PURPOSE: Malignant disease of the anus is rare. Abdominoperineal resection was formerly considered to be the treatment of choice. But, in recent, less ablative and more effective combined therapeutic modalities have been developed. METHODS: we analyzed 33 patients who were diagnosed and treated as anal cancers at the Department of Surgery, Gospel Hospital, Kosin Medical Collage, from July 1, 1988 to Nov. 30, 1997. RESULTS: The ratio of male to female was 1.4:1 and mean age was 56.7 years old. Twenty-two (84.8%) of these cancers were located in the anal canal and 5 (15.2%) in the anal margin. Three main histologic types of the anal cancers were identified: squamous cell carcinoma was the most common lesion, accounted for 17 cases (51.1%), adenocarcinoma accounted for 8 cases (24.2%), malignant melanoma accounted for 8 cases (24.2%). The overall 3-year survival rate and 5-year survival rate of anal cancer were 54.1%, 41.7%. Eleven patients with squamous cell carcinoma were treated curatively: 6 patients were treated with chemoradiotherapy, 3 patients with abdominoperineal resection, one patient with chemoradiotherapy and abdominoperineal resection, one patient with local excision. CONCLUSION: In survival rate, there were no significant differences between chemoradiotherapy group and surgical treatment group. In squamous cell carcinomas, chemoradiotherapy had anal sparing benefit without loss of survival. On univariate analysis, T, N, type of treatment, histologic type had no statistical significances on survival. On multivariate analysis, location of lesion and distant metastasis had statistical significances.
Adenocarcinoma ; Anal Canal ; Anus Neoplasms* ; Carcinoma, Squamous Cell ; Chemoradiotherapy ; Female ; Humans ; Male ; Melanoma ; Multivariate Analysis ; Neoplasm Metastasis ; Survival Rate

No abstract available.
Rhytidoplasty*

No abstract available.
Durapatite* ; Forehead*

No abstract available.
Fascia* ; Foot* ; Free Tissue Flaps* ; Hand* ; Rabeprazole*

No abstract available.
Arm* ; Arthrodesis* ; Contracture* ; Free Tissue Flaps*

Since adult human skin can be grown in chernically defined medium without serum, the skin organ culture has gained a great interest as a method for studies concerning skin biology, pharmacology and toxicology. however, serum supplementation has extensively been used to improve the viahility of tissue culture. This study was undertaken to evaluate the effect of serum on the histologic changes ohserved during the organ culture of the normal human skin. The general architecture of the skin was well maintained for 6 days with or without seru. After then, fetal calf serum or autologous human serum was found to enhance the viability of the epidermis. A confluent layer of necrotic spinous ceils was ovserved earlier and more widespread without serum. The addition of serum had an impressive effect on epibolization. In the absenee of serum, the formation of the epibolus was not only minimal, but also, susceptible to degeneration, and no epibolus remained at 10 days rif incubation. No difference can be found between fetal calf serm and autologous human serum in the formation of the epibolus. There was no favorable effect of serum on the formation of new stratum corneum. The thickness of new straturn corneum increased in parallel with the number of parakeratatic cells, increasing most rapidly between 6 and 8 days of incubation. Parakeratosis was more prominent in the presence of serurn.
Adult ; Biology ; Epidermis ; Humans* ; Organ Culture Techniques* ; Parakeratosis ; Pharmacology ; Selective Estrogen Receptor Modulators ; Skin* ; Toxicology

No abstract available.
Child* ; Humans ; Subclavian Artery*

BACKGROUND: Epidural anesthesia is becoming an increasingly important aspect of anaesthetic practice because it has many advantages. To achieve the appropriate sedation, various methods have been described. The authors applied the ketamine for this purpose in subanesthetic dose and compared with the midazolam that has been most commonly used for intravenous sedation. METHODS: Fifty-seven adult patients undergoing lower abdominal and extremity surgery who were receiving epidural anesthesia were randomely enrolled into this clinical study. They were allocated to three groups to receive only normal saline (group C), midazolam 0.05 mg/kg (group M) and ketamine 0.5 mg/kg midazolam 0.05 mg/kg (group K) in normal saline 10ml, respectively. Hemodynamic and respiratory measurements were recorded at baseline, 1 minute, 3 minute, 5 minute, 10 minute, 20 minute and 30 minute after sedation. The degree of sedation was assessed by a blinded observer using sedation score. RESULTS: There were no significant differences for hemodynamic and respiratory parameters, but decrements of arterial pressure at 1 minute after sedation were most remarkable in the group M. Sedation was satisfactorily achieved by combination of ketamine and midazolam without significant emergence reaction. CONCLUSIONS: The combination of ketamine and midazolam was judged to be suitable alternative for sedation during epidural anesthesia.
Adult ; Anesthesia, Epidural* ; Arterial Pressure ; Extremities ; Hemodynamics ; Humans ; Ketamine* ; Midazolam*

No abstract available.
Cytomegalovirus* ; DNA* ; Humans* ; Polymerase Chain Reaction*

BACKGROUND: This study aimed to evaluate the abilities of transcranial magnetic stimulations(TMS) and electrical stimulations(ES) in predicting clinical recovery in patients with Bell's palsy and to contribute to the understanding of the relations observed between the clinical and electrophysiological time courses of the disease. METHOD: We serially studied 22 patients(9 males, mean age 42) with Bell's palsy. Facial nerve function was graded according to the House-Brackmann grading system. RESULTS: A side-to-side comparison(amplitude ratio) of the amplitude of evoked responses between the initial and follow up studies showed a significant change except for the TMS on the stylomastoid foramen. With the TMS over the parieto-occipital area, the absence of a compound muscle action potential(CMAP) was observed in 19 patients during the early course of the disease. The reappearance(n=14) of evoked muscle potentials after an initial absence was observed in 14 patients with satisfactory recoveries at the last follow-up study. The amplitude ratio of ES and TMS during the early course of the disease correlated with the clinical outcome. CONCLUSIONS: Our findings indicate that TMS and ES can provide an early prediction for the outcome of the palsy. The presence of CMAP at the acute phase or the reappearance of CMAP after an initial absence with TMS suggests a rather good prognosis. Both TMS and ES were found to be useful methods for the assessment of facial palsy and as early predictors for the outcome in patients with Bell's palsy. Serial neurophysiologic studies were also important for evaluation of the prognosis of facial palsy.
Bell Palsy* ; Electric Stimulation ; Facial Nerve ; Facial Paralysis ; Follow-Up Studies ; Humans ; Male ; Paralysis ; Prognosis* ; Transcranial Magnetic Stimulation