We treated the 90 wrists (83 patients) with de Quervain's disease, and studied retrospectively the factors affecting the result of treatment, and the results of several treatment modalities, compared with published series of this disease. There was significant association between outcome and duration of symptoms before treatment, but age, sex, associated disease, and hand dominance were not associated(chi-square test, p < 0.05). And 75 wrists received single injections of steroid and local anesthetic into the tendon sheaths with complete pain relief in 59 wrists (69%). Furthermore, an additional injection gave pain abatement in 6 wrists. And regardless of treatment method, 95% of the whole patients had satisfactory outcome at a mean of 54 months (minimum follow-up, 45 months). We concluded that injection of steroid is the preferred initial treatment in de Quervain's disease, giving complete and lasting relief in 87% of cases.
De Quervain Disease ; Follow-Up Studies ; Hand ; Humans ; Methods ; Retrospective Studies ; Tendons ; Wrist

PURPOSE: We conducted a phase II study in previously untreated patients with unresectable stage IIIB or IV non-small cell lung cancer to evaluate the response rate and toxicity of the combination chemotherapy regimen of etoposide, ifosfamide and cisplatin. MATERIALS AND METHODS: From September 1993 to December 1996, twenty patients with advanced non-small cell lung cancer (stage IIIB 5 and IV 15) (squamous cell 8, adeno- carcinoma 12), were enrolled in this study. There were 13 (65%) males and 7 (35%) females, and median age of patients were 56 years (range: 34~66). Eighteen patients had performance status (ECOG) 0~1, two patients had performance status 2. Treatment was consisted of cisplatin (20 mg/m2 i.v., day 1~4), VP-16 (etoposide) (75 mg/m2 i.v., day 1~4), ifosfamide (1000 mg/m2 i.v., day 1~4) with mesna. This treatment was repeated every four weeks. RESULTS: The overall response rate was 25%. Complete response rate was 5% (1/20) and partial response rate was 20% (4/20). The median cycle of response was 4 (2~6) cycles. The median overall survival time was 28 weeks (9~98 weeks). The median time to progression was 10 weeks (3~50 weeks). Toxicities were evaluated by WHO criteria. Toxicity > GradeIII included: leukopenia 1.6%, thrombocytopenia 3.2%, nausea and vomiting 15%, alopecia 30%, stomatitis 10%. These toxicities were tolerable and reversible. CONCLUSION: VIP regimen was not superior to previous regimens for advanced non-small all lung cancer, and the toxicities were tolerable.
Alopecia ; Carcinoma, Non-Small-Cell Lung ; Cisplatin* ; Drug Therapy, Combination* ; Etoposide ; Female ; Humans ; Ifosfamide* ; Leukopenia ; Lung Neoplasms ; Male ; Mesna ; Nausea ; Small Cell Lung Carcinoma* ; Stomatitis ; Thrombocytopenia ; Vomiting

Epstein's syndrome is a rare disease whish is characterized by the association of thrombocytopenia, macrothrombocytopathia, nephritis and deafness. We experienced a case of Epstein's syndrome in a 12 years old male patient who was presented with a life long history of bleeding, usually as epistaxis, bilateral sensorineural deafness and hematuria with proteinuria starting in late childhood. Hematologic studies showed thrombocytopenia with giant platelets and anemia. A bone marrow aspirate revealed the megakaryocytes to be adequate in number and many giant size platelets. Platelet do not respond to addition of A and epinephrine; collagen and ristocetin induced agglutination response is decreased. It is difficult to be certain the association of thrombocytopenia with giant platelets, nephritis and deafness constitutes a new hereditary disease with a distinct pathogenesis or if it is an expansion of the well recognized Alport's syndrome of hereditary nephritis deafness. We report a case of Epstein's syndrome syndrome with brief review of related literatures.
Agglutination ; Anemia ; Blood Platelets ; Bone Marrow ; Child ; Collagen ; Deafness ; Epinephrine ; Epistaxis ; Genetic Diseases, Inborn ; Hematuria ; Hemorrhage ; Humans ; Male ; Megakaryocytes ; Nephritis ; Nephritis, Hereditary ; Proteinuria ; Rare Diseases ; Ristocetin ; Thrombocytopenia

No abstract available.

BACKGROUND: High dose fentanyl for cardiac surgery in neonates, infants and children can cause severe bradycardia and chest wall rigidity that result in decreased cardiac output and oxygen desaturation due to fixed stroke volume in pediatric patients. To ameliorate the effects of fentanyl, it is common to administer neuromuscular blocking drugs with wanted cardiovascular side effects. This study was designed to compare the cardiovascular variables and oxygen saturation among different muscular relaxants in high dose fentanyl anesthesia. METHODS: Thirty pediatric cardiac patients were allocated randomly into three muscle relaxant groups treated with 0.2 mg/kg pancuronium (n=10), 0.2 mg/kg vecuronium (n=10) or 0.2 mg/kg pipecuronium (n=10) after receiving an initial bolus dose of 25 g/kg of fentanyl. Changes of heart rate (HR), mean arterial blood pressure (MAP), rate-pressure-product (RPP) and oxygen saturation (SpO2) were observed. The same cardiovascular variables were also observed 1 and 2 minutes after the second bolus dose of 25 g/kg fentanyl and compared to the results among muscle relaxants. RESULTS: HR, MAP and RPP decreased significantly (p<0.05) 1 and 2 minutes after injection of the 1st fentanyl, which returned to levels above the control value after administration of pancuronium, vecuronium or pipecuronium. Among muscle relaxants, pancuronium caused the most rapid and significantly high level compared to the control value in HR and MAP. Next was pipecuronium and then vecuronium. In clinical setting, SpO2 was decreased after the 1st fentanyl injection and increased after the injection of muscle relaxants, but not significant statistically. CONCLUSION: In view of hemodynamic changes, pancuronium is most efficient and rapid in returning the hemodynamic variables that was decreased after high dose fentanyl anesthesia in neonates, infants and children whose cardiac output was dependent on HR due to relatively fixed stroke volume.
Anesthesia* ; Arterial Pressure ; Bradycardia ; Cardiac Output ; Child* ; Fentanyl* ; Heart Rate ; Hemodynamics ; Humans ; Infant* ; Infant, Newborn* ; Neuromuscular Blockade ; Oxygen ; Pancuronium* ; Pipecuronium* ; Stroke Volume ; Thoracic Surgery ; Thoracic Wall ; Vecuronium Bromide*

