PURPOSE: Persistence of urgency in women after anti-incontinence surgeries is a distressing problem. We compared post-operative outcome of urgency according to clinical factors and urodynamic findings. And we evaluated the effects of post-operative persistent or de novo urgency on patient satisfaction. MATERIALS AND METHODS: Medical records of 279 consecutive women who had undergone modified fascial sling operation were reviewed. Motor urge defined as urgency with detrusor instability, and patients with urgency but no demonstrable detrusor instability on urodynamic study were diagnosed as sensory urge. Post-operative symptoms and satisfaction were assessed by questionnaire. RESULTS: Of the 279 patients, 53 with motor urge and 115 with sensory urge had pre-operative urgency. Cure or improvement in urgency occurred in 45 (84.9%) and 5 (9.4%) of the motor urge, and 70 (60.9%) and 23 (20.0%) of sensory urge cases, respectively (p<0.05). 105 (84.0%) of 125 patients with cure or improvement of urgency were satisfied for the operation, however, de novo urgency was noted in 8 patients (2.9%) and only 34 (66.7%) of 51 patients with persistent urgency or de novo urgency were satisfied (p<0.05). CONCLUSIONS: Our results suggest that we can predict cure or improvement of urgency with resolution of stress urinary incontinence after sling operation in many patients, and patients with motor urge are more likely to have urgency resolution after sling operations than those with sensory urge. Among various factors, post-operative outcome of urgency has a considerable effect on patient satisfaction.
Female ; Humans ; Medical Records ; Patient Satisfaction* ; Surveys and Questionnaires ; Urinary Incontinence* ; Urodynamics

BACKGROUND & AIMS: Management of ovarian carcinoma presents most commonly by surgery and subsequent platinum-based chemotherapy, but most patients will have either residual or recurrent disease. Taxol, a new antimicrotubule agent, has been indicated as a salvage measure after failure of first-line or subsequent chemotherapy. The purpose of this study is to investigate the efficacy and toxicity of Taxol used as a salvage therapy. MATERIALS & METHODS: Between January 1994 and Jun 1996, 19 patients aged 38-64 years(median 52) with ovarian carcinoma were given Taxol-containing regimen. Taxol was administered at a dose of 135mg/m2 intravenously with cisplatin or carboplatin every 3 weeks. The patients who treated with Taxol only were received 175mg/m2 intravenously with same interval. The median treatment cycle was 6.6 cycles(range, 3 to 15 cycles). Patient's response were evaluated with tumor marker(CA-125) and CT or MRI before and after chemotherapy. Responses and toxicities were defined according to the Gynecologic Oncology Group criteria. (continue)
Carboplatin ; Cisplatin ; Drug Therapy* ; Humans ; Magnetic Resonance Imaging ; Ovarian Neoplasms ; Paclitaxel* ; Salvage Therapy*

For the diagnosis of upper gastrointestinal (GI) lesions, magnification method is usually used in conjunction with chromoscopy, enabling the endoscopist to view subtle mucosal patterns in exquisite detail. Recently published datas have shown that magnifying endoscopy might be a valuable adjunct for the diagnosis, detection, and characterization of inflammatory and neoplastic lesions of the upper GI tract. It is also proven to be an useful surveillance protocol in identifying dysplastic epithelium or early cancer within a segment of Barrett's esophagus. Possible indications for magnifying endoscopy in upper GI tract include screening and surveillance of Barrett's esophagus, defining the extent of esophageal and gastric adenocarcinoma, detecting synchronous/metachronous gastric and esophageal cancers, diagnosing Helicobacter pylori infection, and recognizing minimal mucosal changes in gastroesophageal reflux disease. By grading the quality of evidence for the currently published trials, it is clear that the majority are case series, case reports, and/or observational studies without randomization, control, or blinding. Moreover, other evidence-based criteria such as independent, blind comparisons of magnifying endoscopy with a standard method which evaluates this technology in an appropriate spectrum of patients to whom the test may be applicable, and standardizing methodology would be crucial before magnifying endoscopy becomes a standard procedure in clinical practice. In the future, a uniform classification system for staining and magnifying patterns should be devised and observer agreement should be tested. Futher studies then could be performed based upon consistent, validated, and standardized terminologies and criteria.
Diagnosis, Differential ; Duodenal Diseases/pathology ; Endoscopy, Gastrointestinal/*methods ; Esophageal Diseases/pathology ; Gastrointestinal Diseases/*pathology ; Humans ; Image Enhancement/*methods ; Stomach Diseases/pathology ; Upper Gastrointestinal Tract/pathology

