Pain from cancer is a major problem of managing the oral cancer patients in terminal stage. Overall, pain is reported by about 50% of patients at all stages of cancer and by over 70% with advanced neoplasms. Unrelieved pain can be incapaciting and preclude a satisfying quality of life. But, pain is often poorly assessed, and many clinicians lack sufficient knowledge to optimize cancer pain treatment. There are three basic approaches to the control of pain : modifying the source of pain, altering the central perception of pain, and blocking the transmission of pain to the central nervous system. The optimal use of these approaches and an individualized plan for pain control can maximize both quality and duration of life in dying patients. Opioid analgesics are are the mainstay of pharmacologic treatment. Practical opioid therapy include selection of both drug and route, dose titration, and management of side effects. We present our experienced pharmacologic treatment protocol for cancer pain management that collaborated by Dept. of Hospice, Catholic Medical Center. It will acts as a guideline for our colleague to facilitate the translation of current knowlegde into the clinical practice.
Analgesics, Opioid ; Central Nervous System ; Clinical Protocols ; Hospices ; Humans ; Mouth Neoplasms* ; Pain Management ; Quality of Life

It is interesting and in important to study histochemical changes of glucose-6-phosphatase (G-6-Pase) activity by electron microscopy in order to promote the knowledge needed for diagnosis and prognosis in such liver diseases as von Gierke's disease, hepatoma and various other hepatocellular alterations of different origins. Since we had not accomplished the electron microscopic demonstration of G-6-Pase, although light microscopic studies on changes of the enzyme activity were done in this laboratory, this investigation was planned to obtain a satisfactory technique for ultrastructural demonstration of the enzyme activity. Unfixed frozen sections (80 micro thick) of mouse liver were washed for 2~3 minutes in a 0.4M sucrose solution (pH6.8) containing 4 mM lead nitrate and then incubated for 15~20 minutes at 32~37 degrees C in several different media to which 0.4M sucrose solution was added: A) a modification of the original Chiquoine medium, B) the first modification of the Wachstein-Meisel medium C (the second modification; the 2% lead nitrate solution was reduced in amount to 1.5 m1 instead of 3.0 ml in the medium-B). After incubation, these sections were fixed in 1% osmic acid containing sucrose, followed by embedding in Epon, ultrathin-section, mounting and staining with uranyl acetate and/or lead nitrate. By incubating the sections in the medium (B or C), satisfactory preparations were obtainable for its electron microscopic demonstration. The granular deposits of reaction products were found characteristically on the membranous component of the rough-and smooth-surfaced endoplasmic reticulum and unclear envelope. Occasional deposits were observed within cisternae or vesicles, in the nucleus, and immediate1y adjacent to the cisternal membrane and glycogen areas.
Animal ; Glucose-6-Phosphatase/metabolism* ; Liver/enzymology* ; Liver/ultrastructure ; Male ; Mice ; Microscopy, Electron

Prednisolone, a cortisol analogue, was given intraperitoneally to rats with 5, 10 or 15 doses of 5 mg. per kg. of body weight per day. Sacrificing the animals 24 hours after the last injection, unfixed frozen sections from small pieces of liver tissue were incubated and stained by a modification from the method of Wachstein and Meisel(1965) for glucose-6-phosphatase (G-6-Pase) activity. Some of the tissue blocks were processed for staining with hematoxylin and eosin for histopathological observation. Glucose-6-phosphatase activity, being represented histochemically by brownish-black deposits, was progressively increased after administrations 5 or 10 times. With 15 doses of prednisolone the general histochemical picture of G-6-Pase activity appeared to be similar to that of the control group, except for a different distribution of hepatocytes possessing strong activity. In prednisolone treated rats, the swollen hepatocytes showed a marked, cytoplasmic vacuolization and nuclear pyknosis, particularly in the periportal and midzonal areas of hepatic lobules. Some discussion of the G-6-Pase corticosteroids are presented in terms of their metabolic effects.
Animal ; Glucose-6-Phosphatase/analysis* ; Liver/drug effects ; Liver/enzymology* ; Male ; Prednisolone/pharmacology* ; Rats

No abstract available.
Humans ; Inpatients*

No abstract available.

