No abstract available.
Leiomyosarcoma*

The Duodenal diverticulum is the rare cause of the common bile duct obstruction. We experienced a case of the diverticulum of the second portion of duodenum in a 59-year-old male, who complained recurrent attacks of right upper abdominal pain and fever since 16 months prior to admission. Duodenoscopic finding and UGI study revealed a typical duodenal diverticulum just side to the papilla of Vater. Diverticulectomy and cholecystectomy was performed and after than, he has been free front above mentioned symptoms. We reported a case of duodenal diverticulum which caused recurrent common bile duct obstruction.
Abdominal Pain ; Cholecystectomy ; Common Bile Duct* ; Diverticulum* ; Duodenum ; Fever ; Humans ; Male ; Middle Aged

Nowday, ionizing radiation is one of the methods eradicating the uterine cervical malignancy. However radiation alone or in combination with surgery have an effect on normal tissue as well as the malignant cells, and their changes have been well described in other countries. Unfortunately, the history of radiation modality for cancer treatment is relatively short and the reports about radiation induced changes are limited in our country. We evaluated the radiation-induced changes in cervico-vaginal smears of 107 uterine cervical cancer patients obtained from March, 1985 to October, 1987. Most patients had been received 5,400 Rads of external radiation and intracavitary radiation. Patient's age ranged from 30 to 67 years old. Of 107 cases, 24 cases were normal, 72 cases showed benign radiation changes, 7 cases revealed radiation dysplasia, and residual and recurrent carcinomas found in one and 3 cases, respectively. Cytoplasmic and nuclear enlargement were the most common and noted in 57 and 38 cases, respectively. Vacuolization and polychromasia of the cytoplasm were identified in 43 and 30 cases, respectively. The most common histiocytic change was multinucleation, which was found in about one third. The radiation changes of the cytoplasm and nuclear enlargement persisted for a long time after completion of radiation, however, nuclear degeneration and multinucleation gradually disappeared after 6 months. The inflammation in background prolonged for a long time but degeneration disappeared after 6 months. The biologic significance of post-radiation dysplasia could not evaluated because of short follow up period.

Nowday, ionizing radiation is one of the methods eradicating the uterine cervical malignancy. However radiation alone or in combination with surgery have an effect on normal tissue as well as the malignant cells, and their changes have been well described in other countries. Unfortunately, the history of radiation modality for cancer treatment is relatively short and the reports about radiation induced changes are limited in our country. We evaluated the radiation-induced changes in cervico-vaginal smears of 107 uterine cervical cancer patients obtained from March, 1985 to October, 1987. Most patients had been received 5,400 Rads of external radiation and intracavitary radiation. Patient's age ranged from 30 to 67 years old. Of 107 cases, 24 cases were normal, 72 cases showed benign radiation changes, 7 cases revealed radiation dysplasia, and residual and recurrent carcinomas found in one and 3 cases, respectively. Cytoplasmic and nuclear enlargement were the most common and noted in 57 and 38 cases, respectively. Vacuolization and polychromasia of the cytoplasm were identified in 43 and 30 cases, respectively. The most common histiocytic change was multinucleation, which was found in about one third. The radiation changes of the cytoplasm and nuclear enlargement persisted for a long time after completion of radiation, however, nuclear degeneration and multinucleation gradually disappeared after 6 months. The inflammation in background prolonged for a long time but degeneration disappeared after 6 months. The biologic significance of post-radiation dysplasia could not evaluated because of short follow up period.

The hypertensive lower esophageal sphincter(LES)(mean LES pressure>45mmHg; LES relaxation>75%;normal peristalsis) is an uncommon primary esophageal motor disorder associated with chest pain, dysphagia and globus sensation. We carried out this study to evaluate clinical features, esophageal pressure profiles, endoscopic ultrasonographic findings, and assess the effect of oral nifedipine(30 mg/day for 8 weeks) in patients with hypertensive LES(mean age 53.8 years, M: F:=2:7) and l3 controls(mean age 47.5 years, M:F=4:9), Chief complaints were chest pain(77.8%), dysphagia(33.3%) and globus sensation(22.2%). Esophageal manometry showed a significant(p<0.01) increase in LES pressure and higher trend of residual pressure and body contraction amplitude in patients compared with controls. Two cases of nutcracker esophagus and one case of nonspecific esophageal motor disorder were associated with hypertensive LES patients by eeophageal manometry. Five patients were examined by endoscopic ultrasonography(EUS). Three of them showed a normal ultrasonic structure of the wall of the gastro-esophageal junction. Focal and/ or diffuse thickening of muscularis propria were observed in remaining 2 patients. Oral nifedipine significantly decreased the LES pressure and alleviated most of dysphagia and chest pain in patients with normal EUS finding. In conclusion, hypertensive LES was a heterogenous esophageal motor disorder characterized by high LES pressure, residual pressure and body contraction amplitude. The clinical relevance of endoscopic ultrasonographic finding is yet to be determined, but it may be speculated that nifedipines lack of effect on esophageal pressure profiles in some patients is responsible for thickening of muscularis propria in the area of lower esophageal sphincter. Collecting further data regarding treatment response according to EUS finding is required to validate our speculation.
Chest Pain ; Deglutition Disorders ; Esophageal Motility Disorders ; Esophageal Sphincter, Lower* ; Humans ; Manometry ; Nifedipine ; Sensation ; Thorax ; Ultrasonics

