Inhalation induction of anesthesia is seldom used in a routine adult practice because of the long induction time and the prolonged excitement phase with the risk of laryngospasm and vomiting. So in modern practice, anesthesia is usually administered intravenously and produces unconsclousness pleasantly. However there are situaions where intravenous induction may not be ideal, and where rapid induction is still desired. The author wanted to evaluate the clinical application of inhalation induction of halothane using a vital capacity breath as a substitute for intravenous induction of anesthesia. The patients in this study had an ASA physical status of l or ll and presented no cardiopulmonary disease or abnormal laboratory data. The patients were divided into two group: a control group(n=30) and an experimental group(n=30). Control group: Intravenous induction with thiopental sodium. Experimental group: Inhalation induction with halothane using a vital capacity breath. The results are as follows: 1) The control group consisted of 14 males and 16 females. The mean age was 37.8+/-11.5years, and the ages ranged from 16 to 65 years. The mean body weight was 59.8+/-8.0kg, and body weights ranged from 44 to 75kg. in the experimental group, there were 17 males and 13 females. The mean age was 28.9+/-13.7 years, and the ages ranged from 18 to 65 years. The mean body weight was 57.4+/-8.1 kg, and body weight ranged from 43+/-75kg. 2) In the experimental group, the apnea time ranged from 20 to 105 sec, with a mean of 44.5+/-20.4 sec. The mean induction time was 76.7+/-32.1sec. and induction time ranged from 20 to 150 sec. There was no relationship between apnea time and induction time. 3) The hemodynamic changes were as follows: a. There were significantly greater changes in blood pressure and pulse rate during intubation and postintubation in the control group than in the experimental group(p<0.05). b. There were significant changes in blood pressure and pulse rate in the control group(p<0.05), but seemed not to be hazardous clinically. 4) Induction was impossible in two patients in the experimental group due to profuse secretion or excitement. 5) The side effects in the experimental group included coughs(5 cases), arrythmias(4), excitements(4) and secretion(1), respectively. 6) Postanesthetic comments in the experimental group:27 of the 28 patients remembered the anesthetic smells: 3 pleasantly, 20 moderately and 4 unpleasantly. In conclusion, inhalation induction of halothane using a vital capacity breath is a safe, acceptable and practical alternative to intravenous induction in cooperative adult patients.
Adult ; Anesthesia ; Apnea ; Blood Pressure ; Body Weight ; Female ; Halothane* ; Heart Rate ; Hemodynamics ; Humans ; Inhalation* ; Intubation ; Laryngismus ; Male ; Smell ; Thiopental ; Vital Capacity* ; Vomiting

PURPOSE: To evaluate the role of curative radiotherapy alone in the treatment of uterine cervical carcinomas, by a retrospective analysis with respects to survival and pelvic control, and to find any risk factors of failure MATERIALS AND METHODS: Between Jan. 1990 and Dec. 1995, a total of 187 patients, diagnosed with uterine cervical carcinomas in FIGO stages greater than IA, were treated by curative radiotherapy alone with no chemotherapy. The ages of the patients ranged from 26 to 80 years, with a median of 60 years. The number of patients diagnosed with squamous cell carcinomas were 183 (97.9%). The number of patients with FIGO stage IB1, IB2, IIA, IIB, IIIA, IIIB and IVA were 61 (32.6%), 7 (3.7%), 43 (23.0%), 62 (33.3%), 3 (1.6%), 7 (3.7%) and 4 (2.1%), respectively. External radiotherapy was performed with 6 MV or 10 MV X-rays, with a dose range of 19.8 Gy~ 50.4 Gy (median; 30.6), to whole pelvis. Intracavitary radiation (ICR) was then performed using a high-dose rate remote controlled afterloader with radioisotopes of Co-60 and Cs-137. The fraction size of the ICR was 5 Gy twice a week, and was delivered up to total doses of 10 Gy~ 55 Gy (median; 40). After the ICR, additional pelvic external radiotherapy with midline shielding width of 4 cm was performed with the dose range of 0~30.6 Gy (median; 19.8), and the resultant total doses of A points ranged between 49.8 Gy and 86.0 Gy (median; 70.6). RESULTS: The five-year overall survival rates of FIGO IB1, IB2, IIA, IIB, III and IVA were 88.3%, 83.3%, 86.1%, 65.2%, 60.0% and 50.0%, respectively (p=0.005). The pelvic control rates of each stage were 90.1%, 85.7%, 86.1%, 69.4%, 68.6% and 50.0%, respectively (p=0.03). From the multivariate analysis, the radiation response and tumor diameter were found to be significant factors affecting the overall survival. The significant factors influencing pelvic control were the radiation response and pre-treatment hemoglobin level. CONCLUSION: The radiation response and tumor diameter were significant factors affecting survival, so patients with tumor diameters greater than 4 cm should be considered for a combined modality, such as concurrent chemoradiotherapy.
Carcinoma, Squamous Cell ; Chemoradiotherapy ; Drug Therapy ; Humans ; Multivariate Analysis ; Pelvis ; Radioisotopes ; Radiotherapy* ; Retrospective Studies ; Risk Factors ; Survival Rate

