BACKGROUND: The methods of arrangement of combined intravenous parallel infusions using anti-reflux valve (ARV), with and without anti-syphon valve (ASV) that could decrease occlusion alarm delay were investigated. METHODS: Occlusion challenge tests were mainly performed as bench experiments of four kinds of multiple parallel infusions (10 ml/h and 50 ml/h infusions), which were connected at the proximal or distal portion of ARV, with or without ASV. Alarm threshold was set to 1000 mmHg. Occlusion alarm delays and the compliances of the infusion systems were compared among groups. RESULTS: Without ASV, compared to 10 ml/h infusion alone distal to anti-reflux valve, 50 ml/h infusion distal to anti-reflux valve reduced the mean alarm delay from 416 +/- 7 s to 81 +/- 3 s (P < 0.001). Compared to 50 ml/h infusion alone, combined 10 ml/h and 50 ml/h infusion distal to ARV prolonged the alarm delay from 81 +/- 3 s to 133 +/- 6 s (P < 0.001). However, combined infusions distal to ARV with ASV significantly reduced the alarm delay from 133 +/- 6 s to 74 +/- 5 s (P < 0.001), and also reduced the compliance of the infusion system from 2.31 +/- 0.12 to 1.20 +/- 0.08 microl/mmHg (P < 0.001). CONCLUSIONS: The infusion setup of faster infusion rate, lower compliant system using ASV could effectively decrease occlusion alarm delay during multiple intravenous parallel infusions using ARV.
Anesthetics ; Compliance ; Equipment Safety ; Infusions, Intravenous

Contralateral acute subdural hematomas that occur during removal of brain tumors under general anesthesia are extremely rare, and there are no reports of this developing during awake craniotomy for brain tumors. We report a case of a 12-year-old boy who complained of sudden and severe headache and nausea around the completion of removal of a glial tumor of the frontal lobe under awake anesthesia. Postoperative computerized tomography scan revealed the presence of contralateral acute minimal subdural hematoma. We suggest that during craniotomy with awake anesthesia for brain tumors, contralateral acute subdural hematoma may occur, even in the absence of brain bulging or changes in vital signs. Sudden intra-operative headache and nausea should be investigated by immediate postoperative computerized tomography scans to ascertain diagnosis.
Anesthesia ; Anesthesia, General ; Brain ; Brain Neoplasms ; Child ; Craniotomy ; Frontal Lobe ; Headache ; Hematoma, Subdural ; Hematoma, Subdural, Acute ; Humans ; Nausea ; Vital Signs

Contralateral acute subdural hematomas that occur during removal of brain tumors under general anesthesia are extremely rare, and there are no reports of this developing during awake craniotomy for brain tumors. We report a case of a 12-year-old boy who complained of sudden and severe headache and nausea around the completion of removal of a glial tumor of the frontal lobe under awake anesthesia. Postoperative computerized tomography scan revealed the presence of contralateral acute minimal subdural hematoma. We suggest that during craniotomy with awake anesthesia for brain tumors, contralateral acute subdural hematoma may occur, even in the absence of brain bulging or changes in vital signs. Sudden intra-operative headache and nausea should be investigated by immediate postoperative computerized tomography scans to ascertain diagnosis.
Anesthesia ; Anesthesia, General ; Brain ; Brain Neoplasms ; Child ; Craniotomy ; Frontal Lobe ; Headache ; Hematoma, Subdural ; Hematoma, Subdural, Acute ; Humans ; Nausea ; Vital Signs

PURPOSE: To evaluate the incidence and clinical features of age-related macular degeneration (AMD) in Korea. METHODS: Web-based (www.armd-nova.or.kr) registration was conducted for AMD patients aged 50 or more who were newly diagnosed by retinal specialists in Korea from August 20, 2005 to August 20, 2006. Patient data including ophthalmologic examination, fundus photography, fluorescein angiogram and/or indocyanin green angiogram (ICG), past medical history, behavioral habit, combined systemic diseases were up-loaded. RESULTS: Among finally enrolled 1,141 newly diagnosed AMD patients, 690 patients (60.5%) were male and 451 patients (39.5%) were female. The average age of AMD patients was 69.7+/-8.0. Early AMD was observed in 190 patients and 951 patients had late AMD. Classic choroidal neovascular membrane (CNVM) was observed in 18.6% of exudative AMD patients and 63.4 % had occult CNVM. Subfoveal CNVM was observed in 80.4% of the patients with CNVM. Among the 580 exudative AMD eyes that performed indocyanin green angiography (ICG), 184 eyes (31.7%) had polypoidal choroidal vasculopathy (PCV) and 36 eyes (6.2%) showed retinal angiomatous proliferation (RAP). Age, male gender, smoking, diabetes and hypertension significantly increased the risk of the AMD among Koreans. CONCLUSIONS: Because of the low rate of participation by retinal specialists, definite incidence of AMD was not obtainable. However, the estimated 1-year AMD incidence in the Pusan area of Korea is at least 0.4%. In contrast to Western people, 31.7% of exudative AMD cases were revealed to be PCV and 6.2% were revealed to be RAP. This discrepancy between ethnic groups should be considered in the diagnosis and treatment modality selection of Korean AMD patients.
Aged ; Angiography ; Choroid ; Ethnic Groups ; Eye ; Female ; Fluorescein ; Humans ; Hypertension ; Incidence ; Korea ; Macular Degeneration ; Male ; Membranes ; Photography ; Retinaldehyde ; Smoke ; Smoking ; Specialization

