OBJECTIVES: The diagnosis of ASCUS(atypical squamous cells of undetermined significance) and LSIL(low-grade squamous intraepithelial lesion) was introduced in 1988 by the Bethesda system for reporting cervical/vaginal cytologies. A significant proportion of women referred for colposcopy with low grade cervical cytologic abnormalities(ASCUS and LSIL) will have high grade cervical intraepithelial neoplasia(CIN II or CIN III) and therefore require adequate management. The purposes of this study were to evaluate the usefulness of high risk type HPV(human papillomavirus) DNA detection using PCR(polyerase chain reaction) in patients with low grade cervical cytologic abnormalities in the prediction of high grade CIN and invasive cancer and to determine the clinical triage in the management of low grade cervical cytologic abnormalities. METHODS: We reviewed 18,942 cases of Papanicolau smears that were performed at our hospital from Jan. 1995 to Mar. 1999. Colposcopically directed biopsy or LLETZ(large loop excision of transformation zone) or hysterectomy were performed on 318 patients with abnormal PAP smears of low degree. HPV PCR testing of high risk types(16 and 18) was also performed on 115 patients. RESULTS: Histologic outcome of ASCUS included 43 cases(38.4%) of high grade CIN and invasive cancer, and that of LSIL included 65 cases(47.5%) of high grade CIN and invasive cancer. In cases of high risk HPV type, 19 patients(73.1%) were at age over 30 years. A highly significant correlation was found between a positive test for high risk types of HPV and finding of high grade CIN and invasive cancer. Among 51 women with ASCUS, a positive test for high risk type had a sensitivity and specificity of 40.0% and 86.1%, and positive predictive value(PPV) and negative predictive value(NPV) of 54.5% and 77.5%, respectively. In 64 women with LSIL, a positive high risk type test was associated with sensitivity and specificity of 30.0% and 94.1%, and PPV and NPV of 81.8% and 60.4%, respectively. CONCLUSION: Our results suggest that high risk type HPV may be positively predictive of and may act as a surrogate marker for high grade CIN and invasive cancer in women with low grade cervical cytologic abnormalities. The management of women with a low grade cervical cytologic abnormalities should be active such as colposcopically directed biopsies.
Biomarkers ; Biopsy ; Colposcopy ; Diagnosis ; DNA* ; Female ; Humans* ; Hysterectomy ; Polymerase Chain Reaction ; Sensitivity and Specificity ; Triage

No abstract available.

This clinical and histopatholgical study was performed with 149 cases of acquired melanocyticnevi, which were obtained as surgical specimens from 1975 to 1985 at Depa.rtment of Clinical Pathology, Seoul Red Cross Hopital. The results were as follows: 1) Histologic subdivision of melanocytic nevus into junctional(,J), IJC, compound (C,"), ICI, and intradermal(I) is used. IJC is a lesion in an intermediate state between ,junctional and compound nevus, and ICI, between compound and intradermal nevus. 2) The age distribution of the excisional melanocytic nevus peaks during the third decade of life, with 47% of patients between 21 40 year old of age. 3) Of l49 specimens with excisional melanocytic nevus, the number of junctional, IJC, compound, ICI and intradermal nevus were 17, 4, 21, 32 and 75 in each group And so, it is likely that evolution of the melanocytic nevus have an increased opportunity for surgical excision. 4) Among the 17 cases of junctional nevus, one case is found in 5th and the other one in 7th decade. 5) In distvibution of melanocytic nevus, head including face is the most common site among the body area and then trunk, neck, lower and upper extremity in decreasing orders.
Adult ; Age Distribution ; Head ; Humans ; Neck ; Nevus ; Nevus, Intradermal ; Nevus, Pigmented* ; Pathology, Clinical ; Red Cross ; Seoul ; Upper Extremity

One hundred fifty-seven patients wha underwent radical hysterectomy and pelvic lymphadenectomy for FIGO stage IB and IIA carcinoma of the cervix between February l975 and May 1987 were retros-pectively analysed to identify specific risk factors associsted with treatment failures. Prognostic factors inciuded clinical stage, histologic cell type, degree of differentiation, size of primary tumor, depth of stromal invasian, lymph-vaseular space invasion, and lymph node metastasis. Treatment results were evaluated according to the recurrence rate and 2-year absolute recurrence-free survival(NED) rate by the prognostie faetors and treatment modalities. Patients with lymph node me tases had a significantly higher incidence of bulky primary(-> 4cm), depth of stromal invasion(> 60% thickness), and lymph-vascular invasion(P<0.005). There was significant difference in the recurrence rate and 2-year, NED rate between cervical carcinoma stage IB and I1A(P <0.005). The pat,ients who had bulky primary tum~or(>4cm) and/or depth of stromal invasion (>60% thickness) had a higher recurrence and lower 2-year NKD rate(P<0.025, P<0.005), Unfortunately, it was not possible to demonstrate that these detrimentel effects could be overeorne by postoperetive radiation. When adjoined for these risk group, traditionally reported poor prognostic factors such as nodal metatasis, cell type and differentiation, lyrnphi-vascular mvasion assume less importance in our studies. In this study, prognosis is most inf1ueneed by clinical stage, depth of stromal invasion, and size of primary tumor,
Cervix Uteri* ; Female ; Humans ; Hysterectomy ; Incidence ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Risk Factors ; Treatment Failure*

