Pain is the most persistent and incapacitating symptom of recurrent or metastatic cancer. About 60~90% of patients with metastatic cancer have pain long before the terminal stage of their illness. According to a recent report, in Korea, the proportion of cancer patients who have pain is 52.1% and 62.6% of them are not given adequate analgesia. Despite widespread knowledge about many aspects of pain relief and the availability of appropriate opioid analgesics, inadequate pain management in cancer patients remains pervasive. The reasons can be classified into three categories ; societal barriers, knowledge deficits, and influenced of governmental regulations. Cancer pain can be effectively treated in 85 to 95% of patients with an integrated program of systemic, pharmacologic, and anticancer therapy. However, pain relief in cancer patients remains inadequate because it is not given priority and there is a lack of education and inappropriate understanding of the nature of cancer pain. To overcome these barriers, professional education needs to be focused on the proper assessment of pain, the management of side effects, and the use of adjuvant medications. A better understanding of the pharmacology of opioid analgesics is also needed. In addition, physicians should educate patients to report pain and to take the medications prescribed for pain management effectively.
Analgesia ; Analgesics, Opioid ; Education ; Education, Professional ; Humans ; Korea ; Pain Management ; Pharmacology ; Social Control, Formal

Hemodialysis using Kiil type artificial kidney was performed on two cases of acute renal failure and a case of chronic renal failure and the following results were obtained: 1. A case of acute renal failure recovered from her deteriorated renal function following four consecutive hemodialyses and another following a single hemodialysis of six hours. 2. A case of chronic renal failure is now stabilized clinically and maintained on ambulatory intermittent long-term hemodialysis.
Acute Kidney Injury ; Kidney Failure, Chronic ; Kidneys, Artificial* ; Renal Dialysis* ; Renal Insufficiency*

Cancers of the stomach rank first in cancer deaths in Korea with a high fatality rate. As for the adjuvant treatment of gastric cancer, a meta-analysis of adjuvant chemotherapy trials suggested a limited survival benefit for adjuvant chemotherapy compared with surgery alone. Most of the trials used combination chemotherapy, usually based on fluorouracil or cisplatin. Although the large intergroup trial 116, comparing surgery alone to surgery followed by postoperative fluorouracil, leucovorin, and radiotherapy, indicated a significant survival benefit for postoperative chemoradiotherapy, inadequate surgical resection of regional lymphnodes was an important issue of this trial. Future trials should address the extensive lymphnode dissection, the inclusion of newer chemotherapeutic agents, the use of preoperative chemotherapy, and the use of intraperitoneal therapy. Randomized trials are mandatory for the establishment of a satisfactory strategy.
Chemoradiotherapy ; Chemotherapy, Adjuvant* ; Cisplatin ; Drug Therapy ; Drug Therapy, Combination ; Fluorouracil ; Korea ; Leucovorin ; Radiotherapy ; Stomach ; Stomach Neoplasms*

This article presents a description of the ultrasonographic and computed tomographic findings with a discussion on the imaging features in three patients with epigastric hernias, simulating abdominal wall lipomas. Ultrasonogram showed a heterogeneous hypoechoic mass encircled by echogenic rim within subcutaneous space of the abdominal wall. Computed tomographic findings were a localized fatty mass surrounded by a thin capsule in as sociation with a focal discontinuity of the linea alba. Ultrasonogram was not diagnostic, but computed tomogram was suggestive because of the well demonstrated focal defect in linea alba.
Abdominal Wall ; Hernia* ; Humans ; Lipoma ; Ultrasonography*

The incidence of giant condyloma acuminata of the penis is extremely rare. Although they are considered clinically malignant, the real possibility of malignant changes from them are controversial even among the investigators but cannot be entirely overlooked. Therefore, attention must be focused on this fact, in our conclusion. Two cases of malignancy of the penis which have apparently been transformed from giant condyloma acuminata of the penis are herein presented with review of related literatures. Case I: Sixty nine year old male patient complained of a fungating mass on the sulcus coronaris of the penis with ulceration and bleeding from the mass. Biopsy confirmed giant condyloma acuminata and subsequently circumcision and electrocoagulation were performed. Pathological specimen taken after 4 months because of the recurrence of the mass on the same region showed squamous cell carcinoma of the penis and amputation of penis was performed. Case II: Sixty eight old male patient complained of a growing mass and pain on glans penis. This patient also underwent circumcision and electrocoagulation according to the biopsy finding of giant condyloma acuminata. But 1 year later with recurrence of the mass on the same region, the pathological finding revealed squamous cell carcinoma of penis.
Amputation ; Biopsy ; Carcinoma, Squamous Cell ; Circumcision, Male ; Electrocoagulation ; Female ; Hemorrhage ; Humans ; Incidence ; Male ; Penile Neoplasms ; Penis ; Recurrence ; Research Personnel ; Ulcer

