BACKGROUND: Because of the common etiologic factor, such as smoking, lung cancer and chronic obstructive Pulmonary disease are often present in the same patient. The preoperative prediction of remaining pulmonary function after the resectional surgery is very important to prevent serious complication and postoperative respiratory failure. 99mTc-MAA perfusion scan has been used for the prediction of postoperative pulmonary function, but it may be inaccurate in case of large V/Q mismatching. We compared 99mTc-DTPA radioaerosol inhalation scan with 99mTc-MAA perfusion scan in predicting postoperative lung function. METHOD: Preoperative inhalation scan and/or perfusion scan were performed and pulmonary function test were performed preoperatively and 2 month after operation. We predicted the postoperative pulmonary functions using the following equations. Postpneumonectomy FEV1=Preop FEV1x% of total function of lung to remain RESULTS: 1) The inhalation scan showed good correlations between measured and predicted FEV1, FVC and FEF25-75%. (correlation coefficiency; 0.94, 0.91, 0.87 respectively). 2) The perfusion scan also showed good correlations between measured and predicted FEV1, FVC and FEF25-75%. (correlation coefficiency; 0.86, 0.72, 0.97 respectively). 3) Among three parameters, FEV1 showed the best correlations in the prediction by lung scans. 4) Comparison between inhalation scan and perfusion scan in predicting pulmonary function did not show any significant differneces except FVC. CONCLUSION: The inhalation scan and perfusion scan are very useful in the prediction of postoperative lung function and don't make a difference in the prediction of pulmonary function although the former showed a better correlation in FVC.
Humans ; Inhalation* ; Lung ; Lung Neoplasms ; Perfusion* ; Pulmonary Disease, Chronic Obstructive ; Respiratory Function Tests ; Respiratory Insufficiency ; Smoke ; Smoking

Small cell lung cancer(SCLC) is frequently associated with paraneoplastic syndromes, which occur in approximately 20% of patients at presentation. Clinical Cushing's syndrome secondary to ectopic ACTH production is uncommon, occurring in approximately 5% of all SCLC patients. However, biochemical evidence of hypercortisolism can be detected in up to 50% of patients. Patients with Cushing's syndrome from ectopic ACTH production show hypertension, weakness, hyperglycemia, and hypokalemic metabolic alkalosis, but differ from patients with classic Cushing's disease in that symptoms develop more rapidly. Ectopic ACTH production is associated with a poor response to chemotherapy, short survival, and a high risk of treatment-related complications. We report a case of Cushing's syndrome associated with ectopic corticotropin production in 59-year-old male patient with extensive stage of SCLC.
Adrenocorticotropic Hormone* ; Alkalosis ; Cushing Syndrome* ; Drug Therapy ; Humans ; Hyperglycemia ; Hypertension ; Lung Neoplasms* ; Lung* ; Male ; Middle Aged ; Paraneoplastic Syndromes

PURPOSE: To determine the antitumor activity of VACOP-B regimen for advanced non- Hodgkin's lymphoma (NHL) in terms of complete response rate, disease free survival, and overall survival, to assess the toxicities of this regimen, and to analyze the prognostic factors influencing the treatment results.Patients and methods: Between Apr. 1991 and Aug. 1993, thirty-six previously untreated patients with the intermediate or high grade NHL were treated with VACOP-B (etoposide/doxorubicin/cyclophosphamide/vincristine/prednisolone/bleomycin) combination chemotherapy. In case of initial bulky disease or residual disease after chemotherapy, radiation therapy of involved field was added. RESULTS: Complete response (CR) was achieved in 69% (25/36) of the eligible patients after VACOP-B chemotherapy, and 5 of 11 patients who remained in partial response (PR) after chemotherapy achieved CR after additional radiation therapy of involved field, resulting in 83% (30/36) of CR rate. With a median follow-up of 47.2 months, the disease free survival was 1~42.1+ months, and its median was 24 months. The range of survival time was 7~49.1+ months, and the median survival time was not reached at this time. The projected 3-year survival rate was 70%. Leukopenia was observed in 43% of chemotherapy cycles and thrombocytopenia in 2.3%. However, no treatment-related death was observed. For non-hematologic toxicities, nausea and vomiting were observed in 58% of patients, stomatitis in 58%, peripheral neuropathy in 58%, pulmonary toxicity in 3% and congestive heart failure in 3%. These toxicities were tolerable and all reversible. The prognostic factors influencing the complete response rate were performance status of patient (p=0.026) and relative dose intensity of cyclophosphamide (p=0.013). CONCLUSION: VACOP-B regimen is an effective and tolerable regimen for the intermediate and high grade NHL. And long term follow-up and phase III study will be needed for evaluation of these results compared to previous other treatment modality.
Cyclophosphamide ; Disease-Free Survival ; Drug Therapy ; Drug Therapy, Combination* ; Follow-Up Studies ; Heart Failure ; Hodgkin Disease ; Humans ; Leukopenia ; Lymphoma, Non-Hodgkin* ; Nausea ; Peripheral Nervous System Diseases ; Stomatitis ; Survival Rate ; Thrombocytopenia ; Vomiting

