We examined whether pretreatment with a small dose of thiopental was effective in reducing pain induced by the intravenous injection of rocuronium. Withdrawal movement was used to assess pain reduction. Ninety patients were randomly assigned to one of two groups: patients in the control group were pretreated with 2 mL saline, and those in the thiopental group were pretreated with 2 mL (50 mg) thiopental. Thiopental 5 mg/kg was injected intravenously. After a loss of consciousness, the upper arm was compressed with a rubber tourniquet, and the pretreatment drugs were administered. Thirty seconds later the tourniquet was removed and 0.6 mg/kg rocuronium was administered. Withdrawal movement was assessed using a four-grade scale: no movement, movement limited to the wrist, to the elbow or to the shoulder. The frequency of withdrawal movement in the group pretreated with thiopental was lower than in the control group (34 vs. 13, p 0.05). We concluded that pretreatment with 2 mL (50 mg) thiopental is effective in reducing pain caused by the intravenous injection of rocuronium.
Thiopental/*therapeutic use ; Pain Measurement ; Pain/chemically induced/*prevention & control ; Neuromuscular Nondepolarizing Agents/*adverse effects ; Middle Aged ; Male ; Injections, Intravenous ; Humans ; Female ; *Anesthetics, Intravenous ; Androstanols/*adverse effects ; Adult

Anaplastic thyroid carcinoma (ATC) is one of the most malignant human neoplasms and has a grave prognosis. This study gives an update on our experience with this unusual neoplasm, with specific focus on the response to various treatment modalities. Forty-seven patients with histologically proven ATCs were enrolled (19 men, 28 women; mean age, 62.8 years). This number represents 1.5% among a total of 3, 088 thyroid cancers treated between 1977 and 2002. The mean tumor diameter was 8.8 cm, and 22 patients had distant metastasis. Extrathyroidal extension was seen in 26 (89.7%) of the cases that underwent surgery. Treatment modalities adopted could be classified into 5 groups: Group 1, biopsy only; Group 2, biopsy and chemoradiotherapy; Group 3, debulking only; Goup 4, debulking and chemoradiotherapy; Group 5, complete excision and chemoradiotherapy. Survival was calculated from the time of diagnosis, and comparisons of survival were done by log-rank analysis. The mean survival was 4.3 months (range, 1.0-21 months). The mean survival based on treatment modalities were as follows: Group 1 (n = 10), 2.1 months, Group 2 (n = 8) ; 3.6 months; Group 3 (n = 7), 3.0 months; Group 4 (n = 14), 3.5 months, Group 5 (n = 8), 9.4 months. There was no significant difference in survival time between the various types of treatment modalities. Even though a small improvement in survival was observed with complete excision and aggressive multimodality therapy, nearly all ATCs remain unresponsive to ongoing treatment modalities and as such, present a therapeutic dilemma. A more effective treatment regimen should be sought in order to improve survival.
Treatment Outcome ; Thyroid Neoplasms/mortality/surgery/*therapy ; Survival Analysis ; Radiotherapy, Adjuvant ; Neoplasm Metastasis ; Middle Aged ; Male ; Humans ; Female ; Combined Modality Therapy ; Chemotherapy, Adjuvant ; Carcinoma/mortality/surgery/*therapy ; Aged, 80 and over ; Aged ; Adult

