By means of hospital-based data over 8 years we sought to evaluate the clinical indications and incidence of emergency peripartum hysterectomy by demographic characteristic and reproduction history. From the obstetric record of all deliveries at Chung Goo Hospital between Jan. 1, 1990, and Nov. 31, 1997, we identified all women undergoing emergency cesarean hysterectomy, calculated incidence rates, conducted statistical tests of linear trends and heterogenety, and observed the clinical indicatons preceding the onset of this procedure. There were 16731 deliveries during this period, Cesarean hysterectomy was performed in 24 of 5993 cesarean sections(0.40%) and in 10 of 10738 vaginal deleveries(0.09%), so more frequently after cesarean section than vaginal delivery. The age of patients varied from 22 to 40 years old. The higher the age and the parity of patients, the higher incidence of cesarean hysterectomy was noted. The most common indication of cesarean hysterectomy was uterine atony(52.94%) followed by placental disorders(41.18%), uterine myoma with pregnancy(2.9%) and uterine rupture (2.9%). All patients who had hysterectomy received transfusion from 1 pint to 57 pints. The postoperative complications were bladder injury, febrile morbidity, disseminated intravascular coaguolopathy and wound disruption. There were three maternal deaths, the cause was disseminated intravascular coaguolopathy and amniotic embolism. The data identifiy uterine atony as the primary cause for gravid hysterctomy. The data also illustrated how the incidence of emergency peripartum hysterectomy increases significantly with increasing parity, especially when influenced by a current placenta previa or a prior cesarean section. Maternal morbidity remained high.
Adult ; Cesarean Section ; Embolism ; Emergencies ; Female ; Humans ; Hysterectomy* ; Incidence ; Leiomyoma ; Maternal Death ; Parity ; Peripartum Period* ; Placenta Previa ; Postoperative Complications ; Pregnancy ; Reproduction ; Urinary Bladder ; Uterine Inertia ; Uterine Rupture ; Wounds and Injuries

The incidence of ectopic pregnancy is a marked increase in both the absolute number and rate in recent years. But dramatic decrease in death from ectopic pregnancies probably due to improved diagnosis and management. The aim of the study was to investigate the effect of intramuscular Methotrexate(MTX) injection on the treatment of ectopic pregnancy. The method of the study was made by the retrospective clinical observations on the 32 cases of unruptured ectopic pregnancies in Chung Goo Sung Sim hospital, department of Obstetrics & Gynecology. The results were as follows: 1) The most frequent age group was 25-29 year group(37.5%). 2) Nullipara was 31.3% and the case who experienced artificial abortion was 75%. 3) A previous history of abdominal or pelvic surgery was in 40.6% and pelvic inflammatory in 6.3%. 4) The mean ectopic gestational week was 6.4 weeks, 5) On symptomatological analysis, lower abdominal pain was encounted 53.1%, vaginal spotting was 40.6%. 6) The resolution of patients was obtained in 29 cases(90.6%)of 32 unruptured tubal pregnancies with intramuscular methotrexate treatment. 7) The mean resolution duration was 23.8 days. 8) The side effects of methotrexate were observed in 10 cases(31.2%)of 32 unruptured tubal pregnancies, but the severity of symptoms was mild. Consequently, tveatment by intramuscular injection of MTX expects to be one of the therapies alternating to surgery. However success rate remained 90.6% with and toxicity rate 31.2% with MTX injection. Therefore patients selection criteria and MTX dosage adjustment are more stricdy required for rising success rate and avoidance of toxic complication.
Abdominal Pain ; Diagnosis ; Female ; Gynecology ; Humans ; Incidence ; Injections, Intramuscular ; Methotrexate* ; Metrorrhagia ; Obstetrics ; Patient Selection ; Pregnancy ; Pregnancy, Ectopic* ; Pregnancy, Tubal ; Retrospective Studies

Thyroid hemiagenesis is considered to be a rare congenital anomaly, but its incidence is propabley underestimated because the diagnosis is usually incidental. The left lobe is absent four times as often as the right and women are about three times more likely to have this developmental defect. Many of these patients are hyperthyroid or medical attention. We present the case of a 14-year-old women with right thyroid hemiagenesis associated without other thyroid disorders. The diagnosis of hemiagenesis was established by isotope imaging and thyroid ultrasound. In most of the clinical reports on thyroid hemiagenesis, an association with other thyroid disorders was found such as hyperthyroidism, multinodular goitre, hypothyroidism, benign adenama, Graves' disease, acute and subacute thyroiditis, and carcinoma. Even if morphology and function of thyroid gland is normal on diagnosis, a follow-up survey should be recommended.
Adolescent ; Diagnosis ; Female ; Follow-Up Studies ; Graves Disease ; Humans ; Hyperthyroidism ; Hypothyroidism ; Incidence ; Thyroid Gland* ; Thyroiditis, Subacute ; Ultrasonography

