Modern medical oncology has introduced various anti-cancer drugs since the World War I and II. Unlike for the solid tumors, hematological malignancies had been documented some limitations for curing it with chemotherapeutic agents only. In 1960, Dr. Nowell and Dr. Hungerford had discovered elongated chromosome (Philadelphia chromosome) which has documented as a product of translocation between 9th and 22nd chromosome in the patients with chronic myeloid leukemia. In 1970s, immunochemistry technique using monoclonal antibody has spread world widely and from 1990s, flow cytometry method has been available. In appreciation of these evolutions in basic science, the treatment strategy ofhematological malignancies has changed from the chemotherapeutic agents to targeted agents. Among the targeted agents, some drugs are newly developed and others are recreated as anti-cancer drugs after long-time of discard because of their toxicities or teratogenic effects. Nowadays, we are in the middle of flood of targeted agents, for example, tyrosinekinase inhibitors, epidermal growth factor receptor blockers, farnesyl transferase inhibitors, histone deacetylase inhibitors, and etc. In 21st century, the optimal treatment of hematological malignancies should follow a tailor- made strategy according to the patient and disease itself. In the present article, some representative agents will be introduced in accordance with target diseases.
Flow Cytometry ; Hematologic Neoplasms ; Histone Deacetylase Inhibitors ; Humans ; Immunochemistry ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Medical Oncology ; Receptor, Epidermal Growth Factor ; Transferases ; World War I

BACKGROUND: Epidural and intravenous (IV) administration of opioids are commonly used for postoperative pain management. However, studies that compare the epidural and IV routes of opiate administration show conflicting results. The purpose of this study was to determine the superior route of analgesics by comparing the effect of epidural fentanyl-bupivacaine with IV morphine using patient-controlled analgesia (PCA) system in the management of posterior thoracic surgery pain. METHODS: Sixty patients undergoing elective thoracic surgery were randomly assigned to receive either Epiural-PCA (Epi-PCA, n=30) or IV-PCA (n=30) when postoperative pain first increased to 40/100 mm (by visual analogue scale; VAS). Epi-PCA group received epidural bolus of 0.1% bupivacaine 10 ml containing fentanyl 100 microgram and then followed by Epi-PCA with 0.1% bupivacaine 100 ml containing fentanyl 800 microgram (basal infusion 2 ml/hr, PCA dose 1 ml, lock-out interval 30 min), IV-PCA group received repeated IV boluses of 3 mg of morphine until postoperative pain decreased to 40/100 mm and then followed by a IV-PCA with morphine (basal infusion 0.005 mg/kg/hr, PCA dose 0.02 mg/kg, lock-out interval 8 min). Analgesic efficacy, degree of patient satisfaction and pain, analgesics consumptions, forced vital capacity (FVC), forced expired volume in one second (FEV1) and side effects were evaluated. RESULTS: There were no significant differences in analgesic efficacy and degree of patient satisfaction and pain in both group. But the PHS were significantly lower (p<.05), and FEV1 higher (p<.05) in Epi-PCA group, signifying better analgesia during movement (cough and deep breaths). CONCLUSIONS: We concluded that an epidural PCA with mixture of fentanyl and bupivacaine administration is superior to that of intravenous PCA with morphine in the management of pain after thoracic surgery.
Analgesia ; Analgesia, Patient-Controlled* ; Analgesics ; Analgesics, Opioid ; Bupivacaine ; Fentanyl ; Humans ; Hydrogen-Ion Concentration ; Morphine* ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Patient Satisfaction ; Thoracic Surgery* ; Vital Capacity

Since introduction of venous flap in 1980, many experimental studies and clinical applications of various kinds of venous flaps were reported. Venous flap has the following advantages : (1) nonbulky and goo-quality of flap (2) long & large vascular pedicle (3) easy & rapid elevation of flap (4) no sacrifice of major arteries (5) a single operative field. But, we also have some disadvantages of difficult handling of the pliable veins and the tmcertainty of flap survival. For the better result we had to design the size of the flap larger than that of defect and increase the number of draining vein to reduce the postoperative edema of the flap. We have treated the defects of soft tissue of the hand using free arterialized venous flap from the flexor aspect of the forearm & had an excellent results.
Arteries ; Edema ; Forearm ; Hand* ; Veins ; Wounds and Injuries*