The purpose of this study was to evaluate the effect of high glucose on prostaglandin E2 production in human gingival fibroblasts and periodontal ligament cells in vitro. In control group, the cells(5x10(4) cells/ml) were cultured with Dulbecco's Modified Eagle's Medium contained with 10% fetal bovine serum, 45mg/dl glucose. In experimental groups, glucose was added to the above culture condition at the final glucose concentrations of 100mg/dl(Test group 1), 200mg/dl (Test group 2) and 400mg/dl(Test group 3). Then each group was tested for the cell proliferation rate, protein levels, and prostaglandin E2 production at 1/2, 1, 2, 5 days. The results were as follows ; 1. As glucose concentration increased, cell proliferation rate decreased significantly at 1, 2, 5 days in human gingival fibroblasts and periodontal ligament cells(P<0.01). 2. In human gingival fibroblasts, test group 2 and 3 showed significantly decreased protein levels as compared to control group at 5 days(P<0.01). 3. In human periodontal ligament cells, as glucose concentration increased, protein levels decreased significantly at 2 days and 5 days(P<0.01). 4. Prostaglandin E2 production in human gingival fibroblasts and human periodontal ligament cells significantly increased as glucose concentration increased(P<0.01). The results at 5 days showed obvious difference as compared to those at 2 days. From the above results, high glucose appeared to affect cellular activities including cell proliferation rate, protein levels and enhance prostaglandin E2 production. It was assumed that prostaglandin E2 production by high glucose enhances inflammatory reaction and has a toxic effect on human gingival fibroblasts and human periodontal ligament cells. This study suggests that periodontal disease in diabetic patient is related to prostaglandin E2 production.
Cell Proliferation ; Dinoprostone* ; Fibroblasts* ; Glucose* ; Humans* ; Periodontal Diseases ; Periodontal Ligament*

About one tenth of all CNS neoplasms involves the brain. Due to their location in the ventricles they often present similar nonspecific clinical manifestation. Localization and differential diagnosis are dependent on radiological investigation. For the identification of specific CT characteristics of the intraventricular tumors and the differental diagnosis, we retrospectively analyzed 22 pathologically proved cases seen on CT. Important differential features included age and sex of the patient, the location within the ventricle, and the morpholgic appearance of the mass and density on CT before and after intravenous administration of contrast material. Meningiomas (4 cases) and a germinoma showed increased density on the precontrast CT scans, and demonstrated dense uniform enhancement of the postenhanced scan. Choroid plexus papillomas (3 cases) showed dense uniform contrast enhancement. Intraventricular neurocytomas (3 cases) demonstrated characteristic attachment to the septum pellucidum, confinement of the lateral and third ventricle, and calcification within the mass Colloid cysts (2 cases) showed characteristic location of anterosuperior aspect of the third ventricle. In conclusion, CT findings of intraventricular tumors are usually nonspecific. The location of the mass and the patient's age are the most helpful information in the differential diagnosis.
Administration, Intravenous ; Brain ; Colloid Cysts ; Diagnosis ; Diagnosis, Differential ; Germinoma ; Humans ; Meningioma ; Neurocytoma ; Papilloma, Choroid Plexus ; Retrospective Studies ; Septum Pellucidum ; Third Ventricle ; Tomography, X-Ray Computed

