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

Aspiration of gastric content is always a threat in emergency operations. The consequences of pulmonary aspiration are connected with both the volume and the character of the material inhaled, but perhaps the most serious consequences result from the relative acidity of gastric secretions. Inhalation of materiaI with a pH less than 2.5 causes an immediate iatense bronchoconstriction, epithelial degeneration of the bronchi, pulmonary edema and hemorrhage. Once the aspiration of material from the stomach is thought to have occurred, the airway should be cleared as soon as possible and any aspirated material remaining in the oropharynx should be cleared by means of suction. This experimental study was carried out to assess the therapeutic effect of suction on pulmonary aspiration of hydrochloric acid and the changes in chest X-ray findings caused by aspiration of the acid. The condition of oxygenation of the animals were studied by blood gas analysis. In this experiment,24 rabbits weighing 1.8-2.2 kg were used and divided into 4 groups each group consisting of 6 rabbits. Group I: No suction after aspiration Group II: Immediate suction after aspiration Group III: Suction 5 seconds after aspiration Group IV: Suction 10 secoads after aspiration Each of the four groups in the state prior to aspiration served as a control. All experimental animals were anesthetized by intravenous injection of ketamine 75 mg/kg and HC1 (pH: l.0, 2 ml/kg) was instilled into the trachea through a tracheostomy tube while the animals were fixed in a head-up position. Suction was made 5 times vigorously through a tracheostomy tube using an electric suction apparatus in the suction groups. Spontaneous respiration was maintained in room air throughout the experiment. To see cehange in the findings of the lung, chest X-ray was taken 24 hours after the aspiration of HCL. The sample of arterial blood was taken from the femoral artery and analyzed for blood gas 5 minutes, 10 minutes, 30 minutes, 1 hour and 2 hours after the aspiration of HCl. The results were as follows:1) In all rabbits except one in group II, the findings of radioopacity was visible in the lungs 24 hours after the aspiration of HCL. 2) In the chest X-ray findings, group I revealed radioopacity in the area of 74.76+/-8.93% of the whole lung field, group II in the area of 9.13+/-5.84%, group III in the area of 40.67+/-15.89% and group IV in the area of 58.96+/-6.65%. 3) In blood gas analysis, PaO2 decreased to 52.2% of control at 5 minutes in all aspiration groups (P<0.01) and 2 hours later, the recovery of PaO2 values observed were 73.2% of the control in group I, 88.7% in group II, 82.7% in group II and 77.1% in group IV, The value of the PaCO2, was significantly decreased at 10 minutes, 30 minutes, 1 hour and 2 hours in group II(P<0.01) after aspiration but in the other groups, the changes were insignificant. The value of pH shown insignificant decrease in group I and group IV, and insignificant increase in group II and group III. From the above findings, the pulmonary changes after the aspiration of hydrochloric acid seemed not to be lessened by suction treatment after 10 seconds following aspiration of the acid.
Animals ; Blood Gas Analysis ; Bronchi ; Bronchoconstriction ; Emergencies ; Femoral Artery ; Hemorrhage ; Hydrochloric Acid ; Hydrogen-Ion Concentration ; Inhalation ; Injections, Intravenous ; Ketamine ; Lung ; Oropharynx ; Oxygen ; Pulmonary Edema ; Rabbits* ; Respiration ; Stomach ; Suction* ; Thorax ; Trachea ; Tracheostomy

There are various etilogic factors concerned in the formation of pulmonary edema but it is rare that pulmonary edema is elicited as a consequence of direct current shock. The cause of this complication is unknown. The mechanism of pulmonary edema is suspected that acute alteration or disparities in atrial or ventricular mechanical function of the heart consequent to the application of electrical discharge precipitate pulmonary congestion. A case of acute pulmonary edema following the use of direct current shock during anesthesia for mitral commissurotomy was experienced. The patient was treated with oxygen, diuretics, steroid, continuous positive pressure ventilation and partial cardiopulmonary bypass. The patient recovered without further event.
Anesthesia ; Cardiopulmonary Bypass ; Diuretics ; Estrogens, Conjugated (USP) ; Heart ; Humans ; Oxygen ; Positive-Pressure Respiration ; Pulmonary Edema* ; Shock* ; Thoracic Surgery*

With the goal of providing optimal care to patients, student-centered active learning and the development of clinical competency have become vital components of the education of future physicians capable of sustainably coping with future challenges. However, the shape of future medicine is dramatically changing based on advances in information and communication technology, and the current classroom model seems to have difficulties in fully preparing students for the future of medicine. New trends in teaching and assessment methods include computer-aided instruction, virtual patients, augmented reality, human patient simulations, and virtual reality for the assessment of students’ competency. The digital technologies introduced in medical and dental education include Google Forms to collect students’ answers, YouTube livestreaming, Google Art & Culture (an online art museum), and choose-your-own-adventure as a story-telling technique. Innovations in digital technology will lead the way toward a revolution in medical and dental education, allowing learning to be individualized, interactive, and efficient.

