BACKGROUND: As treatment of head and neck cancer has improved, the trend showed that distant metastases(DMs) have become an increasingly common cause of death. Knowing about the presence of DMs is important for deciding treatment protocol. OBJECTIVES: The purpose of this study was to identify tumor characteristics(site of primary tumor, TNM staging, tumor differentiation) of head and neck squamous cell carcinoma related to higher incidence of DMs and determine the accuracy of blood test(alkaline phosphatase, calcium, LFT) in detection of DMs. MATERIALS AND METHODS: A retrospective review was carried out on 74 patients of 134 patients admitted to department of Otolaryngology, Gyeongsang National University Hospital from January 1987 to June 1994. RESULTS: The review revealed 21 DMs in 18 patients. DMs occurred in 18(24.3%) of 74 patients. Lung(47.6%) and bone(42.9%) were common DM site. As site of primary tumor, pharynx increased the incidence of DMs more than larynx, PNS & nasal cavity and oral caity. The incidence of DMs was increased in patients who had tumors of advanced T stage, N stage, Stage(statistically significant, p<0.05) and poor histologic differentiation(statistically insignificant, p=0.11). CONCLUSION: Abnormal alkaline phosphatase and hypercalcemia showed low sensitivity(56% and 0%) for detection of bone metastases. So blood tests(alkaline phosphatase, calcium) may be not useful for screening test for bone metastases. But the sensitivity of abnormal LFT was insignificant due to only one case of liver metastases in our study.
Alkaline Phosphatase ; Calcium ; Carcinoma, Squamous Cell* ; Cause of Death ; Clinical Protocols ; Head and Neck Neoplasms ; Head* ; Humans ; Hypercalcemia ; Incidence ; Larynx ; Liver ; Mass Screening* ; Nasal Cavity ; Neck* ; Neoplasm Metastasis* ; Neoplasm Staging ; Otolaryngology ; Pharynx ; Retrospective Studies

No abstract available.
Pneumonia*

OBJECTIVES: This study is based on the report including the psychological assessment results and therapeutic interventions of the survivors from hijacked Samho Jewerly by Somali pirates on January 15th, 2011. METHODS: We first assessed the emotional, cognitive, and personality functions of 7 crews, took 4-sessions of cognitive behavioral therapeutic intervention, conducted after-treatment assessments, and compared them with the previous results. RESULTS: Some of the crew showed PTSD due to the exposure to the stress triggered by the extreme state of fear, presented reexperience, avoidance of the trauma and chronical arousal state. CONCLUSION: Although this study was investigated with the minority group related to the one single accident, each case revealed the changes of symptoms and course after the trauma. The same traumatic event had different influences as how each individual perceived the experience. Furthermore, each clinical course was individually different either, depending on age, psychological resource, social support, daily life stress, or secondary gain.
Arousal ; Humans ; Minority Groups ; Ships ; Stress Disorders, Post-Traumatic ; Stress, Psychological ; Survivors

BACKGROUND: Epidural opioids and local anesthetics provide excellent postoperative analgesia. In addition, soft tissue and intra-articular injection of bupivacaine and morphine may have a beneficial analgesic effects after total knee arthroplasty (TKA). This study was designed to assess the additional analgesic effect of combined soft tissue, and intra-articular injection of morphine and bupivacaine in patients undergoing TKA under spinal anesthesia with continuous epidural morphine and bupivacaine injection. METHODS: Forty patients aged 55 to 75 years for a TKA under spinal anesthesia were randomly divided into 2 groups. The both group of patients received a continuous epidural infusion using a two-day infusor containing morphine 5 mg in 100 ml of 0.125% bupivacaine. The experimental group of patients (n = 20) received soft tissue, and intra-articular injection containing 10 mg morphine in 100 ml bupivacaine 0.125%. The control group of patients (n = 20) received soft tissue, and intra-articular injection of 100 ml normal saline. Postoperative pain was assessed using the visual analog scale (VAS) at 1, 2, 4, 8, 12, 24, and 48 h postoperatively and side effects, such as hypotension, nausea, vomiting, pruritus, and respiratory distress were recorded. Whenever patients demanded supplemental analgesia, diclofenac sodium 75 mg was injected intramuscularly and the need for additional analgesic requirement was recorded. RESULTS: The experimental group of patients had significantly lower pain score and analgesic requirements than the control group for 2 days. There was no difference in the incidence of side effects between groups. CONCLUSIONS: Combined soft tissue, and intra-articular injection of morphine and bupivacaine with continuous epidural morphine and bupivacaine infusion reduces postoperative pain and supplementary analgesic requirements than continuous epidural morphine and bupivacaine infusion only in patients undergoing TKA.
Analgesia ; Analgesics, Opioid ; Anesthesia, Spinal ; Anesthetics, Local ; Arthroplasty* ; Bupivacaine* ; Diclofenac ; Humans ; Hypotension ; Incidence ; Infusion Pumps ; Injections, Intra-Articular* ; Knee* ; Morphine* ; Nausea ; Pain, Postoperative ; Pruritus ; Visual Analog Scale ; Vomiting

