No abstract available.
Embryonic Structures* ; Extremities*

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

PURPOSE: Pouch dilatation and band slippage are the most common long-term complications after laparoscopic adjustable gastric banding (LAGB). The aim of the study is to present our experience of diagnosis and management of these complications. MATERIALS AND METHODS: The pars flaccida technique with anterior fixation of the fundus was routinely used. All band adjustments were performed under fluoroscopy. We analyzed the incidence, clinico-radiologic features, management, and revisional surgeries for treatment of these complications. We further presented the outcome of gastric plication techniques as a measure for prevention of these complications. RESULTS: From March 2009 to March 2012, we performed LAGB on 126 morbidly obese patients. Among them, 14 patients (11.1%) were diagnosed as having these complications. Four patients (3.2%) had concentric pouch dilatations, which were corrected by band adjustment. Ten (7.9%) had eccentric pouch with band slippage. Among the ten patients, there were three cases of posterior slippage, which were corrected by reoperation, and seven cases of eccentric pouch dilatation with anterior slippage. Three were early anterior slippage, which was managed conservatively. Two were acute anterior slippage, one of whom underwent a revision. There were two cases of chronic anterior slippage, one of whom underwent a revision. The 27 patients who underwent gastric plication did not present with eccentric pouch with band slippage during the follow-up period. CONCLUSION: The incidence of pouch dilatation with/without band slippage was 11.1%. Management should be individualized according to clinico-radiologic patterns. Gastric plication below the band might prevent these complications.
Adult ; Female ; Gastroplasty/adverse effects/*methods ; Humans ; Laparoscopy ; Male ; Middle Aged ; Obesity, Morbid/*surgery ; Postoperative Complications ; Treatment Outcome

PURPOSE: The objective of this study was to survey potential candidates for bariatric/metabolic surgery for procedure preferences. METHODS: Questions asked were divided into 5 categories: (1) demographic and anthropometric data, comorbidities, and favored surgery; (2) awareness of safety, effectiveness, and complications of each type of surgery; (3) discordances in opinion between self-selected and medically recommended procedures; and (4, 5) reasons for/against particular surgery. RESULTS: From 1 October to 15 November 2018, 104 respondents adequately responded and were included in the analysis. The number (%) of female respondents was 79 (76.0%). The number (%) of respondents by decade was 17 (16.3%) in their 20s, 65 (62.5%) in their 30s, 19 (18.3%) in their 40s, and 3 (2.9%) in their 60s, respectively. Mean body mass index was 37.1 ± 6.3 kg/m2. Comorbidities were type 2 diabetes in 34 (32.7%) and hypertension in 35 (33.7%). The most favored procedure was sleeve gastrectomy (SG) in 78 (75.0%), adjustable gastric band (AGB) surgery in 12 (11.5%), Roux-en-Y gastric bypass (RYGB) in 6 (5.8%), and gastric plication (GP) in 8 (7.7%). Major reasons for choosing procedures were; “adjustable” for AGB, “stomach sparing” for GP, “excellent weight loss” for SG, and “comorbidity resolution” in RYGB. CONCLUSION Candidates for bariatric/metabolic surgery favored SG followed by AGB, GP, and RYGB, and their choices were compatible with current evidence-based clinical practice.

Microsurgical clipping is considered the treatment of choice for ruptured intracranial aneurysms. However, ruptured posterior circulation aneurysms remain technically difficult to expose or clip and outcomes in these cases are poorer than those seen in cases of anterior circulation aneurysms. Therefore, endovascular treatment becomes another treatment option in cases of ruptured posterior circulation aneurysms. But, the vertebral artery may not be selected due to luminal narrowing, which are atherosclerotic stenosis clinically, congenital anomalies, or acquired kinking, and structural problem of angle between aorta, subclavian artery and vertebral artery. In these cases, other approaches can be used through, for example, subclavian, axillary, or brachial artery approach. But sometimes such prcedures may be also inappropriate. One other approach is direct percutaneous vertebral artery approach. Though this one also doesn't overcome many clinical and anatomical problems. The authors present two cases of ruptured basilar tip aneurysms which was treated with endovascular Guglielmi detachable coil embolization with open surgery and catheterization, because the one had anatomical problem, and the other had structural problem.
Aneurysm* ; Aorta ; Brachial Artery ; Catheterization ; Catheters ; Constriction, Pathologic ; Embolization, Therapeutic ; Intracranial Aneurysm ; Phenobarbital ; Subclavian Artery ; Vertebral Artery*

The pencil beam convolution (PBC) algorithms in radiation treatment planning system have been widely used to calculate the radiation dose. A new photon dose calculation algorithm, referred to as the anisotropic analytical algorithm (AAA), was released for use by the Varian medical system. The aim of this paper was to investigate the difference in dose calculation between the AAA and PBC algorithm using the intensity modulated radiation therapy (IMRT) plan for lung cancer cases that were inhomogeneous in the low density. We quantitatively analyzed the differences in dose using the eclipse planning system (Varian Medical System, Palo Alto, CA) and I'mRT matirxx (IBA, Schwarzenbruck, Germany) equipment to compare the gamma evaluation. 11 patients with lung cancer at various sites were used in this study. We also used the TLD-100 (LiF) to measure the differences in dose between the calculated dose and measured dose in the Alderson Rando phantom. The maximum, mean, minimum dose for the normal tissue did not change significantly. But the volume of the PTV covered by the 95% isodose curve was decreased by 6% in the lung due to the difference in the algorithms. The difference dose between the calculated dose by the PBC algorithms and AAA algorithms and the measured dose with TLD-100 (LiF) in the Alderson Rando phantom was -4.6% and -2.7% respectively. Based on the results of this study, the treatment plan calculated using the AAA algorithms is more accurate in lung sites with a low density when compared to the treatment plan calculated using the PBC algorithms.
Humans ; Lung ; Lung Neoplasms