With the goal of providing optimal care to patients, student-centered active learning and the development of clinical competency have become vital components of the education of future physicians capable of sustainably coping with future challenges. However, the shape of future medicine is dramatically changing based on advances in information and communication technology, and the current classroom model seems to have difficulties in fully preparing students for the future of medicine. New trends in teaching and assessment methods include computer-aided instruction, virtual patients, augmented reality, human patient simulations, and virtual reality for the assessment of students’ competency. The digital technologies introduced in medical and dental education include Google Forms to collect students’ answers, YouTube livestreaming, Google Art & Culture (an online art museum), and choose-your-own-adventure as a story-telling technique. Innovations in digital technology will lead the way toward a revolution in medical and dental education, allowing learning to be individualized, interactive, and efficient.

The Alcyon Co-60 gamma rays was studied for electron contamination. The surface dose, attributable almost entirely to contamination electrons, has a linear dependence on field width for square fields and an inverse square dependence on distance from the bottom of the fixed head assembly. Build-up and surface dose measurements were taken with and without an acrylic blocking tray in place. Further measurements were made with a copper filter designed to reduce secondary electrons emitted by photon interactions with the acrylic tray. The results are discussed in relation to skin sparing effect for radiation therapy patients. And to achieve the maximum skin sparing effect, the selection of the optimum SSD and TSD is needed.
Copper ; Gamma Rays* ; Head ; Humans ; Silver Sulfadiazine ; Skin

Lymphadenopathy is a relatively uncommon finding of minimally differentiated acute myelogenous leukemia (AML-MO). We experienced a case of AML-MO in a 57-year-old man initially presented with multiple cervical lymphadenopathy. Bone marrow aspiration revealed myeloblasts, which were negative for myeloperoxidase, Sudan black B, Periodic acid-Schiff, non-specific esterase and double esterase reaction. In cell surface marker studies, CD13, CD14, CD33, CD34, CD45 and HLA-DR were present. CT scan of neck demonstrated multiple lymphadenopathy at both internal jugular chains, spinal accessory chains and submandibular area. He died about two weeks after diagnosis without specific treatment.
Case Report ; Fatal Outcome ; Human ; Leukemia, Myelocytic, Acute/*complications/pathology ; Lymphatic Diseases/*complications/pathology ; Male ; Middle Age ; Neck ; Tomography Scanners, X-Ray Computed

No abstract available.
Bile Ducts, Extrahepatic* ; Carcinoma, Hepatocellular*

PURPOSE: Anatomy and morphology of superficial veins vary from patient to patient. Thorough assessment of variations is mandatory for successful treatment of primary varicose vein. Alos in complex case clinical examination alone is unable to achieve diagnostic goals. Duplex scan is a highly accurate, noninvasive technique that can provide both anatomic and physiologic information. METHODS: Thirty-eight legs in 30 patients with primary varicose veins were examined clinically first then with portable doppler. Patients then underwent duplex scanning by surgical team and results of tests were compared with other clinical examinations. RESULTS: On duplex scanning, 25 legs (66%) had saphenofemoral junction (SFJ) incompetence, 9 legs (24%) had saphenopopliteal junction (SPJ) incompetence and 4 legs (10%) had perforator incompetence. The respective sensitivity of clinical examination with portable doppler in SFJ, SPJ was 91.6%, 81.8%. CONCLUSION: Clinical and doppler assessment was unreliable. Routine preoperative duplex scanning is likely to reduce recurrence by identifying sites of reflux with greater accuracy.
Humans ; Leg ; Recurrence ; Varicose Veins* ; Veins

BACKGROUND: This study was designed to test the hypothesis that a combined femoral and politeal sciatic nerve blocks (FPSNB) would have excellent clinical properties and better patient satisfaction than epidural anesthesia for the great saphenous veins stripping (GSVS) surgery with multiple stab avulsion (MSA). METHODS: Sixty patients were allocated into two groups. The epidural group received epidural anesthesia with 15 ml of 0.75% ropivacaine (n = 30), and the FPSNB group received a combined FPSNB with 25 ml of 1.5% mepivacaine with a nerve stimulator (n = 30). We assessed the anesthetic and postoperative records. A questionnaire-based study including patient satisfaction for anesthetic techniques (100 point scale) was conducted 3 days postoperatively by a blinded observer. RESULTS: The time from initial injection to the start of surgery and the duration of sensory blockade were not different between groups (P > 0.05). The percentage of patients with anesthesia-related complications in epidural anesthesia was 33.3%, 46.6%, 23.3% and 20% for shivering, hypotension, bradycardia and postoperative voiding difficulty, respectively. FPSNB did not produce these complications. Additional analgesia with 50-100 microgram of fentanyl was more frequently used in FPSNB (60% vs 6.7%, FPSNB vs Epidural group, P < 0.01), but patient satisfaction of FPSNB was higher than epidural anesthesia (88.1 +/- 13.2 vs 76.5 +/- 15.8, FPSNB vs Epidural group, P < 0.01). CONCLUSIONS: A combined FPSNB with a small amount of narcotics is an adequate anesthetic technique for unilateral GSVS surgery with MSA.
Amides ; Analgesia ; Anesthesia, Epidural ; Bradycardia ; Fentanyl ; Humans ; Hypotension ; Mepivacaine ; Narcotics ; Nerve Block ; Patient Satisfaction ; Saphenous Vein ; Sciatic Nerve ; Shivering