We investigated the antineoplastic potentials of recombinant adenovirus containing wild-type p53 cDNA (Ad5CMV-p53) for malignant gliomas. In four human glioma cell lines (U-251 and LG expressing endogenous mutant p53, and U-87 and EFC-2 expressing wild-type p53) and two rat glioma cell lines (9L and C6, each expressing mutant and wild-type p53), gene transfer efficiency determined by X-gal staining and Western blotting was varied (10-99% at 10-500 multiplicity of infection, MOI). Growth inhibitory effect was drastic (>90% at 100 MOI) in U-251 cells and only moderate or minimal in other cell lines harboring wild-type p53 or low gene transfer efficiency. Ex vivo transduction of U-251 cells with Ad5CMV-p53 suppressed the in vivo tumorigenicity of the cells. Histopathologic examination for Ad5CMV-p53 toxicity to rat brains showed inflammatory reactions in half of the tested brains at 10(8) MOI. U-251 cells were inoculated intracerebrally in nude mice and injected Ad5CMV-p53 into the tumor, in which neither the tumor suppression nor the survival benefit was observed. In conclusion, heterogeneity of the cellular subpopulations of malignant glioma in p53 status, variable and insufficient gene delivery to tumor, and adenoviral toxicity to brain at higher doses may be limiting factors to be solved in developing adenovirus-p53 gene therapy for malignant gliomas.
Adenoviruses, Human ; Animal ; Brain Neoplasms/therapy* ; Cell Division ; Gene Therapy* ; Genetic Vectors ; Glioma/therapy* ; Human ; Mice ; Mice, Nude ; Protein p53/physiology ; Protein p53/genetics* ; Rats ; Tumor Cells, Cultured

We investigated the antineoplastic potentials of recombinant adenovirus containing wild-type p53 cDNA (Ad5CMV-p53) for malignant gliomas. In four human glioma cell lines (U-251 and LG expressing endogenous mutant p53, and U-87 and EFC-2 expressing wild-type p53) and two rat glioma cell lines (9L and C6, each expressing mutant and wild-type p53), gene transfer efficiency determined by X-gal staining and Western blotting was varied (10-99% at 10-500 multiplicity of infection, MOI). Growth inhibitory effect was drastic (>90% at 100 MOI) in U-251 cells and only moderate or minimal in other cell lines harboring wild-type p53 or low gene transfer efficiency. Ex vivo transduction of U-251 cells with Ad5CMV-p53 suppressed the in vivo tumorigenicity of the cells. Histopathologic examination for Ad5CMV-p53 toxicity to rat brains showed inflammatory reactions in half of the tested brains at 10(8) MOI. U-251 cells were inoculated intracerebrally in nude mice and injected Ad5CMV-p53 into the tumor, in which neither the tumor suppression nor the survival benefit was observed. In conclusion, heterogeneity of the cellular subpopulations of malignant glioma in p53 status, variable and insufficient gene delivery to tumor, and adenoviral toxicity to brain at higher doses may be limiting factors to be solved in developing adenovirus-p53 gene therapy for malignant gliomas.
Adenoviruses, Human ; Animal ; Brain Neoplasms/therapy* ; Cell Division ; Gene Therapy* ; Genetic Vectors ; Glioma/therapy* ; Human ; Mice ; Mice, Nude ; Protein p53/physiology ; Protein p53/genetics* ; Rats ; Tumor Cells, Cultured

BACKGROUND: Mohs micrographic surgery (MMS) achieves higher cure rates for cutaneous squamous cell and basal cell carcinomas than any other therapeutic modality. For a unifocal tumor, a 100% cure rate after MMS should theoretically be possible, however for primary basal cell carcinoma, 98-99% 5-year disease-free rates have been achieved. OBJECTIVE: Our purpose was to investigate the pitfalls in microscopic Interpretation of frozen sections in Mohs micrographic surgery for basal cell carcinoma which decrease the cure rate after surgery. METHODS: From March 1991 to February 1998, fifty-nine patients were diagnosed with basal cell carcinoma at our department. All the tumors were removed with Mohs micrographic surgery and frozen section specimens were stained with hematoxylin-eosin. The microscopic evaluation was done by Mohs surgeon and pathologist. RESULTS: We can summarize the matters that demand special attention during microscopic Interpretation of frozen sections in Mohs surgery as two groups. First, as false negative interpretation, there are 1) small nests of tumor scattered within areas of heavy inflammation 2) tumor present along the hair follicle, 3) tumor present along a cut edge, 4) empty space in a tissue section, 5) hair follicle-like structure of the tumor, 6) gland-like structure of the tumor, and 7) infiltrative BCC-like inflammatory cells. Second, as a false positive interpretation, there are 1) foreign body reactions or scar containing trapped pilosebaceous structures, 2) horizontal and tangential cuts through the pilosebaceous apparatus, 3) some epidermal neoplasms including solar lentigines, seborrheic keratoses, and acantholytic actinic keratoses, and 4) contamination of the tumor tissue. CONCLUSION: With careful attention to the examples which can affect the interpretation as mentioned above, it may be possible to detect complete removal of tumor mass and achieve higher cure rate. We could achieve a 100% of cure rate for primary basal cell carcinoma and 95 % of cure rate for recurrent basal cell carcinoma after Mohs Micrographic surgery in our hospital from March 1991 to February 1998.
Carcinoma, Basal Cell* ; Cicatrix ; Foreign Bodies ; Frozen Sections ; Hair ; Hair Follicle ; Humans ; Inflammation ; Keratosis, Actinic ; Keratosis, Seborrheic ; Lentigo ; Mohs Surgery*

