Our purpose was to compare the safety and efficacy of intravaginal misoprostol versus dinoprostone vaginal tablet for induction of labor at term pregnancies. Two hundred three patients with indications for induction of labor at term were randomly assigned to receive either intravaginal misoprostol or dinoprostone vaginal tablet. Fifty micrograms of misoprostol was placed in the posterior vaginal fornix every six hours, with a potential maximum of four doses. 3 milligrams of dinoprostone vaginal tablet was placed in the posterior vaginal fornix every eight hours, with a potential maximum of three doses. Further medication was withheld with the occurrence of spontaneous rupture of membrane, entry into adequate contraction pattern(twenty second sustained with two or more frequent uterine contraction in 10 minutes), nonreassuring FHR tracing, or delivery. Artificial membrane rupture with both study protocol was done at the discretion of the attending physician. After membrane rupture, in the cases of failure of active labor or arrest of dilation, oxytocin was administerated. Among those evaluated, 100 received misoprostol and 102 received dinoprostone. The average interval from start of induction to vaginal delivery was shorter in the misoprostol group(784.7 +/- 389.3 min) than in the dinoprostone group(988.3 +/- 369.5 min)(p<0.01). There was no significant difference in change of Bishop score between the two groups. No statistically significant differences were noted between two groups in case of need for oxytocin and oxytocin total dose, but significant difference was noted between two groups in case of indication for oxytocin augmentation. There were no significant differences in the routes of delivery. Intravaginal administration of misoprostol appears to be as effective as dinoprostone vaginal tablet for labor induction at full term pregnancies. Complications associated with prostaglndin administration were not statistically different between the two treatment groups.
Administration, Intravaginal ; Dinoprostone* ; Humans ; Membranes ; Membranes, Artificial ; Misoprostol* ; Oxytocin ; Pregnancy* ; Rupture ; Rupture, Spontaneous ; Uterine Contraction ; Vaginal Creams, Foams, and Jellies*

BACKGROUND: Although the stapled anastomotic technique has achieved efficacy in gastrointestinal surgery, there are only a few experimental results comparing the physical properties of the anastomotic site, pathologic features of the healing process, and physiologic change after the operation. Moreover, there have been no comparative study among various stapled anastomotic techniques. The purpose of this study was to evaluate the safety of various stapled anastomotic techniques by comparing the physical properties of the anastomotic site, pathologic features of the healing process and physiologic change observed for the classical hand-sewn anastomotic technique with those observed for various stapled anastomotic techniques in the normal porcine colon and rectum. METHODS: Twelve male pigs were grouped into 4 according to the anastomotic techniques; standard Albert-Lembert two-layer hand-sewn anastomosis, stapled end-to-end anastomosis, stapled end-to-side anastomosis, and stapled side-to-side anastomosis. Each anastomotic technique was applied at 3 sites (ascending colon, transverse colon, and rectum). Groups of animals underwent a second surgery on the 4th week postoperatively, and the anastomotic properties were assessed with respect to the first day of defecation, bursting pressure, tensile strength, gross scar formation, microscopic inflammatory cell infiltration, telangiectasia, lymphangiectasia, foreign-body reaction, granulation and fibrosis. RESULTS: No significant difference among the respective anastomotic techniques was found with respect to the first day of defecation, bursting pressure, tensile strength, microscopic inflammatory cell infiltration, telangiectasia, and lymphangiectasia. However, more scar formation, foreign-body reaction, granulation and fibrosis were observed in the hand-sewn anastomosis. There was no significant difference among the groups of various stapled anastomotic techniques. CONCLUSION: According to this animal study, various stapled anastomoses were superior to the standard Albert-Lembert two-layer hand-sewn anastomosis with less scar formation, foreign-body reaction,granulation and fibrosis. In colorectal surgery, various stapled anastomotic techniques can be safely applied in accordance with the respective purpose and the anatomical characteristics.
Animals ; Breast Neoplasms* ; Breast* ; Cicatrix ; Colon* ; Colon, Transverse ; Colorectal Surgery ; Defecation ; Fibrosis ; Foreign-Body Reaction ; Humans ; Lymphatic Vessels ; Male ; Mastectomy ; Mastectomy, Radical ; Mastectomy, Segmental* ; Neoplasm Metastasis ; Rectum ; Recurrence ; Retrospective Studies ; Swine ; Telangiectasis ; Tensile Strength