Chordoid glioma is an uncommon low-grade tumor of the third ventricle with histologic features of a chordoma and immunolabeling for glial fibrillary acid protein. We present a rare case of a patient with a chordoid glioma of the third ventricle and review the literature regarding this tumor's clinical, radiological and pathologic aspects.
Chordoma ; Glial Fibrillary Acidic Protein ; Glioma* ; Humans ; Third Ventricle*

OBJECTIVES: Chronic pain is one of the most common experiences of humans and a typical psychophysiological disorder. The aim of this study was to measure the psychophysiological responses in chronic pain patients using a biofeedback system, and to compare them with the results from normal healthy subjects. METHODS: Forty two patients with chronic pain (17 males and 25 females, average age 44.67+/-11.10 years) and 42 normal healthy controls (17 males and 25 females, average age 45.17+/-10.46 years) participated in this study. Electromyography (EMG), skin conductance (SC), and skin temperature (ST) were recorded using biofeedback system during the 3 phases (baseline, stress, and recovery) of stress reactivity test, and average values of them were calculated. Difference of values between two groups in each corresponding phase was analyzed with independent t-test, and change of values across phases of stress reactivity test was analyzed with paired t-test (all two-tailed, p<0.05). RESULTS: Compared to normal controls, chronic pain patients had higher value of EMG (baseline : 8.10+/-5.97 micronV vs 4.72+/-1.52 micronV, t=-3.56, p<0.01 ; stress : 11.25+/-6.89 micronV vs 8.49+/-4.78 micronV, t=-2.13, p<0.05 ; recovery : 7.12+/-3.77 micronV vs 4.78+/-1.59 micronV, t= -3.70, p<0.01) and SC (baseline : 1.06+/-1.0 micronS vs 0.42+/-0.29 micronS, t=-4.0. p<0.01 ; stress : 1.87+/-2.05 micronS vs 1.03+/-0.86 micronS, t=-2.47, p<0.05 ; recovery : 1.74+/-1.77 micronS vs 0.64+/-0.59 micronS, t=-3.8, p<0.01) in all the 3 phases. But, skin temperature comparison did not reveal significant differences in all the 3 phases between two groups. CONCLUSION: Psychophysiological responses of chronic pain patients in stress reactivity test were different from those of normal healthy controls. These results suggest that sympathetic nervous system is more activated in chronic pain patients.
Biofeedback, Psychology ; Chronic Pain ; Electromyography ; Female ; Humans ; Male ; Psychophysiologic Disorders ; Psychophysiology ; Skin ; Skin Temperature ; Sympathetic Nervous System

Inguinoscrotal bladder hernia is relatively common in obese males over 50 years old, especially patients with benign prostate hyperplasia. Various imaging modalities are used for diagnosis of inguinoscrotal bladder hernia. In particular, ultrasonography has many benefits, including non-invasiveness, and the fact that it does not require exposure to radiation; however, no domestic cases of ultrasonographic diagnosis of inguinoscrotal bladder hernia have been reported. The authors report on a case of a 67-year-old male patient with right scrotal swelling diagnosed as inguinoscrotal bladder hernia by ultrasonography, including three-dimensional imaging. Findings on ultrasonography showed a sacular lesion in the scrotum, which was connected to the urinary bladder through the inguinal canal; additional findings on CT, PET, and cystography showed that the entire lesion had a dumbbell shape.
Hernia ; Hernia, Inguinal ; Humans ; Hyperplasia ; Imaging, Three-Dimensional ; Male ; Prostate ; Scrotum ; Urinary Bladder

