PURPOSE: The purpose of the study was to investigate how much understand about artificial hydration in patients with terminal cancer, according to the subject groups, including patients, families, and general public. METHODS: Data were collected from June 2007 to December 2007 and the participants included 22 hospitalized patients in the hospice unit of S Hospital, 100 families, and 101 participants who participated in a hospice education program for the general public. The questionnaire was developed through literature review, interview with patients' families, and expertise consultation. Data were analyzed using descriptive statistics with an SAS program. RESULTS: Understanding of artificial hydration among patients, families and general public was examined from three perspectives. From an ethical perspective, 'if you receive artificial hydration, you can live longer', 45.5%, 63%, and 52.4% of the above three groups, respectively, answered "yes". From an emotional perspective, 'artificial hydration must be provided', 81.8%, 70% and 58.4%, respectively, agreed. From a cultural perspective, 'if artificial hydration is not provided for the patient, the families will feel painful', 95.5%, 83%, and 88.2%, respectively, answered "yes". CONCLUSION: This study found the differences in understanding of artificial hydration among patients, families and general public, and also found that less than 50 percent of the participants understood artificial hydration appropriately. We suggest, therefore, that patients' understanding about artificial hydration should be determined in the clinical setting and then followed by individualized education according to given medical situations.
Fluid Therapy ; Hospices ; Humans ; Phenothiazines ; Terminally Ill ; Surveys and Questionnaires

BACKGROUND: Recently, Doppler echocardiography has been widely used to evaluate left ventricular(LV) diastolic filling. However, There are only limited date about the influence of LV systolic function on the pattern of left ventricular diastolic filling. METHODS: To evaluate the changes of Doppler echocardiographic parameters of left ventricular filling induced by variations in left ventricular systolic function in dilated cardiomyopathy(DC) with heart failure(HF), 25 patients(M : F=14 : 11) with DC and HF, and 21 age-matched normal subjects(M : F=13 : 8) were examined by ECG, phonocardiography and echocardiography. From the Doppler recording, A2D(time from second heart sound to the onset of early diastolic mitral flow), peak velocity at early diastole(E) and late diastole(A), ratio of E to A velocity(E/A) and flow velocity integral(FVI) were measured. RESULTS: In 22 patients with DC and HF without mitral regurgitation(MR), A2D was significantly prolonged(119.5+/-12.7 vs 92.4+/-14.1msec, p<0.01), and early diastolic peak velocity and E/A velocity ratio were decreased as compared with the normal subjects(E=0.39+/-0.08 vs 0.57+/-0.12m/sec, p<0.01, E/A : 0.87+/-0.19 vs 1.33+/-0.19 vs 1.33+/-0.18, p<0.05). There were significant correlations between A2D and FVI(r=+0.73, p<0.01), and between E/A velocity ratio and FVI(r=-0.78, p<0.01). However, in 3 patients with MR, A2D(88.7+/-12.1msec), E(0.56+/-0.05m/sec), and E/A(1.32+/-0.12) were similar to those in normal subjects, despite of decreased FVI(12.0+/-0.9cm). CONCLUSIONS: These data show that a change of left ventricular systolic function in patients without MR may influence a diastolic filling pattern of left ventricle but not in patient with MR, and suggest that MR masks left ventricular distolic filling abnormalities.
Cardiomyopathy, Dilated* ; Echocardiography ; Echocardiography, Doppler* ; Electrocardiography ; Heart ; Heart Sounds ; Heart Ventricles ; Humans ; Masks ; Phonocardiography ; Ventricular Function, Left*

Osteoma is a slow-growing benign tumor composed of mature bone. Paranasal sinus osteoma is benign, well-circumscribed, slow-growing, frequently asymptomatic and usually diagnosed incidentally. However, depending on the location, osteoma may lead to headaches, proptosis, rhinorrhea, diplopia, hyposmia and facial deformity. While it is generally agreed that surgical intervention is not indicated, symptomatic osteomas are always treated surgically, typically with open procedures. As an alternative, the endonasal technique presents several important advantages: better visualization of anatomic structures; preservation of the natural drainage pathway; absence of scar formation; reduced morbidity; shorter hospital stay; and limited bleeding. We experienced a case of osteoma presenting with occipital headache and that was removed using anintranasal endoscopic approach. Here we report this case with a review of literature.
Cicatrix ; Congenital Abnormalities ; Diplopia ; Drainage ; Ethmoid Sinus ; Exophthalmos ; Headache* ; Hemorrhage ; Length of Stay ; Orbit* ; Osteoma*

BACKGROUND: The recurrent temporal lobe epilepsy induces contralateral cell damage and secondary epileptogenesis in the contralateral hippocampus of rats. This phenomenon is fairly constant and has been used as a model of human temporal lobe epilepsy. It is necessary to understand this patho-mechanism in order to prevent this cell damage. METHODS: We have investigated the patho-mechanism of secondary epileptogenesis by using the rat model injected with kainic acid (KA) into the unilateral hippocampus. KA model shows initial complex partial seizures originating from the limbic structures and following convulsive status epilepticus. Immunohistochemical staining for c-fos expression, TUNEL stain for apoptosis, and hematoxylin-eosin (H-E) stain for morphologic changes were used. RESULTS: In the injected hippocampus, transient activation of c-fos was expressed in the dentate gyrus and CA3 hippocampal area, which were shaded out within 24 hours after the onset of limbic seizure. The stained cell with normal appearance was not observed in the H-E stain after 72 hours due to diffuse cell death. In the contralateral hippocampus, transient expression of c-fos was observed in the dentate gyrus, hilus, CA3, and CA1 area. But the expression of c-fos in the CA3 and CA1 area was sustained to 24 hours. Cell loss was mild in the CA3 and hilus, and mild cell degeneration and shrinkage were observed in the CA1 area. Apoptotic body was expressed in the CA1 area at 72 hours after the onset of seizure. CONCLUSION: These results mean that the area of prolonged expression of c-fos is vulnerable to apoptosis. Also it suggests that the patho-mechanism of ipsilateral hippocampus is an acute cytotoxic edema, whereas the contralateral damage is an apoptosis.
Animals ; Apoptosis ; Cell Death* ; Dentate Gyrus ; Edema ; Epilepsy, Temporal Lobe ; Hippocampus* ; Humans ; In Situ Nick-End Labeling ; Kainic Acid ; Models, Animal ; Neurons* ; Rats* ; Seizures* ; Status Epilepticus

