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

No abstract available.
Adult* ; Arteries* ; Humans

No abstract available.

Vernet syndrome associated with varicella zoster virus (VZV) has been rarely reported. The diagnosis is established based on typical symptoms such as dysphagia, hoarseness, and unilateral difficulty in neck movement. Lack of skin lesions is common and makes it harder to consider VZV infection. A 53-year-old woman presented with left neck pain, dysphagia, hoarseness, and headache, with an erythematous vesicle on her neck. Laryngoscopy revealed paralysis of her left-soft palate and left-vocal cord. Upon cerebrospinal fluid (CSF) examination, her white blood cell (WBC) count, protein levels, glucose levels, and VZV antibody titer were elevated; moreover, VZV-DNA was detected. Magnetic resonance imaging (MRI) showed no sign of brain tumor, aneurysm or fracture. The patient was diagnosed with Vernet syndrome associated with VZV infection, having presented with a skin lesion involving the cervical segment.
Aneurysm ; Brain Neoplasms ; Cerebrospinal Fluid ; Chickenpox* ; Deglutition Disorders ; Diagnosis ; Female ; Glucose ; Headache ; Herpesvirus 3, Human* ; Hoarseness ; Humans ; Laryngoscopy ; Leukocytes ; Magnetic Resonance Imaging ; Middle Aged ; Neck ; Neck Pain ; Palate ; Paralysis ; Skin*

BACKGROUND/AIMS: Treatment of chronic hepatitis B with interferon results in a sustained loss of hepatitis B virus DNA and hepatitis B e antigen (HBeAg) and remission of liver disease only in a proportion of cases. Recently, mutations of hepatitis B virus (HBV) core gene have been reported as being related to the failure of interferon treatment in chronic hepatitis B. This study investigated whether core gene mutations of HBV are related to non-response to interferon therapy and whether the recurrence of HBeAg and HBV DNA in initial responders to interferon therapy is associated with the emergence of HBV core gene mutants. METHODS: The precore/core gene sequence was determined by polymerase chain reaction (PCR) and direct sequencing of PCR product in serum samples obtained before interferon treatment from 10 responders and 10 non-responders to interferon therapy. In addition, precore/core gene sequence was determined in serum samples obtained before interferon treatment and after recurrence from 10 patients who showed recurrence of HBeAg and HBV DNA after initial response to interferon therapy. RESULTS: In samples from 10 responders, there were 7 missense mutations and 71 silent mutations. However, there were 43 missense mutations and 109 silent mutations in samples from 10 non-responders. In samples obtained before interferon treatment from the 10 patients who showed recurrence after initial response, 8 missense mutations and 74 silents mutations were found. The nucleotide sequences from the samples obtained after the recurrence showed 6 silent nucleotide substitutions compared with the sequences from the samples obtained before interferon treatment. CONCLUSIONS: Mutations in the core protein of HBV occur more frequently in non-responders than responders to interferon therapy of chronic hepatitis B and may be a factor responsible for the failure of interferon treatment. The recurrence of HBeAg and HBV-DNA in initial responders to interferon therapy is not associated with the emergence of the HBV core gene mutants.
Adolescent ; Adult ; Antiviral Agents/*therapeutic use ; DNA, Viral/genetics ; English Abstract ; Female ; Hepatitis B Virus/*genetics ; Hepatitis B, Chronic/*drug therapy/virology ; Human ; Interferon-alpha/*therapeutic use ; Male ; *Mutation ; Viral Core Proteins/*genetics

No abstract available.
Forehead* ; Hyaluronic Acid* ; Imaging, Three-Dimensional* ; Pilot Projects*

This study was done to identify the normal and variants of saphenous tributaries in Korean adults. The pattern of confluence of saphenous tributaries, medial accessory saphenous, lateral accessory saphenous, superficial epigastric, superficial circumflex iliac and superficial external pudendal veins, was carefully examined in 249 lower limbs (right, 129; left, 120) of embalmed Korean cadavers (73 males and 56 females). The medial accessory saphenous vein drained into the great saphenous vein directly (in 82.3%) or by a common trunk (in 17.7%) with the superficial epigastric or superficial external pudendal vein. The lateral accessory saphenous vein entered the great saphenous (in 67.1%) or the femoral vein (in 32.9%) directly or, forming a common trunk with other saphenous tributaries. The superficial epigastric vein joined the great saphenous (in 77.1%) or the femoral vein (in 22.9%) directly or, by a common trunk with other saphenous tributaries. The superficial circumflex iliac vein reached the great saphenous (in 83.1%) or the femoral vein (in 16.9%) directly or, by a common trunk with other saphenous tributaries. The superficial external pudendal vein opened into the great saphenous (in 95.2%) or the femoral vein (in 4.8%) directly or by a common trunk with other saphenous tributaries. In Koreans, the incidence of the normal pattern of saphenous tributaries was 23.7% and in 76.3% any one of variant saphenous tributaries entered the femoral or the great saphenous vein by a common trunk with other saphenous tributaries.
Adult ; Cadaver ; Femoral Vein/*anatomy & histology ; Humans ; Iliac Vein/*anatomy & histology ; Korea ; Saphenous Vein/*anatomy & histology ; Thigh/*blood supply

No abstract available.
Sciatic Nerve*

PURPOSE: To analyze the relationship of age to serum prostate-specific antigen (PSA) levels among Koreans without clinically evident prostate cancer in a community-based study. MATERIALS AND METHOD: A total of 375 healthy men aged 50 to 79, residing in the small farming villages of Jeong-Eup county, Korea were examined with serum PSA(Hybritech Tandem-R) and digital rectal examination. One case of patient with prostate cancer was excluded. RESULTS: The serum PSA concentration is correlated with patient age(In PSA=-1.56+0.0257 x Age, r=0.32, p-value<0.0001). The recommended age-specific reference ranges of serum PSA(95th percentile) for men aged 50-59 years is 0-2.80ng/m1; for 60-69 years,0-3.56ng/m1; and for 70-79 years, 0-4.57ng/m1. CONCLUSIONS: The serum PSA concentration is correlated with patient age in Korean men and the age-specific PSA reference ranges for Korean are lower than those for Caucasian.
Digital Rectal Examination ; Humans ; Jeollabuk-do ; Korea ; Male ; Prostate-Specific Antigen* ; Prostatic Neoplasms ; Reference Values*

The most common anterior mediastinal tumors originate from the thymus. Among them, thymic carcinomas occur as an early local invasion and wide spread metastases. However, when squamous cell carcinoma in the thymus or mediastinum is identified, an occult primary lung cancer must be excluded because the histologic types resemble those found more typically in the lung. CD5 and cytokeratin immunohistochemical staining is useful in evaluating biopsy samples from those tumors. Spuamous cell carcinoma of an unknown primary origin in the mediastinum is a rare occurrence and there are only a handful of case reports. Here we describe a case with an anterior mediastinal mass of squamous cell carcinoma with unknown primary origin. A resection of the mediastinal mass without an association with the lung was performed. Immunohistochemical stainings were positive using cytokeratin 13, and negative using CD5 and cytokeratin 7. This was followed by chemotherapy for presured thymic carcinoma.
Biopsy ; Carcinoma, Squamous Cell* ; Drug Therapy ; Hand ; Keratin-13* ; Keratin-7* ; Keratins* ; Lung ; Lung Neoplasms ; Mediastinum ; Neoplasm Metastasis ; Thymoma ; Thymus Gland*