The incidence of conjoined twins is so rare that few anesthesiologists have an opportunity of managing them. Especially in Korea, there are only a few reports describing the anesthetic management for surgical separation of newborn conjoined twins. We experienced the successful anesthetic management for surgical separation of thoraco-xiphopagus conjoined twins without any particular problems. After applying the noninvasive monitors (ECG, pulse oximeter), one of the twins (twinA) with congenital heart disease was administered with intravenous ketamine for induction of anesthesia and intubated without neuromuscular blocker. Anesthesia was maintained with N2O-O2 and hand ventilation using Mapleson D breathing circuit. After maintaining airway of the twinA, the twinB was intubated and maintained with the same manner. Eighteen days after the separation procedure, the twinA with congenital heart disease died and the other one, twinB has been alive with normal growth and development.
Anesthesia ; Growth and Development ; Hand ; Heart Defects, Congenital ; Humans ; Incidence ; Infant, Newborn ; Ketamine ; Korea ; Neuromuscular Blockade ; Respiration ; Twins, Conjoined* ; Ventilation

BACKGROUND/AIMS: The endoscopic mucosal resection has now been adopted for a useful modality in both curative therapy and accurate diagnosis of early gastric cancer. A retrospective study was done to evaluate the indication and the limitation of endoscopic mucosal resection of early gastric cancer. METHODS: We studied 20 cases of early gastric cancer treated by endoscopic mucosal resection in Chungnam National University Hospital from November, 1995 to July, 1997. RESULTS: 1) The size affected the curability: 83. 3% of lesions less than 2 cm and 50. 0% of those larger than 2 cm were resected completely. 2) The depth of cancer invasion affected the curability: 87. 5% of lesion confined to mucosa were resected completely, while all of submucosal cancers were resected incompletely. 3) Among fourteen cases resected completely, three cases of lesions larger than 2 cm were residual cancer and two of those less than 2 cm were recurred locally. CONCLUSIONS: To be a curative therapy by endoscopic mucosal resection of early gastric cancer, we think that careful selection of the lesion, that is lesion less than 2cm and confined to mucosa, is necessary
Chungcheongnam-do ; Diagnosis ; Mucous Membrane ; Neoplasm, Residual ; Retrospective Studies ; Stomach Neoplasms*

PURPOSE: In this retrospective study, we attempted to evaluate the treatment outcome and the prognostic factors of thymoma treated with surgery, radiotherapy and chemotherapy. METHODS AND MATERIALS: Between 1979 and 1998, 55 patients with thymoma were treated at the Seoul National University Hospital. Of these, 11 patients underwent surgery only, 33 patients received postoperative radiotherapy and 11 patients received radiotherapy only. Twenty-three patients had gross total resection and 21 patients subtotal resection. For postoperative radiotherapy, the radiation dose consisted of 41.4-55.8 Gy. The average follow-up was 64 months, and ranged from 2 to 160 months. The sex ratio was 1:1 and the median age was 48 years (15-74 years). Overall survival and disease-free survival were determined via the Kaplan-Meier method, and the log-rank was employed to evaluate for differences in prognostic factor. RESULTS: The five- and 10-year survival rates were 87% and 65% respectively, and the median survival was 103 months. By univariate analysis, only stage ( p=0.0017) turned out to be significant prognostic factors of overall survival. Also, stage ( p=0.0007) was significantly predictive for overall survival in mutivariated analysis. CONCLUSION: This study showed the stage was found to be important prognostic factors, which influenced survival. Especially, as incomplete resection is related with poor results, complete resection is important to cure the invasive thymoma.
Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Radiotherapy ; Retrospective Studies ; Seoul ; Sex Ratio ; Survival Rate ; Thymoma* ; Treatment Outcome*

Imipramine(Tofranil(R)) is one of the tricyclic antidepressants commonly used in depressive symptoms or enuresis. An accidental or nonaccidental poisoning of imipramine is common today. A 16 years old girl was admitted to Seoul National university Hospital because of unocnsciousness and frequent attacks of seizure after the impulsive ingestion of 1.4gm of imipramine. She showed variable arrhythmias such as complete RBBB, secod degree AV block and ventricular tachycardia and recovered from poisoning without residual myocardial damage. We present a case of imipramine poisoning with cardiac arrhythmias with review of literatures.
Adolescent ; Antidepressive Agents, Tricyclic ; Arrhythmias, Cardiac* ; Atrioventricular Block ; Depression ; Eating ; Enuresis ; Female ; Humans ; Imipramine ; Poisoning* ; Seizures ; Seoul ; Tachycardia, Ventricular