This is retrospective study of the 18 patients of SLAP lesion which were found during arthroscopic treatment of 92 patients. The patients were diagnosed as recurrent shoulder dislocation (50 patients), shoulder impingement syndrome (36 patients) and SLAP lesion (four patients), clinically and radiologically, between March 1989 and June 1995. SLAP lesion were found in eleven patients with recurrent shoulder dislocation, three patients with impingement syndromes. Solitary SLAP lesions were found in four patients. Mean follow-up time was 36 months (range, 12 to 72 months) and average age of patients were 26 years old. Type I SLAP lesion by Snyder's classification were eight cases, type II were seven cases, type III were two cases and type IV was one case. Arthroscopic debridement of frayed or degenerated labrum and biceps tendon anchor were per formed in ten cases of type I and III. In type II and IV, six cases were repaired by arthroscopic placement of multiple suture, two cases were repaired by biodegradable tack (Suretac). The result were quantitated with Rowe rating scale. Eleven cases were exellent, four cases were good, and three cases were fair with Rowe rating scale. Our study revealed that these lesions were not uncommon in instability or impingement of shoulder. Type II SLAP lesion was frequently associated with anterior shoulder instability.
Adult ; Classification ; Debridement ; Follow-Up Studies ; Humans ; Retrospective Studies ; Shoulder ; Shoulder Dislocation ; Shoulder Impingement Syndrome ; Sutures ; Tendons

Minimally invasive surgery is widely used in benign gynecologic diseases and may be used in malignancies. We performed a single-port access laparoscopy staging - bilateral salpingo-oophorectomy, laparoscopy-assisted vaginal hysterectomy, bilateral pelvic lymphadenectomy, infracolic omentectomy, and washing cytology - in a borderline ovarian tumor. The number of harvested pelvic lymph nodes were twenty-three and there were no intraoperative or postoperative complications. Single-port access laparoscopic staging may be performed in selected patients. The efficacy, safety, and potential benefits of this technique should be evaluated in further trials.
Female ; Genital Diseases, Female ; Humans ; Hysterectomy, Vaginal ; Laparoscopy ; Lymph Node Excision ; Lymph Nodes ; Postoperative Complications

OBJECTIVE: To compare the efficacy of a pulmonary recruitment maneuver using lower airway pressure (30 cm H2O) and intraperitoneal bupivacaine, alone or in combination, for reducing shoulder pain after gynecologic laparoscopy.METHODS: A prospective controlled study was performed in a teaching hospital with patients who underwent elective gynecologic laparoscopic surgery. Two hundred eighty-seven patients were randomized into 1 of 4 groups: group A, placebo; group B, intraperitoneal instillation of bupivacaine; group C, CO2 removal by a pulmonary recruitment maneuver; group D, combination of intraperitoneal bupivacaine and pulmonary recruitment maneuver. The interventions were performed at the end of surgery. Shoulder pain was recorded on a visual analog scale (VAS) at 1, 6, 12, and 24 hours postoperatively.RESULTS: The overall incidence of shoulder pain was 49.8% and the incidence tended to gradually decrease from group A to group D (59.0% in group A, 54.8% in group B, 44.4% in group C, and 41.5% in group D; P=0.026). In addition, the VAS scores gradually decreased from group A to D, although a statistically significant difference was only found at 6 hours postoperatively (P=0.03). There were no complications related to the interventions.CONCLUSION: The combination of a pulmonary recruitment maneuver with intraperitoneal bupivacaine significantly reduced shoulder pain after gynecologic laparoscopy.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01039441

OBJECTIVE: This study was conducted to compare the perioperative outcomes in patients with symptomatic uterine myoma who underwent laparoscopic (LM) or laparoscopically assisted myomectomy (LAM). METHODS: A total of 207 patients with myoma underwent LM or LAM in Samsung Medical Center between October 2006 and March 2010. Of them, 121 patients with LM and 50 with LAM met the inclusion criteria and were compared for the perioperative outcomes. RESULTS: The operation time was significantly shorter in the LAM group than in the LM group (111 min versus 139 min; p<.001, respectively). Estimated blood loss was significantly higher in the LAM group (p<.001). Intraoperative, early postoperative complications, hospitalization days and postoperative analgesics use were similar between the 2 study groups. CONCLUSION: LM and LAM is comparable in the perioperative outcomes in patients with symptomatic uterine myoma.
Analgesics ; Female ; Hospitalization ; Humans ; Laparoscopy ; Lipopolysaccharides ; Myoma ; Postoperative Complications

