BACKGROUND: Pain is among the most prevalent symptoms experienced by patients with cancer. Severe pain is incompatible with quality of life. Although cancer pain can be effectively treated in 70-90% of patients with the principle of pain management, between 60% and 70% of cancer patients pain is inadequately treated. Both knowledge and attitudes of medical professionals are important for effective pain management. This study was designed to survey residents knowledge and attitudes toward cancer pain management in order to offer the basic data for researching the problems and education program of cancer pain management. METHODS: In February 1997, we surveyed 116 residents practising in 7 departments of one university hospital, including physicians and surgeons, with a case-oriented questionnaire assessing knowledge and attitudes toward cancer pain management. RESULTS: The percentage of residents choosing the correct answer for knowledge about pain management was, pain in the drug abuser(42.2%), equianalgesic dosing(47.4%), physical dependence(50.9%), WHO analgesic ladder(61.2%), neuropathic pain(62.9%), around the clock dosing(69.8%). The percentage of residents choosing answer for attitude toward cancer pain management ; upper limit to opioid prescription(46.5%), reluctance to prescribe morphine(45.7%), need of education for pain management(99.1%). Fear of side effects was the most frequent reason of their reluctance to prescribe opioids(80.4%.) Physicians had higher level of knowledge than surgeons(P=0.004). CONCLUSIONS: This study shows the presence of barriers to adequate pain control in Korea as identified in other countries. There is the lack of konwledge about cancer pain management and doctors are reluctant to prescribe because of negative attitudes towards pain management. This suggests a need for not simply offering knowledge but problemsolving education and training of pain management.
Education ; Humans ; Korea ; Pain Management* ; Quality of Life ; Surveys and Questionnaires

A case of enteric cyst in the anterior two-thirds of the tongue is reported. The patient, a 42 day-old female infant, presented with a protruding tongue mass since birth. Under the impression of ectopic thyroid gland or leiomyoma, complete resection was performed. The mass proved to be an enteric cyst, lined by small intestinal mucosa with an underlying coat of smooth muscle. Enteric cysts arising in the tongue is rare and only 8 such cases have been reported in the literature.
Female ; Humans ; Infant ; Intestinal Mucosa ; Leiomyoma ; Muscle, Smooth ; Parturition ; Thyroid Dysgenesis ; Tongue*

Statistical observation was made on the 1949 patients with cardiovascular diseases who had been treated in Dept. of Internal Medicine, Seoul national University Hospital during the period of four years, from jan. 1972 to Dec. 1975. 1) The patients wth cardiovascular diseases accounted for 20.2% out of total 9,638 medical inpatients. The incidence for the consecutive years was not apparently variable. 2) The diseases occured most frequently in the sixth decades and the incidence decreased in the order of fifth and seventh decades. 3) The disease was more prevalent in male than female with ratio of 1.3 of 1. 4) The hypertension was the most common disease among cardiovascular diseases, accounting for 67.5% of patients with cardiovascular diseases and 13.6% of total medical inpatients. The disease occurred most frequently in the sixth decades and the incidence decreased in the order of fifth and seventh decades with male preponderance. 81.8% of patients with hypertension was essential hypertension and 18.2% was secondary hypertension. Secondary hypertension was caused by parenchylmal renal diseases in most patients and there were only several patients with renovascular and endocrine hypertension. 40.2% of patients with essential hypertension had no complications, 38.6% had cerebral vascular accidents, 12.1% had uremia and 9.1% had congestive heart failure. The patients with malignant hypertension was 9.6% of total patients with hypertension. 5) Rheumatic heart disease was 14% of patients with cardiovascular diseases, being second in incidence. It was more prevalent in female than male with ratio of 1 male to 1.3 female and affected the mitral valve in most of the cases, whereas involvement of aortic valve was rare. 6) The coronary heart disease was 5.3% of patients with cardiovascular diseases, being third in incidence. It occured most frequently in seventh and sixth decades and affected male two times more frquently than female. 7) The congenital heart disease was 2.9% of patients with cardiovascular diseases, of which atrial septal defect was highest in incidence. 8) The cor-pulmonale was 1.4%, pericarditis 1.4%, endocarditis 0.9%, postpartum heart disease 1.2%, myxedematous heart disease 0.2%, arrhythmia 2.1%, peripheral vascular disease 1.1% and miscellaneous 0.6% of patients with cardiovascular diseases. 9) Postpartum heart failure and endocarditis was remarkably decreased in incidence recently and there were one patients with beriberi heart disease and one patient with syphilitic heart disease during those years of this study.
Aortic Valve ; Arrhythmias, Cardiac ; Beriberi ; Cardiovascular Diseases* ; Coronary Disease ; Endocarditis ; Female ; Heart Defects, Congenital ; Heart Diseases ; Heart Failure ; Heart Septal Defects, Atrial ; Humans ; Hypertension ; Hypertension, Malignant ; Incidence ; Inpatients ; Internal Medicine ; Korea* ; Male ; Mitral Valve ; Pericarditis ; Peripheral Vascular Diseases ; Postpartum Period ; Rheumatic Heart Disease ; Seoul ; Uremia

