No abstract available.
Thorax* ; Tomography, X-Ray Computed*

PURPOSE: To determine whether neoadjuvant androgen deprivation therapy (NADT) improves clinical outcomes in patients with prostate cancer treated with definitive radiotherapy. MATERIALS AND METHODS: We retrospectively reviewed medical records of 201 patients with prostate cancer treated with radiotherapy between January 1991 and December 2008. Of these, 156 patients with more than 3 years of follow-up were the subjects of this study. The median duration of follow-up was 91.2 months. NADT was given in 103 patients (66%) with median duration of 3.3 months (range, 1.0 to 7.7 months). Radiation dose was escalated gradually from 64 Gy to 81 Gy using intensity-modulated radiotherapy technique. RESULTS: Biochemical relapse-free survival (BCRFS) and overall survival (OS) of all patients were 72.6% and 90.7% at 5 years, respectively. BCRFS and OS of NADT group were 79.5% and 89.8% at 5 years and those of radiotherapy alone group were 58.8% and 92.3% at 5 years, respectively. Risk group (p = 0.010) and radiation dose > or =70 Gy (p = 0.017) affected BCRFS independently. NADT was a significant prognostic factor in univariate analysis, but not in multivariate analysis (p = 0.073). Radiation dose > or =70 Gy was only an independent factor for OS (p = 0.007; hazard ratio, 0.261; 95% confidence interval, 0.071-0.963). CONCLUSION: NADT prior to definitive radiotherapy did not result in significant benefit in terms of BCRFS and OS. NADT should not be performed routinely in the era of dose-escalated radiotherapy.
Follow-Up Studies ; Humans ; Medical Records ; Multivariate Analysis ; Prostatic Neoplasms* ; Radiotherapy* ; Radiotherapy, Intensity-Modulated ; Retrospective Studies

No abstract available.
Jaw* ; Osteoradionecrosis*

No abstract available.
Jaw* ; Osteoradionecrosis*

Anterior exposure to the upper two thoracic vertebrae is technically difficult with transcervical approach. The authors used a transstermal biclavicular approach to the T1 metastatic adenocarcinome in a 47 year old patient. The advantages of this approach are that : 1) it levels the insertion of the sternocleidomastoid muscles intact and prevents the complication of respiratory problem, 2) it gives most wide surgical field among the other similar approaches, and 3) this procedure is not transpleural but transmediastinal approach.
Humans ; Middle Aged ; Muscles ; Spine* ; Thoracic Vertebrae

PURPOSE: This study was undertaken to determine whether lipid peroxidation induced by hydroxyl radicals play a critical role in cisplatin(cis-diamminedichloroplatinum II)-induced acute renal failure. METHODS: Animals received cisplatin at a single i.p. dose of 5 mg/kg, and changes in renal function were measured at 48 hr after cisplatin injection. RESULTS: Cisplatin caused an increase in serum creatinine level, which was accompanied by reduction in GFR. The fractional excretion of Na(+), glucose, and inorganic phosphate was increased in animals treated with cisplatin alone. Cisplatin treatment in vivo inhibited PAH uptake by renal cortical slices and Na(+)-K(+)-ATPase activity in microsomal fraction. Lipid peroxidation was increased in cisplatin-treated kidneys. When animals received the antioxidant N,N'-diphenyl-p-phenylenediamine(DPPD), the iron chelator deferoxamine, and hydroxyl radical scavengers dimethylthiourea and sodium benzoate before cisplatin injection, alterations in renal function and lipid peroxidation induced by cisplatin were significantly prevented. Exposure of renal cortical slices to cisplatin in vitro caused an increase in LDH release and lipid peroxidation, which were completely prevented by DPPD and deferoxamine. By contrast, hydroxyl radical scavengers(dimethylthiourea and thiourea) did not prevent cisplatin-induced LDH release despite they inhibited cisplatin-induced lipid peroxidation. CONCLUSION: These results suggest that the lipid peroxidation resulting from generation of hydroxyl radicals may play a role in cisplatin-induced acute renal failure. In addition, the protective effects of hydroxyl radical scavengers in vivo studies are different from the results obtained from in vitro studies using renal cortical slices.
Acute Kidney Injury* ; Animals ; Cisplatin ; Creatinine ; Deferoxamine ; Glucose ; Hydroxyl Radical ; Iron ; Kidney ; Lipid Peroxidation* ; Rabbits* ; Reactive Oxygen Species ; Sodium Benzoate

