No abstract available.
Humans*

BACKGROUND: Application of PEEP increases lung volume and improves oxygenation. High PEEP levels may cause alveolar overdistension or barotrauma. It was hypothesized that there will be an effect of level of PEEP on respiratory resistance and an effect of ventilatory mode on respiratory compliance. This study aimed to investigate the effects of ventilation modes and levels of PEEP on respiratory mechanics during controlled ventilation under general anesthesia. METHODS: In 14 mechanically ventilated patients without cardiopulmonary symptoms and signs, we measured the respiratory mechanics using the inspiration interrupter technique during a constant flow. Dynamic and static compliance, airway resistance, visco-elastic tissue and total respiratory system resistance were calculated at 0, 5, 10, 15, and 20 cmH2O of positive end-expiratory pressure (PEEP) in VCV mode, VCV with inspiratory pause mode, and PCV mode, respectively. RESULTS: The dynamic compliance of the PCV mode was higher than that of the VCV mode. The highest static compliance was at 10 cmH2O PEEP. At 20 cmH2O PEEP, pulmonary compliance was decreased and the tissue resistance was increased. CONCLUSIONS: These results suggest that the respiratory mechanics including respiratory resistance should be monitored for applying PEEP. Further studies on clinical condition such as acute lung injury and ARDS were needed.
Acute Lung Injury ; Airway Resistance ; Anesthesia, General* ; Barotrauma ; Compliance ; Humans ; Lung ; Oxygen ; Positive-Pressure Respiration ; Respiration, Artificial ; Respiratory Mechanics* ; Respiratory System ; Ventilation*

PURPOSE: Despite recent advances in chemotherapy, the treatment outcome of advanced non-small cell lung cancer (NSCLC) remains poor and NSCLC is still the predominant source of cancer-related mortality in worldwide. Thus, we evaluated the efficacy and safety of a combination chemotherapy with vinorelbine, carboplatin, and ifosfamide (NCI) in advanced NSCLC patients. MATERIALS AND METHODS: A total of 26 patients was enrolled in this study between December 1997 and June 1998. All entered patients were treated with NCI combination chemotherapy (vinorelbine 25 mg/m2/day i.v. days 1 and 8; carboplatin 300 mg/m2/day i.v. day 1; ifosfamide 3 g/m2/day i.v. day I; and mesna 2.4 g/m2/day i.v. day 1 after completion of ifosfamide infusion, treatment repeated every 4 weeks). RESULTS: Among 26 patients, 23 patients were evaluable. Nine out of 23 evaluable patients had a partial response (response rate 39%; 95% confidence interval 19~59%). The median survival of the total 23 evaluable patients was 7.4 (range; 3~9.3+) months. The median progression-free survival was 2.8 (range; 0~7.7+) months. Among total 70 cycles of chemotherapy, leukopenia of grade II or more was observed in 6%, and tbrombo- cytopenia of grade II or more in 1%. There was no treatment-related death. Main non-hematologic toxicities were nausea/vomiting, stomatitis and peripheral phlebitis, almost of which were tolerable. CONCLUSION: NCI chemotherapy seemed to be moderately active and well tolerated in patients with advanced NSCLC.
Carboplatin* ; Carcinoma, Non-Small-Cell Lung* ; Disease-Free Survival ; Drug Therapy ; Drug Therapy, Combination* ; Humans ; Ifosfamide* ; Leukopenia ; Mesna ; Mortality ; Phlebitis ; Stomatitis ; Treatment Outcome

BACKGROUND: The prognostic outlook for Hodgkin's disease has markedly improved in recent decades and 70 to 80% of patients can be cured with the modern combination chemotherapy. However, there is no standard treatment strategy according to each stage of the disease. In the present work we analysed retrospectively the therapeutic outcomes of 66 newly diagnosed patients with Hodgkin's disease treated with the strategy of Korea Cancer Center Hospital (KCCH) between 1989 and 1998. Also we studied to identify prognostic factors influencing the therapeutic outcome of the disease. METHODS: The treatment strategy of our institute was as follows; Patients in clinical stage IA with cervical, inguinal or mediastinal involvement and favorable histology (lymphocyte predominant) received radiotherapy without staging laparotomy. However, other patients of IA and the patients in IB, IIA, IIB, IIIA1 were recommended staging laparotomy to determine pathologic stage. The patients who were contraindicated to or refused staging laparotomy, or who were in clinical stage IIIA2, IIIB, IVA, IVB received chemotherapy. The patients in pathologic stage I or II received radiotherapy, and who in IIIA, IIIB, IIB, IV were treated with chemotherapy. The patients who have had massive tumor in any stage received additional radiotherapy following chemotherapy and who had residual lymph node after chemotherapy received additional radiotherapy to involved area. RESULTS: Of all 66 patients, 13 patients received radiotherapy alone and 53 patients were treated with chemotherapy +/- radiotherapy. Staging laparotomy was performed in 6 patients and pathologic stage tended to be upstaged after laparotomy. A complete response (CR) rate following treatments was reached to 81.8% (54/66, 95% C.I.=72.3~91.3%). Five-year progression free survival and overall survival rate were 59.1% and 74.3%, respectively. In prognostic factors analysis, age (P=0.0323) and performance status (P=0.0183) were the independent prognostic factors influencing overall survival. CONCLUSION: The outcome of Hodgkin's disease treated with our strategy was as good as that in other institutes. However, the prognosis of the patients who did not reach complete remission was poor. The prognostic factors analysis showed that age and performance status, which were not considered in establishment of treatment strategy, were the independent factors influencing the outcome of Hodgkin's disease. Further studies to develop treatment strategy considering all important prognostic factors including age and performance status and to increase complete response rate and ultimately overall outcome were warranted.
Academies and Institutes ; Disease-Free Survival ; Drug Therapy ; Drug Therapy, Combination ; Hodgkin Disease* ; Humans ; Korea ; Laparotomy ; Lymph Nodes ; Prognosis ; Radiotherapy ; Retrospective Studies* ; Survival Rate ; Treatment Outcome*