A histological and electron microscopic study were conducted in order to observe a morphological changing pattern of patellar ligament autograft after endoscopic ACL reconstruction. Seventeen patients among 117 consecutive series which underwent endoscopic ACL reconstruction from January 1990 to March 1995, were involved in this study according to the various follow-up periods. In second-look arthroscopic finding at 6 months follow-up after ACL reconstruction, reconstructed ACL was covered with synovium and round-shaped, and after the biopsy active bleeding could be seen. In histological study, 6 months follow-up, spindle or ovoid shaped fibroblast with hypercellularity, high crmp patterns of collagen fiber, and parallel arrangement of fibroblast to collagen fiber were noted. The cellularity of fibroblast decreased in according to periods of follow up. At 12 months follow up, spindle or ovoid fibroblast, its cellularity and arrangement pattern and crimp pattern of collagen fiber seemed to be almost similar to those of normal ACL. This similaryity continued up to 2 years and 2 months after reconstruction. In EM study, until 6 months follow-up after reconstruction, the graft showed randomly arranged fibroblasts with hypercellularity, which had abundant cytoplasm with marked irregular cytoplasmic borders and prominent nuclear indentation, Collagen fibrils were immature and showed a unimodel distribution with small diameter. At 12 months follow-up, elongated fibroblasts appeared, but these cells contained folded nuclei and abundant cytoplasm. Collagen fibrils had parallel arrangement and sparse cross striation, and comprised of mainly small fibrils and scattered large fibrils. After 24 months follow-up, the cellularity decreased more. The regular arrangement of collagen fibrils with wavy pattern similar to normal anterior cruciate ligament was noted. Two distinctive population of the small and large diameter of fibrils was also observed (bimodal distribution). At 26 months, the large and small collagen fibrils compresed a characteric bimodal pattern with parallel arrangement, but the majority of fibroblasts had irregular cytoplasmic contour, and abundant cytoplasm with increased organelles, which indicated the active function. These findings suggest that the graft are still immature even at 26 months in postoperative follow up despite considerable maturation of collagen fibril.
Anterior Cruciate Ligament ; Autografts ; Biopsy ; Collagen ; Cytoplasm ; Fibroblasts ; Follow-Up Studies ; Hemorrhage ; Humans ; Organelles ; Patellar Ligament ; Synovial Membrane ; Transplants

An experimental study on the effect of the induced dislocation of the femoral head on the femoral anteversion was made in the hips of 55 rabbits, three to four weeks old. The results were as follows; l. In 49 of the 55 operated rabbits, a relative increase of anteversion was observed on the dislocated side, as compared with the nonoperated femur, the differences ranging from 3 to 55 degrees with an average of 20.0 degrees. 2. The anteversion angle of dislocated hip showed steady and gradual increase with the increase of age. 3. The anteversion increase was detected very early after operation; 3 of the 4 rabbits, belonging 4 to 7 days group after operation showed the anteversion increase. 4. The collapse of proximal femoral epiphysis was observed in 42 of the total 55 hips. The incidence of the collapse was higher in postoperative 4 weeks and more groups. 5. The color change, pale discoloration, of the articular cartilage was observed in 32 of the total 55 hips. The icnidence of pale discoloration was higher in the groups within 8 weeks after operation.
Cartilage, Articular ; Congenital Abnormalities ; Dislocations ; Epiphyses ; Femur ; Head ; Hip ; Incidence ; Rabbits

Atrial flutter is and infrequent, but potentially unstable tachyarrythmia that occurs in pediatric ages. Transesophageal atrial pacing was used for treatment of 10 episodes of atrial flutter in 7 patients. At the time of atrial flutter conversion, patients were 6 days to 14 years old. 6 patients had associated with congenital heart disease. The atrial cycle length of atrial flutter ranged from 140 to 280 msec with variable atrioventricular conduction. Transesophageal atrial pacing was performed using a bipolar 4 F transesophageal electrode catheter. Atrial flutter conversion was accomplished with stimulation bursts using about 5 seconds of stimuli, 10 msec in duration at 20 to 27 mA. Pacing cycle length was 45 to 110 msec less than the atrial cycle length of tachycardia in 6 episodes. But in a neonate, underdrive pacing converted atrial flutter to sinus rhythm. Conversion attempts were unsuccessful on 2 occasions. Transesophageal atrial pacing is a safe and effective, minimally invasive technique for treatment of atrial flutter in infants and children.
Adolescent ; Atrial Flutter* ; Catheters ; Child* ; Electrodes ; Heart Defects, Congenital ; Humans ; Infant* ; Infant, Newborn ; Tachycardia