Debonding of cement-femoral stem interface has been suggested as a initial focus of loosening mechanism in many previous studies of cemented total hip replacement. The purpose of this study was to investigate the effect of debonding of cement-femoral stem interface to the cement-bone inter- face by using three-dimensional non-linear finite element analysis. Three cases of partial debonded, full debonded, and full bonded cement-bone interface were modelled with partial bonding of distal 70mm from the tip of femoral stem. Each situation was studied under loading simulating one-leg stanced gait of 68kg patient. The results showed that under partial and full debonded cement-stem interface conditions the peak von Mises stress (3.1 MPa) were observed at the cement of cement-bone interface just under the calcar of proximal medial of femur, and sudden high peak stresses (3.5 MPa) were developed at the distal tip of femoral stem at the lateral bone-cement interface in all 3 cases of bonding. The stresses were transfered very little to the cement of upper lateral bone-cement interface in partial and full debonded cases. Once partial or full debonded cement-femoral stem interface occured, 3 times higher stress concentration were developed on the cement of proximal medial cement-bone interface than full bonded interface, and these could cause loosening of cemented total hip replacement. Clinically, preservation of more rigid cement-femoral stem interface may be important factor to prevent loosening of femoral stem.
Arthroplasty, Replacement, Hip ; Femur ; Finite Element Analysis* ; Gait ; Humans

The soft tissue sarcoma ih the Orthopedic surgery is not common, occuring in less than one percent of all malignant tumors. Whille the sarcoma is comparatively highly malignant, its treatment has been varied, and the effect of the each treatment has been controversial and generally poor on statisties. We studied 58 cases of soft tissue sarcoma in the Orthopedic department of Pusan Gospei Hospital in the 6 years period from March, 1975 to March, 1981. We confirmed the sarcoma diagnosis by biopsy, and measured the size, the degree of local infilteration and occurrence of metastasis with the help of plain X-ray, angiography, lung and bone scan, and computerized tomograms. We made treatment plans according to above results. We classified the soft tissue sarcoma into 8 histologic types and obtained following conclusions: l. Among the 58 cases of soft tissue sarcoma, and majority is consisted of fibrosarcoma, liposarcoma and rhabdomyosarcoma. 2. There were 41 cases occurred in the lower extremity and 17 cases in the upper extremity. Thus soft tissue sarcoma are more frequent in the lower extremity, especially in thigh (2 patients). 3. We found 19 cases between the age of 41 to 50 years. In general, the soft tissue sarcoma are more frequent between the age of 31 to 50 years. 4. Among the 58 cases, 10 patient came to our hospital because of recurrence of soft tissue sarcoma, after receiving local excision in other hospitals. In other words 17 percent of our cases showed recurred sarcoma and duration of recurrence was within 16 months. 5. Metastasis of the soft tissue sarcoma had taken place in 17 patients (29%), most frequently metastasis to the lung in 12 cases (70%). 6. We treated 30 cases by chemotherapy and radiotherapy after excision or amputation. In 15 sarcomas that could not be excised, but the medical treatment with chemotherapy and radiotherapy. 7. The follow-up study revealed better result obtained in the group of aggresive treatment with anticancer chemotherapy and radiotherapy after excision or amputation.
Amputation ; Angiography ; Biopsy ; Busan ; Clinical Study ; Diagnosis ; Drug Therapy ; Fibrosarcoma ; Follow-Up Studies ; Humans ; Liposarcoma ; Lower Extremity ; Lung ; Neoplasm Metastasis ; Orthopedics ; Radiotherapy ; Recurrence ; Rhabdomyosarcoma ; Sarcoma ; Thigh ; Upper Extremity

