OBJECTIVE: To evaluate the relationship between amniotic fluid interleukin-8 and the presence, severity and pattern of acute inflammatory lesions in the placenta delivered after preterm labor with intact membranes. METHODS: The relationship between placental histologic finding and amniotic fluid interleukin-8 was examined in 46 consecutive patients who were admitted with the diagnosis of preterm labor with intact membranes and who delivered singleton gestations within 5 days. RESULTS: The prevalence of acute histologic chorioamnionitis was 63.0%(29/46) and that of positive amniotic fluid culture was 17.4%(8/46). The most frequent site of histologic inflammation was chorion-decidua(56.5%, 26/46). The median amniotic fluid interleukin-8 increased significantly according to the presence and higher severity of inflammation in each type of placental section (p<0.05 for each). Three patterns of inflammation were identified in chorion-decidua: non-marginating, marginating, and mixed. Median amniotic fluid interleukin-8 and the rate of severe histologic chorioamnionitis (grade> or = 4) increased significantly in the order of non-marginating, marginating, and mixed (p<0.05 for each). CONCLUSION: Both the presence and greater severity of acute histologic chorioamnionitis are associated with an elevated amniotic fluid interleukin-8. A marginating and mixed pattern of inflammation are associated with a higher amniotic fluid interleukin-8. Amniotic fluid interleukin-8 is a reliable prenatal marker of histologic chorioamnionitis.
Amniotic Fluid* ; Chorioamnionitis ; Diagnosis ; Female ; Humans ; Inflammation* ; Interleukin-8* ; Membranes ; Obstetric Labor, Premature* ; Placenta ; Pregnancy ; Prevalence

Leiomyoma of vagina is relatively rare benign tumor. And majority of these lesions occur in labia major and anterior vaginal wall. The recurrence of this tumor is extremely rare and its cellular atypism, mitotic activity, tumor size and contour are known as important factors in its recutrence. A case of recutrent leiomyoma causing urinary frequency in vesicovaginal septum was reported with a brief review of literature.
Leiomyoma* ; Recurrence ; Vagina

OBJECTIVE: This study was performed to identify the prognostic factor for survival of patients with recurrent cervical cancer. METHODS: Sixty-eight patients were diagnosed as recurrent cervical cancer at the Seoul National University Hospital from January, 1988 to December, 1998. Recurrence was defined as new evidence of tumor after 6 months of disease free survival. Retrospective analysis was done in terms of clinical features and the Cox proportional hazard model was used to identify independent variables associated with an improved survival rate. Histopathologic types were distributed as follows; squamous cell carcinoma in 70.6%, adenocarcinoma in 11.8%, adenosquamous cell carcinoma in 11.8%, and small cell carcinoma in 1.5%. Distribution of FIGO stage was as follows; stage I in 25.0%, stage II in 66.2%, and stage III in 4.4%. Sites of recurrence were as follows; central pelvic recurrence in 44.1%, pelvic side wall recurrence in 11.8%, and distant metastasis in 44.1% and the most common site of distant recurrence was extrapelvic lymph nodes (29.4%). 29.4% of recurrences were observed within the first 12 months after initial therapy, 50.0% within 2 years and 64.7% within 3 years. RESULTS: Positive rate of SCC-Ag at initial diagnosis was 45.2% with cutoff value of 2.0 ng/ml. Positive rate of SCC-Ag at the diagnosis of recurrence was 60.0%. Overall response rate to the treatment was 29.1%. Complete response rate was higher in central pelvic recurrrence than pelvic side wall recurrence and distant metastasis (P = 0.002) and also higher in normal SCC-Ag level (< or = 2.0 ng/ml) at the diagnosis of recurrence than elevated level (P = 0.032). Cumulative survival rates of 1 year after recurrence was 66.8%, 2 year 36.7%, and 5 year 18.7%. Central recurrence showed higher cumulative survival rate than pelvic side wall or distant recurrence (P = 0.029). The patients with elevated SCC-Ag level at the time of diagnosis of recurrence showed lower cumulative survival rate than those with normal SCC-Ag level (P < 0.001). Cox proportional hazard model showed that SCC-Ag elevation at the time of diagnosis of recurrence retained significant values in predicting survival(OR = 2.56; 95% CI = [1.22-5.39]; P = 0.01). CONCLUSION: SCC-Ag elevation at the diagnosis of the recurrence is a strong independent prognostic indicator for survival of patients with recurrent cervical cancer.
Adenocarcinoma ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Diagnosis ; Disease-Free Survival ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Proportional Hazards Models ; Recurrence ; Retrospective Studies ; Seoul ; Survival Rate ; Uterine Cervical Neoplasms*