No abstract available.
Angiography ; Catheters* ; Coronary Vessels* ; Spasm*

Rupture of the internal carotid artery (ICA) during endoscopic sinus surgery is a rare complication. However, it can potentially result in death within minutes. In the event of a traumatic injury to the ICA during sphenoid sinus exploration, it is very difficult to control the bleeding. We present a case of carotid-cavernous fistula after an accidentally-developed ICA bleed during endoscopic sphenoidotomy. The patient was successfully treated with endovascular embolization techniques that included detachable microcoils.
Carotid Artery, Internal* ; Carotid-Cavernous Sinus Fistula ; Fistula* ; Hemorrhage ; Humans ; Rupture ; Sphenoid Sinus

Nasal extranodal natural killer/T cell (NK/T cell) lymphoma is more common in East Asia than in the United States, comprising up to 7-10% of all non-Hodgkin's lymphoma. Early nasal symptoms are nonspecific and similar to chronic rhinosinusitis, such as nasal obstruction and nasal bleeding. With disease progression, inflammation and necrosis of the mucosa increase, hindering pathologic diagnosis. We experienced a case of nasal extranodal NK/T cell lymphoma in a 58-year-old woman who presented with recurrent periorbital swelling.
Cellulitis* ; Dacryocystitis* ; Diagnosis ; Disease Progression ; Epistaxis ; Far East ; Female ; Humans ; Inflammation ; Lymphoma* ; Lymphoma, Non-Hodgkin ; Middle Aged ; Mucous Membrane ; Nasal Obstruction ; Necrosis ; United States

Purpose: To investigate the efficacy and safety of radiofrequency ablation (RFA) for papillary thyroid microcarcinoma (PTMC) after > 10 years of follow-up. Materials and Methods: This study included five patients who underwent RFA to treat PTMCs (five lesions, mean diameter 0.5 cm, range 0.4–0.7 cm) between November 2006 and December 2009. The inclusion criteria were histopathologically confirmed PTMCs, a single PTMC lesion without extrathyroidal extension, no metastasis, and ineligibility or refusal to undergo surgery. RFA was performed by a single radiologist using a radiofrequency generator and an internally cooled electrode. We retrospectively analyzed the procedure-induced complications, serial changes in ablated tumors, recurrence, and local as well as lymph node metastasis based on data obtained from medical records and radiological images. Results: The mean follow-up period was 130.6 months (range 121–159 months). Three patients underwent a single RFA session, and two patients underwent two RFA sessions. We observed no procedure-induced complications. Three tumors completely disappeared after ablation, and ablation of the other two tumors resulted in the formation of a small scar that showed long-term stability (mean duration 16.8 months, range 12–27 months). At the last follow-up, no patient showed recurrence or lymph node metastasis, and serum thyroglobulin levels were within normal limits in all patients. Conclusion RFA may be effective and safe to treat low-risk PTMC in patients who refuse or are ineligible for surgery.

Schwannoma is slowly-growing, benign tumor that originates from the schwann cell and is rarely found in the external auditory canal (EAC). In this article, we describe a 30-year-old female patient with 12x7x4 mm EAC schwannoma located between the helical crura and tragus of the left ear. The schwannoma was easily removed by local excision. We discuss the differential diagnosis, clinical and histologic features, and treatment of EAC schwannoma.
Adult ; Diagnosis, Differential ; Ear ; Ear Canal* ; Female ; Humans ; Neurilemmoma*

Purpose: To investigate the efficacy and safety of radiofrequency ablation (RFA) for papillary thyroid microcarcinoma (PTMC) after > 10 years of follow-up. Materials and Methods: This study included five patients who underwent RFA to treat PTMCs (five lesions, mean diameter 0.5 cm, range 0.4–0.7 cm) between November 2006 and December 2009. The inclusion criteria were histopathologically confirmed PTMCs, a single PTMC lesion without extrathyroidal extension, no metastasis, and ineligibility or refusal to undergo surgery. RFA was performed by a single radiologist using a radiofrequency generator and an internally cooled electrode. We retrospectively analyzed the procedure-induced complications, serial changes in ablated tumors, recurrence, and local as well as lymph node metastasis based on data obtained from medical records and radiological images. Results: The mean follow-up period was 130.6 months (range 121–159 months). Three patients underwent a single RFA session, and two patients underwent two RFA sessions. We observed no procedure-induced complications. Three tumors completely disappeared after ablation, and ablation of the other two tumors resulted in the formation of a small scar that showed long-term stability (mean duration 16.8 months, range 12–27 months). At the last follow-up, no patient showed recurrence or lymph node metastasis, and serum thyroglobulin levels were within normal limits in all patients. Conclusion RFA may be effective and safe to treat low-risk PTMC in patients who refuse or are ineligible for surgery.