induced* ; Female ; Patient Acceptance of Health Care*

BACKGROUND/AIMS: We studied to evaluate the virological and biochemical responses to lamivudine and to detect YMDD mutants in patients who received long-erm lamivudine therapy. METHODS: We conducted a one-ear trial of lamivudine in 45 Korean patients with chronic liver disease due to hepatitis B virus. The patients were treated with a single oral average dose of 100 mg of lamivudine every day for 12 months. RESULTS: The suppression of serum HBV DNA was sustained in 77.8% of the patients and the normalization of serum ALT in 80%. The proportions of patients with HBeAg seroconversion were 25%. YMDD mutants were detected in 4 of 8 patients who showed sustained HBV DNA and serum ALT response (n=31) and in 3 of 8 patients who showed HBV DNA or serum ALT breakthrough (n=9). The response to lamivudine therapy in HBeAg-egative patients was excellent. CONCLUSION: Lamivudine therapy resulted in a significant virological and biochemical improvements and were well tolerated. But, YMDD mutants were detected during lamivudine therapy.
DNA ; Hepatitis B e Antigens ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Humans ; Lamivudine* ; Liver Diseases* ; Liver*

BACKGROUND: When local anesthetics for regional anesthesia is used, usually small amounts of bicarbonate are added for rapid onset. This addition gives the mixed solution a more alkaline pH. The following result is an increased unionized form of the local anesthetic and rapid penetration of the drug into tissue. Unfortunately, no data about adequate mixing volumes of domestic lidocaine and bicarbonate is available. METHODS: We examined six mixing pairs of two kinds of 2% lidocaines and three kinds of 8.4% bicarbonates for minimum volumes of bicarbonate to cause a precipitation of 2% 20 ml lidocaine. RESULTS: The mean volumes of bicarbonate to cause precipitation were 1.54 ml for Kwang-Myung lidocaine with Kwang-Myung bicarbonate, 2.90 ml for Kwang-Myung lidocaine with Dae-Won bicarbonate, 2.73 ml for Kwang-Myung lidocaine with Je-Il bicarbonate, 0.97 ml for Je-Il lidocaine with Kwang-Myung bicarbonate, 1.26 ml for Je-Il lidocaine with Dae-Won bicarbonate and 1.39 ml for Je-Il lidocaine with Je-Il bicarbonate. CONCLSIONS: We conclude that the Kwang-Myung lidocaine and the Je-Il lidocaine could cause precipitation when mixing with a smaller bicarbonate volume than foreign textbook recommended.
Anesthesia, Conduction ; Anesthetics, Local ; Bicarbonates ; Hydrogen-Ion Concentration ; Lidocaine

The authors had performed stereotactic surgery to diagnose and treat 2 cases of neurocysticercosis under the local anethesia. Generally, such the open surgery need a general anethesia which may increase the chance of brain parenchyml injury. However, the stereotactic surgery has the advantage of being an easy and precise procedure under local anethesia. The authors reviewed the literature and discussed the stereotactic surgery in the diagnosis, and treatment of neurocysticercosis.
Albendazole ; Brain ; Diagnosis ; Neurocysticercosis* ; Praziquantel

The volumetric caudal epidural steroid injection has been advocated to facilitate the delivery of medications to the lesion site. This study was aimed to examine the actual spreading patterns of this technique, using epidurogram. A total of 32 patients with chronic low back pain accompanied by radiculopathy of various causes (degenerative spondylosis, herniated nucleus pulposus, spondylolisthesis, and spinal stenosis) were included. The volumetric caudal epidural injection of the 10 mL mixture of contrast medium 5 mL, 0.5% bupivacaine 1 mL, triamcinolone 1.5 mL (60 mg) and normal saline 25 mL was performed. Immediately after the cessation of the first spread, the subsequent solution of another 10 mL of contrast medium 5 mL, 0.5% bupivacaine 1 mL and normal saline 4 mL was injected. This procedure was repeated serially until the total volume to be 50 mL. Continuous fluoroscopic imaging was obtained after each injection. Average time taken to complete the study was 37 sec per every 10 mL. The spreading levels of the mixture were distributed mainly at mid to lower lumbar area in the majority of the patients. During the subsequent injections, the levels were not changed significantly. This was thought to be due to the minimal resistance in cephalad direction, anatomic variations and Starling effect of epidural space.
Adult ; Aged ; *Anesthesia, Epidural ; Anesthetics, Local/*pharmacokinetics ; Bupivacaine/*pharmacokinetics ; Chronic Disease ; Female ; Fluoroscopy ; Glucocorticoids, Synthetic/pharmacokinetics ; Human ; Low Back Pain/*drug therapy ; Male ; Middle Age ; Spinal Diseases/drug therapy ; Triamcinolone/pharmacokinetics

PURPOSE: A model and a program was developed for training surgeons in laparoscopic urethrovesical anastomosis in order to improve the laparoscopic suture technique for urologists with no previous experience. MATERIALS AND METHODS: The procedures were performed on a pelvic trainer using a videolaparoscopic unit. The program consisted of a simple suture, urethrovesical anastomosis with interrupted sutures, and urethrovesical anastomosis with continuous sutures. The trainees enrolled in this study were 5 residents from the urologic department who had little experiences in laparoscopic suturing. The trainees performed each procedure 10 times and the elapsed time was recorded. Univariate analysis of the general linear model was used to assess the significance of progression. RESULTS: In the first lesson of the simple suture, the mean elapsed time was 5.45+/-3.00 minutes (range 2.78-9.83minutes) and each trainee demonstrated a difference in the elapsed time for suturing. After the tenth lesson was complete, the mean elapsed time was 1.48+/-0.17 minutes (range 1.35- 1.70 minutes) and the time differences between each trainee decreased. In urethrovesical anastomosis with interrupted sutures, the mean elapsed time decreased from 24.07+/-3.97 minutes at the 1st lesson (range 16.13- 29.47 minutes) to 13.10+/-2.53 minutes (range 11.75-19.47 minutes) after 10 lessons. In urethrovesical anastomosis with continuous sutures, the mean time decreased from 39.61+/-3.60 minutes (range 34.41-45.71 minutes) after one lesson to 30.42+/-5.75 minutes (range 19.50-38.82 minutes) after 10 lessons. There were significant differences in the elapsed time up to the 2nd lesson compared with the 10th lesson in all procedures (p-value<0.05). CONCLUSIONS: The skills of the trainee can be improved by a model and a program for training laparoscopic urethrovesical anastomosis. In particular, urethrovesical anastomosis, in which many urologists find difficulty, may become more accessible using this model and program.
Anastomosis, Surgical ; Laparoscopy ; Linear Models ; Suture Techniques ; Sutures