Multiple myeloma manifestated by necrotizing fasciitis is quite rare. Most of the patients affected with necrotizing fasciitis have some risk factors : Chronic general or local diseases, leukoenia, immunodeficiency diseases, malignancy, and an age of 50 years or more. We have experienced a case of necrotizing fasciitis associated with multiple myeloma presented as jaundice, pain, swelling of right buttock, ab-domiminal distension in 65-year-old man. His general status was improved after incision and drainage of wound and systemic chemotherapy. We recommend that multiple myeloma should be considered if necrotizing fasciitis is diagnosed.
Aged ; Buttocks ; Drainage ; Drug Therapy ; Fasciitis, Necrotizing* ; Humans ; Jaundice ; Multiple Myeloma* ; Risk Factors ; Wounds and Injuries

PURPOSE: To evaluate the clinical and imaging findings of signet ring cell carcinoma of the breast. MATERIALS AND METHODS: We retrospectively evaluated the clinical, mammographic and ultrasonographic (US)findings of five patients aged 23 -49 (mean 37) years with signet ring cell carcinoma of the breast. Diagnosis involved US-guided core-needle biopsy. In all patients the stomach was evaluated endoscopically after confirmation of the breast lesion. Metastatic breast cancer was confirmed in four patients and primary breast cancer in one. RESULTS: Three of the four patients with metastatic signet ring cell carcinoma complained of breast pain and swelling or enlargement. Mammography indicated the presence showed of diffuse increased density and skin thickening, without calcifications, while US demonstrated diffuse marked skin thickening, lymphatic dilatation, and axillary lymph node enlargement. Neither modality revealed the presence of mass, however. In the remaining patient, an enlarged breast mass was observed; mammography showed no abnormality, but US revealed an illdefined hypoechoic mass. Mammographic and US findings in the patient with primary signet ring cell carcinoma of the breast indicated an ill-defined spiculated mass, resembling other breast carcinomas. CONCLUSION: Metastatic signet ring cell carcinoma of the breast showed clinical symptoms similar to these seen in inflammatory breast cancer, though the former condition occurred in younger women. Radiographs demonstrated diffuse increased density and skin thickening without associated microcalcifications or mass.
Biopsy ; Breast Neoplasms ; Breast* ; Carcinoma, Signet Ring Cell* ; Diagnosis ; Dilatation ; Female ; Humans ; Inflammatory Breast Neoplasms ; Lymph Nodes ; Mammography ; Mastodynia ; Retrospective Studies ; Skin ; Stomach

This study investigated the comparison of electromyographic change of neuromuscular blocking effect induced vecuronium between the ulnar, facial and tibial nerve in 24 healthy adult patients anesthetized with thiopental, N2O and enflurane. Neuromuscular monitoring commenced immediately after administration of thiopental. After supramaximal stimulation was achieved, a bolus of vecuronlum 0.08mg/kg was injected intravenously. And then single twitch nerve stimulation(T1) was applied to the nerves using surface electrodes and the electrical response of muscles recorded using the RELAXOGRAPH(Dates Co.). The patients were allocated randomly to 3 groups of 8 patients respectively: the ulnar nerve troup was the control, and the facial nerve group and the tibial nerve group were the studing group. We assessed electromyographic responses from abductor digiti minimi muscle in the ulnar nerve, orbicularis oris muscle in the facial nerve and flexor hallucis brevis muscle in the tibial nerve to single twitch nerve stimulation respectively. And the onset time, the time from injection of vecuronium to 25% and 75% recovery to T1, and recovery index of the ulnar, facial and tibial nerve groups were measured. The obtained results were as follos: 1) The onset time was faster in the facial nerve group compared with the ulnar nerve group. 2) The time from injection of vecuronium to 25% recovery of T1 was more prolonged in the facial nerve group compared with the ulnar nerve group. 3) The time from injection of vecuronium to 75% recovery of T1 and recovery index were more shorter in the tibial nerve group compared with ulnar nerve group.
Adult ; Electrodes ; Enflurane ; Facial Nerve ; Humans ; Muscles ; Neuromuscular Blockade ; Neuromuscular Monitoring ; Thiopental ; Tibial Nerve* ; Ulnar Nerve ; Vecuronium Bromide*

The management of patient undergoing thoracic aortic surgical procedures represents a major challenge for the anesthesiologists. Aortic cross-clamping and unclamping are particularly hszardous during the- course of the thoracic aortic operation. Proximal hypertension, myocardial ischemia and arrhythmia have been reported to occur after application of the aortic cross-clampmg. Removal of the cross-clamp often results in severe hypotension with subsequent myocardial, cerebral and renal ischemia. In this case, the patient was managed successfully using Regitine drip during the cross-clamp and slow release of clamp during unclamp, combined with slight overhydration just before unclamp.
Aortic Aneurysm, Thoracic* ; Arrhythmias, Cardiac ; Humans ; Hypertension ; Hypotension ; Ischemia ; Myocardial Ischemia ; Phentolamine