Patients undergoing thoracotomy experience severe postoperative pain and marked respiratory impairment. Analgesics(narcotics or loeal anesthetics) administered via epidural catheter in epidural space have been shown to provide postoperative analgesia and improve respiratory mechanics after thoracotomy. Several different methods have been utilized in an attempt to reduce pain and pulmonary mechanics after thoracotomy. These include epidural blocks using local anesthetics, epidural narcotics, ketamine, steroid, and clonidine. These methods have been shown to provide pain relief with relative preservation of lung volumes in the postoperative period, but have disadvantages. Especially epidural local anesthetics may cause hypotension and motor blockade of lower extremities, and epidural narcotics may cause pruritus, nausea and vomiting, urinary retension and respiratory depression. In an attempt to provide excellent analgesia and improve pulmonary mechanics after thoracotomy and to decrease the side effects associated with the intermittent bolus administration of epidural narcotics or local anesthetics, we performed a study of continuously administered epidural infusion of small concentration of fentanyl combined with low concentration of bupivacaine. Twenty eight patients undergoing thoracotomy were randomized into groups based upon a postoperative pain regimen as indicated: Group I: intermittent intramuscualr injection of nalbuphine 0.2 mg/kg(n=13), Group II: continuous epidural injection of mixtures of 0.2/ bupivacaine and fentanyl 3 ug/ml(n= 15). Two, 8, 24 and 48 hours postoperative, the following indices were measured: visual analogue pain scale, vital capacity, tidal volume, arterial blood gas analysis(pH, PaCo2, PaO2), side effects, and 24 hour urine 17-ketosteroids. The results were as follows: 1) Pain score was evaluated by visual analogue pain scale postoperatively and the pain scores significantly decresed in group II as compaired with those in group L 2) Vital capacity and tidal volume in group II were more improved than group I. 3) There was no difference in arterial blood gas analysis except for decreased PaO2 at 2 hour and 24 hour compared with preoperative value in group L 4) Major complications in group II were two cases of nausea and vomiting, one case of urinary retension, whereas only I patient in group I complained of nausea and vomiting. 5) No significant difference occurred in 24 hour urine l7-ketosteroid at 24 hour and 48 hour postoperatively in group I and group II, which were within normal limits.
17-Ketosteroids ; Analgesia* ; Anesthetics, Local ; Blood Gas Analysis ; Bupivacaine* ; Catheters ; Clonidine ; Epidural Space ; Fentanyl* ; Humans ; Hypotension ; Injections, Epidural ; Ketamine ; Lower Extremity ; Lung ; Mechanics ; Nalbuphine ; Narcotics ; Nausea ; Pain Measurement ; Pain, Postoperative ; Postoperative Period ; Pruritus ; Respiratory Insufficiency ; Respiratory Mechanics ; Thoracotomy* ; Tidal Volume ; Vital Capacity ; Vomiting