Chronic sclerosing sialadenitis, Mikulicz disease or Kuttner tumor has been recently recognized as a spectrum of IgG4-related sclerosing disease. IgG4-related disease is characterized by a high serum IgG4 level and tissue infiltration of IgG4-positive plasmacytes. We report three cases of chronic sclerosing sialadenitis with variably associated systemic involvement. All patients presented with a submandibular mass or swelling, and all the resected submandibular glands showed diffuse lymphocytic infiltration, lymphoid follicles, and septal fibrosis. Two of the specimens revealed numerous IgG-positive plasma cells, most of which were IgG4-positive on immunohistochemical staining. One of them was associated with dacryoadenitis and hypophysitis. The other patient had ureterorenal lesions. Immunohistochemical study was unavailable in remaining one case, but the histologic features along with elevated IgG level and associated pancreatitis supported the diagnosis. All patients received steroid therapy postoperatively and are doing well. Salivary gland involvement in IgG4-related fibrosclerosis should be recognized in systemic medical pathology.
Dacryocystitis ; Fibrosis ; Humans ; Immunoglobulin G ; Mikulicz' Disease ; Pancreatitis ; Plasma Cells ; Salivary Glands ; Sialadenitis ; Submandibular Gland

PURPOSE: To classify the cavernous sinus lesions, to describe their radiological findings, and to assess the usefulness of MR compared to CT. METHODS AND MATERIALS: Fourty-five patients with lesions involving the cavernous sinus proved by histological and/or clinical and imaging methods were studied retrospectively and classified into neoplastic, vascular, and inflammatory lesions. CT and MR findings were compared in 21 patients evaluated by both modalities simultaneously according to these 4 categories. RESULTS: Pitiutary macroadenoma was the most common cavernous sinus lesion(42%). Diffuse convex bulging of the lateral wall of cavernous sinus was the most frequent radiological finding(84%), and the others were encasement of the cavernous carotid artery(49%), remodelling of the surrounding bones(44%), and complete obliteration of Meckel's cave(38%), in descending order of frequency. Bulging of the lateral wall of cavernous sinus was equally well demonstrated on both modalities, but encasement or displacement of the cavernous carotid artery and complete or partial obliteration of Meckel's cave were much better delineated on MR than on CT with the ratio of 3.8:1 and 4.6: 1, respectively. Only bone changes were much better demonstrated on CTthan on MR with the ratio of 3.8: 1. CONCLUSION: MR issuperior to CTin demonstrating thecavernouscarotid artery encasement and obliteration of Meckel's cave, but CT is much better than MR in demonstrating bone changes.
Arteries ; Carotid Arteries ; Cavernous Sinus* ; Humans ; Retrospective Studies

No abstract available.
Methemoglobinemia*

On a standpoint of commonly available ESWL for the treatment of urinary stone, percutaneous stone extraction had the role of cooperation to it, and sometimes it could be the first procedure of choice. We have performed percutaneous extraction of the renal and upper ureteral stones in 35 renal unite. The overall success rate was 78.4%, average operation time was 81 minutes, mean fluoroscopic exposure time was 11 minutes, average postoperative hospital stay was 7 days. Causes of failure were as followings ; five inadequate calyceal puncture, one ureteral perforation, one impacted stone, and one downward stone migration. The complications were inappropriate position of the nephrostomy tube, prolonged hematuria through nephrostomy tube, and partial ureteral avulsion. They were not serious but resolved by conservative management.
Hematuria ; Length of Stay ; Punctures ; Ureter ; Urinary Calculi

From 1981 to 1987, 91 patients underwent radical nephrectomy for renal cell carcinoma. The regional lymph nodes were resected in 42 patients with disease localized to the kidney. The following results were obtained. 1. 5 year survival rates for patients with stage TlNOMO, T2NOMO and T3aNOMO were 100, 81.8 and 66.4 %, respectively, and for patients with stage T3bNOMO or regional lymph node involvement was 0 %. 2. The incidence of regional lymph node involvement in patients with stage T1, T2 and T3a was 0, 13.0 and 31.8%, respectively. 3. The extended lymphadenectomy for renal cell carcinoma was not proved to be more effective than radical nephrectomy only. 4. Staging was correct with computerized tomography in 71.0% of the lesions but stage T1 was determined correctly by computerized tomography in 100 % of patients. When the efficiency of computerized tomography and the possibility of regional lymph node involvement is considered, and extended lymphadenectomy is not a suggested addition to radical nephrectomy in patients with stage T1 renal cell carcinoma. In the future radioimmunoassay techniques or magnetic resonance imaging techniques may provide additional information in the evaluation of metastatic disease.
Carcinoma, Renal Cell* ; Humans ; Incidence ; Kidney ; Lymph Node Excision ; Lymph Nodes* ; Magnetic Resonance Imaging ; Nephrectomy ; Radioimmunoassay ; Survival Rate