BACKGROUND: Endoscopic Ultrasonography(EUS), a combination of endoscopy and ultrasonography is one of the most useful tools for diagnosis of digestive system diseases. EUS is useful in staging the primary tumor invasion and regional lymph node metastasis because of its ability to image the gut wall and adjacent structures in unique detail. We performed a study preoperatively for assessing the accuracy and limitation of EUS in gastric carcinoma. METHODS: In 75 patients(Male 54, Female 21, Mean age 62.3 years) with a gastric carcinoma confirmed by endoscopic biopsy, we performed EUS preoperatively. The results were compared with the postoperative histopathologic staging. RESULTS: 1) In assessing the depth of tumor invasion, EUS accuracy on depth of invasion was 76.0% and overstaging and understaging were 14.7% and 9.3%, respectively. 2) In assessing the lymph node metastasis, the accuracy rate of EUS was 65.3%. A rate of false-positive diagnosis was 27.3%, and a rate of false-negative diagnosis was 24.5%.3) In assessing the incidence of lymph node metastasis for each T stage, the involve rate was 10.5% in pT1, 36.4% in pT2, 95.7% in pT3, 100% in pT4. CONCLUSIONS: EUS is the most accurate diagnostic methods presently available to determine tumor infiltration depth and lymph node metastasis.
Biopsy ; Diagnosis ; Digestive System Diseases ; Endoscopy ; Endosonography* ; Esophagus* ; Female ; Humans ; Incidence ; Intestines* ; Lymph Nodes ; Neoplasm Metastasis ; Stomach* ; Ultrasonography

BACKGROUND/AIMS: Electrohydraulic lithotrypsy(EHL) under cholangioscopic control has been performed for difficult bile duct stones. The percutaneous transhepatic approach is technically easy and useful in diagnosis and treatment of bile duct obstruction and stones. Biliary stenting with self expanding metal stent is gaining increasingly wider acceptance as a palliative treatment of bile duct obstruction. METHODS: Between Sep. 1994 and Sep. 1996, EHL under choledochoscopy by percutaneous transhepatic approach was performed in 30 cases(Male: 13, Female: 17). After PTBD with 7F pig tail catheter, the percutaneous transhepatic passage was dilated over guide wire with dilaters of increasing size up to 16Fr in 3-Sdays. In one week, after fistula had been estabilished, choledochoscopy was performed. RESULTS: (1) Mean age was 61.3 years. Mean stone number was 2.5. And mean stone size was 1.6 X 2.3 cm. (2) Com.plete removal of the stone was achieved in all patients(100%). (3) There were no serious complications. (4) In six cases, Endocoils were implanted with successful decompression of obstructions and simultaneous removal of biliary stones located at both side of stricutre. CONCLUSIONS: Percutaneous transhepatic choledochoscopy is easy and safe and assists in the diagnosis and treatment of biliary stricture and the management of difficult CBD stone.
Bile Ducts ; Catheters ; Cholestasis ; Common Bile Duct* ; Constriction, Pathologic ; Decompression ; Diagnosis ; Female ; Fistula ; Humans ; Palliative Care ; Stents

