In this study, caudal anesthesia was performed with 0.25% bupivacaine and 0.25% bupivacaine-1% lidocaine mixtures at the end of operation. Anesthetics were administered randomly with the volume of 0.5 ml/kg, 0.75 ml/kg, 1.0 ml/kg and 1.25 ml/kg individually. The results were as following: 1) The more the volume of loeal anesthetics administered, the higher the spinal dermatome was blocked(P<0.005) and adequate analgesic levels were achieved. Body height classification by under and over 100 cm does not have statistically significant to determined of local anesthetic dosage. 2) Volume of local anesthetic solution required to block a spinal segment and body weight was most correlated to each other. At least 0.75 ml/kg or 1.0 ml/kg of local anesthetics are average amount for adequate pain control of pediatric urologic patients. 3) Only 17(24%) in 70 patients were required additive analgesic during postoperation 24 hours. 4) Local anesthetic volume required to block per a spinal segment was gradually increased with increased age and it markedly increased from 7 years old patients, this results have statistically significant correlationship. 5) The average volume of local anesthetic solution in patients under and over 100 cm in body height were 0.95+/-0.235 ml/spinal segment and 1.576+/-0.443 ml/spinal segment respectively(P< 0.0005). 6) Analgesic duration did not depend on operation site and body height(cm), analgesic duration tend to prolonged a little in patients who had undergone penoscrotal operation. 7) There was no statistical difference in analgesic durations between 0.25% bupivacaine group and 0.25% bupivacaine-1% lidocaine mixture group. With above results, we suggest that caudal analgesia in pediatric urologic patients who had undergone inguinal or penoscrotal operation would be simple, safe and effective method for postoperative pain relief.
Analgesia ; Anesthesia, Caudal* ; Anesthetics ; Anesthetics, Local ; Body Height ; Body Weight ; Bupivacaine ; Child ; Classification ; Humans ; Lidocaine ; Pain, Postoperative*

Numerous advances have been applied for the management of hemophiliac patients and the life expectancy of them was markedly improved. But they have many problems yet such as transmission of infections, adverse reactions to plasma products, development of factor VIII inhibitor and inadequate coagulation in the medical and/or surgical treatment. Anesthetic care should be managed with gentle, atraumatic intubation and careful positioning of patient pointing to the prevention of bleeding from hemorrhagic diathesis. We present a case of hemophilia A who had in operation for olecranon fracture of left ulna. It is important that anesthesiologist should realize that certain pathophysiological changes, especially coagulation disorders, might be occurred during surgical procedures and that perioperative preparation and management for them should be kept well.
Anesthesia, General ; Factor VIII ; Hemophilia A* ; Hemorrhage ; Hemorrhagic Disorders ; Humans ; Intubation ; Life Expectancy ; Olecranon Process ; Plasma ; Ulna

PURPOSE: To clarify the clinical benefit derived from the combined modality therapy (CMT) consisting of chemotherapy (CT) and involved field radiotherapy (RT) for stage I and II angiocentric lymphomas of the head and neck. MATERIALS AND METHODS: Of 143 patients with angiocentric lymphoma of the head and neck treated at our hospital between 1976 and 1995, 104 patients (RT group) received involved field RT alone with a median dose of 50.4 Gy (range : 20-70 Gy), while 39 patients (CMT group) received a median 3 cycles (range : 1-6 cycles) of CT before involved field RT. The response rate, patterns of failure, complications, and survival data of the RT group were compared with those of the CMT group. RESULTS: Despite a higher response rate, local failure was the most common pattern of failure in patients of both groups. The patterns of failure, including the systemic relapse rate were not influenced by the addition of combination CT. Although both modalities were well tolerated by the majority of patients, aberrant immunologic disorders or medical illnesses, such as a hemophagocytic syndrome, sepsis, intractable hemorrhage, or the evolution of second primary malignancies were more frequently observed in patients of the CMT group. The prognosis of patients in the RT group was relatively poor, with a 5-year overall actuarial survival rate of 38% and disease-free survival rate of 32%, respectively. However, their clinical outcome was not altered by the addition of systemic CT. Achieving complete remission was the most important prognostic factor by univariate and multivariate analyses, but treatment modality was not found to be a prognostic variable influencing survival. Conclusions : Involved field RT alone for angiocentric lymphoma of the head and neck was insufficient to achieve an improved survival rate, but the addition of CT to involved field RT failed to demonstrate any therapeutic advantage over involved field RT alone.
Combined Modality Therapy ; Disease-Free Survival ; Drug Therapy* ; Head* ; Hemorrhage ; Humans ; Lymphohistiocytosis, Hemophagocytic ; Lymphoma* ; Multivariate Analysis ; Neck* ; Prognosis ; Radiotherapy* ; Recurrence ; Sepsis ; Survival Rate

For treatment of Total Skin Electron beam Therapy (TSET), measurement of dose at various conditions is need on the contrary to usual radiotherapy. When treating TSET with modified Stanford technique based on linear accelerator, the energy of treatment electron beam, the spatial dose distribution and the actual doses deposited on the surface of the patient were measured by using EBT2. The measured energy of the electron beam was agreed with the value that measured by ionization chamber, and the spatial dose distribution at the patient position and the doses at several point on the patient's skin could be easily measured by EBT2 film. The dose on the patient that was measured by EBT2 film showed good agreement with the data measured simultaneously by TLD. With the results of this study, it was proven that the EBT2 film can be one of the useful dosimeter for TSET.
Electrons ; Humans ; Particle Accelerators ; Skin

PURPOSE: The purpose of this report is to describe the proton therapy system at Samsung Medical Center (SMC-PTS) including the proton beam generator, irradiation system, patient positioning system, patient position verification system, respiratory gating system, and operating and safety control system, and review the current status of the SMC-PTS. MATERIALS AND METHODS: The SMC-PTS has a cyclotron (230 MeV) and two treatment rooms: one treatment room is equipped with a multi-purpose nozzle and the other treatment room is equipped with a dedicated pencil beam scanning nozzle. The proton beam generator including the cyclotron and the energy selection system can lower the energy of protons down to 70 MeV from the maximum 230 MeV. RESULTS: The multi-purpose nozzle can deliver both wobbling proton beam and active scanning proton beam, and a multi-leaf collimator has been installed in the downstream of the nozzle. The dedicated scanning nozzle can deliver active scanning proton beam with a helium gas filled pipe minimizing unnecessary interactions with the air in the beam path. The equipment was provided by Sumitomo Heavy Industries Ltd., RayStation from RaySearch Laboratories AB is the selected treatment planning system, and data management will be handled by the MOSAIQ system from Elekta AB. CONCLUSION: The SMC-PTS located in Seoul, Korea, is scheduled to begin treating cancer patients in 2015.
Cyclotrons ; Helium ; Humans ; Korea* ; Metallurgy ; Particle Accelerators ; Patient Positioning ; Proton Therapy* ; Protons* ; Radiation Oncology ; Respiratory System ; Seoul