PURPOSE: To evaluate the relationship between urethral hypermobility and Valsalva leak point pressure (VLPP), subjective symptom degree in women with stress urinary incontinence. MATERIALS AND METHODS: 229 patients who were diagnosed as stress urinary incontinence and had undergone all of standing cystourethrogaphy, urodynamic study including VLPP, and recording questionnaire of incontinence were included in this study. The subjective degree of stress urinary incontinence was graded to 3 grades by Stamey classification, and urethral mobility more than 2.0 cm on standing cystourethrography was determined as the urethral hypermobility. And patients were stratified 3 groups according to the VLPP of less than 60, 60 to 90 and greater than 90 cmH2O. Correlation between urethral hypermobility and VLPP, subjective symptom degree were evaluated. RESULTS: According to the VLPP of less than 60, 60 to 90 and greater than 90 cmH2O, urethral hypermobility was noted in 49.4%, 86.6%, 92.4%, respectively. The rate of urethral hypermobility increased according to VLPP does with statistical significance (p<0.05). And in subjective symptom grade I, II, III urethral hypermobility was noted in 75.0%, 79.7%, 61.0%, respectively. There was not significant correlation between urethral hypermobility and subjective symptom degree (p=0.15). CONCLUSION: Our results suggest that there is significant correlation between urethral hypermobility and VLPP. And in some of patients with stress urinary incontinence urethral hypermobility and intrinsic sphincter deficiency are coexist. However, we suggest that the preoperative evaluation for urethral hypermobility and intrinsic sphincter deficiency is needed to assess the surgical outcome more exactly in the patients with stress urinary incontinence.
Classification ; Female ; Humans ; Surveys and Questionnaires ; Urinary Incontinence ; Urodynamics

No abstract available.
Dysgerminoma*

Calcific constrictive pericarditis is considered to be a nonspecific response to chronic inflammation. This disease has become rare, because the cause of it is usually tuberculosis, which has the tendency to decrease. Other possible causes of it include radiation, rheumatoid disorders, sarcoidosis, and trauma. Whatever the etiology, it can lead to cardiac tamponade by reducing cardiac diastolic filling. We report, herein, the case of a patient with heart failure by a calcific pericardial ring.
Cardiac Tamponade ; Heart Failure* ; Heart* ; Humans ; Inflammation ; Pericarditis, Constrictive ; Sarcoidosis ; Tuberculosis

From Jan. 1984 to Dec. 1993, 46 patients with malignant germ cell tumor of ovary were identified in tumor registry of Seoul National University Hospital. The clinicopathologic features of these patients were reviewed. The mean age of patient was 21.6 years (range 1-54), and common presenting symptoms were abdominal mass (19/46), abdominal pain (9/46), abdominal distension (7/46), and epigastric discomfort (2/46) in order. Dysgerminoma was the most common histologic type (19/46, 41.3%), followed by endodermal sinus tumor (13/46, 28.2%), mixed germ cell tumor (6/46, 13/0%), embryonal carcinoma(5/46, 10.8%), immature teratoma(2/46, 4.3%), and chorio- carcinoma (1/46, 2.1%). Among 6 mixed germ cell tumors, dysgerminoma mixed with endodermal sinus tumor component was the most frequent combination. Fifty percent of patients were with FIGO stage I, and 26% with stage III. Overall two year disease free survival was 89.1%. Patients with dysgerminoma showed more favorable 2 year disease free survival (100%) than endodermal sinus tumor or mixed germ cell tumor (84.6%, 66.6% respectively). Patients age, disease stage, histologic type and future child-bearings should be considered in the management of malignant ovarian germ cell tumor. Multicenter prospective randomized studies are needed to identify the more rational treatment strateges of these rare malignant tumors.
Abdominal Pain ; Disease-Free Survival ; Dysgerminoma ; Endodermal Sinus Tumor ; Female ; Germ Cells* ; Humans ; Neoplasms, Germ Cell and Embryonal* ; Ovary ; Seoul