The hypertensive lower esophageal sphincter(LES)(mean LES pressure>45mmHg; LES relaxation>75%;normal peristalsis) is an uncommon primary esophageal motor disorder associated with chest pain, dysphagia and globus sensation. We carried out this study to evaluate clinical features, esophageal pressure profiles, endoscopic ultrasonographic findings, and assess the effect of oral nifedipine(30 mg/day for 8 weeks) in patients with hypertensive LES(mean age 53.8 years, M: F:=2:7) and l3 controls(mean age 47.5 years, M:F=4:9), Chief complaints were chest pain(77.8%), dysphagia(33.3%) and globus sensation(22.2%). Esophageal manometry showed a significant(p<0.01) increase in LES pressure and higher trend of residual pressure and body contraction amplitude in patients compared with controls. Two cases of nutcracker esophagus and one case of nonspecific esophageal motor disorder were associated with hypertensive LES patients by eeophageal manometry. Five patients were examined by endoscopic ultrasonography(EUS). Three of them showed a normal ultrasonic structure of the wall of the gastro-esophageal junction. Focal and/ or diffuse thickening of muscularis propria were observed in remaining 2 patients. Oral nifedipine significantly decreased the LES pressure and alleviated most of dysphagia and chest pain in patients with normal EUS finding. In conclusion, hypertensive LES was a heterogenous esophageal motor disorder characterized by high LES pressure, residual pressure and body contraction amplitude. The clinical relevance of endoscopic ultrasonographic finding is yet to be determined, but it may be speculated that nifedipines lack of effect on esophageal pressure profiles in some patients is responsible for thickening of muscularis propria in the area of lower esophageal sphincter. Collecting further data regarding treatment response according to EUS finding is required to validate our speculation.
Chest Pain ; Deglutition Disorders ; Esophageal Motility Disorders ; Esophageal Sphincter, Lower* ; Humans ; Manometry ; Nifedipine ; Sensation ; Thorax ; Ultrasonics

The purpose of this study was to identify the relationship between the clinical response to neoadjuvant chemotherapy and PCNA and VEGF protein expression, apoptosis and its related gene expression such as Bcl-2 and Bax in cervical cancer. We retrospectively reviewed 30 patients with locally advanced or bulky cervical cancer treated with three courses of neoadjuvant chemotherapy followed by radical hysterectomy or radiation therapy at Seoul National University Hospital from June 1995 to June 1998. The specimen were obtained before chemotherapy by colposcopy directed biopsy. The protein expressions of Bcl-2, Bax, VEGF and PCNA were examined by immunohisto- chemical staining and the apoptosis was examined by TUNEL staining. These results were compared with chemotherapeutical response which was evaluated by colposcopy or CT/MRI. There were 2 CR(complete response), 19 PR(partial response) and 9 NC(no change) and there was no progressive disease. There was no significant difference between responder and nonresponder according to the age, tumor size and FIGO stage. The 3 year survival rates of responder and nonresponder were 90.0% and 66.7% respectively and there was significant difference between two groups(p=0,015). The expression of Bcl-2 and Bax was positive in 23.3%(7/30) and 46.7%(14/30). The expression of VEGF was positive in 83.3%(25/30). PCNA PI(positive index), defined as PCNA positive cells in percentage was more than 25.0% in 20 cases. Apoptotic index, defined as the number of the cells undergoing apoptosis per 1,000 tumor cells, ranged from 3 to 53(mean 22.3). Although there was no significant relationship between the clinical response to neoadjuvant chemotherapy and the expre- ssion of Bcl-2, Bax, VEGF and PCNA PI, apoptotic index was significantly higher in responder than nonresponder when the cutoff value of positive was defined as apoptotic index more than 5(p=0.032). In conclusion, the evaluation of the pattern of apoptosis before neoadjuvant chemothera- py is potentially useful for the prediction ofz tumor response to neoadjuvant chemotherapy for cervical cancer.
Apoptosis* ; Biopsy ; Colposcopy ; Drug Therapy* ; Gene Expression ; Humans ; Hysterectomy ; In Situ Nick-End Labeling ; Proliferating Cell Nuclear Antigen* ; Retrospective Studies ; Seoul ; Survival Rate ; Uterine Cervical Neoplasms* ; Vascular Endothelial Growth Factor A*

No abstract available.
Plasma Exchange* ; Plasma* ; Seoul*

No abstract available.
Plasma Exchange* ; Plasma* ; Seoul*

Prior to 1988, endometrial cancer was clinically staged but there was the considerable discrepancy between clinical and aetual stage. FIGO surgical staging classification of endometrial cancer(I988) provides the advanatage of recognizing the true disease distribution and extension, and more rational treatraent can be accomplished. This retrospective study was based on a clinical review of 73 patients with endometrial carcinoma from l982 through 1991 who underwent primary surgical evaluation. A11 cases were restaged ueing the newly adopted FIGO surgical staging. The distribution of FIGO clinical staging was as follows:85 patients(89.1%) were with stage I, 5(6.9%) with stage II, 2(2.7%) with stage III and 1(l.3%) with stage IV. Surgical restaging according new FlG0 classification reveald 56(76.7%) patients with stage I, 1(1.4%) with stage II, 14(19.2%) with stage III and 2(2.7%) with stage IV. Surgery upstaged 12.3% of clinical stage I patients, In clinical stage II patients, 80.0% was doenstaged. There wes no stage changing in cliaical stage III and IV patients. The acturial survival rates for surgical stages I a, I b, I c, and III were 80.0%, 77.2%, 68.4A%, and 35.0% respectively. By using FIGO surgical staging, the initial extent of endometrial cancer can be more accurately evaluated and we may predict prognosis and survival relatively well.
Classification ; Endometrial Neoplasms* ; Female ; Humans ; Prognosis ; Retrospective Studies ; Survival Rate