Doppler sonography has been introduced to evaluate uterine and ovarian diseases. It has been reported to be used to distinguish benign from malignant adnexal masses. The purpose of this study was to assess the blood flow characteristics of adnexal masses and to determine the optimal cut-off points for the Doppler indices obtained, resistance index and pulsatility index, to best differentiate benign from malignant lesions. We performed pulsed Doppler ultrasound in seventy-eight adnexal masses between February 1989 and June 1994. The pulsatility and resistance index were calculated from the waveforms generated from blood flow within the ovary. There were 51 benign and 27 malignant histologically proved ovarian lesions. All women have been operated on. The results were as follows ; Benign tumors and cysts had a significantly higher pulsatility index(mean, 1.23+/-0.74; range, 4.46-3.36) and resistance index(mean, 0.64+/-0.19; range 0.34-1.43) than did malignant tumors(pulsatility index : mean, 0.87+/-0.49; range, 0.31-2.27; resistance index : mean, 0.50+/-17; range, 0.23-0.8). However, some overlap in individual values for benign and malignant lesions was found. In conclusion, our data suggest that high pulsatility and resistance indices may indicate benign adnexal masses ; however, considerable overlap in pulsatility and resistance indices between benign and malignant lesions were noted, and further work will be needed before the validity of these factors is proved.
Female ; Humans ; Ovarian Diseases ; Ovary ; Ultrasonography

No abstract available.
Breast Neoplasms* ; Breast* ; Female ; Humans ; Pregnancy ; Pregnancy Trimester, Second* ; Pregnancy*

No abstract available.
Ifosfamide*

The recent introduction of chemotherapy in the treatment of gynecological malignancies has gained wide acceptance along with prstoperative and prostperative adjuvant therapy and with preradiation and concurrent chemoradiation therapy. But, the side effects of chemotherapy including bleeding and infection due to, bone marrow suppression have reaulted in delayed treatment and a reduction in the chemotherspeutic agent used. Recent efforts overcome this bone marrow suppression have led to development of the various human colony-stimulating factor indluding recombinant granulocyte colony-stimulating factor. The author investigated the clinical benefita and toxicity of G-CSF used during chemotherapy of various gynecological malignancies at the Departent of Obstetrics & Gynecology at Hanyang University between August, 1991 and July, 1992. The results were as follows ; 1. An increase in the number of neutrophils following a single injection of G-CSF was noted in 19 out of 21 cases(600~1,000/mm3 before injection, 4,500~12,000/mm3 after injection). The remaining 2 cases showed an increase after 3~5 continuous injections. 2. To assess the increase in neutrophils according to the dosage of G-CSF given, 100 and 300microgram/m* of G-CSF were injected in each trial of chemotherapy in a single case of ovarian cancer. The results were a 1.5 time increase when injected when injected with 300microgram/m*. 3. After injecting into a patient with recurrent endometrial cancer who was managed with 15gm of ifosfamide, 50gm of cis-platinum, 50gm of adriamycin and 3gm of mesna following surgery, no evidence of neutropenia could be found after 4days of prophylactic G-CSF injections. 4. Patients with cervix cancer with metastasis to the lung were first treated with GM-CSF in one trial and G-CSF in the nest. Patients treated with Gm-CSF for a period of 7 days showed leukocytosis(3,600/mm3) but the number was reduced to 1,400/mm3 after 7 days. On the other hand, patients treated with G-CSF showed an increase of 5,700/mm3 within one day and this figure did not decrease until 20 days later. 5. The toxic effects of G-CSF included on case of severe back pain was easily managed by administration acetaminophen. Others were headache, chills, general weakness and redness of the oral mucosa and injection area. Most of these symptoms disappeared within 2 days. The G-CSF is effective in neutropenia during chemotherapy thereby decreasing the incidence of treatment delay or dose reduction. It also increases the amount of chemotherapeutic agent administered and its toxicity is more tolerable making a rigid systemic chemotherapeutic regime possible.
Acetaminophen ; Back Pain ; Bone Marrow ; Chills ; Cisplatin ; Colony-Stimulating Factors ; Doxorubicin ; Drug Therapy* ; Endometrial Neoplasms ; Female ; Granulocyte Colony-Stimulating Factor ; Granulocyte-Macrophage Colony-Stimulating Factor ; Gynecology ; Hand ; Headache ; Hemorrhage ; Humans ; Ifosfamide ; Incidence ; Leukopenia* ; Lung ; Mesna ; Mouth Mucosa ; Neoplasm Metastasis ; Neutropenia ; Neutrophils ; Obstetrics ; Ovarian Neoplasms ; Uterine Cervical Neoplasms