Cushing disease in children and adolescents, especially with multiple pituitary adenomas (MPAs), is very rare. We report 17-year-old boy with MPAs. He presented with a vertebral compression fracture, weight gain, short stature, headache, and hypertension. On magnetic resonance imaging (MRI), only a left pituitary microadenoma was found. After surgery, transient clinical improvement was observed but headache and hypertension were observed again after 3 months later. Follow-up MRI showed a newly developed right pituitary microadenoma 6 months after the surgery. The need for careful clinical and radiographic follow-up should be emphasized in the search for potential MPAs in patients with persistent Cushing disease.
Adolescent* ; Child ; Follow-Up Studies ; Fractures, Compression* ; Headache ; Humans ; Hypertension ; Magnetic Resonance Imaging ; Male ; Pituitary ACTH Hypersecretion* ; Pituitary Neoplasms* ; Weight Gain

PURPOSE: To compare the efficacy of ketamine between intranasal (IN) administration and intramuscular (IM) injection for pediatric procedural sedation and analgesia (PPSA). METHODS: A prospective study was conducted during 3 months. Ketamine was given by IN or IM route before primary repair of facial laceration for procedural sedation. The administration dose was 8 mg/kg for IN and 4 mg/kg for IM. We evaluated resistance scale on administration, sedation scale, satisfaction of physician and parents. RESULTS: One hundred children were enrolled into this study. IN administration was given to 50 children, and IM injection to 50 children each. In the IN group, 75%(36 of 50) showed severe resistance, whereas only 34%(17 of 50) showed severe resistance and 50%(25 of 50) showed mild resistance in IM group. Successful rate of sedation after initial administration was 82%(41 of 50) in IM group and 34% in IN group. Satisfaction of physicians and parents was high in IM injection group. CONCLUSION: Intranasal administration of Ketamine is less effective and provides lower satisfaction than intramuscular injection for procedural sedation of pediatric patients in the emergency department.
Administration, Intranasal ; Analgesia ; Child ; Conscious Sedation ; Emergencies ; Humans ; Injections, Intramuscular ; Ketamine ; Lacerations ; Parents ; Prospective Studies

PURPOSE: The preoperative s-CEA level are correlated to the extent of the tumor and distant metastasis in patients with colorectal cancer. This study was performed to analyze patterns of distant metastasis and survival rate according to the levels of preoperative s-CEA and evaluate the significance of chest CT and bone scan as methods of preoperative staging work-up in patients with high s-CEA level (>or=20 ng/ml). METHODS: A retrospective study was performed on 1,136 colorectal cancer patients who underwent surgery in Asan medical center between 1989 and 1995. These patients were classified into 3 groups according to preoperative s-CEA level (group A: <6; group B: >or=6,<20; group C: >or=20). We scrutinized the patterns of metastasis and compared the survival rates between the groups. Another study was, then, conducted prospectively on the basis of the above results. One hundred and sixty nine patients with s-CEA level (>or=20 ng/ml) were routinely examined by chest CT and bone scan for preoperative metastatic work-up in addition to the conventional work-up. Statistical analysis was performed by chi-squared test, Kaplan-Meier and log-rank test. RESULTS: The preoperative s-CEA level and the tumor stages were significantly correlated (P=0.009). The distant metastasis rates in group A, B, and C were 22.7% (163/719), 49.1% (115/234), 76.5% (140/183), respectively (P=0.000). Five year survival rate of each group were significantly different in far advanced stage, stage III (0.71 vs. 0.61 vs. 0.51 : P=0.002) and stage IV (0.21 vs. 0.10 vs. 0.05 : P=0.004). In stage I and II, however, we couldn't find statistical differences. Among 169 patients with s-CEA level above 20ng/ml, 52 (30.7%) had liver metastasis. Twenty three patients (13.6%) had lung metastasis. Twenty (11.8%) cases of pulmonary metastasis were found on chest CT scan and 3 cases on chest X-ray or abdominal CT scan. Only 4 (2.4%) cases, however, had bone metastasis on bone scan. CONCLUSIONS: These results suggest that the high preoperative s-CEA level seemed to be closely correlated with distant metastasis and prognosis. A meticulous preoperative staging work-up including chest CT scan is recommended in patients with high preoperative s-CEA level.
Chungcheongnam-do ; Colorectal Neoplasms* ; Humans ; Kaplan-Meier Estimate ; Liver ; Lung ; Neoplasm Metastasis ; Prognosis ; Prospective Studies ; Retrospective Studies ; Survival Rate ; Thorax ; Tomography, X-Ray Computed