Thyroid hemiagenesis is considered to be a rare congenital anomaly, but its incidence is propabley underestimated because the diagnosis is usually incidental. The left lobe is absent four times as often as the right and women are about three times more likely to have this developmental defect. Many of these patients are hyperthyroid or medical attention. We present the case of a 14-year-old women with right thyroid hemiagenesis associated without other thyroid disorders. The diagnosis of hemiagenesis was established by isotope imaging and thyroid ultrasound. In most of the clinical reports on thyroid hemiagenesis, an association with other thyroid disorders was found such as hyperthyroidism, multinodular goitre, hypothyroidism, benign adenama, Graves' disease, acute and subacute thyroiditis, and carcinoma. Even if morphology and function of thyroid gland is normal on diagnosis, a follow-up survey should be recommended.
Adolescent ; Diagnosis ; Female ; Follow-Up Studies ; Graves Disease ; Humans ; Hyperthyroidism ; Hypothyroidism ; Incidence ; Thyroid Gland* ; Thyroiditis, Subacute ; Ultrasonography

Parathyroid cysts are an uncommon cause of neck masses, which are rarely suspected before surgery. Although several theories of their origin have been proposed, none has been proven satisfactorily to the exclusion of the others. We experienced a 33-year-old euthyroid woman presenting with a mass on the jugular notch. She complained of throat discomfort. An ultrasound of the mass in the neek suggested a thyroglossal duct cyst. Treatment consisted of a neck exploration and the removal of a 4x3x3 cm cystic mass. The cystic mass contained a clear fluid with a high level of parathyroid hormones in excess of 11.4 ng/ml. The pathological diagnosis revealed a benign parathyroid cyst. This report reviews current knowledge of parathyroid cysts as well as the relevant literature.
Adult ; Diagnosis ; Female ; Humans ; Neck ; Pharynx ; Thyroglossal Cyst ; Ultrasonography

PURPOSE: Korea started breast cancer screening as part of the National Cancer Screening Program (NCSP) in 1999. In order to identify under-served groups, we investigated mammography uptake in the National Breast Cancer Screening Program. MATERIALS AND METHODS: The study population was participants in the National Breast Cancer Screening Program from 2004 to 2008. We analyzed participation rates by insurance type, age group, and area of residence. RESULTS: Total participation rates for breast cancer screening increased from 18.2% in 2004 to 35.0% in 2008. The participation rate in the group aged 60 to 69 years showed the greatest increase, 21.3%, among the four age groups. Although the screening rate increased continuously, the participation rate of the Medical Aid Program (MAP) group was low compared to the National Health Insurance (NHI) group. Moreover, the increasing trend of mammography uptake in the MAP group was much lower than that of the NHI group. CONCLUSION: The participation rate for breast cancer screening in the NCSP in Korea has increased. However, the participation rate in mammography among MAP recipients is still lower than that of NHI beneficiaries. To increase mammography uptake, it is important to make it available to everyone by ensuring inclusion of all population subgroups.
Aged ; Breast ; Breast Neoplasms ; Early Detection of Cancer ; Humans ; Insurance ; Korea ; Mammography ; Mass Screening ; National Health Programs ; Patient Participation

PURPOSE: This study was done to determine the diagnostic efficacy of clinical examination, fine needle aspiration(FNA) cytology, mammography and ultrasonography in palpable breast mass. METHODS: We performed 248 FNA cytology of palpable breast mass, among which 106 cases were histologically examined during the period of from Jan. 1994 to Dce.1997 at the Department of Surgery, Chonbuk National University Hospital. Among 106 patients, mammographys were taken for 96 patients, and ultrasonographys for 73 patients. RESULTS: Main clinical symptom was palpable mass on breast at the she visited the hospital. Clinical diagnosis based on symptoms and physical examination had 96.9% of sensitivity, 57.5% of specificity. Based on definite histologic diagnosis, the sensitivity of FNA cytology was 96.9%, specificity 91.7%, and diagnostic accuracy 93.5%, respectively. 86.1% of cytologic malignancy was proven to be malignant histologically, and 100% of cytologically benign cases were turned out histologically benign. Mammography was performed on 96 cases and the results were as follows; sensitivity 89.3%, specificity 84%, and diagnostic accuracy 86.8%. Ultrasonography in 73 cases showed 93.5% sensitivity, 51.4% specificity, and 74.6% diagnostic accuracy. CONCLUSIONS: FNA cytology was reliable and safe diagnostic method compared to physical examination, mammography, and ultraxonography. And FNA cytology of palpable breast mass should be diagnostic procedure of choice for those patients classified clinically as probably benign or malignant.
Biopsy, Fine-Needle* ; Breast* ; Diagnosis ; Humans ; Jeollabuk-do ; Mammography* ; Needles ; Physical Examination ; Sensitivity and Specificity ; Ultrasonography*