Ovarian mucinous cystadenoma of borderline malignancy was consisted of intestinal mucinous cystadenomas of borderline malignancy and Mullerian mucinous papillary borderline tumors. Mullerian mucinous papillary tumors was lined by mucinous epithelium of endocervical type and characterized by papillae architecturally similar to those of serous borderline tumors. These tumors have clinical and pathologic differences from those of intestinal mucinous cystadenomas of borderline malignancy.We report a case of ovarian Mullerian mucinous papillary cystadenomas of borderline malignancy with review of literature.
Cystadenoma, Mucinous ; Cystadenoma, Papillary* ; Epithelium ; Female ; Mucins* ; Ovary

Despite the frequent use of the fibular free flap, there have been no reports of severe compartment syndrome of the donor leg that necessitated limb amputation. A 66-yr-old man had a fibular osseous free flap transfer from the left leg to the mandible that was complicated by postoperative compartment syndrome. An extensive chronic leg wound resulted, which was treated with multiple debridements and finally with below-knee amputation. Successful coverage of the below-knee amputation stump was accomplished with a nonisland pedicled foot fillet flap. Various foot fillet flaps may be used acutely as a free or an island pedicled flap, but dissection of the vascular pedicle may be difficult in a chronically inflamed wound because of inflammation and adhesions to surrounding tissue. The nonisland pedicled foot fillet flap may be considered as a useful option for treatment of a chronically inflamed stump wound after below-knee amputation.
Aged ; Amputation ; Compartment Syndromes/*diagnosis/etiology ; Drainage ; Free Tissue Flaps/*adverse effects ; Humans ; Knee Joint/physiology ; Leg/*surgery ; Male ; Postoperative Complications

PURPOSE: To correct breast ptosis, reduction mammoplasty and mastopexy have been developed in a way that minimizes complications. Recently, as the mean age of breast cancer occurrence is decreasing, the need for breast reconstruction in patients with breast cancer is rising. If mastopexy is performed with breast reconstruction at the same time, the size of the normal breast and the new one is not quite different. We decided to apply Z-plasty, which is a widely-used technique in plastic surgery to lengthen or change the direction of tension of the tissue. METHODS: From March 2008 to December 2009, we performed breast reconstruction in 6 patients with breast cancer and scar contracture. After breast reconstruction, mastopexy with Z-plasty was applied to correct the asymmetry. The new nipple-areolar complex is placed on the line connecting the midclavicle and the current nipple. The inferior border of the new areola corresponds with the inferior border of the original areola, and the superior border about 2 cm upward the original superior border. We drew two oblique lines connecting the medial end of the incision line lower to the nipple-areola complex and the lateral end of the inframammary fold for Z-plasty. The excess tissue between these two lines was removed and the new triangular flaps were put together. RESULTS: The average age of patients was 42.6 years, aged from 36.1 to 48.1 The weight of removed tissue was between 54g and 95 g, with the mean of 74 g. The average distance from the midclavicle to the nipple was 24 cm before surgery, and 21 cm after the surgery. The average operation time per patient (1 mastopexy) was 45 minutes, and the patients were satisfied with the size and shape. CONCLUSION: Applying Z-plasty for the mastopexy on the normal breast ptosis is a relatively simple way to achieve symmetry in patients who need breast reconstruction.
Aged ; Breast ; Breast Neoplasms ; Cicatrix ; Contracture ; Female ; Humans ; Mammaplasty ; Nipples ; Surgery, Plastic