OBJECTIVE: The importance of surgico-pathologic staging in endometrial cancer to identify risk factors of the therapeutic and prognostic value has been recognized only recently. Recognition of subsets of patients should minimize treatment related morbidity and mortality for those patients with a good prognosis, while identifying patients who are at high risk for recurrence and therefore likely to benefit from adjuvant therapy. METHODS: This rettospective study was based on clinical review of 76 patients with endometrial cancer from 1983 through 1994 who underwent surgical treatment in Department of Obstettics and Gynecology at Seoul National University Hospital. All cases were restaged using the newly adopted FIGO surgical staging. Univariate and multivariate analysis were carried to compare the importance of prognostic variables. RESULTS: Significant prognostic factors in endometrial cancer were histologic subtype, depth of myometrial invasion, cervical invasion, parametrial invasion, adnexa metastasis, lymph node metastasis and peritoneal cytology(p<0.05). Age and histologic grade were not significant prognostic factors(p>0.05). Multivariate analysis showed that surgical stage and depth of myometrial invasion were important factors that predict recurrence(p<0.05). CONCLUSION: This study has yielded important information for therapeutic approach to endometrial cancer.
Endometrial Neoplasms* ; Female ; Gynecology ; Humans ; Lymph Nodes ; Mortality ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Risk Factors ; Seoul

BACKGROUND: To maximize the histological advantage and minimize the physiological disadvantage, we have been using the skeletonized gastroepiploic artey (GEA) as a free graft for total arterial revascularization. The aims of the current study was to assess the efficacy of the skeletonized GEA as a composite or extended graft for total arterial revascularization. MATERIAL AND METHOD: Between January 2000 and Feburary 2005, 133 patients (43 female, mean age=61.8 yrs) undergoing coronary artery bypass grafting (CABG) with a skeletonized GEA as free graft (22 extended, 107 composite and 4 others) were enrolled in this study. Coronary angiograms were performed in the immediate (median 14 days, n=86), early (median 366 days, n=56) and midterm (median 984 days, n=29) postoperative periods. RESULT: There were 3 (2.2%) early and 4 (3.3%) late cardiac-related deaths. The mean number of distal anastomoses per patient was 3.34 for total graft and 1.92 for GEA graft. The immediate, early, and midterm GEA patency were 157/159 (98.7%), 106/112 (94.6%), and 53/56 (94.6%), respectively. During follow-up, four patients required percutaneous intracoronary intervention because of GEA and target coronary artery stenosis or competitive flow. CONCLUSION: These data demonstrate satisfactory clinical and angiographic results in the skeletonized GEA as free graft for total arterial revascularization. Although we need a careful longer follow-up, the skeletonized GEA as a free graft will be a valuable option 'to be' for CABG.
Coronary Artery Bypass* ; Coronary Stenosis ; Coronary Vessels* ; Female ; Follow-Up Studies ; Gastroepiploic Artery* ; Humans ; Postoperative Period ; Skeleton* ; Transplants*

Thoracic endovascular aortic repair has become a widespread alternative treatment option for thoracic aortic aneurysm. The debranching of arch vessels may be required to provide an acceptable landing zone for an endovascular stent graft. We report a case where the bypass graft used in the thoracic endovascular aortic repair procedure compressed the left internal jugular vein, causing acute thrombotic occlusion.
Aorta ; Aortic Aneurysm, Thoracic ; Blood Vessel Prosthesis ; Jugular Veins* ; Thrombosis ; Transplants*