The purpose of this open-labeled prospective study was to compare the treatment effects of cyclical etidronate and alendronate on the lumbar bone mineral density (BMD), bone resorption, and back pain in elderly women with osteoporosis. Fifty postmenopausal women with osteoporosis, age ranging from 55 to 86 years (mean: 70.7 years), were randomly divided into two groups with 25 patients in each group: the cyclical etidronate group (etidronate 200 mg daily for 2 weeks every 3 months) and the alendronate group (5 mg daily). The BMD of the lumbar spine (L1-L4) measured by DXA, the urinary cross-linked N-terminal telopeptides of type I collagen (NTX) level measured by the enzyme-linked immunosorbent assay, and back pain evaluated by the face scale score were assessed at baseline, 6 months, and 12 months. There were no significant differences in baseline characteristics including age, body mass index, years since menopause, lumbar BMD, urinary NTX level, and face scale score between the two treatment groups. Etidronate treatment sustained the lumbar BMD following a reduction in the urinary NTX level and improved back pain, while alendronate treatment reduced the urinary NTX level more significantly, resulting in an increase in the lumbar BMD, and similarly improved back pain. No serious adverse events were observed in either group. This study confirmed that alendronate treatment had a greater efficacy than etidronate treatment in increasing the lumbar BMD through the reduction of bone resorption in elderly women with osteoporosis.
Spinal Fractures/prevention & control/radiography ; Osteoporosis, Postmenopausal/*drug therapy ; Middle Aged ; Lumbar Vertebrae/*drug effects ; Humans ; Female ; Etidronic Acid/adverse effects/*therapeutic use ; Bone Density Conservation Agents/adverse effects/*therapeutic use ; Bone Density/*drug effects ; Biological Markers/blood/urine ; Back Pain/drug therapy ; Alendronate/adverse effects/*therapeutic use ; Aged, 80 and over ; Aged

The optimal goals in the surgical treatment of rectal cancer are curative resection, anal sphincter preservation, and preservation of sexual and voiding functions. The quality of complete resection of rectal cancer and the surrounding mesorectum can determine the prognosis of patients and their quality of life. With the emergence of total mesorectal excision in the field of rectal cancer surgery, anatomical sharp pelvic dissection has been emphasized to achieve these therapeutic goals. In the past, the rates of local recurrence and sexual/ voiding dysfunction have been high. However, with sharp pelvic dissection based on the pelvic anatomy, local recurrence has decreased to less than 10%, and the preservation rate of sexual and voiding function is high. Improved surgical techniques have created much interest in the surgical anatomy related to curative rectal cancer surgery, with particular focus on the fascial planes and nerve plexuses and their relationship to the surgical planes of dissection. A complete understanding of rectum anatomy and the adjacent pelvic organs are essential for colorectal surgeons who want optimal oncologic outcomes and safety in the surgical treatment of rectal cancer.
Rectum/pathology/*surgery ; Rectal Neoplasms/pathology/*surgery ; Pelvis/*surgery ; Magnetic Resonance Imaging ; Humans ; Dissection/methods

This manuscript is meant to be a brief account of Korean medical history. Only justification for the author, who is not a historian by any means, to undertaken such a venture is that there is scarcely a book on the subject in any Western language.
History of Medicine, Ancient ; History of Medicine, Medieval ; History of Medicine, Modern ; Korea ; Medicine, Oriental Traditional*

To seek a practical and inexpensive method to preserve gonococcal cultures, a few methods were compared. The following methods kept the cultures alive for only a short period of time: skim milk at -20 degrees C; tryptic soy broth with 15% glycerol at -20 degrees C; cystine tryptic agar at 35 degrees C. Most of the test cultures survived for more than 4 weeks in the following media: one half strength dextrose starch agar; one half strength dextrose starch agar with ferric nitrate; one half strength dextrose starch agar with antimicrobic CNV. Dextrose starch agar could be substituted by GC medium base with a slight modification. It is concluded that preservation of gonococci in one half strength dextrose starch agar with CNV, which produces less frequent contamination, is a practical method to maintain cultures for teaching and quality control.
Agar ; Bacteriological Techniques ; Culture Media* ; Glucose ; Neisseria gonorrhoeae* ; Preservation, Biological/methods* ; Starch