PURPOSE: Composite tissue allotransplantation is a new therapeutic modality to reconstruct major tissue defects of the head and neck region and extremities. However, there is a serious ethical debate about whether the risks posed by the life-long immunosuppression that a recipient would have to take justify the benefits of receiving this non-life saving procedure. The purpose of this study is to examine differences between expert and non-expert groups in risk acceptance and expectations regarding hand and foot allotransplantations. METHODS: The author conducted a survey of 345 subjects in total (lay public n=110; medical students, n=120; doctors, n=115), using a questionnaire-based instrument, the Louisville Instrument for Transplantation (translated to Korean). RESULTS: Of the three groups studied, risk acceptance was found to be lowest in the doctor group and highest in the non-expert group, and the difference was significant (p < 0.05). The expectations of aesthetic and functional improvement from the procedure, however, were found to be highest in the non-expert group and lowest in the doctor group, and the differences were also significant (p < 0.05). CONCLUSION: The results of this study shows that the three populations have noticeable differences in risk acceptance and expectations regarding hand and foot allotransplantations. Therefore, accurate and sufficient information on these procedures should be provided to patients from both medical and ethical perspectives.
Extremities ; Foot ; Hand ; Head ; Humans ; Immunosuppression ; Neck ; Students, Medical ; Transplants

Desmoplastic fibroma is one of the uncommon osseous tumors that present in the skull. Although classified as benign tumor, desmoplastic fibroma exhibits local aggressiveness and has a high potential for recurrence. The most common sites include metaphysis of long bones and mandible. Only 15cases have been described in the skull. We report the 16th case of desmoplastic fibroma of the skull.
Fibroma, Desmoplastic* ; Mandible ; Recurrence ; Skull*

PURPOSE: Surgical reconstruction of an ischial soft tissue defect presents a challenging problem owing to a high rate of recurrence, especially in paraplegic patients. Although various muscle, musculocutaneous and fasciocuta- neous flaps have been used in the reconstruction of ischial soft tissue defect, it is still controversial which type of flaps are the best. We had performed a relatively durable adductor magnus perforator island flap based on the perforators originated from the first medial branch of the profunda femoris artery for coverage of ischial soft tissue defect where was not a region universally reconstructed by perforator flap. METHODS: From August 2005 to January 2008, the adductor magnus perforator island flap were used for resurfacing of the ischial soft tissue defects in a series of 6 patients(4 male and 2 female). Ages ranged from 26 to 67 years(mean, 47.5 years), and follow-up period from 13 to 26 months(mean, 16.7 months). Causes were 4 pressure ulcers, 1 cellulitis and 1 suppurative keratinous cyst. RESULTS: The sizes of these flaps ranged from 12 to 18cm in length and 7 to 9cm in width. The flaps survived in all patients. Marginal loss over the distal area of the flap by infection was noted in one patient, which was treated successfully with a subsequent split-thickness skin graft. Average thickness of the flap was 0.94cm, which was more thicker than other perforator flaps. Long term follow- up showed a good flap durability. CONCLUSION: In planning a reconstructive option of ischial soft tissue defect, the adductor magnus perforator island flap is a relatively large cutaneous flap with a durable thickness. With proper patient selection, careful vascular dissection and postoperative management, we recommend this flap as a good and suitable option for coverage of the ischial soft tissue defect.
Arteries ; Cellulitis ; Follow-Up Studies ; Humans ; Keratins ; Male ; Muscles ; Patient Selection ; Perforator Flap ; Pressure Ulcer ; Recurrence ; Skin ; Transplants