BACKGROUND & PURPOSE: The ocular torsion (OT) and tilt of the subjective visual vertical (SVV) are sensitive brainstem signs and helps us to localize lesion. We calibrated the degree of OT, SVV tilt and head tilt to investigate their characteristics and temporal profiles in patients with brainstem lesion. METHODS: We selected 15 patients with acute brainstem stroke. We took serial fundus photographs and body pictures in upright position at various times after the stroke. We also determined the deviations of patient's SVV. The data measurement for this investigation ranged from day 2 to day 47. RESULTS: Eight of ten patients with lateral medullay infarction showed ipsiversive tilt of SVV and OT. Among four patients with pontine infarction, one showed ipsiversive tilt and three contraversive. One patient with midbrain hemorrhage showed cotraversive tilt. The resolution of OT and the tilt of SVV in medullary lesions occurred over the periods ranging from 7 days to more than 47 days and was slower in patients with upper brainstem lesion than lower brainstem lesion. The directions of head tilt in our patients, especially with medullary lesions, were rather different from the previous reports. CONCLUSION: The vestibular dysfunction by the brainstem lesions disturbs the eye and head stabilization and also distorts the perception of the subjective vertical in space. The direction of OT and the tilt of SVV is ipsiversive in lower brainstem lesion and contraversive in upper brainstem lesion. But head tilt is contraversive in most lower brainstem lesion as well as upper brainstem lesion. Large-grouped study for the direction of head tilt is thought to be needed. These signs are compensated in the course of clinical recovery.
Brain Stem Infarctions* ; Brain Stem* ; Head* ; Hemorrhage ; Humans ; Infarction ; Mesencephalon ; Stroke

In the microsurgical dissection of the lateral wall of the cavernous sinus, interrelationships of its nerves have been studied in 100 Korean adult half heads. And in the serial coronal section of the cavernous sinus in 10 half heads, the structures of the lateral wall have been studied. The relationships of the nerves of the lateral wall were classified to five types according to the course of the trochlear nerve. Each length of the Parkinson's triangle and the angle between trochlear and ophthalmic nerves were measured. There data were compared with those of the other races. The lateral wall of the sinus was composed of two layers. The orientation of the fibers of the deep layer was variable in regions. The oculomotor nerve was enveloped with sheath extended from dura mater and it was connected with deep layer of the lateral wall. The trochlear nerve was enveloped with sheath formed y division of innermost part of the deep layer. The venous sinus was found between the two layers of the lateral wall. The neurosurgical significance of the lateral wall of the sinus was discussed.
Adult ; Cavernous Sinus* ; Continental Population Groups ; Dura Mater ; Head ; Humans ; Oculomotor Nerve ; Ophthalmic Nerve ; Trochlear Nerve

PURPOSE: To evaluate the effectiveness and safety of primary intravitreal ranibizumab injection as a treatment for retinopathy of prematurity. METHODS: Retrospective analysis of the medical records of patients diagnosed with retinopathy of prematurity and treated with intravitreal ranibizumab injection from January 1, 2013 to January 1, 2016 was performed. We complied with the standards for ‘prethresold, type 1’ established by the Early Treatment of Retinopathy of Prematurity study for intravitreal ranibizumab injection. The follow-up period after injection was at least 9 months. Patients who received additional treatment such as laser photocoagulation or intravitreal injection without reactivation of retinopathy of prematurity were excluded. RESULTS: A total of 21 patients (39 eyes) were included in this study. Nine (16 eyes) were male and 12 (23 eyes) were female. The average duration between treatment decision and intravitreal ranibizumab injection was 2.1 ± 1.5 days. Complete regression of the plus sign occurred 18.2 ± 9.1days after injection. One eye with reactivation was treated with panretinal laser photocoagulation while four other eyes with reactivation were treated with intravitreal bevacizumab injection. There were 87.1% (34/39) eyes that underwent primary intravitreal ranibizumab injection with stable results without any reactivation. There were no systemic complications related to intravitreal ranibizumab injection. CONCLUSIONS: Primary intravitreal ranibizumab injection as a treatment for retinopathy of prematurity showed good efficacy and safety. However, thorough evaluation is needed after primary intravitreal ranibizumab injection due to the potential for reactivation. Long-term monitoring is needed after intravitreal ranibizumab injection.
Bevacizumab ; Female ; Follow-Up Studies ; Humans ; Intravitreal Injections ; Light Coagulation ; Male ; Medical Records ; Ranibizumab* ; Retinopathy of Prematurity* ; Retrospective Studies