PURPOSE: The study aimed to explore the health consequences that women experienced after miscarriage and the factors related to them. METHODS: A convenience sample consisting of 102 women who had miscarried within 2 years was used. Women were recruited from hospitals and enterprises in Seoul and Gyeong-Gi Province. Participants completed a self-administered questionnaire containing a physical and psychological symptoms checklist developed for this study. RESULTS: More than 40% of the miscarriages occurred after 9 weeks of pregnancy and 35% of women were found to have had a previous miscarriage prior to this study. Psychological symptoms were more prevalent and prolonged than the physical symptoms, furthermore, the frequencies of the symptoms experiencedwere not consistent with the duration of symptoms. Employed women and women with early miscarriages complained of more physical symptoms; however, psychological symptoms were not different according to women's characteristics. Employment was a significant factor affecting physical symptoms. CONCLUSION: Health care professionals need to inform and educate women and the family of the potential health changes during the recovery after the miscarriage. Health consequences due to miscarriages also need to be incorporated in women's reproductive health care. Nursing care should consider factors of maternal age, employment status, and obstetrical conditions upon the apparent social changes.
Abortion, Spontaneous ; Checklist ; Delivery of Health Care ; Employment ; Female ; Humans ; Maternal Age ; Nursing Care ; Pregnancy ; Surveys and Questionnaires ; Reproductive Health ; Social Change

To increase the survival area of the venous flap, we studied the arterialized venous flap in a rabbit ear model. The ears of 12 New Zealand white rabbits(n=24) were randomized into three groups, group A receiving arterio-venous anastomosis 14 days before the arterialized venous flap elevation; group B receiving bipedicled flap elevation 14 days before arterialized venous flap elevation; group C receiving no pretreatment before the arterialized venous flap elevation. Tc -pertechnetate scan was performed on all groups immediately after the arterialized venous flap elevation to evaluate the blood flow of the flap. The survival area of the flap was measured 14 days after the arterialized venous flap elevation. Average ratio of survival area was 92% in Group A, 88% in group B, which were comparatively higher than the 12% in group C. The entire flap was visualized in groups A and B on scan images, however, only the proximal area of the anterior and posterior marginal vein was visualized in group C. Flap survival pattern was similar to that of the scan image and the slope of time-activity curve of groups A and B was much steeper than that of group C. High survival rate of group A, which received the arterio-venous anastomosis as a pretreatment, may be due to the decrease of resistance of outflow during the 14 days. Anticipated mechanisms involved are, valve insufficiency due to high pressure arterial inflow, development of vascular collaterals in the flap, and opening of arteriovenous(A-V) shunt. Bipedicled flap elevation as a pretreatment may not effect on valves, however, may impair the sympathetic nerve and cause ischmic stimuli which in turn may develop vascular collaterals and make an opening of the A-V shunt.
Ear ; New Zealand ; Survival Rate ; Veins

BACKGROUND: The inflammatory nodules on the legs are often difficult to distinguish because of clinical variations and similarity of histopathologic features. Both erythema nodosum and erythema induratum are known to be associated with various conditions, especially tuberculosis. In Korea where tuberculosis is still a major health problem, it may be a cause for the inflammatory nodules on the legs. OBJECTIVE: The purpose of this study was to establish the correlation with Mantoux test and inflammatory nodule and evaluate the efficacy of antitubercular therapy in Korea. METHODS: We performed the prospective study of 26 patients with inflammatory nodules on the legs. All patients preformed Mantoux test and skin biopsy. The patients who had strongly positive Mantoux reaction were treated with antitubercular therapy. RESULTS: The ages of the 26 patients (Male 4:Female 22) ranged from 12 to 76 years. All patients had recurrent painful, tender subcutaneous nodules on the legs. Fourteen patients of total 26 patients had a strongly postive Mantoux reaction (induration > or = 20 mm). They were treated with combination antitubercular therapy. After antitubercular therapy, skin lesions subsided in 12 patients within 2 months and in the remaining 2 patients, subsided within 4 months. The therapy was well tolerated except for flu-like symptom in one patient and drug induced hepatitis in the other patient. CONCLUSION: We suggest that antitubercular therapy is effective in the management of patients with a strongly positive Mantoux reaction with chronic recurrent inflammatory nodules on the legs in Korea.
Biopsy ; Erythema Induratum ; Erythema Nodosum ; Hepatitis ; Humans ; Korea ; Leg* ; Prospective Studies ; Skin ; Tuberculosis