No abstract available.
Rectal Neoplasms*

Angiogenesis depends on the net balance between positive and negative angiogenic factors. Tumor cells are angiogenic resulting from increased production of positive factors and decreased production of negative factors. Among these, vascular endothelial growth factor and glioma- derived angiogenesis inhibiting factor are related to glioblastoma multiforme. The p53 gene is more frequently mutated than any other known oncogene or tumor suppressor gene in human tumors including glioblastoma multiforme. Angiogenesis is reported to be controlled by p53 regulation in recent studies. To examine the effect of p53 overexpression on angiogenesis in glioblastoma multiforme, we performed immunohistochemical staining in 51 cases of glioblastoma multiforme, using monoclonal antibodies to p53 protein and factor VIII. 20 cases of low grade astrocytoma were used as control. p53 overexpression was present in 15(75%) of 20 cases of low grade astrocytoma and the mean vessel count was 37.7+/-9.9 at x200 field and 17.5+/-5.8 at x400 field. p53 overexpression was present in 35(68%) of 51 cases of glioblastoma multiforme and the mean vessel count was 91.9 45.8 at x200 field and 40.7 19.1 at x400 field. Mean vessel count in low grade astrocytoma with p53 overexpression was 39.4 10.2 at x200 field and 18.9 5.7 at x400 field, while in cases without p53 overexpression it was 32.4+/-7.6 at x200 field and 13.2 3.5 at x400 field. Mean vessel count in glioblastoma multiforme with p53 overexpression was 94.5+/-51.8 at x200 field and 42.1+/-16.8 at x400 field, while in cases without p53 overexpression it was 86.1+/-29.5 at x200 field and 37.1+/-16.8 at x400 field. The mean survival time was 12.4 months in the 39 cases of glioblastoma multiforme in which follow-up studies were possible. Significant prognostic factors were age, p53 overexpression and adjuvant therapy. These results show that p53 gene mutation is one of the many contributing factors to angiogenesis in glioblastoma multiforme. In addition, other oncogenes and tumor suppressor genes, as well as growth factors may be involved. Age, p53 overexpression and adjuvant therapy proved to be significant prognostic factors, while microvessel density was not.
Angiogenesis Inducing Agents ; Antibodies, Monoclonal ; Astrocytoma ; Brain Neoplasms* ; Brain* ; Factor VIII ; Follow-Up Studies ; Genes, p53* ; Genes, Tumor Suppressor ; Glioblastoma ; Humans ; Intercellular Signaling Peptides and Proteins ; Microvessels ; Oncogenes ; Survival Rate ; Vascular Endothelial Growth Factor A

No abstract available.
Rectal Prolapse*

No abstract available.
Cushing Syndrome*

BACKGROUND: For the evaluation of pulmonary nrtery branches after operation of right ventricular outflow obstructive disease, we reviewed the usefulness of both simple X-ray and lung perfusion scan with 99mTc-macroaggregated albumin compared with cardiac angiography. METHODS: From March, 1986 to July, 1993, at Seoul National University Children;s Hospital, we chose 23 cases who underwent both simple X-ray and cardiac angiography among the patients who had distinct difference between right and left pulmonary blood flow in lung perfusion scan after operation of right ventricular outflow obstructive disease. So we calculated the ratio of right and left pulmonary blood flow and Spearman correlation coefficient. RESULTS: Of the 23 cases, 17 cases were tetralogy of Fallot, 4 cases pulmonary atresia, 1 case double outlet right ventricle, and 1 case truncus arteriosus. The mean age at poeration was 27 months, and the mean postoperative follow-up period was for 68 months. The correlation coefficient between cardiac angiography and simple X-ray was 0.86(p<0.01), and that beteen cardiac angiography and lung perfusion scan was 0.80(p<0.01). CONCLUSION: The cardiac angiography has been known as the best diagnostic tool for the evaluation of pulmonary artery branches after operation of right ventricular outflow obstructive ddisease, but we proposed that the lung perfusion scan should be widely used because its results were similar with those of cardiac angiography.
Angiography ; Double Outlet Right Ventricle ; Follow-Up Studies ; Humans ; Lung* ; Perfusion* ; Pulmonary Artery* ; Pulmonary Atresia ; Seoul ; Tetralogy of Fallot ; Truncus Arteriosus