PURPOSE: A retrospective study was undertaken to determine the role of conventional radiotherapy with or without surgery for treating a supraglottic carcinoma in terms of the local control and survival. MATERIALS AND METHODS: From Jan. 1986 to Oct. 1996, a total of 134 patients were treated for a supraglottic carcinoma by radiotherapy with or without surgery. Of them, 117 patients who had completed the radiotherapy formed the base of this study. The patients were redistributed according to the revised AJCC staging system (1997). The number of patients of stage I, II, III, IVA, IVB were 6 (5%), 16 (14%), 53 (45 %), 32 (27%), 10 (9%), respectively. Eighty patients were treated by radical radiotherapy in the range of 61.2~79.2 Gy (mean : 69.2 Gy) to the primary tumor and 45.0~93.6 Gy (mean : 54.0 Gy) to regional lymphatics. All patients with stage I and IVB were treated by radiotherapy alone. Thirty-seven patients underwent surgery plus postoperative radiotherapy in the range of 45.0~68.4 Gy (mean : 56.1 Gy) to the primary tumor bed and 45.0~59.4 Gy (mean : 47.2 Gy) to the regional lymphatics. Of them, 33 patients received a total laryngectomy (+-lymph node dissection), three had a supraglottic horizontal laryngectomy (+-lymph node dissection), and one had a primary excision alone. RESULTS: The 5-year survival rate (5YSR) of all patients was 43%. The 5YSRs of the patients with stage I+I, III+V were 49.9%, 41.2%, respectively (p=0.27). However, the disease-specific survival rate of the patients with stage I (n=6) was 100%. The 5YSRs of patients who underwent surgery plus radiotherapy (S+T) vs radiotherapy alone (RT) in stage II, III, IVA were 100% vs 43% (p=0.17), 62% vs 52% (p=0.32), 58% vs 6% (P<0.001), respectively. The 5-year actuarial locoregional control rate (5YLCR) of all the patients was 57%. The 5YLCR of the patients with stage I, II, III, IVA, IVB was 100%, 74%, 60%, 44%, 30%, respectively (p=0.008). The 5YLCR of the patients with S+T vs RT in stage II, III, IVA was 100% vs 68% (p=0.29), 67% vs 55% (p=0.23), 81% vs 20% (P<0.001), respectively. In the radiotherapy alone group, the 5YLCR of the patients with a complete, partial, and minimal response were 76%, 20%, 0%, respectively (P<0.001). In all patients, multivariate analysis showed that the N-stage, surgery or not, and age were significant factors affecting the survival rate and that the N-stage, surgery or not, and the ECOG performance index were significant factors affecting the locoregional control. In the radiotherapy alone group, multivariate analysis showed that the radiation response and N-stage were significant factors affecting the overall survival rate as well as locoregional control. CONCLUSION: In early stage supraglottic carcinoma, conventional radiotherapy alone is an equally effective modality compared to surgery plus radiotherapy and could preserve the laryngeal function. However, in the advanced stages, radiotherapy combined with concurrent chemotherapy for laryngeal preservation or surgery should be considered. In bulky neck disease, all the possible planned neck dissections after induction chemotherapy or before radiotherapy should be attempted.
Drug Therapy ; Humans ; Induction Chemotherapy ; Laryngectomy ; Multivariate Analysis ; Neck ; Neck Dissection ; Radiotherapy* ; Retrospective Studies ; Survival Rate

OBJECTIVES: The percutaneous vertebroplasty provides a good result in the treatment of osteoporotic vertebral compression fractures. But, the epidural leakage of polymethylmetacrylate(PMMA) after vertebroplasty may decrease the therapeutic effects because of the compression of thecal sac and/or nerve roots. The authors carried out a prospective study to evaluate the causative factors of epidural leakage of PMMA and to assess the influence on the outcome. METHODS: This study involved 347 vertebral levels of compression fractures in 159 patients. Among these, the epidural leakages were identified in 92 vertebral levels(26.5%) in 64 patients(40.3%) on post-operative CT scan. RESULTS: The incidence of epidural leakage of PMMA was significantly higher in the level above T7(p=0.001). The large amount of the injected PMMA and the use of an injector also increased the incidence(p=0.03 and p=0.045, respectively). The position of the needle tip in the vertebral body and the pattern of venous drainage did not influence. The immediate post-operative visual analogue scale(VAS) scores and facial scales(FS) were higher in the patients with epidural leakage(p=0.009). But there were no significant differences between the two groups after three months of operation(p=0.541). Conclusions: The incidence of epidural leakage of PMMA after percutaneous vertebroplasty appears to have relationship with the amount of PMMA and the levels injected. The epidural leakage of PMMA reduced the immediate therapeutic effects of vertebroplasty, but did not influence the late outcome. However, the epidural leakage should be avoided because of its potential neurological complications.
Drainage ; Fractures, Compression* ; Humans ; Incidence ; Needles ; Osteoporosis ; Polymethyl Methacrylate* ; Prospective Studies ; Tomography, X-Ray Computed ; Vertebroplasty*