No abstract available.
Syringomyelia*

We herein report two patients with epidermolysis bullosa acquisita(EBA), who had showed the atypical clinical features. A 25-year-old male presented with multiple pruritic vesicles, erosion and crusts which occurred more severely on the face than any other sites of the skin and healed with atrophic scar formation. Histopathologically, there was a subepidermal neutrophilic blister with moderate perivascular lymphohistiocytic infiltrates in the dermis, and the diagnosis of EBA was confirmed by means of direct immunofluorescence and salt-split direct immunofluorescence test performed on the perilesional skin. The other patient was a 24-year-old female who had had multiple painful ulcerative lesions on the oral mucosa for 4 months. After then, vesicles and bullae developed to progressively generalize to the anterior neck, chest and lower leg. Histolopathologic examination of peribullous skin showed a subepidermal bulla with neutrophils and eosinophils. The salt-split skin direct immunofluence test showed IgG and IgM binding to the dermal side only. We diagnosed this patient as nonscarring inflammatory EBA. Both patients were treated with prednisolone, colchicine, and dapsone resulting in clinical improvement, but their skin lesions recurred several months after discontinuing medication.
Adult ; Blister ; Cicatrix ; Colchicine ; Dapsone ; Dermis ; Diagnosis ; Eosinophils ; Epidermolysis Bullosa Acquisita* ; Epidermolysis Bullosa* ; Female ; Fluorescent Antibody Technique, Direct ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Leg ; Male ; Mouth Mucosa ; Neck ; Neutrophils ; Prednisolone ; Skin ; Thorax ; Ulcer ; Young Adult

Patients with symptomatic stenosis of the basilar artery have a poor prognosis and the treatment options are limited. Surgical bypasses are technically difficult and there is no proven benefit. Percutaneous angioplasty shows significant complications because of dissection, restenosis secondary to elastic recoil and embolic phenomena. The medical treatment with aspirin and wafarin showed the annual risk of 20% for symptomatic basilar artery stenosis as repoted in WASID(Warfarin-Aspirin Symptomatic Intracranial Disease)study. We report a patient with symptomatic high grade stenosis of the basilar artery refractory to appropriate maximal medical therapy, in whom endovascular stenting was performed successfully without preliminary balloon angioplasty. Excellent angiographic result was achieved and there were no procedural and periprocedural complications. The patient was asymptomatic except preprocedural mild dysarthria and had no neurological symptoms during clinical follow-up of 2 months at outpatient department. Primary stenting of basilar artery stenosis may be an alternative to balloon angioplasty for patient with symptomatic lesions refractory to medical therapy or in whom anticoagulation is contraindicated.
Angioplasty ; Angioplasty, Balloon ; Aspirin ; Basilar Artery* ; Constriction, Pathologic ; Dysarthria ; Follow-Up Studies ; Humans ; Outpatients ; Prognosis ; Stents* ; Vertebrobasilar Insufficiency*

Hypoxia is one of the major causes of neonatal mortality. Hypoxia-induced tissue injuries are resulted from complex mechanisms such as DNA damage and apoptosis. In this study, we aimed to elucidate the changes in the expression of DNA repairing enzymes such as 8-hydroxyguanine glycosylase 1 (OGG1) and apurinic/apyrimidinic endonuclease 1 (APE1) and brain derived neurotrophic factor (BDNF) in the fetal cerebral tissue after intrauterine hypoxic injury. For this study, pregnant Sprague-Dawley rats were exposed to hypoxic gas (10% O2, 5% CO2, 85% N2) for 2 or 4 hours at postconception day 14.5 and 15.5. After 24 hours, the animals were anesthetized with ethyl ether and fetuses were obtained by laparatomy. Hematoxylin-eosin stain, immunohistochemical stain, and western blot were employed for analysis. The caspase-3 immunolabeled cells were significantly increased within the cerebral cortex after hypoxic injury. The expressions of OGG1, APE1, and BDNF were also increased in the cerebral tissue after hypoxic injury at post-conception day 14.5, in a dose-dependent manner. However, the expression of BDNF was significantly decreased in the cortical tissue exposed to hypoxic injury at postconception day 15.5. These results demonstrate that fetal hypoxic injury induces apoptosis of the nerve cells and promotes the expressions of the DNA repairing enzymes and neurotrophic factors. In addition, these results suggest that protection mechanisms against hypoxic injury alter along the progression of the fetal development.
Animals ; Anoxia ; Apoptosis ; Blotting, Western ; Brain-Derived Neurotrophic Factor ; Caspase 3 ; Cerebral Cortex ; DNA ; DNA Damage ; DNA Repair ; Ether, Ethyl ; Fetal Development ; Fetus ; Guanine ; Humans ; Infant ; Infant Mortality ; Nerve Growth Factors ; Neurons ; Rats ; Rats, Sprague-Dawley