Quantitative measurement of BK virus DNA (Q-BKDNA) has been used for the early diagnosis and monitoring of BK virus-associated nephropathy (BKVAN). This study was designed to determine the BKDNA cutoff for the diagnosis of BKVAN. Between June 2005 and February 2007, 64 renal transplant recipients taken renal biopsies due to renal impairment submitted plasma and urine for Q-BKDNA. Eight BKVAN patients (12.5%) had median viral loads of 6.0 log(10) copies/mL in plasma and 7.3 log(10) copies/mL in urine. Among 56 non-BKVAN patients, 45 were negative for Q-BKDNA; 4 were positive in plasma with a median viral load of 4.8 log(10) copies/ mL, and 10 were positive in urine with a median viral load of 4.8 log(10) copies/mL. Receiver operating characteristic curve analysis showed that a cutoff of 4.5 log(10) copies/mL in plasma and a cutoff of 5.9 log(10) copies/mL in urine had a sensitivity of 100% and a specificity of 96.4%, respectively. A combined cutoffs of 4 log(10) copies/ mL in plasma and 6 log(10) copies/mL in urine had better performance with a sensitivity of 100% and a specificity of 98.2% than each cutoff of urine or plasma. QBKDNA with the combined cutoffs could reliably diagnose BKVAN in renal transplant recipients.
Adolescent ; Adult ; BK Virus/*genetics ; Biopsy ; Calibration ; DNA, Viral/*genetics ; Female ; Humans ; Kidney Diseases/*virology ; Kidney Transplantation/*methods ; Male ; Middle Aged ; Polymerase Chain Reaction ; Polyomavirus Infections/diagnosis ; Treatment Outcome

A case of primary carcinoid tumor of the liver with striking central fibrous scar in a 61-year-old male is reported. Tumor cells contained electron dense secretory granules with an average diameter 150~200 nm which demonstrated positive immunohistochemical reaction for neuron-specific enolase, synaptophysin and chromogranin. The stellate central scar was observed in various hepatic tumors including focal nodular hyperplasia, fibrolamellar carcinoma, or sclerosing hepatocellular carcinoma, but have not been reported in carcinoid tumor.
Carcinoid Tumor* ; Carcinoma, Hepatocellular ; Cicatrix ; Focal Nodular Hyperplasia ; Humans ; Liver ; Male ; Middle Aged ; Phosphopyruvate Hydratase ; Secretory Vesicles ; Strikes, Employee ; Synaptophysin

The purpose of our study was to evaluate children who underwent hepatic resection for primary malignant hepatic tumor in the period from January 1994 to December 2001. A total of 8 patients, seven with hepatoblastoma (HB) and one with hepatocellular carcinoma (HCC). were studied. One HCC was respectable at the initial diagnosis, but five cases of unresectable HB received two cycles of transarterial chemoembolization (TACE) before operation. One patient with an unresectable HB with bone marrow metastasis was operated after one cycle of TACE and one cycle of systemic chemotherapy based on CCG-823F protocol. All 6 patients who underwent TACE and neoadjuvant chemotherapy showed marked redcuction in tumor volume and a clear outline of the lesion. Major complication was not noticed. Mean alpha-fetoprotei (alpha-FP) level at diagnosis, after neoadjuvant chemotherapy and after postoperative chemotherapy was 9,818 (42-35,350), 664, and 10.1 ng/mL, respectively. Half life of the alpha-FP after complete resection was 5.1 days (3.0-8.7 days). Median follow up period was 57.1 months (10-97 months) and all the patients are alive with NED. In conclusion, preoperative chemotherapy, especially TACE, is effective, safe, and useful to treat initially unresectable hepatoblastoma, and serial level of the serum alpha-FP is a useful tumor marker for diagnosis and monitoring therapeutic responses.
Bone Marrow ; Carcinoma, Hepatocellular ; Child ; Diagnosis ; Drug Therapy ; Follow-Up Studies ; Half-Life ; Hepatoblastoma ; Humans ; Neoplasm Metastasis ; Tumor Burden