BACKGROUND: Current studies on multimodal strategy for N2 non-small cell lung cancer are being high interest have drawn much attention. N2 lung cancer, however, is composed of is divided into several subgroups with that have different prognoses. The prognostic factors still ramain controversial. METHODS: Between January 1990 and June 1999, 180 patients with N2 lung cancer who underwent surgical resection were investigated, excluding 10 of these for surgical mortality. All patients underwent mediastinal lymph node dissection. 20 clinicopathologic factors were investigated by univariable and multivariable analyses to identify significant prognostic factors among resected N2 disease. RESULTS: The overall 5-year survival rate was 20.6%. Multivariable analyses among overall patients revealed 3 significant prognostic factors:Age, Histologic type, Vascular invasion. Based on the result, 49 patients with both age more than 60 and pathologic Non-squamous cell showed a 5-year survival of 5.0%, whereas 37 patients with neither of the factors showed a 5-year survival of 56.6%(p<0.001). And 12 patients with both vascular invasion and pathologic Non-squamous cell showed a 5-year survival of 11.9%, whereas 67 patients with neither of the factors showed a 5-year survival of 33.6%(p=0.01). CONCLUSION: The prognosis of surgically resected N2 disease varies according to the 2 significant prognosis factors. Tumor size may be an additional influencing factor in the prognosis of N2 disease.
Carcinoma, Non-Small-Cell Lung ; Humans ; Lung Neoplasms ; Lung* ; Lymph Node Excision ; Lymph Nodes* ; Mortality ; Neoplasm Metastasis* ; Prognosis ; Survival Rate

No abstract available.
Rheumatoid Nodule* ; Scalp*

BACKGROUND: Dermatophytosis is sometimes difficult to diagnose deinitively if it has atypical clinical characteristics and mycological tests are negative. Histopathologic findings may be different depending upon the location and causative dermatophytes. OBJECTIVE: The purpose of the present study was to evaluate histopathologic characteristics nf dermatophytosis depending upon the areas of involvement. METHODS: We evaluated the clinical and histopathologic features of 32 cases of dermatophytosis which were diagnosed by skin biopsies at the Dermatology Department of branch hospitals of Catholic University Medical College from March 1985 to August, 1994. Histopathologic features were observed in three dilferent groups divided by location, area of terminal hair, areas of vellus hair and hairless areas. RESULTS: Epidermal changes including hyperkeratosis, parakeratos, acanthosis, spongiosis and neutrophilic exocytosis were frecuently observed in the three groups of Iermatophytosis. In 7 cases of tinea capitis and linea barbae, follicular and inflamma or changes of the deep dermis were important. Hyphae and spores were observed in 71%(5 cases) and 57%(4 cases) respectively, in the follicles. In 19 cases of tinea faciale, tiriea corporis and tinea cruris, change epidermis and superficial dermis as well as findings of follicular infundibulum were important. Herphae were observed in 84%(16 cases) and 53%(10 cases) in the stratum corneum and vellus hir follicle respectively, and in 3 cases the hyphae were observed only in the vellus hair follicle. Sandwich sign, known to be important clue of dermaliophytosis, was observed in only 5%(1 cacse, In 6 cases of tinea manus and linea pedis, hyphae and spores were rebserved in 100% (6 cases) and 33%(2 cases) respectively, in the stratum corneum. CONCLUSION: We consider tha histopathologic observations may of great help to diagnose some difficult cases of dermatophytosis and the presence of hyphae n .he vellus hair follicle may be a more frequent and important finding than the sandwich sign the dermatophytosis of the vellus hairy regions.
Arthrodermataceae ; Biopsy ; Dermatology ; Dermis ; Epidermis ; Exocytosis ; Hair ; Hair Follicle ; Hospitals, Satellite ; Hyphae ; Neutrophils ; Skin ; Spores ; Tinea Capitis ; Tinea*

With the continuous development of diagnostic techniques of precancerous lesion and an improved patient-transfer system, it is unusual to examine patients who have a life-threating malignant skin lesion. However it is still a problem in some far-advanced inoperable skin tumors which have been neglected and have become aggravated, Another problem in oncologic surgery is previous irradiation around a lesion. The only effective way to treat these lesions is to excise widely and cover with an appropriate free flap. But in such conditions, selection of recipient vessel is not easy. Many surgeons have used vein graft as the conduit from a distant non-radiated vessel to the free flap. This technique requires a long segment of vein for anastomosing both the artery and vein. We used intra-lesional vessels as the recipient vessel of the free flap, which were suspiciously damaged by irradiation and malignant cell infiltration. The guidelines include: 1) malignancy-infiltrated vessels are to be dissected until a clear field is obtained under a frozen section 2) irradiated vessel can be used only if active spurting is present without intraluminal thrombosis. All of our case obtained satisfactory results in all cases except one of irradiated squamous cell carcinoma at inguinal area whose gracilis myocutaneous free flap loss was in 10%. But even this case, the cause of partial loss of the flap may not be due to a vascular problem but an internal failure of the flap. We concluded, that carefully selected intra-lesional vessels, although they may be damaged by irradiation or malignant cell infiltration can be used as the recipient vessels of free flaps.
Arteries ; Carcinoma, Squamous Cell ; Free Tissue Flaps* ; Frozen Sections ; Humans ; Skin ; Thrombosis ; Transplants ; Veins

We report a case of mycosis fungoides with small follicular papules and plaques on the trunk. Histopathological findings showed lymphocytic infiltration within and around the follicular epithelium and Pautrier's microabscess in the epidermis. Immunohistochemical studies showed atypical T lymphocytes infiltrating the follicles and electron microscopic examination revealed the presence of lymphocytes with large convoluted nuclei around the follicles. These findings suggest that the follicular lesions were specific for a special variant of mycosis fungoides.
Epidermis ; Epithelium ; Lymphocytes ; Mycosis Fungoides* ; T-Lymphocytes