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate changes in the adjacent segment after posterior instrumentation and fusion in thoracolumbar spinal fractures. SUMMARY OF LITERATURE REVIEW: The incidence of adjacent-segment disease is increasing as spinal surgery becomes more common. Many studies have been conducted on the risk factors for adjacent-segment changes in the lumbar spine, but few articles have been published on this topic in the thoracolumbar spine. MATERIALS AND METHODS: The records of 50 patients who received treatment from 2000 to 2013 were reviewed retrospectively. They underwent posterior instrumentation and fusion due to thoracolumbar fracture and were followed up for more than 2 years. To evaluate changes in the adjacent segment, immediate postoperative and last follow-up values of the sagittal angle, disc height, and disc angle were compared between groups divided by age (more or less than 50 years), laminectomy, and fusion levels. The Pfirrmann grade of the discs proximal and distal to the fusion level was also measured using preoperative magnetic resonance imaging. RESULTS: Thirty-six patients were male and 14 were female. The average age of the 50 patients was 45.6 years, and the mean follow-up period was 4.3 years. There were no cases of adjacent-segment disease. The mean kyphotic sagittal angle progression was 6.8° (range, −11° to 28.5°, p=0.000). The mean change of disc height of the proximal adjacent segment was 0.3 mm (range, −1.6 to 3.4 mm, p=0.013) and 0.6 mm (range, −4.1 to 5.8 mm, p=0.013) in the distal adjacent segment. Laminectomy did not make a significant difference. In the group below 50 years of age, the angle of the adjacent segment discs increased by 0.8° (range, −3.1° to 5.1°, p=0.004) at the proximal adjacent segment and by 0.5°(range, −4.8° to 2.9°, p=0.016) at the distal adjacent segment. Proximal adjacent disc height decreased as the fusion levels increased. As the preoperative Pfirrmann grade increased, degenerative changes in the proximal adjacent segment disc tended to accelerate. CONCLUSIONS: Adjacent-segment disease after lumbar fusion surgery was not found in adjacent segments of the thoracolumbar spine. This seems to be due to the anatomical characteristics of the lumbar spine, which is more flexible than the thoracolumbar vertebra. The mobile segments of the lumbar spine may account for this difference, rather than the instrumentation and fusion procedure itself.
Female ; Follow-Up Studies ; Humans ; Incidence ; Laminectomy ; Magnetic Resonance Imaging ; Male ; Retrospective Studies ; Risk Factors ; Spinal Fractures ; Spine

OBJECTIVE: To analyze the prognostic role of revised version of International Federation of Gynecology and Obstetrics (FIGO) stage (2013) in epithelial ovarian cancer and compare with previous version staging classification METHODS: We retrospectively enrolled patients with epithelial ovarian cancer treated at Samsung Medical Center from 2002 to 2012. We reclassified the patients based on the revised FIGO staging classification. RESULTS: Eight hundred seventy-eight patients were enrolled (stage I, 22.8%; stage II, 10.4%; stage III, 56.2%; stage IV, 10.7%). Previous stage IC (98, 11.1%) was subdivided into IC1 (9, 1.0%), IC2 (57, 6.4%), and IC3 (32, 4.1%). In addition, previous stage IV (94, 1.7%) was categorized into IVA (37, 4.2%) and IVB (57, 6.5%) in new staging classification. Stage IIC (66, 7.5%) has been eliminated and integrated into IIA (36, 4.1%) and IIB (55, 6.2%) in revised classification. Revised FIGO stage IC3 had significant prognostic impact on PFS (hazard ratio [HR], 3.840; 95% confidence interval [CI], 1.361 to 10.83; P=0.011) and revised FIGO stage IIIC appears to be an independent, significant poor prognostic factor for PFS (HR, 2.541; 95% CI, 1.242 to 5.200; P=0.011) but not in the case of previous version of FIGO stage IIIC (HR, 1.070; 95% CI, 0.502 to 2.281; P=0.860). However, any sub-stages of both previous and revised version in stage II and IV, there was no significant prognostic role. CONCLUSION: Revised FIGO stage has more progressed utility for informing prognosis than previous version, especially in stage I and III. For stage II and IV, further validation should be needed in large population based study in the future.
Classification* ; Gynecology ; Humans ; Neoplasm Staging ; Obstetrics ; Ovarian Neoplasms* ; Prognosis ; Retrospective Studies ; Survival Analysis*

OBJECTIVE: The purpose of our study is to investigate the feasibility of the laparoscopy and compare perioperative outcomes between laparoscopy and laparotomy in pregnant women with non-malignant ovarian tumor. METHODS: Retrospective comparative analysis of 56 pregnant women who underwent laparoscopy or laparotomy due to non-malignant ovarian tumors at Samsung Medical Center, Seoul, Korea, between October 1994 and December 2010 were performed. RESULTS: Among 56 patients, 22 and 34 pregnant women underwent laparotomy and laparoscopy, respectively. There were no statistically significant differences between the two groups about general characteristics including age, gestational age, torsion, surgeon type, pain at diagnosis and clinical outcomes including tocolytics use, operation type, operation time, the ratio of normal full-term vaginal delivery, Apgar score. However, pathological longest tumor size was larger in laparotomy group than laparoscopy group (9.0 cm vs. 5.8 cm; p=0.001) and laparoscopy was related with significantly less estimated blood loss (200 vs. 50 mL; p=0.001) and short hospital days (7 vs. 4 days; p<0.001). CONCLUSION: Laparoscopy for the treatment of non-malignant ovarian tumors in pregnant women is feasible and has benefits such as less estimated blood loss during the surgery and hospital stays when compared with laparotomy. However, laparoscopic adnexal surgery for large tumor size may be still challenging in pregnant women.
Apgar Score ; Female ; Gestational Age ; Humans ; Korea ; Laparoscopy ; Laparotomy ; Length of Stay ; Pregnancy ; Pregnant Women ; Retrospective Studies ; Tocolytic Agents