Malignant melanoma constitutes approximately 1% of all cancer (1,2). As the biologic behavior seems to be unpredictable, variation in the metastatic spread are not infrequently met. The common sites of metastasis are lymph nodes, lung, liver, brain, bone, heart, adrenal glands, and gastrointestinal tract in descending order (2). However multiple organ involvement is a common feature at the advanced stage. A 38-year-old male had developed pancreatic pseudocyst during the course of malignant melanoma at right sole. It was proven to be from matastatic malignant melanoma.
Adrenal Glands ; Adult ; Brain ; Gastrointestinal Tract ; Heart ; Humans ; Liver ; Lung ; Lymph Nodes ; Male ; Melanoma* ; Neoplasm Metastasis ; Pancreatic Pseudocyst*

OBJECTIVE: The aim of this study is to extend the indications of hysteroscopic myomectomy. METHODS: Total 304 women who had undergone hysteroscopic myomectomy between February 2001 and March 2005, were selected. Clinical characteristics, laboratory data and postoperative results were analyzed. RESULTS: Mean size of myoma is 3.5 cm, mean op. time is 47 minutes, mean deficit of distension media is 193 cc, types of distension media is URIONE(R) and normal saline, average duration of hospitalization is 4.9 days, average changes of Hb. is 1.5 g/dL, complications of op. were happended in 14 cases, that is uterine perforation (n=8), hyponatremia (n=2), pulmonary edema (n=2), delayed bleeding (n=2). CONCLUSION: The indications of hysteroscopic myomectomy can be extended. In case that patient want to preserve the uterus, deep myometrial embedded or pure intramural myoma might be resected hysteroscopically by single- or multi-step procedure. Hysteroscopic myomectomy performed at observational period may be alternative to hysterectomy in selected cases. In case of recurrence, repeat procedure may reduce the chance of hysterectomy. Intraoperative ultrasonographic guidance is an important procedure in hysteroscopic myomectomy. It lower the complications and morbidity rate.
Female ; Hemorrhage ; Hospitalization ; Humans ; Hyponatremia ; Hysterectomy ; Myoma ; Pulmonary Edema ; Recurrence ; Uterine Perforation ; Uterus

PURPOSE: Among various modalities of treatment in hepatic metastasis of colorectal cancer, hepatic resection has been proven to be the most effective treatment. This analysis was intended to determine important prognostic parameters and to understand clinically significant factors during hepatic resection and follow-up period in patients with hepatic metastasis from colorectal cancer. MATERIALS AND METHODS: Among 1,022 colorectal cancer patients treated at Asan Medical Center from July 1989 to December 1995, 99 patients were found to have liver metastasis at the time of first diagnosis or during follow-up period. These 99 patients were the subject of analysis in this retrospective clinical study. Surgical resection with curative intent was done in 35 patients and chemotherapy in 46 patients. Eighteen patients were with no treatment or misssed during follow-up. Survival rate was analysed according to clinicopathological parameters: sex, age, location of primary tumor, preoperative serum CEA level, TNM staging of primary tumor, number of hepatic metastasis, distribution, synchronous or metachronous lesions, diesase free interval, mode of treatment, type of resection, tumor free resection margin. RESULTS: Overall survival of the patients with hepatic metastasis was significantly related with numbers of metastasis (<4 vs. >4), distribution (unilobar vs. bilobar), synchronous or metachronous lesions, disease free interval ( < 12 vs. > 12 months), mode of treatment (hepatic resection vs. chemotherapy vs, no treatment, p<0.01. A multivariate analysis showed a significant association of survival with mode of treatment (p<0.01). Survival of patients with hepatic resection was significantly related with resection margin (positive vs. < 1 cm vs. > 1 cm), TNM staging of primary tumor (II vs. III), number of hepatic metastasis (p<0.01), disease free interval (p<0.05). A multivariate analysis showed a significant correlation with survival for tumor free resection margin (p<0.01). CONCLUSION: An aggressive approach of hepatic resection in the colorectal liver metastasis will improve survival, if the lesion pennits. In patients with hepatic resection, tumor free resection margin was the most important prognostic parameter by the uniand multivariate analysis. Therefore, every effort should be made to ensure that the clear margin be kept at least more than 1 cm during hepatic resection.
Chungcheongnam-do ; Colorectal Neoplasms* ; Diagnosis ; Drug Therapy ; Follow-Up Studies ; Humans ; Liver ; Multivariate Analysis ; Neoplasm Metastasis* ; Neoplasm Staging ; Retrospective Studies* ; Survival Rate