Kawasaki disease (KD) is an immune-mediated disease which is a leading cause of acquired cardiovascular disease in developed country. Recently, tumor necrosis factor-alpha (TNF-alpha) blocker, infliximab has been considered a promising option for patients with refractory KD. Although chronic use of a TNF-alpha blocker could increase risk of opportunistic infections, a few studies have documented that use of infliximab was safe without serious adverse effects in patients with KD. We observed serious bacterial infection after infliximab treatment in an infant with refractory KD. Our patient was a 5-month-old male infant diagnosed with KD who did not respond to repeated doses of intravenous immunoglobulin. We effectively treated him with a single infusion of infliximab (5 mg/kg), but gram-negative (Acinetobacter lwoffii) septicemia developed after infliximab infusion. Therefore, we report a case of serious septicemia after treatment with infliximab, and suggest considering the risk of severe infection when deciding whether to prescribe infliximab to an infant with refractory KD.
Bacterial Infections ; Cardiovascular Diseases ; Developed Countries ; Humans ; Immunoglobulins ; Infant* ; Male ; Mucocutaneous Lymph Node Syndrome* ; Opportunistic Infections ; Sepsis* ; Tumor Necrosis Factor-alpha ; Infliximab

PURPOSE: The purposes of this article are to identify CT findings distinguishing nasal polyps, that are the most common cause of the nasal polypiod lesions, from other nasal cavity masses and to identify differential points between benign and malignant masses of nasal cavity. MATERIALS AND METHODS: We classified 567 cases of pathologically proved nasal cavity masses into 4 different groups on CT according to the sites of origin and surrounding bone changes. RESULT: The nasal polyps were the most common cause of nasal cavity masses(515/567). Group I had a high diagnostic specificity for the nasal polyps (513/515, 99.6%) although inverted papilloma (8/522) and malignant melanoma(1/522) showed similar CT appearances. The representitive nasal mass of Group Ila was the inverted papilloma (15/24, 66.5% of the inverted papilloma). Group III pattern was seen in 3 cases of benign minor salivary gland tumor and 2 cases of pyogenic granuloma. Group IV suggested malignancy and thus was mostly observed in malignant tumors except I case of inverted papilloma and 1 case of granulomatous necrosis. CONCLUSION: The differential diagnosis between nasal polyps and the other nasal cavity masses is possible by characteristic bone changes and their sites of origin revealed on CT. In addition, it is possible to differentiate malignant masses from benign in most cases.
Diagnosis, Differential* ; Granuloma, Pyogenic ; Nasal Cavity* ; Nasal Polyps* ; Necrosis ; Papilloma, Inverted ; Salivary Glands, Minor ; Sensitivity and Specificity

PURPOSE: To evaluate the imaging findings of endometrial stromal sarcoma (ESS) according to histopathologic grade. MATERIALS AND METHODS: Six patients with pathologically proven ESS were included in this study. The histopathologic diagnosis was low-grade ESS for three patients and high-grade ESS for the three others. Preoperative CT or MR images were evaluated in terms of tumor size, location, growth pattern, the presence of hemorrhage or necrosis, status of the endometrial cavity, and invasion of surrounding structures. The imaging features of ESSs, which varied according to their histopathologic grade, were compared. RESULTS: The mean maximal diameter of low-and high-grade ESSs was 6 cm and 11.2 cm, respectively. All three low-grade ESSs were located mainly in the myometrium, but two high-grade ESSs were situated in the endometrial cavity and associated with focal tumor extension into the myometrium. One high-grade ESS had completely replaced the uterus. Low-grade ESSs were relatively well-defined, but high-grade ESSs had an irregular and lobulated margin. Intratumoral hemorrhage and necrosis were, respectively, found in two and three high-grade ESSs. Widening of the endometrial cavity was noted in all three high-grade ESSs, and lymph node metastasis had occurred in one. CONCLUSION: The imaging findings of ESS vary from a well-defined intramural mass to a bulky infiltrating mass, and depend on their histopathologic grade.
Animals ; Diagnosis ; Female ; Hemorrhage ; Humans ; Lymph Nodes ; Magnetic Resonance Imaging* ; Mice ; Myometrium ; Necrosis ; Neoplasm Metastasis ; Sarcoma ; Sarcoma, Endometrial Stromal* ; Uterine Neoplasms ; Uterus