Histopathological and electron microscopical studies were made on 7 cases of Reye syndrome. Histologically brain edema with neuronal degeneration and fatty change in the liver were constant findings, and fatty change of kidneys, heart and pancreas were variably observed. Electron microscopy revealed characteristic mitochondrial abnormalities in the hepatocytes, proximal convoluted tubular cells of kidneys, pancreatic acinar cells and nerve cells, in which the mitochondria were distended with expansion of matrix space and the matrix substance was converted to granular or flocculent material. Lipid droplets of small size were also observed in the various cells. In the hepatocytes abnormal shaped microbodies were noted and the rough endoplasmic reticulum was dilated. Virus-like particles were not found. It is suggested that Reye syndrome is not a rare disease-entity in Korea since the cases of Reye syndrome comprised 3.2 percent of all pediatric autopsies during the same period. The significance and the specificity of the mitochondrial changes in Reye syndrome are discussed.
Brain/pathology ; Case Report ; Child ; Child, Preschool ; Female ; Human ; Infant ; Kidney/pathology ; Liver/pathology ; Male ; Microscopy, Electron ; Myocardium/pathology ; Reye Syndrome/pathology*

Juvenile rheumatoid arthritis (JRA) is basically the same disease as rheumatoid arhritis in the adult. However juvenile rheumatoid arthritis has many features that differ from rheumatoid arthritis in the adult, and since the onset of the disease occurs before the age of puberty, variable alterations in growth may occur. In this study, fifty cases of juvenile rheumatoid arthritis treated at Severance Hospital from January 1970 to December 1977 were analysed clinically and the following results were obtained. 1. By classification, the polyarticular type (46%) was most frequent, followed by the pauciarticular type (34%) and systemic type (20%) in order. 2. The most frequent joint affected was the knee (82%) followed by the ankle (60%), hand (22%), wrist (20%), etc. 3. The extra-articular manifestations on admission were high fever (40%), rash (16%), carditis (14%), lymphadenopathy (14%), etc. 4. Laboratory findings on admission showed increased ESR (88%), positive rheumatoid factor (15.5%), positive ANA (16.6%), etc. 5. Clinical symptoms were managed medically and surgically with aspirin, salicylates and steroids, physical therapy, and synovectomy.
Adolescent ; Arthritis, Juvenile Rheumatoid/classification ; Arthritis, Juvenile Rheumatoid/epidemiology* ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Human ; Korea ; Male

We have had 37 patients with cerebral arteriovenous malformation and subarachnoid hemorrhage, who were admitted to the Department of Neurosurgery, Yonsei Medical Center from 1964 to 1976. All of the cerebral arteriovenous malformations were proved by cerebral angiography. Since the site of the lesions were considered to have a close relation to the neurologic deficit and the results of surgery, various analysis of clinical manifestations and of the cerebral angiographic findings were attempted. Out of 37 patients, surgery was performed in 28 and the results were analysed according to the various type of surgical procedure.
Adolescent ; Adult ; Cerebral Angiography ; Child ; Child, Preschool ; Female ; Human ; Infant ; Infant, Newborn ; Intracranial Arteriovenous Malformations/radiography ; Intracranial Arteriovenous Malformations/surgery* ; Male ; Methods ; Middle Age ; Subarachnoid Hemorrhage/radiography ; Subarachnoid Hemorrhage/surgery

A minimal test scheme, consisting of deoxyribonuclease (DNase) and tween 80 hydrolysis (TEH) together with a few other biochemical tests, was used to make tentative identification of Serratia marcescens from clinical specimens. The identifications were reevaluated by testing comprehensive biochemical characteristics of 52 isolates, and all were found to be correct. The biochemical reactions of the isolates were very homogenous, showing typical characteristics of the species except in the urease test and acid production from sucrose, adonitol and inositol. These facts support the feasibility of the use of the minimal identification scheme. Pigment production was noted only in 7 isolates invalidating the value of this characteristic for the identification. Fifty-seven isolates were tested for their antibiotic susceptibility. They were found most frequently susceptible to gentamicin (47.4%), chloramphenicol (35.0%) and kanamycin (28.1%). Many isolates (49.1%) were multiply resistant to ampicillin, chloramphenicol, gentamicin, kanamycin, streptomycin and tetracycline.
Antibiotics/pharmacology* ; Cells, Cultured ; Drug Resistance, Microbial ; Human ; Microbial Sensitivity Tests ; Serratia marcescens/drug effects ; Serratia marcescens/isolation & purification ; Serratia marcescens/metabolism*