The purpose of this study was to evaluate the difference of subgingival bacterial compositions between periodontally healthy and diseased sites. Subgingival plaque samples were obtained from 100 sites in 20 untreated adult periodontitis patients(experimental group), and 100 sites in healthy individuals(control group). Before sampling, probing pocket depth(PPD) and clinical level of attachment(CAL), Plaque Index(PI), and Sulcus Bleeding Index(SBI) were recorded for each sampled sites. Microbial samples were collected from the bases of gingival sulci or periodontal pockets with sterile curettes. The samples were examined under darkfield microscope(x400). At least 150 bacteria were evaluated and categorized on the basis of bacterial morphology and motility, i.e. cocci, non-motile rods, motile rods, and spirochetes. In control group, subgingival microbial flora consisted of 73.7% of cocci, 20.0% of non-motile rods, 4.3% of motile rods, and 2.0% of spirochetes. The microbial samples from experimental group consisted of 51.5% of cocci, 19.4% of non-motile rods, 17.6% of motile rods, and 11.6% of spirochetes. The proportion of cocci was higher in control group than in experimental group. Proportions of motile rods and spirochetes were higher in experimental group than in control group. The proportion of nonmotile rods in experimental group and control group was not significantly different. Sulcus Bleeding Index and Plaque Index showed high correlation with the bacterial composition. These findings suggests that examination of subgingival bacterial proportion may serve as more sensitive mirror of the local periodontal status than clinical parameters.
Adult* ; Bacteria ; Chronic Periodontitis* ; Hemorrhage ; Humans ; Periodontal Pocket* ; Spirochaetales

BACKGROUND: Myroides species are widely distributed in nature, but clinical infection by these organisms are extremely rare. We report herein prolonged outbreak of urinary tract infection by Myroides species. METHODS: Forty-four Myroides spp. were isolated from urine samples from 25 patients over a period of nine months, and random amplified polymorphic DNA (RAPD) method was performed to characterize the genotype of these isolates. RESULTS: All of the subjects were hospitalized patients with indwelling urinary catheter. Five of the patients showed concomitant pyuria, which could be considered as evidence of urinary tract infection, and isolation of these organisms in the remainder of the patients could be considered as simple colonization. All the isolates were resistant to antimicrobial agents tested. RAPD analysis showed identical DNA fingerprinting patterns in all the isolates. CONCLUSION: This study revealed that all the Myroides spp. isolated from urinary specimens of prolonged outbreak were genotypically the same. Because of its resistance to multiple antimicrobial agents, prevention of dissemination of this strain is clinically important.
Anti-Infective Agents ; Colon ; DNA ; DNA Fingerprinting ; Epidemiologic Studies* ; Genotype ; Humans ; Pyuria ; Urinary Catheters ; Urinary Tract Infections* ; Urinary Tract*

BACKGROUND: Myroides species are widely distributed in nature, but clinical infection by these organisms are extremely rare. We report herein prolonged outbreak of urinary tract infection by Myroides species. METHODS: Forty-four Myroides spp. were isolated from urine samples from 25 patients over a period of nine months, and random amplified polymorphic DNA (RAPD) method was performed to characterize the genotype of these isolates. RESULTS: All of the subjects were hospitalized patients with indwelling urinary catheter. Five of the patients showed concomitant pyuria, which could be considered as evidence of urinary tract infection, and isolation of these organisms in the remainder of the patients could be considered as simple colonization. All the isolates were resistant to antimicrobial agents tested. RAPD analysis showed identical DNA fingerprinting patterns in all the isolates. CONCLUSION: This study revealed that all the Myroides spp. isolated from urinary specimens of prolonged outbreak were genotypically the same. Because of its resistance to multiple antimicrobial agents, prevention of dissemination of this strain is clinically important.
Anti-Infective Agents ; Colon ; DNA ; DNA Fingerprinting ; Epidemiologic Studies* ; Genotype ; Humans ; Pyuria ; Urinary Catheters ; Urinary Tract Infections* ; Urinary Tract*