OBJECTIVE: The purpose of this study was to evaluate the patients' characteristics and treatment results for 31 granulosa cell tumors (GCTs) of the ovary. METHODS: We retrospectively reviewed the medical records of 31 patients with GCT who received treatment from January, 1997 to April, 2005. They were grouped into 21 adult types, 4 juvenile types and 6 recurrent GCTs. Clinicopathological characteristics, treatment results and follow-up data were investigated from medical records and/or telephone surveys. RESULTS: In adult types, the median age of patients was 42 years (20 to 81 years). The most common present symptom was vaginal bleeding (10/21, 47.6%). All patients with adult type had FIGO stage I with median follow-up of 32 months (5-103 months). No recurrence developed in this group. In juvenile types, the median age was 8 years (2-14 years). Precocious puberty was presented in 2 of 4 (50%). Three had FIGO stage I and one had FIGO stage IIIa. Two patients were given adjuvant chemotherapy with bleomycin, etoposide, cisplatin (BEP) regimens for six cycles. No recurrence was found during median follow-up of 20.5 months (16-27 months). In recurrent GCTs, cytoreductive surgery and adjuvant chemotherapy were given to 5 patients. One patient, who had a disease with multiple liver and multiple lung metastases, was given palliative chemotherapy. All patients were alive, two were clinically in complete response. CONCLUSION: There was no recurrence in adult types and juvenile types, and no dead of disease in recurrent group. However, because of the propensities of GCT to recur years after initial diagnosis and to grow slowly with indolent course, prolonged surveillance with serial physical examination and imaging studies is reasonable.
Adult ; Bleomycin ; Chemotherapy, Adjuvant ; Cisplatin ; Diagnosis ; Drug Therapy ; Etoposide ; Female ; Follow-Up Studies ; Granulosa Cell Tumor* ; Granulosa Cells* ; Humans ; Liver ; Lung ; Medical Records ; Neoplasm Metastasis ; Ovarian Neoplasms ; Ovary* ; Physical Examination ; Puberty, Precocious ; Recurrence ; Retrospective Studies ; Telephone ; Uterine Hemorrhage

OBJECTIVE: Tissue inhibitors of metalloproteinases (TIMPs) play a key role in maintaining homeostasis of the extracellular matrix (ECM) by controlling matrix metalloproteinases (MMPs). In addition to their role in regulating MMPs, TIMPs have also been shown to have pluripotential effects on cell growth, apoptosis and differentiation. The aim of this study was to examine TIMP-2 level in serous ovarian tumor tissues and to understand further the role of TIMP-2 protein in ovarian tumorigenesis. METHODS: Expression of TIMP-2 was assessed by immunohistochemistry in a total of 57 ovarian specimens including five normal ovaries, 12 benign serous cystadenomas, 20 serous borderline tumors and 20 serous carcinomas. RESULTS: The present study found that TIMP-2 immunostaining was significantly more frequent in serous carcinomas, mainly in tumor epithelium, compared with cells of the other tissues studied. CONCLUSION: TIMP-2 in serous ovarian carcinoma may function to favor tumor growth in serous ovarian tumorigenesis. Additional research is now needed to elucidate further the role of TIMP-2 in the biological behavior of ovarian serous tumors.
Apoptosis ; Carcinogenesis ; Cystadenoma, Serous ; Epithelium ; Extracellular Matrix ; Female ; Homeostasis ; Immunohistochemistry ; Matrix Metalloproteinases ; Metalloproteases ; Ovarian Neoplasms ; Ovary ; Tissue Inhibitor of Metalloproteinase-2

OBJECTIVE: The aim of this study was to investigate the association of phosphorylated AKT (pAKT) expression and radiation resistance in cervical cancer. METHODS: A retrospective review was made of the records of 25 women who received primary radiation therapy due to locally advanced cervical cancer (LACC) with FIGO stage IIB-IVA. Nine patients regarded as radiation resistant developed local recurrences with a median progression free interval of 10 months. Sixteen patients did not show local recurrences, and were regarded as a radiation sensitive group. Using pretreatment paraffin-embedded tissues, we evaluated pAKT expression by immunohistochemistry. RESULTS: A significant association was found between the level of pAKT expression and local recurrence. Immunohistochemical staining for pAKT was significantly more frequent in the radiation resistant than in the radiation sensitive group (p=0.007). The mean progression free survival (PFS) was 84 months for patients with pAKT negative staining (17 cases) and 44 months for patients with pAKT positive expression (8 cases)(p=0.015). CONCLUSION: These results suggest that signaling from PI3K/pAKT can lead to radiation resistance in LACC.
Disease-Free Survival ; Female ; Humans ; Immunohistochemistry ; Negative Staining ; Recurrence ; Retrospective Studies ; Uterine Cervical Neoplasms*