Duplicated gallbladder (GB) is a rare congenital disease. Surgical management of a duplicated GB needs special care because of concurrent bile duct anomalies and the risk of injuring adjacent arteries during surgery. An 80-year-old man visited an emergency room with right upper quadrant abdominal pain. Computed tomography (CT) revealed cholecystitis with a 2-bodied GB. Because of this unusual finding, magnetic resonance choledochopancreatography was performed to detect possible biliary anomalies. The 2 GB bodies were unified at the neck with a common cystic duct, a so-called V-shaped duplicated GB. The patient's right posterior hepatic duct joined the common bile duct (CBD) near the cystic duct. The patient underwent laparoscopic cholecystectomy without adjacent organ injury, and was discharged uneventfully. Surgeons should carefully evaluate the patient preoperatively and select adequate surgical procedures in patients with suspected duplicated GB because of the risk of concurrent biliary anomalies.
Abdominal Pain ; Aged, 80 and over ; Arteries ; Bile Ducts ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute* ; Common Bile Duct ; Cystic Duct ; Emergency Service, Hospital ; Gallbladder* ; Hepatic Duct, Common ; Humans ; Laparoscopy ; Neck ; Patient Rights ; Surgeons

OBJECTIVE: In this study, the exposure levels of polycyclic aromatic hydrocarbons (PAHs) and urinary 1-hydroxypyrene(1-OHP) were surveyed among the workers using coal tar paint. METHOD: The study subjects for the exposed group were 107 male coal tar workers in 10 factories, and for the comparison group were 201 male clerk workers who had never been exposed to coal tar paint. Ambient PAHs, and pre-shift and end-shift urinary 1-OHP were sample and 16 PAHs were analysed. Smoking history was recorded during the survey day. RESULTS: The geometric mean of ambient concentration of total PAHs was 120.17 microgram/m3. Naphthalene had the highest level among the 16 PAHs. The pre-shift 1-OHP in the exposed group (8.89 micro mol/mol creatinine) was significantly higher than that in the control group (0.29 micro mol/mol creatinine). The end-shift 1-OHP in the exposed group (19.02 micro mol/mol creatinine) was significantly higher than that in the pre-shift (8.89 micro mol/mol creatinine) (Ed- confirm). 1-OHP of smokers was significantly higher than that of non-smokers in both groups. The difference between pre-shift and end-shift 1-OHP in smokers (12.40 micro mol/mol creatinine) was twice as high as that in non-smokers (6.06 micro mol/mol creatinine). The difference of 1-OHP between smokers and nonsmokers was 7.59 micro mol/mol creatinine in pre-shift and 13.96 micro mol/mol creatinine in end-shift. Thus, the effect of smoking and exposure to PAHs on 1-OHP may not be additive. In regression analysis for 1-OHP, the significant independent variables were pre-shift 1-OHP and PAHs. The direction of these variables was positive. When the analysis was performed in workers exposed to higher PAHs, smoking was significant independent variable. CONCLUSION: The above results suggest that not only ambient PAHs but also smoking, one of the most important non-occupational PAHs source, influenced the level of 1-OHP. Moreover, the effect of smoking to 1-OHP changed according to the exposure level of PAHs.
Coal Tar* ; Coal* ; Creatinine ; Humans ; Male ; Paint* ; Polycyclic Hydrocarbons, Aromatic* ; Smoke ; Smoking

Seizure activity increases glucose utilization within the brain in response to neuronal injury. In this study, we investigated the expression of two brain glucose transporter (GLUT) proteins, GLUT1 and GLUT3, in the mouse hippocampus after kainic acid (KA) treatment. Forty-eight hours after KA (30 mg/kg) injection, mice were sacrificed and a histological evaluation of KA-treated hippocampus revealed cell death using cresyl violet staining and immunohistochemistry for caspase-3. In KA-treated hippocampus, reactive astrocytic changes were confirmed by increased immunoreactivity of glial fibrillary acidic protein (GFAP). Enhanced GLUT1-positive endothelial cells were present in the hippocampus after KA treatment. However, GLUT3-positive neurons were not localized to the KAtreated hippocampus. In particular, although GLUT-3 was not expressed in the hippocampus, pronounced GLUT3- positive cells were observed in the hypothalamic paraventricular nucleus (PVN), which controls energy metabolism. Thus, these results indicate that changes in endothelial GLUT1 and neuronal GLUT3 levels in response to neural injury may play important roles in neuroprotection against brain excitotoxicity.
Animals ; Benzoxazines ; Brain ; Caspase 3 ; Cell Death ; Endothelial Cells ; Energy Metabolism ; Glial Fibrillary Acidic Protein ; Glucose ; Glucose Transport Proteins, Facilitative ; Hippocampus ; Immunohistochemistry ; Kainic Acid ; Mice ; Neurons ; Paraventricular Hypothalamic Nucleus ; Proteins ; Seizures ; Viola