A carcinoid tumor of the stomach is uncommon, has no clinical symptoms, and is regarded as a benign. It is also incidentally found in most cases. 48-year-old woman with gastric carcinoid tumor was admitted. She had suffered from a anorexia and a dry mouth for 4-months. A gastroscopy revealed a polypoid mass on the greater curvature of the mid-body of the stomach which was subsequently thought to be an adenocarcinoma. An endoscopic mucosectomy revealed however, that it was a carcinoid tumor. A case of carcinoid tumor of the stomach is here by presented with a brief literature review.
Adenocarcinoma ; Anorexia ; Carcinoid Tumor* ; Female ; Gastroscopy ; Humans ; Middle Aged ; Mouth ; Stomach*

PURPOSE: To describe the CT findings and charicteristic clinical manifestation of primary malignant pulmonarymesenchymal tumors. MATERIALS AND METHODS: This study involved nine histopathologically proven cases of malignantprimary pulmonary mesenchymal tumors, as follows : MFH(n=2), leiomyosarcoma(n=2), pulmonary blastoma(n=1),neurogenic sarcoma(n=1), rhabdomyosarcoma(n=1), liposarcoma(n=1) and hemangiopericytoma(n=1). Two patients weremale and seven were female; their median age was 45. We retrospectively analyzed tumor size, location,characteristic of the peripheral margin, relationship to airways, and whether there was distal atelectasis orobstructive pneumonitis and lymph node involvement. We also reviewed distant metastasis, tumor growth rate and theinterval between surgery and recurrence, as seen on follow-up CT scans(n=6). RESULTS: Lesions were located at theright upper (n=2), right middle (n=1), right lower (n=1) and left lower lobe (n=2); in three cases, the whole leftlung (left upper + left lower lobe) was involved. CT findings showed that in all cases, the largest diameter ofmasses ranged from 3 to 15 cm; a well-demarcated margin was seen (smooth in eight cases, psiculated in one) andthis was well enhanced(inhomogeneous in six cases, homogeneous in three). In six cases, masses encircled ordisplaced the peritumoral small bronchus, and in five cases, were located in the peripheral lung field. In fourpatients who underwent endobronchoscopy, no endobronchial lesions were present, and in six cases scans initial CTscans showed no lymph-node involvement. In two cases, mass size doubled within one month. On initial diagnosis,distant metastasis was seen in seven cases, and in three, recurrent lesions were detected within postoperative sixmonths. CONCLUSION: If in the differential diagnosis of lung cancer, a mass seen on CT images is well demarcated,large, peripheral, inhomogeneously enhanced, encircles or displaces the peritumoral small bronchus, shows earlydistant metastasis, is high locally invasive, and recurs early with relative sparing of the lymph nodes, thepossibility of primary malignant pulmonary mesenchymal tumor shouldbe considered.
Bronchi ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Lung ; Lung Neoplasms ; Lymph Nodes ; Neoplasm Metastasis ; Pneumonia ; Pulmonary Atelectasis ; Recurrence ; Retrospective Studies

Recently, a method of color Doppler sonography has been described that is based onestimation the integrated Doppler power spectrum which is represented as "Power Doppler"ultrasonography. Several potential advantages of Power Doppler ultasonography overconventional color Doppler ultrasonography include that noise is represented in uniform patternin power mode, the relative angle independence and abscence of aliasing effect. It appearsto be a potentially useful particularly for evaluating slow flow in parts of the body wherethe signal is weak because blood vessels are small or deep. This could be applied to theevaluation of the flow in the ovarian tumors. And it is believed that the analysis of bloodflow characteristics as well as angiogenesis location and the amount and arrangement ofmicrovascular network may help in distinguishing malignant versus benign tumors.We will represent a preliminary report to demonstrate a efficacy of power Dopplerultrasonography in the detection of ovarian tumor vascularity. Thirty-one patients with ovarianmasses were prospectively evaluated with power and conventional color Dopplersonography using 7.0 MHz endovaginal probe or 3.0 MHz transabdominal probe with a pulserepetition frequency of 700 Hz. The evaluation criteria were the detection of vasculature,the arterial waveform analysis if possible, and defining the vascular location. With conventionalcolor Doppler sonography, the vascularity within the ovarian tumors could be detectedin 74.2% of total patients, and 90.3% of total patients with power Doppler sonography,Doppler waveform analysis was possible in 83.9% of total patients with power Dopplersonography and in 71.0% at conventional color Doppler sonography. The vascular patternswithin each parts(solid area, septum, pericystic) of the ovarian tumors were relatively welldefined with power Doppler sonography as compare to those with conventional color Dopplersonography.In conclusion, power Doppler ultrasonography was shown to be superior to conventionalcolor Doppler ultrasonography in the depiction of ovarian intratumoral vasculature.
Blood Vessels ; Humans ; Noise ; Prospective Studies ; Ultrasonography, Doppler* ; Ultrasonography, Doppler, Color