BACKGROUND: Since the bioavailability of itraconazole capsule is influenced by patients gastric acidity, it results in treatment failure due to its low dissolution and subsequent low absorption when administered in fasting. Itraconazole Melt-Extrusion tablet has been lately developed in order to improve its dissolution profile. It is the first clinical study to evaluate the efficacy and safety of itraconazole Melt-Extrusion tablet in Korea. OBJECTIVE: This study was conducted to evaluate the efficacy and safety of itraconazole melt-extrusion tablet 400mg daily for 1 week(pulse therapy) for hyperkeratotic type of tinea pedis and manus. METHODS: A clinical and mycological investigation was made of 812 outpatients with hyperkeratotic type of tinea pedis and/or tinea manus who had visited at 52 general hospitals under the lead of the Korean Dermatological Association from June to December, 1998. Patients confirmed by clinically and microscopically as hyperkeratotic type of tinea pedis and/or tinea manus were administered 2 tablets twice a day for one week and followed up for 8 weeks from the start of the medication. RESULTS: The results were summarized as follows; 1. Clinical symptoms of hyperkeratotic type of tinea pedis and/or tinea mauns were significantly improved at the end of study, week 8(p<0.001). 2. Clinical response rate, defined as more than 50% decrease of the sum of the clinical symptom scores, was 79.3%(512/646). 3. Mycological cure rate, dafined as both culture and KOH negative at week 8, was 78.2%(244 /312). 4. 40(5.5%) patients, of the 727 patients evaluable for drug safety evaluation, were reported to have adverse event. CONCLUSION: Itraconazole Melt-Extrusion tablet 400mg/day for 1 week (pulse therapy) is effective and safe in the treatment of hyperkeratotic type of tinea pedis and/or tinea manus.
Absorption ; Biological Availability ; Fasting ; Gastric Acid ; Hospitals, General ; Humans ; Itraconazole* ; Korea ; Outpatients ; Tablets ; Tinea Pedis* ; Tinea* ; Treatment Failure

PURPOSE: This study was performed to find out the natural history of lung cancer in Pusan-Kyungnam area and changing of that in previous report. MATERIALS AND METHOD: We studied retrospectively 508 patients with pathologically proven lung cancer from January 1991 to December 1995. We analysed age and sex distribution, initial symptoms before diagnosis, first method yielding histologic diagnosis, cell types of lung cancer, initial stage of lung cancer, schema of overall patients, survivial of lung cancer patients, and prognostic factors affecting survival of lung cancer patients.. RESULTS: The overall male to female ratio was 4.5: 1 and the age distribution ranged from 20 to 86 years, and the median age of overall patients was 60 years. Histologic classification revealed that the most prevalent type was squamous cell carcinoma (251 cases, 49.4%), followed by adenocarcinoma (141 cases, 27.8%), small cell carcinoma (91 cases, 17.9%), and large cell carcinoma (3 cases, 0.6%). In non-smali cell lung cancer 56.8% were stage IIIb and IV, therefore curative operation was done in 18.7% of all cases, but in small cell lung cancer 65.6% were extended disease. Meidan survival of overall patients was 11.8 months. There was a quite difference in survival among the stages. In non-small cell lung cancer, median survival was 59.7 months, 27.3 months, 18.5 months, 12.7 months, 5.9 months in stage I, II, IIIa, IIIb, IV in each. In small cell lung cancer, median survival of limited disese was 12.2 months and median survival of extended disease was 6.7 months. The stage and the performance status were independent prognostic factors in both small cell and non-small cell lung cancer. CONCLUSION: The prognosis of patients with lung cancer was still grave, but the survival was better than that of a previous report. This may be accorded to increase in early diagnosis and operation and advance in supportive care.
Adenocarcinoma ; Age Distribution ; Busan* ; Carcinoma, Large Cell ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Classification ; Diagnosis ; Early Diagnosis ; Female ; Gyeongsangnam-do* ; Humans ; Lung Neoplasms* ; Lung* ; Male ; Natural History ; Prognosis ; Retrospective Studies ; Sex Distribution ; Small Cell Lung Carcinoma

No abstract available.
Prune Belly Syndrome*