Chronic hypoxia has been associated with change in neurovascular behavior, mediated, in part, by erythropoietin (EPO). EPO, a hematopoietic growth factor, could act as a neurotrophic factor. In the present study, we investigated the characteristics of EPO and erythropoietin receptor (EPOR) expressions by cortical neuron in vivo and in vitro and tested the hypothesis that EPO serves protective functions under chronic hypoxia. E18, P5 and P7 mice for 3 days and primary cultured neurons for 6 days were incubated in hypoxic conditions consisted of a mixture of 10% O2, 5% CO2, 85% N2. To study expressions of EPO, EPOR, caspases, pAKT, pERK, and PARP, immunohistochemical stainning and western blotting were carried out. In addition to expressing EPO and EPOR under normoxic conditions, neurons increased their expression of EPO and EPOR under hypoxia. The effects of recombinant EPO appeared to be mediated via the phosphatidylinositol (PI) 3- kinase-AKT pathway, correlated directly with activation of caspase 3. Also recombinant EPO decreased expression of caspase 8, but not caspase 9. Finally, recombinant EPO decreased apoptosis of cultured neurons as evaluated by expression of PARP. These data support a role for EPO in maintenance of cortical neuron under chronic hypoxia.
Animals ; Anoxia* ; Apoptosis ; Blotting, Western ; Caspase 3 ; Caspase 8 ; Caspase 9 ; Caspases ; Erythropoietin ; Mice ; Neurons* ; Phosphatidylinositols ; Receptors, Erythropoietin

OBJECTIVE; This study was conducted to evaluate the effect of pregnancy on the activities of oxygen hee radical generating and scavenging system in the female rats. MATERIAL & METHOD; Rats weighing 200-220 gm were grouped to non-pregnant, 2nd trimester and 3rd trimester of pregnancy. The experiment was carried out following overnight fasting. Animals were anesthetized by administration of pentothal sodium, and blood was drawn via abdominal aorta. After exsanguination, the liver, kidney, heart, lung, with or without placenta tissues were excised immediately. The excised tissue was frozen in liquid nitrogen rapidly, and stored in liquid nitrogen for analysis. RESULTS; The gain in body weight was higher in pregnant rats than in normal rats. Lipid peroxidation was not significantly different among all groups in the liver, kidney, heart, lung, and placenta tissue. Xanthine oxidase activity of the kidney in the 3rd trimester of pregnancy was lower than that of non-pregnant rats. Superoxide dismutase activity of the liver was significantly decreased in the 2nd and 3rd trimester of pegnancy compared with that of non-pregnant rats, and that of lung was also decreased than that of non-pregnant rats. Catalase activity of the kidney was decreased in the 2nd and 3rd trimester of pregnancy compared with that of non-pregnant rats. Glutathione content of the liver was markedly decreased in the 2nd and 3rd trimester of pregnancy compared with that of non-pregnant rats. CONCLUSION; In conclusion, these results suggest that oxygen free radical will not increase in the liver, kidney, heart, lung, and placenta during normal pregnancy, but in the cases of overproduction of oxygen free radical, the liver, kidney, and lung will have me chance of tissue damage because of decreased activity of some anti-oxidant enzymes and/or decreased amount of anti-oxidant materials.
Animals ; Aorta, Abdominal ; Body Weight ; Catalase ; Exsanguination ; Fasting ; Female ; Glutathione ; Heart ; Humans ; Kidney ; Lipid Peroxidation ; Liver ; Lung ; Nitrogen ; Oxygen* ; Placenta ; Pregnancy ; Rats ; Sodium ; Superoxide Dismutase ; Thiopental ; Xanthine Oxidase