BACKGROUND: At most centers, general anesthesia (GA) has been preferred for endovascular treatment (EVT) of ruptured intracranial aneurysms (RIAs). In this study, we analyzed procedural results, clinical outcomes, and follow-up angiographic findings for patients undergoing EVT for RIA under local anesthesia (LA) with conscious sedation (CS). METHODS: We retrospectively evaluated 308 consecutive patients who underwent EVT for RIAs at a single institution between June 2009 and February 2017. EVT under LA with CS was considered for all patients with aneurysmal subarachnoid hemorrhage, regardless of Hunt and Hess (HH) scale score. RESULTS: EVT was performed for 320 aneurysms in 308 patients with subarachnoid hemorrhages. The mean patient age was 55.5±12.6 years. Moderate (III) and poor (IV, V) HH grades were observed in 75 (24.4%) and 77 patients (25%), respectively. Complete occlusion immediately after EVT was achieved for 270 (84.4%) of 320 aneurysms. Thromboembolic complications and intraprocedural ruptures occurred in 25 (7.8%) and 14 cases (4.3%), respectively. The morbidity rate at discharge (as defined by a modified Rankin scale score of 3 or greater) was 27.3% (84/308), while the mortality rate was 11.7% (36/308). Follow-up angiographic results were available for 210 (68.1%) of 308 patients. Recanalization was observed in 64 (29.3%) of 218 aneurysms in 210 patients. CONCLUSION: Based on our experience, EVT for RIAs under LA with CS was feasible, regardless of the clinical grade of the subarachnoid hemorrhage. Complication rates and follow-up angiographic results were also comparable to those observed when GA was used to perform the procedure.
Anesthesia, General ; Anesthesia, Local ; Aneurysm ; Conscious Sedation ; Endovascular Procedures ; Follow-Up Studies ; Humans ; Intracranial Aneurysm ; Mortality ; Retrospective Studies ; Rupture ; Subarachnoid Hemorrhage

BACKGROUND: A poincare plot of the heart rate variability (HRV) allows for the quantitative display of the vagal tone in conscious humans. However, relatively little is known about standard deviation 1 (SD1) from the poincare plot reflecting the vagal tone and correlating with the high frequency (HF) spectral power of the HRV during general anesthesia. Thus, the association of SD1 from the poincare plot was examined, along with the HF spectral power of the HRV during general anesthesia. METHODS: Beat-to-beat electrocardiograms were recorded for 5 min in 23 patients (isoflurane group, n = 13; sevoflurane group, n = 10) before, during and after general anesthesia. The low frequency (LF) and HF spectral powers, the LF/HF ratio of the HRV and the SD1 and standard deviation 2 (SD2) from the poincare plot were calculated. RESULTS: Both the HF spectral power of the HRV and SD1 from the poincare plot were reduced following general anesthesia, but recovered thereafter. The recovery of both the HF spectral power and SD1 from the poincare plot in the sevoflurane group was faster than those in the isoflurane group. There were strong correlations between the HF spectral power and SD1 before, during and after anesthesia. CONCLUSIONS: These data suggest that the SD1 from the poincare plot is a useful and valid parameter for analysis of the vagal tone during general anesthesia.
Anesthesia ; Anesthesia, General* ; Electrocardiography ; Heart Rate* ; Heart* ; Humans ; Isoflurane

PURPOSE: Trauma is one of the leading causes of death, especially among young people. Life-threatening conditions are very common in multiple-traumatized patients due to concurrent multi-organ injuries. Treating such severely injured patients is time critical. However, in Korea, the transfer of severely injured patients is not uncommon due to the lack of a mature trauma care system. In developed countries, the preventable trauma death rate is very low, but the rate is still very high in Korea. This study's objective was to demonstrate the current serious state in which severely injured patients have to be transferred from a Regional Emergency Medical Center even though it actually serves as a trauma center. METHODS: Ajou University Medical Center is a tertiary hospital that serves as a trauma center in Gyeonggi-do. The medical records at Ajou University Medical Center for a 1-year period from January 1, 2008, to December 31, 2008, were retrospectively reviewed. A severely injured patient was defined as a patient who showed more than 15 point on the ISS (injury severity score) scale. We investigated the clinical characteristics of such patients and the causes of transfer. RESULTS: Out of 81,718 patients who visited the Regional Emergency Medical Center, 19,731 (24.1%) were injured patients. Among them, 108 severely-injured patients were transferred from one Regional Emergency Medical Center to other hospitals. The male-to-female ratio was about 3.5:1, and the mean ISS was 23.08. The most common mechanism of injury was traffic accidents (41.7%). A major cause of transfer was the shortage of intensive care units (44.4%); another was for emergent operation (27.8%). Most of the hospitals that received the severely-injured patients were secondary hospitals (86.1%). CONCLUSION: Although the Regional Emergency Medical Center played a role as a trauma center, actually, severely-injured patients had to be transferred to other hospitals for several reasons. Most reasons were related with the deficiencies in the trauma care system. If a mature trauma care system is well-organized, the numbers of transfer of severely injured patients will be reduced significantly.
Academic Medical Centers ; Accidents, Traffic ; Cause of Death ; Developed Countries ; Emergencies ; Humans ; Injury Severity Score ; Intensive Care Units ; Korea ; Medical Records ; Retrospective Studies ; Tertiary Care Centers ; Trauma Centers