OBJECTIVE: To evaluate the clinical outcome of coil embolization for unruptured intracranial aneurysm (UIA) with oculomotor nerve palsy (ONP) compared with surgical clipping. METHODS: A total of 19 patients presented with ONP caused by UIAs between Jan 2004 and June 2008. Ten patients underwent coil embolization and nine patients surgical clipping. The following parameters were retrospectively analyzed to evaluate the differences in clinical outcome observed in both coil embolization and surgical clipping : 1) gender, 2) age, 3) location of the aneurysm, 4) duration of the symptom, and 5) degree of ONP. RESULTS: Following treatment, complete symptomatic recovery or partial relief from ONP was observed in 15 patients. Seven of the ten patients were treated by coil embolization, compared to eight of the nine patients treated by surgical clipping (p = 0.582). Patient's gender, age, location of the aneurysm, size of the aneurysm, duration of symptom, and degree of the ONP did not statistically correlate with recovery of symptoms between the two groups. No significant differences were observed in mean improvement time in either group (55 days in coil embolization and 60 days in surgical clipping). CONCLUSION: This study indicates that no significant differences were observed in the clinical outcome between coil embolization and surgical clipping techniques in the treatment of aneurysms causing ONP. Coil embolization seems to be more feasible and safe treatment modality for the relief and recovery of oculomotor nerve palsy.
Aneurysm ; Humans ; Intracranial Aneurysm ; Oculomotor Nerve ; Oculomotor Nerve Diseases ; Retrospective Studies ; Surgical Instruments

BACKGROUND: This nationwide survey was undertaken to characterize the general pathological features of colorectal cancer in Korea, and especially to elucidate the geographical characteristics by means of their anatomical distribution. METHODS: We analysed 1,676 colorectal cancers (from 1,602 patients) surgically resected in 1998 at 15 institutions from nine geographical sites in Korea. RESULTS: The topographic incidence of colorectal cancer in seven out of the total nine geographical sites, was the highest in the rectum (32-54%); and those from Wonju and Cheongju were in the sigmoid colon (28% for both). The right colon cancer incidence was 42% in Wonju and 36% in Cheongju, while it was 17-22% in the other areas. The cecal cancer incidences in Wonju and in Taegu were 7% and 8%, respectively, but 0-4% in the other areas. As for histology, moderately differentiated adenocarcinoma was the most frequent (46-84%), except for in Wonju and Chonju, where the most predominant type was well differentiated (63% and 52%, respectively). CONCLUSION: The incidence of right colon cancer was higher in Wonju and Cheongju, than in the other geographical sites. The cecal predilection was prominent in Taegu and Wonju. The Elucidation of geographical differences in degree of differentiation for tubular adenocarcinoma seems to require further cumulative study with strict guidelines.
Adenocarcinoma ; Cecal Neoplasms ; Chungcheongbuk-do ; Colon, Sigmoid ; Colonic Neoplasms ; Colorectal Neoplasms* ; Daegu ; Gangwon-do ; Humans ; Incidence ; Jeollabuk-do ; Korea ; Pathology ; Rectum

BACKGROUND/AIMS: It has been reported that lymph node (LN) metastasis occurs in approximately 10 percent of patients with submucosally invasive colorectal carcinoma. The present study was performed to determine the clinical significance of absolute and relative depth of submucosal invasion and to find the associated pathological risk factors of LN metastasis in submucosally invasive colorectal carcinoma. METHODS: From June, 1989 to May, 1999, 2,580 patients were pathologically confirmed as having colorectal carcinoma. Of these patients, a total of 61 subjects with submucosally invasive carcinoma could be reviewed pathologically and were included in this retrospective analysis. The relative depth of submucosal invasion was evaluated by Kudo (sm1, 2, 3) and modified Haggitt (L1, 2, 3) classifications, and the absolute depth was measured. RESULTS: The absolute depth of submucosal invasion was significantly correlated with the relative depth evaluated by both Kudo and modified Haggitt classifications (p<0.01). Of 51 patients in whom the status of LN metastasis could be evaluated, six (11.8%) showed LN metastasis. Among the patients with LN metastasis, there was no one with sm1 or L1 in the relative depth and 500 micrometer or less in the absolute depth. The risk of LN metastasis was related to the gross type, and lymphatic or vessel invasion (p<0.05). CONCLUSIONS: The risk factors for LN metastasis in submucosally invasive colorectal carcinoma were the gross type and lymphatic or vessel invasion. The results also suggest that the absolute depth of submucosal invasion might be a useful parameter to select the patients for the endoscopic treatment.
Classification ; Colorectal Neoplasms* ; Humans ; Lymph Nodes* ; Neoplasm Metastasis* ; Retrospective Studies ; Risk Factors*