OBJECTIVES: It was aimed to observe the regional cerebral blood flow (rCBF) response on methamphetamine challenge test in rats which were subjected to repeated administration of methamphetamine, and to investigate the mechanism(s) of changes in rCBF response in relation to the dopaminergic receptors and cyclic AMP. METHODS: Male Sprague-Dawley rats received daily injections of methamphetamine (0.3 mg/kg, i.p.) for 10 days, and were then allowed a 4-day drug-free period. Naive and methamphetamine-pretreated rats were challenged with topical application of methamphetamine on the surface of parietal cortex through a cranial window. The changes in rCBF were measured by laser-Doppler flowmetry. RESULTS: Acute topical application of methamphetamine dose-dependently increased rCBF with little effect on mean arterial blood pressure. The methamphetamine-induced increases in rCBF were significantly blocked by SCH23390, a D1-like receptor antagonist, but not by sulpiride, a D2-like receptor antagonist. Repeated administration of methamphetamine induced progressive augmentation of rCBF in response to the challenge of methamphetamine. Repeated administration of methamphetamine in combination with SKF38393, a D1-like receptor agonist, as well as with SCH23390 significantly attenuated the development of augmentation of rCBF response to methamphetamine. The augmentation of rCBF response was markedly inhibited by pretreatment with 2',3'-dideoxyadenosine, a specific adenylyl cyclase inhibitor, and Rp-cAMPS, a protein kinase A inhibitor, respectively. CONCLUSION: Based on these results, it is suggested that repeated administration of methamphetamine induces an augmentation of rCBF in response to the challenge of methamphetamine, and that D1-like receptor-mediated cyclic AMP plays a critical role in the development of augmentation of methamphetamine-induced rCBF response.
2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-benzazepine ; Adenylyl Cyclases ; Animals ; Arterial Pressure ; Cyclic AMP ; Cyclic AMP-Dependent Protein Kinases ; Dideoxyadenosine ; Humans ; Laser-Doppler Flowmetry ; Male ; Methamphetamine* ; Rabeprazole ; Rats* ; Rats, Sprague-Dawley ; Sulpiride

The Heterotopic pancreas is defined as the presence of pancreatic tissue lacking anatomical and vascular continuity with the main body of pancreas. Heterotopic pancreas or ectopic pancreas is found in 0.55% to 13.7% of autopsy series and also found one in approximately every 500 operations in abdominal surgery. The most common sites are the antrum of stomach, duodenum, and proximal jejunum. Most masses of heterotopic pancreas in stomach were encountered in the distal one third, usually within 5 or 6 cm of pylorus. We have recently experienced a case of hetertopic pancreas that was located in fundus which is not the usual site. Gastrofiberscopy revealed a 2 2.5 cm sized protruding mass on the fundus. There was apperared an umbilical shaped dimple on the center with a relatively normal mucosa. Endoscopic ultrasonography revealed a 2.5 cm sized hypoechoic mass of fundus, originating from submucosal and muscular layer. It was considered a submucosal tumor, such as leiomyoma, and subsequently wedge resection was performed. Histologic finding showed pancreatic acni.
Autopsy ; Duodenum ; Endosonography ; Jejunum ; Leiomyoma ; Mucous Membrane ; Pancreas* ; Pylorus ; Stomach*

Hepatosplenic gamma delta-cell lymphoma is a rare histologic type of peripheral T-cell lymphomas, clinically characterized by predominant involvement of liver and spleen, no or little adenopathy, and an often aggressive course. We report a case of bone marrow involvement of hepatosplenicgamma delta-cell lymphoma in a 21- year-old woman who presented with fever, anemia, thrombocytopenia, and hepatosplenomegaly. A lymphoma was found subsequently by bone marrow biopsy and computed tomography scan of the abdomen and pelvis. Immunologic characterization of lymphoma cells in bone marrow revealed positivity for CD2, CD3, and CD16/56, and negativity for CD4, CD5, CD7, CD8, CD34, and terminal deoxynucleotidyl transferase (TdT). Conventional cytogenetic studies revealed the presence of isochromosome 7q. Using the PCR-SSCP technique, monoclonal gene rearrangement of the T-cell receptor gamma chain was demonstrated. Thus, we could make a confirmatory diagnosis as hepatosplenic gamma delta-cell lymphoma.
Abdomen ; Anemia ; Biopsy ; Bone Marrow* ; Cytogenetics ; Diagnosis ; DNA Nucleotidylexotransferase ; Female ; Fever ; Gene Rearrangement ; Humans ; Isochromosomes ; Liver ; Lymphoma* ; Lymphoma, T-Cell, Peripheral ; Pelvis ; Receptors, Antigen, T-Cell ; Spleen ; Thrombocytopenia