BACKGROUND: The serum levels of serum total IgE, peripheral eosinophils and eosinophil cationic protein (ECP) are known to be elevated in patients with atopic dermatitis. However, the relationship between these laboratory findings and the clinical severity of atolpic dermatitis is controversial. OBJECTIVE: The purpose of this study was to evaluate serum total IgE, peripheral eosinophil counts, ECP as severity indices or disease markers of atopic dermatitis in Korea. METHODS: One hundred and thirty patients were evaluated for the symptoms and signs of atopic dermatitis, and classified into a mild, moderate or severe group according to the clinical severity. We measured for total serum IgE, peripheral eosinophil counts, ECP and assessed allergen-specific IgE using multiple allergosorbent test-chemiluminescent assay (MAST-CLA) and CAP-fluoroenzyme immunoassay (CAP-FEIA). RESULTS: Serum total IgE and peripheral eosinophil counts of patients with atopic dermatitis showed a statistically significant correlation with the clinical severity (p<0.05). Patients from the severe atopic dermatitis group revealed significantly higher ECP level than those in the mild or moderate group (p<0.05). The most common inhalant allergen was D. farinae, followed by D. pteronyssinus, housedust, and the most common food allergen was wheat, followed by soyabean and egg white. CONCLUSION: Total serum IgE, peripheral eosinophils and eosinophil cationic protein (ECP) were good indices reflecting the severity of atopic dermatitis.
Dermatitis ; Dermatitis, Atopic* ; Dust ; Egg White ; Eosinophil Cationic Protein ; Eosinophils ; Humans ; Immunoassay ; Immunoglobulin E ; Korea ; Triticum

OBJECTIVE: Large loop excision of transformation zone(LLETZ) is gaining popularity as an alternative to other ablative or cone methods for the treatment of cervical intraepithelial neoplasia(CIN). The optimal management of CIN after LLETZ, however, remains controversial and the reliable predictors of residual disease after LLETZ have not been consistently identified. This study was performed to identify factors to predict residual disease after LLETZ. METHODS: From August 1993 to July 1995, 133 patients who received subsequent hysterectomy after LLETZ in Department of Obstetrics and Gynecology at Seoul National University Hospital were retrospectively reviewed. Residual disease was defined as positive findings of CIN or further advanced findings in hysterectomy specimen. The age of patients, the severity of disease and the status of resection margin(RM) were analyzed for predictive values of residual disease. The Chi-square test, Fisher's exact test and Student t-test were used for statistical analysis. RESULTS: The residual disease after hysterectomy was negative in 85.7%(114/133) and positive in 14.3%(19/133). Among 19 cases with positive residual disease, 3 cases were revealed to be microinvasive cervical cancer. The mean age of patients with no residual disease was 42.5 years(range; 27-71) and that of patients with residual disease was 49.1 years(range; 33-72). Nine out of 94 cases(9.6%) with negative RM and 10 out of 39 cases(25.6%) with positive RM in LLETZ had residual disease. Two out of 14 cases(14.3%) with CIN II and 17 out of 119 cases(14.3%) with CIN III in LLETZ had residual disease. The success of LLETZ which means no residual disease was influenced by the age of patients(p=0.005) and the status of resection margin of LLETZ(p=0.032). CONCLUSION: The negative resection margin in LLETZ does not always guarantee that there is no residual disease. Close preoperative workup and more aggressive treatment plan(wide conization or hysterectomy) should be considered in patients who has higher possibility of positive residual disease such as old age and positive resection margin in LLETZ.
Cervical Intraepithelial Neoplasia* ; Conization ; Gynecology ; Humans ; Hysterectomy ; Obstetrics ; Retrospective Studies ; Seoul ; Uterine Cervical Neoplasms